Part I
Why Skill Standards?

• The Benefits of Skill Standards
• The Role of Skill Standards in Education and Workforce Preparation
• Organizing Occupational Functions in Health Services
• Filling a Gap

Health care skill standards are statements that answer the question, "What does a worker need to know and be able to do to contribute to the safe and effective delivery of health care?" The standards inform current and future health care workers, employers, and educators about what skills and knowledge workers need in order to succeed _ in a job and in a lifelong career. It is envisioned that these standards will help provide the foundation for better worker preparation and performance.

The Benefits of Skill Standards

A major benefit of having nationally validated health care skill standards is the potential to forge strong links among the various stakeholders. National skill standards provide a common language, common goals, and a common reference point for employers, workers, students, labor union representatives, educators, and consumers. In addition, national skill standards may provide benefits particular to each stakeholder. For example:

• employers recruit, screen, and place potential employees more efficiently;
• workers are better prepared for jobs and career development, thereby fulfilling employer expectations and increasing their chances for mobility and advancement;
• labor organizations maximize member employment security through enhanced education, portable skills, and career development opportunities;
• students have clear goals in their training for future employment;
• educators design quality and focused instruction consistent with the needs of the industry; and
• consumers enjoy high quality, efficient health care delivery by well-trained workers.

The Role of Skill Standards in Education and Workforce Preparation

In the face of a thriving global economy, expectations for workforce preparation have shifted over the past decade. At least two factors are influencing the shift. The first is that today's complex workplace demands workers who are more flexible and more highly skilled than ever before. The second is a fear that the U.S. may be losing its competitive edge to nations that are more successful in training their workforce to meet high-level standards.

Concerns over workforce preparation have been echoed by worries about educational achievement. An alarm bell sounded in the 1980s when the U.S. Department of Education report, A Nation at Risk, alerted the country to the need to upgrade academic achievement levels and set a broad program for doing so. The response to this and other critical documents was a new national reform effort represented by several reports and pieces of legislation, such as America 2000: An Education Strategy (which set goals for students to acquire "world class" academic and career preparation skills as a means of enhancing national economic well-being) and the Carl D. Perkins Vocational and Applied Technology Education Act of 1990 (which initiated federal efforts to reshape vocational education). Another closely related reform initiative is represented by the U.S. Department of Labor's 1991 report from its Secretary's Commission on Achieving Necessary Skills (SCANS). The SCANS report expressed concerns that American students lack basic academic skills, knowledge about the work world, and the ability to adjust to a changing environment. The report set forth standards deemed necessary for success in a high performance workplace, i.e., the modern workplace characterized by teamwork and a goal orientation. SCANS laid much of the groundwork for a national movement promoting the use of voluntary skill standards.

Concern about the effectiveness of schools in preparing students for the workplace led to increasing calls for greater accountability. In turn, this also led to an emphasis on the development of skill standards, which have become the focus of numerous national and state initiatives. For example, the Goals 2000: Educate America Act called for states to develop challenging standards systems. It further established a National Skill Standards Board to oversee the development and use of national skill standards. The Board is also charged with strengthening the links between schools, workplaces, and unions by generating support among employers, workers, educators, students, and parents.

Recent efforts in Congress are directed at further consolidation of federal education and training programs. They call for business, industry, and education to collaborate in establishing local workforce development boards.

What are the guiding principles for these new initiatives? First, collaboration -- all stakeholder groups must be represented in project and program planning. In the NHCSSP, groups that had not previously worked together collaborated intensely to develop the National Health Care Skill Standards. Second, linkages -- educators must create links among elementary, secondary, and post-secondary programs to meet industry requirements. Skill standards provide a common language across all levels of education and industry, enhancing the prospects for effective collaboration and linkage. In summary, well-articulated skill standards are key to the national strategy to upgrade worker skills and increase American economic competitiveness. Figure 2 depicts how skill standards developed by industry, labor, and education provide the foundation for worker preparation for the high performance workplace of the future. Within this framework, educators and industry can work together to produce work-ready, entry-level employees whose efficiency, productivity, and flexibility will compete favorably in the global market.

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Figure 2 The Role of Skill Standards in the Creation of High Performance Workplaces High performance workplaces are the key to economic competitiveness. Skill standards link employers, workers, and educators by providing a common language and common goals.

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Organizing Occupational Functions in Health Services

One of the fundamental issues for this development effort was organizing the standards to meet industry needs. Certainly, the standards should cover the major areas of work, but should they address only specific occupations, focus on groups of occupations, or be applicable to all occupations? Alternatively, should standards be organized around some other characteristic, such as site of care delivery or type of service or function? Project participants and staff researched and discussed these questions for many months before agreeing that a broad approach, focusing on groups of occupations or functions, was best. Three major characteristics of the health services sector influenced the final decision: (1) currently, there are over 250 health care occupations; (2) these occupations are continually changing; and (3) professional associations and labor organizations have already established standards for a number of them. Thus, the decision was made not to direct standards at specific occupations; rather, national standards should address major categories of related occupations and functions. Specifically, the NHCSSP sought to develop standards for a core set of skills essential and appropriate to most workers in health services, and four clusters of related occupations and functions. Although the Core and Cluster standards would apply to all levels of health care workers, their primary target is workers at the career-entry and technical (i.e., pre-baccalaureate) levels, to whom they provide a foundation for subsequent career choices. This broad approach avoids duplication of efforts and makes a unique and vital contribution to the initial preparation of health care workers. Health care core and occupational clusters can be seen in Figure 3. The clusters are broadly defined according to their functions.

• Therapeutic* functions maintain or change the health status of the client over time; they include care management, dental assisting, dietetics, home health, medical assisting, nursing, pharmacy, rehabilitation, respiratory care, social work, and others.
• Diagnostic* functions create a picture of client health status at a single point in time; they include cardiology, imaging, medical laboratory, radiography, and others.
• Information Services functions document client care; they include medical records management, risk management, unit coordination, utilization review, and others.
• Environmental Services functions provide a therapeutic environment for the delivery of care; they include central supply, facility maintenance, food service, housekeeping, and others.

The cluster configuration is consistent with reform efforts in industry and in education. For example, the Carl D. Perkins Vocational and Technology Act of 1990 mandates broad vocational, rather than job-specific, training and an integration of academic and vocational content. Furthermore, the Act requires programs to provide students with a general understanding of "all aspects of an industry." As described previously, the Secretary's Commission on Achieving Necessary Skills defined generic workplace or employability skills needed by workers. The SCANS standards consist of foundation skills (basic skills, thinking skills, and personal qualities) and workplace competencies (managing resources, handling interpersonal situations, accessing and storing information, understanding systems, and using technology). The NHCSSP primarily used the SCANS findings to inform the development of standards for the health care core. This core represents an extension of SCANS skills into the health services context. Table 1 shows the various points of overlap between the SCANS skills and the eight Health Care Core Standards.

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Table 1 Summary of SCANS Employability Skills and the NHCSSP Core Standards X indicates areas where NHCSSP core standard overlaps with SCANS, but is specific to the health services industry.

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Filling a Gap

Prior to this project, skill standards for health care workers were available only at the generic and the occupation-specific levels. Rather than replacing existing occupational licensing or credentialing criteria, the newly proposed Core and Cluster Standards augment them, applying to a majority of health care workers and serving as the foundation for later career specialization or more specific occupational training. The NHCSSP Standards fill the gap between general employability standards (e.g., SCANS) and occupational certification or licensure. Specifically, the NHCSSP Standards provide a means for both entry into health services employment, and horizontal and vertical movement within a career area.

Figure 4 shows the different levels of standards that apply to health care workers. They are represented as concentric circles, beginning at the center with general employability skills, moving outward to NHCSSP Standards (Core and Cluster) and ending with occupation-specific standards (technical and professional).

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Figure 4 NHCSSP Standards in Relation to Generic Employability and Occupational-Specific Standards

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