Competence Performance Research Articles

Anglo-American Strategic Relations and the Far East, 1933-1939 (review)

This is an unabashedly revisionist book. It is not that its thesis is arresting: Anglo-American "special" relations originated in the Far East between 1933 and 1939 when London and Washington pursued parallel rather than joint policies to maintain the western Pacific balance of power. Rather, Kennedy's revisionism stems from attacking the supposed failings of almost every historian who has studied interwar Anglo-American relations, in particular, and British and American foreign and defence policy, in general; the list includes Brian Bond, Robert Dallek, Michael Howard, Peter Lowe, Malcolm Muir, David Reynolds, Donald Watt, and everyone in-between. Thus, works about Anglo-American relations after 1937 "fail to appreciate the true nature of the ongoing relationships that already existed" (p. 16 and n. 2). Non-American historians, critical of American policy in the 1930s for not supporting Britain, "have laboured under a number of mistaken liberal notions" (p. 3). Others "confuse Japan's tactical or operational competence and innovation with strategic superiority" (p. 10). Word limits prevent me from going on; I will just say that for Kennedy, the list of poor and/or unfortunate historians who have failed to provide an accurate account of Anglo-American relations in the context of the 1930s is staggering. Hence, his revisionism.

An artificial intelligence approach for improving plant operator maintenance proficiency

Construction plant maintenance practice and its plant operators are inextricably linked. This is because, unlike plant operating within the manufacturing sector, construction plant is largely dependent upon operator skill and competence to maintain the item in a safe, fully operational condition. Research has previously successfully modelled machine breakdown, but revealed that the operator’s impact upon machine breakdown rates can be considerable. A conceptual model methodology with which to assess the maintenance proficiency of individual plant operators is presented. Specifically, an artificial intelligent classification model is proposed as a means of classifying plant operator maintenance proficiency into one of three bandings. These are good, average and poor. The results of such work will form the basis of new prescriptive guidelines, for incorporation into the new certificate of training achievement (CTA) scheme, available to inexperienced construction plant operators. The paper concludes with an indication of the palpable benefits of such research, to plant owners and the construction industry at large.

How do we Assess Technical Skills in Surgery?

Increasing public awareness and scrutiny have highlighted the need for the ability to detect inadequate technical skill. Traditional assessment methods have addressed knowledge, communication and to some extent judgement, but the ability to measure technical skills has been hampered by the lack of objective methods, instead relying on the subjective ‘good hands’/‘bad hands’ approach, or merely on the log book as a record of operative competence. Recent advances have introduced methods of objective assessment, which are becoming established or are research tools undergoing evaluation. It is recognized that outcome does vary between surgeons, but finding a ‘standard’ patient to evaluate this concept is not possible, therefore the skills laboratory provides an acceptable solution, although some of the techniques are also amenable to the operating theatre. Another concern is how much of technical performance is due to dexterity and how much is due to knowledge. Performance can therefore be broken down at a base level to a number of tasks and core skills. However, if measuring procedures (i.e. consisting of a number of skills and tasks) knowledge and decision-making ability (which arises from this knowledge) could be incorporated, this would be helpful. Unfortunately, these baseline tasks are best aimed at more junior surgeons.

Neurosurgical training in the United kingdom and ireland: assessing progress and attainment.

To review neurosurgical training in the United Kingdom and Ireland in the past decade and the methods used to monitor training and assess trainee competence. A database was compiled with data from 1990 to 2000 on behalf of the Specialist Advisory Committee in Neurosurgery from trainee logbook operative totals submitted on achieving accreditation or receiving the Certificate of Completion of Surgical Training. During the 11-year period, 109 trainees achieved accreditation or Certificate of Completion of Surgical Training. The median duration of training, including research, was 6.1 years. The total training duration per year did not change overall, although results suggested an increasing trend in the duration of clinical training (excluding research) from 4.8 to 5.6 years since 1997. The median age at accreditation or at receipt of Certificate of Completion of Surgical Training was 35 years 7 months. At completion of training, the Specialist Advisory Committee used operative totals in addition to reports from trainers to analyze the trainees' competence. Despite changes to the training system and a reduction in hours of work, the quality of training, as reflected by median operative totals, did not change during the decade. The database also permitted assessment of operative experience gained within each training program. The duration of training and training standards in terms of operative experience have remained constant during the past decade. Operative totals provide an objective method of assessing trainee progress and attainment and enable a comparison of experience offered by different training programs. An alternative method of assessing trainee operative competence that can be used in conjunction with median operative totals is proposed.

Caesarean section: techniques and complications

Caesarean section is the most commonly performed obstetric operation in the world. While the debate continues about the ideal Caesarean section rate, safety and cost remain the main areas of concern. Prophylactic antibiotics and improvements in surgical techniques, aiming at reduced operating time and blood loss, have contributed to the safety of this operation over the years. Obstetrics and gynaecology training programmes should incorporate basic surgical training as well as training for advanced operative competence. Health personnel should take necessary precautions to avoid exposure to hepatitis B and HIV. Prior planning, anticipation and preparedness, adherence to surgical principles and an early call for help, all bring the best results. The method of Caesarean section has remained essentially the same over the years although a few refinements have been made. Cohen's incision for entry, single-layer closure of the uterus and non-closure of both the layers of the peritoneum are recommended. Many of these changes discussed in this chapter have been tested in randomized trials. Further studies are needed to select the optimal package for performing a Caesarean section.

Consumer Trust, Value, and Loyalty in Relational Exchanges

The authors develop a framework for understanding the behaviors and practices of service providers that build or deplete consumer trust and the mechanisms that convert consumer trust into value and loyalty in relational exchanges. The proposed framework (1) uses a multidimensional conceptualization for the trustworthiness construct; (2) incorporates two distinct facets of consumer trust, namely, frontline employees and management policies and practices; and (3) specifies value as a key mediator of the trust–loyalty relationship. The authors test the proposed model using data from two service contexts—retail clothing (N = 264) and nonbusiness airline travel (N = 113). The results support a tripartite view of trustworthiness evaluations along operational competence, operational benevolence, and problem-solving orientation dimensions. Moreover, the authors find evidence of contingent asymmetric relationships between trustworthiness dimensions and consumer trust. For frontline employees, benevolent behaviors demonstrate a dominant “negativity” effect (i.e., a unit negative performance has a stronger effect than a unit positive performance), whereas problem-solving orientation has a dominant “positivity” effect (i.e., a unit positive performance has a stronger effect than a unit negative performance). Value completely mediates the effect of frontline employee trust on loyalty in the retailing context and partially mediates the effect of management policies and practices trust on loyalty in the airlines context. The role of frontline employees is more critical in the retailing context, whereas management practices and policies play the dominant role in the airlines context. Overall, the proposed framework successfully models trust and loyalty mechanisms across the two industries examined in the study, while remaining sensitive to essential contextual differences.

Preventing Medical Errors in Point-of-Care Testing Security, Validation, Performance, Safeguards, and Connectivity

c Objective.—To prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. Participants.—Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. Evidence.—This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. Consensus Process.—Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. Conclusions.—The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined errorprevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes. (Arch Pathol Lab Med. 2001;125:1307‐1315)

Preventing medical errors in point-of-care testing: security, validation, safeguards, and connectivity..

o prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. CONCENSUS PROCESS: Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes.(Arch Pathol Lab Med. 2001;1307-1315)

Design and Evaluation of a Competence Promoting Decision Support System

One of the problems associated with decision support system in general is their possibly negative impact on the operator's competence. In order to avoid and even counter this effect, a system was designed based on a multi-agent-architecture. This system, ComPASS, is a competence promoting decision support systems assisting machine operators in their tasks of finding and solving problems causing the standstill of CNC machine-tools. In addition, an instrument to measure this effect was developed. In this paper the system design, its scope and the competence measurement are detailed.

Partial-coverage posterior ceramic restorations. Part 2: operative innovations.

The application of multisurfaced tooth-colored restorations in the posterior dentition is an exercise in risk tolerance when dentin occupies the bulk of the tooth substrate. Part 1 of this article discussed the capricious nature of dentin bonding and acknowledged the prime tenet that clinical success involves more than esthetic realism in the posterior dentition. Success with indirect ceramic restorations is dependent on interfacial integrity, which is contingently related to operative competence. Innovative clinical techniques are described in this article, along with a discussion of the need for excellence in all phases of this demanding restorative sequence. Restorative success in the posterior dentition is profoundly influenced by the variability of operative competence and diligence. Part 2 of this two-part article offers innovative solutions to the unique challenges of partial-coverage ceramic restorations.

Partial-coverage posterior ceramic restorations. Part 1: a return to diligence.

The application of multisurfaced tooth-colored restorations in the posterior dentition is an exercise in risk tolerance when dentin occupies the bulk of the tooth substrate. Not only is interfacial integrity capricious, but also a recent in vivo study has confirmed that dentin bond strengths deteriorate with time. Although the literature is replete with esthetic guidelines for posterior restitution, most practicing clinicians appreciate the prime tenet that clinical success involves more than esthetic realism in the posterior dentition. Success with indirect ceramic restorations is dependent on interfacial integrity, which, although multitudinous, is contingently related to operative competence. Innovative clinical techniques are described in this two-part article, along with a discussion of the probationary status of current adhesive options and the need for excellence in all phases of this demanding restorative sequence. Restorative success in the posterior dentition is profoundly influenced by the variability of operative competence and diligence. This article discusses the precincts of posterior indirect ceramic restorations and submits a number of innovative solutions to the clinical challenge.

Sex proportion and performance evaluation among high‐ranking military officers

AbstractThis field study examined the relationships between sex proportion and performance evaluation among 3014 high‐ranking officers (Majors and Lieutenant Colonels) in the Israeli Defense Forces. Women's performance was rated lower than that of men when the women were token members of their units. However, the performance of women was rated higher than that of men when they constituted a higher proportion. Men's overall performance did not co‐vary with proportion. In addition, the interaction of sex with proportion had a significant effect on the dimensions of Operational and Analytic Competence. The pattern of findings supports Kanter's framework of skewed and tilted groups. Copyright © 2001 John Wiley & Sons, Ltd.

Cusum analysis of trends in operative selection and conversion rates for laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) requires a high degree of technical ability, spatial resolution and dexterity. Assessing trainees and competent operators is an important aspect of quality assurance in patient care. Most institutions quote mean conversion rate as a method of comparing operators' performance. The purpose of the present study was to use the technique of cumulative sum (cusum) analysis to determine whether a learning curve phenomenon exists in operators performing LC. Data were obtained retrospectively by reviewing the operative records of all patients undergoing elective and acute cholecystectomy for a 30-month period coinciding with the commencement of LC at North Shore Hospital. Patients' age and gender, date and type of operative procedure, duration of operation, and name of operator were recorded. Mean and cusum-transformed data were derived for all operations as well as for four individual operators' performances. Over the study period a total of 614 cholecystectomies was performed, with 85% attempted laparoscopically. A total of 9.8% required conversion to the open technique. Time trend analysis with the cusum technique for all surgeons revealed an inverse relationship between selection rate and conversion rate. Analysis of four individual surgeons revealed three different time trend profiles. There was a direct inverse relationship between conversion rate and selection rate, in that careful selection is associated with a low conversion rate. Comparison of individual surgeons' performance showed wide variation, with only one surgeon exhibiting the phenomenon of a learning curve. Contrary to other reports, we found that performance on LC was not always related to operative experience. This highlights the need for a more objective method to analyse operator competence than operator experience alone.

A Pictorial Essay of Clinical Innovations with Posterior Tooth-coloured Restorations

The application of multi-surfaced posterior tooth-coloured restorations is an exercise in risk tolerance when dentine occupies the bulk of the tooth substrate. Success with posterior tooth-coloured restorations is dependent on interfacial integrity. Although the literature is full of guidelines on producing aesthetically pleasing restorations, most practising clinicians appreciate that clinical success involves more than aesthetics: success is strongly dependent on operative competence. This article describes a number of innovative clinical techniques and discusses the probationary status of current adhesive options and the need for excellence in all phases of these demanding restorative sequences.

Long-term outcomes in oncological surgery: influence of individual prognostic factors

In addition to tumor stage there are factors influencing the long-term outcome of an oncological operation. Age per se is not a risk factor; however, comorbidity coinciding with increased age definitely must be regarded as a decisive risk factor. The best prediction of the operative risk is achieved by the ASA classification. Frequently used scores such as ECOG and the Karnofsky index are of little help. Since most elderly patients are excluded from prospective, controlled and randomized studies, only individualized assessments concerning the risk profile are useful at present. However, the overall operative competence of a center is most relevant in the treatment of the so-called "risk patient".

Psychomotor ability testing and human reliability analysis (HRA) in surgical practice

This review deals with the methodology that exists for assessing the intrinsic or innate abilities required for acquisition of the necessary skills with training so that operative competence and proficiency are reached by surgical trainees at the end of the training programme. In addition, it covers human reliability analysis (HRA) as a technique (long-used in high-risk industries) for ensuring safe execution of operations and a good clinical outcome. Both subjects are relatively new in surgery and most of the account is based on work carried out at Dundee University of Dundee Department of Surgery and Molecular Oncology and Surgical Skills Unit over a 10-year period. The methodology for both is still relatively crude but, nonetheless, progress has been made. In surgery the important role of psychomotor ability testing is in the selection of and the assessment of progress of trainees during the surgical residency. HRA applies both to surgical trainees when good habits and practice become ingrained and during the entire working career of consultant surgeons.

The role of engineering in knowledge management - the key to wealth creation

The term "knowledge economy" is now widely used to signify the growth of a new industrial era, encompassing the capture and exploitation of global knowledge, to create new, or improved, processes or products which, in turn, give rise to wealth creation. But how does knowledge arise and how is it part of the enabling process that leads to new processes or products? How are raw data turned into wealth creation? And what is the role of engineering in this process? This paper describes a Capability Framework, which shows how the collective operational competence of any organisation is driven by the procedures regulating its activity, the information availability and the human skills applied. It further shows how the learning and experience that support the decision making are fundamental in determining the quality and effectiveness of the process through which the activity is directed. The Capability Framework also shows the linkages with creativity and innovation which, applied through the transformation mechanism provided by engineering, can harness collective capability and with the Business Strategy establish wealth creation through technology introduction and new product development. This approach identifies the basis for the controlled management of business performance improvement by channelling effort through the three fundamental segments (staff development, information systems and operating processes) to provide a platform for the implementation of continuous improvement initiatives in a self-sustaining environment. Additionally, it highlights the importance of knowledge capture as a means of improving the decision making process, particularly in recognition of the increasing proliferation of basic technology that is the unavoidable by-product of specialisation. The importance of culture change, as the essential catalyst for sustainable improvement, is presented in the context of repositioning the field of engineering to reignite creativity and innovation as the drivers of wealth creation.

The dyadic capabilities concept: examining the processes of key supplier involvement in collaborative product development

The increased use of suppliers in the new product development process has important implications for the strategic performance of organisations. In this paper an analysis of supplier collaboration in the development process is deployed to support the development of a dyadic (or two-level) capabilities analysis of the strategic management of the innovation process. By setting an organisation's competencies within the context of their customer or supplier interactions this paper supports the view posited by Ford et al. (1986) that interaction defines the value of assets and resources. In a study of collaboration in the UK auto industry, it was found that both operational and relational competences are critical factors in the performance of the new product development process. Thus, the ability of customers and suppliers to develop both structured and ad hoc processes of interaction is shown to be important to the development process from early supplier selection process.

Agile‐based competence management: the relation between agile manufacturing and time‐based competence management

Agile manufacturing is largely dependent on the capabilities of its people to learn and evolve with change. However, while agile manufacturing uses e‐commerce enabled technology in a decentralized organizational setting, it remains unclear how these individual capabilities should be linked to other organizational resources to create an agile organization. Another important modern management research perspective is the internal resource‐based perspective, resulting in a phenomenon called competence‐based competition with renewed attention for competence management. Competence management comprises the management, building, leveraging and deployment of strategic and operational competencies, the causal relationships and linkages between them, and the way competencies are embedded in organizational and individual resources. In this paper, we explore the relation between agile management and time‐based competence management, and study its adoption in small batch discrete parts manufacturing environments with the help of a coarse fact‐finding survey research.

Culture and Change: linking business focus to operational competence in the Prison Service

The Prison Service Core Competence Framework (CCF) is increasingly being used for the purposes of enhancing recruitment, selection, training and staff development. The framework may well have applications across the forensic field.