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Strategic approaches on the use of digital tools and data to improve the delivery of public value

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Image source: Gilaxia from Getty Image Signature | Canva

The COVID-19 pandemic has produced disrupted governments while altering levels of public trust and underscoring the importance of strong digital government foundations. On the positive side, this has created an opportunity for governments worldwide to revisit their strategic approaches to using digital tools and data to improve the delivery of public value. 

Digital government in the post-pandemic age is recently understood as “the use of digital technologies as an integrated part of a government’s modernization strategies to create and deliver public value,” according to the Organization for Economic Cooperation and Development (OECD). 

The article hereby intends to gaze upon some of the best practices in strategy execution as far as the enablement of a digital government in various countries around the globe from perspectives as important as a framework for strategy execution, initiative management, strategy implementation costs, and communication strategy for results strategy.

1. A Comprehensive National Government Data Strategy (the Netherlands) 

Data Agenda Overheid is the Netherlands’ national government data strategy developed and led by the Dutch Ministry of the Interior and Kingdom Relations. The strategy aims to accelerate the ethical use of data within central and local governments to foster better policy-making and resolve social challenges, paying specific attention to legislation and public values, data management, knowledge sharing, and investment in people, organizations, and cultural change. Below (see Table 1) are some of the main costs for action points in the Data Agenda Governments:

2. Communication Strategy on the Outcomes of the Digital Government Agenda (Colombia) 

Part of becoming more proactive is having a well-equipped public sector capable of responding to citizens’ requests before they are submitted. For this process to function, the public sector must have in place referential strategies or policies to anticipate future scenarios, prepare for the next steps and guide civil servants in their actions. 

For example, the Ministry of Information Technology and Communications of Colombia (MINTIC) has developed a communication strategy called Estrategia de Comunicaciones 2018 that functions as a policy lever to inform citizens about the outcomes of the digital government strategy and initiatives of the Colombian government. 

The strategy consists of general and specific messages and communication channels targeted to the respective relevant audience. It specifies available tools and communication toolkits that public servants can draw on to communicate proactively with the public. The strategy also includes a detailed action plan with information on the topic, content, and channels to convey the government’s message. 

The existence of a communication strategy enhances the anticipatory and organizational capacity of the Colombian government to engage with citizens and guide public servants to promptly communicate with the public once outcomes from the digital government strategy or initiatives emerge. Ultimately, this approach enhances public trust by fostering transparency regarding the result of projects and improving contact with citizens, thereby reinforcing the legitimacy of the government’s actions

3. Initiatives for a Secure Cloud Strategy Execution (Australia)

   

The Secure Cloud Strategy has been developed to guide Australians through the digital change brought about by the COVID-19 pandemic and make sure everyone has the opportunity to make the most of what the cloud has to offer. The strategy is based on several key initiatives designed to prepare agencies for the shift to the cloud and support them through the transition:

  • Initiative 1: Independent cloud strategy for government agencies. Australian agencies are encouraged to develop their journeys to the cloud based on the following: value case, workforce plan, “best fit” cloud models, service readiness, and transition approach.
  • Initiative 2: Layered certification model. Sharing information and assessments through a Common Assessment Framework to help improve security practices while at the same time reducing the burden on agencies to recreate material.
  • Initiative 3: Redeveloped Cloud Services Panel to align with the procurement recommendations for a new procurement pathway that better supports cloud commodity purchases. Streamlining the current cloud strategy arrangements in alignment with the implementation of the ICT Procurement Review will create a commodity procurement pathway that will ensure the government can procure and access a wider range of innovative cloud services for use by the government.
  • Initiative 4: Dashboard to show service status for adoption, compliance status, and services panel status and pricing. The cloud dashboard capability seeks to provide enhanced transparency of cloud usage and compliance cross-government and support clearer guidance regarding the costs, service suitability, and government status in a cloud environment.
  • Initiative 5: Cloud service qualities baseline and assessment capability. A cloud qualities baseline capability and assessment framework were developed to enable assessments for the new and existing cloud. This framework includes a baseline and measurement criteria to assess the cloud service. Once complete, assessments are published to provide greater visibility of how services can meet requirements and enable the re-use of assessments across the government.
  • Initiative 6: Cloud responsibility model supported by a cloud contracts capability. The approach will include evolving ICT contracts to articulate the responsibilities across the different deployment and service models and strengthen these baseline contract provisions.
  • Initiative 7: Whole-of-government cloud knowledge exchange platform. Deliver a platform for agencies to better collaborate and reuse common capabilities for their cloud adoption and use. The development of the platform considers how users interact with the service, accessibility, governance, operations, and technology.
  • Initiative 8: Building a Digital Capability program to include cloud skills. A long-term approach to developing a cloud skills capability to ensure the value and opportunity of the cloud is harnessed.

4. Digital Government Roadmap, Strategic Key Performance Indicators (KPIs), and Maturity Model to reflect on a High Commitment to Digital Transformation (United Arab Emirates)

   

The UAE is among the world’s leading countries in various digital life indexes, including The KPI Institute’s Government Services Index (GSI) 2022 due to the significant advancement of its information and communication technology sector.  

The United Arab Emirates is the top performer in the Middle East as far as digital transformation, consistently moving towards a data-driven and paperless government. The Strategy for Government Services states that 100 percent of government services will be accessible from anywhere and 24/7 by 2030. The UAE Strategy for Government Services aims to boost its competitiveness in the services sector and position it as the best in the world in rendering government services. 

As far as digital “content provision” is concerned, the UAE is ranked high on the availability of basic public information and resources online. The UAE Institutional Framework reveals a strong focus among other things, on digital government strategy, organizational structure, legislation on access to information and privacy, and open data policy. 

The UAE Digital Strategy may be one of the most comprehensive in the world, built on a well-designed digital government roadmap with enablers, a results-measurement framework based on strategic KPIs, and an institutional maturity assessment model to guide successful digital transformation. The UAE Digital Government Roadmap comprises six main pillars encompassing 64 national digital enablers.

The Digital Strategy Measurement framework reveals four areas of measurement, such as public satisfaction and digital capabilities, and 10 strategic KPIs, which all exhibit 2025 targets for achievement of digital government transformation results (see Figure 1).

Figure 1. Strategic KPIs | The UAE Digital Government Strategy 2025

The UAE Digital Government Maturity Model aims to assess the UAE government organizations on both federal and local levels against a framework that helps create clarity about the UAE digital government capabilities and to inform investments in new capabilities. The maturity model comprises eight main dimensions (See Figure 2). Each dimension has a set of sub-dimensions that guide enabling actions that each government entity might take to increase its maturity along each dimension. Each sub-dimension has a set of specific items to be used by each UAE government entity to determine their level of maturity for each sub-dimension and dimension.

Figure 2. The maturity model’s eight main dimensions | The UAE Digital Government Strategy 2025

The five levels of maturity range from Level 1 representing a very low level of maturity to level 5 representing a very high level of maturity (See Figure 3). The assessment responses provide an outline for a roadmap for a successful digital government transformation.

Figure 3. The five levels of maturity | The UAE Digital Government Strategy 2025

The objective is 100 percent a very high level of maturity for all UAE government entities on both federal and local levels by 2025.

This article was first published in the 24th printed edition of PERFORMANCE Magazine. You can get a free digital copy from the TKI Marketplace here or purchase a print copy from Amazon for a nominal fee here.

MyDigital: Malaysia’s digital transformation goals by 2030

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Image source: Mohd Jon Ramlan | Unsplash

Accelerating a digital economy is no longer just an option but a must. The United Nations reported that digital technologies have reached 50% of the developing world’s population and helped transform societies. Meanwhile, the paper “The Role of the Digital Economy in Rebuilding and Maintaining Social Governance Mechanisms” suggests that digitization improves society at all levels, from the automation of businesses to new opportunities to human behavior and social relationships, especially interactions between governments and citizens.

Malaysia is not an exception. The COVID-19 pandemic forced traditional brick-and-mortar businesses to pivot online, and millions of Malaysians followed. This is evident in their shopping, entertainment, and education needs. 

The digital economy has been identified as a key economic growth area (KEGA) in realizing the Shared Prosperity Vision 2030, a blueprint released in 2020 by the government. It reflects the aspiration of making Malaysia a country that develops sustainably while achieving equitable economic distribution and inclusive growth. According to the Shared Prosperity Vision 2030, Malaysia should have clear policies and raise awareness on enabling citizens to adapt to the future economy instead of leaving them as mere consumers. Hence, MyDIGITAL was launched.

MyDIGITAL is a national initiative that epitomizes the government’s aspirations to successfully transform Malaysia into a digitally-driven, high-income nation and a regional leader in the digital economy. MyDIGITAL’s three goals are to inspire decision-makers to become creators, users, and adopters of innovative business models; use human capital to flourish in the digital economy; and cultivate a consolidated ecosystem that empowers society to embrace the digital economy. To meet these objectives, six strategic thrusts have been identified:

  1. Drive digital transformation in the public sector. This can be accomplished by leveraging digital technologies, data, and digital intelligence, improving public servants’ digital skill sets, and enhancing the quality of online services. By the end of the year, the goal is for all ministries and agencies to provide cashless payment options and 80 percent cloud storage across the government. In the short term, transforming the Administrative Modernization and Management Planning Unit (MAMPU) will fuel digitalization and adapt to emerging digital technologies.
  2. Boost economic competitiveness by accelerating digital adoption, empowering digital management, and shaping emerging business models through digitalization. Businesses that embrace technology and build on the digital economy will generate value and thrive as the economy transforms. The goal is to have Malaysian industries be powered by innovative ideas and models. With economic growth led by local entrepreneurs, the focus will be on productivity and improving livelihoods. This will bring in new industry players, resulting in a more vibrant and innovative economy.
  3. Establish enabling digital infrastructure to help individuals participate in the digital economy. Through a conducive digital environment provided by seamless and extensive digital connectivity, the government and businesses will be able to operate with ease and continuously innovate. Malaysia has made significant progress in improving the state and coverage of such key infrastructure. Broadband, data centers, and submarine cable landing stations are among the digital infrastructures targeted by this thrust. These infrastructures enable data generation, flow, exchange, consumption, and storage.
  4. Build agile and competent digital talent to ensure that digitalization is successfully embedded across talent development, various levels of education, and the upskilling and reskilling of the existing workforce. The key challenge for Malaysians as job requirements change and new jobs surface is to acquire the necessary skills to remain relevant. To thrive in the evolving digital economy, current and future workforces should be well-equipped with digital skills.
  5. Create an inclusive digital society to bridge the digital divide and ensure that everyone benefits from the digital economy. There are numerous government initiatives and programs in place to improve the well-being of society. However, a digital divide persists across income, strata, age, gender, and skill sets. To create a digitally responsible society, ethical behavior in the use of digital technology will be prioritized. This will be expressed through the improvement of safety and ethics in digital activities and transactions and through cybersecurity. For instance, companies can leverage existing initiatives, such as the Information Security Governance, Risk & Compliance Health Check Assessment.
  6. Establish a trusted, secure, and ethical digital environment that allows businesses and society to fully reap the benefits of digital services without jeopardizing safety, data security, privacy, dependability, or ethical standards. The development of a holistic ecosystem is required, and this may involve a regulatory framework and cyber security capabilities to prevent threats or breaches that can disrupt the digital economy.

Twenty-two strategies, 48 national initiatives, and 28 sectoral initiatives support these strategic thrusts. Phase 1 began in 2021 and will last until 2022, when the foundation for digital adoption will be strengthened. In Phase 2 (2023-2025), inclusive digital transformation will be prioritized, and Phase 3 (from 2026 to 2030) will position Malaysia as a regional leader in digital content and cyber security.

MyDIGITAL’s mission is to ensure that all Malaysians benefit from the opportunities of the digital revolution. To realize this, active participation from strong partnerships and between all stakeholders are necessary. With MyDIGITAL’s implementation, the rakyat’s standard of living and well-being are expected to improve, businesses will be able to optimize resources and expand their operations and market, and the government will be able to provide more efficient and effective services.

To learn more about strategy planning, sign up for The KPI Institute’s Certified Strategy and Business Planning Professional course.

Editor’s Note: This article was written by Aikaterini Sachinoglou and originally appeared in the 22nd edition of Performance Magazine Printed Edition.

Hybrid working: a new way of planning workplace strategy

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The COVID-19 pandemic has forever altered how organizations around the world operate. In the IBM Institute for Business Value’s study “COVID-19 and the future of business Executive epiphanies reveal post-pandemic opportunities,” 55 percent of respondents say the pandemic has resulted in “permanent changes to their organizational strategy.” An even larger 60 percent say COVID-19 has “adjusted their approach to change management” and “accelerated process automation,” with 64 percent acknowledging a shift to more cloud-based business activities.

In planning, one of the most important aspects organizations nowadays must tackle is workplace strategy. According to Gallup’s most recent survey on what employees want going forward, five in 10 say they want hybrid work arrangements for the future. For organizations worldwide, this means planning and managing moves to hybrid work environments. 

What is a hybrid work strategy?

Hybrid working environments are the out-turn of the COVID-19 pandemic and refer to corporate arrangements by which some employees operate on-site while others work from home. The manifestation of more flexible working conditions in times of the COVID-19 pandemic has shifted employee expectations and desires greatly as far as the perceived benefits of in-person work. Consequently, organizations who do not embrace remote working conditions as part of their overall short-term and long-term workplace strategy may be at an increased risk of employee turnover, disengagement, and inability to attract and retain talent in the future.

Crafting the hybrid work strategy

One of the main aspects organizations must understand about hybrids is that there is no standard approach to it. Short-term planning will most likely imply experimenting with working schedules and juggling on-site and remote working arrangements to find the best fit for the organization. As for long-term planning, organizations will have to agree on their strategic position regarding a hybrid working model and relate it to their specific organizational context. A strategy plan that embraces the future outlook of a hybrid working environment should therefore consider the following:

  • The overall strategic position of the organization towards hybrid working as well as the development of internal policies and procedures to support that position;
  • A communication plan to share the organization’s hybrid working model with all employees and other stakeholders of the organization; 
  • An approach to the adoption and dissemination of new technology as well as reviewing existing systems and equipment for updates and renewal;
  • A plan to put in place the necessary security measures that ensure system integrity and data protection;
  • A training and development plan for managers to enhance their skills in effectively coordinating remote individuals and teams; for employees to understand the operational and legal implications of hybrid working

Performance management as part of the hybrid work strategy

As part of a hybrid work strategy, organizations generally have to adapt to increased remote working requirements. In this context, performance may become harder to observe, and managers will ultimately have to admit that they can no longer monitor every aspect of performance, nor should it be necessary for them to do so. Planning for a hybrid strategy would therefore have to consider the following:

  • The re-configuration and re-design of the performance management system and processes to fit the purpose of a remote working environment;
  • A shared organizational culture that embraces flexibility encourages presenteeism and stimulates the right remote working approaches and behaviors;
  • The re-shaping of managerial skill and aptitude to manage performance based on outcomes, contribution, and value;
  • Principles of communication that promote regular social and human connection opportunities to support employee engagement and team building

Measures introduced to ensure staff safety in the workplace

In terms of physical working place, many organizations may feel the need to proceed in a cautious wait-and-see mode while taking active steps to increase the safety of their working environments and ensure the well-being of their employees. Some straightforward actions in this respect can refer to the following:

  • Altering working space layouts by moving workstations apart and having employees work back-to-back or side-to-side (rather than face-to-face);
  • Staggering shifts – having employees start and finish work at different times – or staggering break times as a way of reducing the number of people in the workplace or taking breaks at any one time;
  • Reducing the number of meetings or the duration of such meetings as a temporary measure to maintain social distancing

Short-term vs. long-term hybrid strategy

The last question one has to answer here is: “Does our organization plan for a short-term hybrid strategy or a long-term one?”. When planning a hybrid strategy short-term, an organization must absolutely think “workplace value proposition.” This involves the benefits employees have for returning to on-site work. It’s quite clear that pointing to job requirements as the primary reason employees must return to the office will not work. In this context, organizations may need to focus on the distinct opportunities that an on-site environment creates as opposed to a remote one and find the best way to effectively communicate them. 

When planning for a hybrid strategy long-term, executives have already accepted that pandemic-related changes in strategy, management, operations, and budgetary priorities are here to stay. These are generally organizations with an international structure with employees working from different parts of the world, companies that operate through digital tech and cloud adoptions, and entities that are more project-based and service oriented, rather than product-based with intricate supply-chain networks. 

So when adopting a hybrid working model and strategy, it is mainly important that one considers the organization itself, the roles that meet remote work criteria, the interdependency level of team members, and individual comfort with work from home conditions and protocols.

References: 

CIPD (2021), Planning for Hybrid Working, Advice on how organizations can plan and manage a move to hybrid working. Available at: Planning for hybrid working | CIPD

CIPD (2020), Embedding New Ways of Working: Implications for the Post-Pandemic Workplace. Available at: Embedding new ways of working: implications for the post-pandemic workplace (cipd.co.uk)

IBM Institute for Business Value (2020), COVID-19 and the future of business Executive epiphanies reveal post-pandemic opportunities. Available at: COVID-19 and the future of business (ibm.com)

Resuscitating restaurants: What drives performance culture today

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Image source: Elle Hughes | Pexels

The restaurant industry was hit hard by the pandemic. It has to manage many changes, and the most challenging one is retaining talent. According to the National Restaurant Association’s State of the Restaurant Industry (2022) report, more than one million jobs in the hospitality and restaurant industries remain unfilled, and 78 percent of restaurant operators lack the staff to meet customer demand. Data also shows that three out of every four employees intend to quit their jobs within the next year.

In order to mitigate talent management concerns, Chipotle, an American fast-casual restaurant chain with a presence in the United Kingdom, Canada, Germany, and France, developed new strategies and launched programs that are focused on meeting employee expectations and boosting employee experience.

Retention strategies

Chipotle’s benefits program, Cultivate Me, provides its employees with a best-in-class benefits and perks package. It includes bonuses (annual and quarterly), education assistance and debt-free degrees, free meals (one free meal per day), paid time off, assistance program (free access to counselling), 401(k) retirement savings, healthcare services and advocacy,  and benefits in Chipotle partners (discounts in big brands and gyms).

Observing that the turnover rate raised continually in the industry, Chipotle launched learning and upskilling programs. Employees are given multiple options, ranging from high school diploma programs and college classes to courses teaching high-end computer networking skills. The company also introduced a mentoring program for future executives.

Another initiative to boost employee retention was asking employees about the tasks they want automated. The restaurant chain started its automation efforts by developing together with Miso Robotics an autonomous kitchen assistant that makes tortilla chips. The robot called Chippy is already being tested and is soon to be integrated into restaurants, leaving employees to focus on more important tasks. The company also started implementing a new digital scheduling program and upgrading its learning portal. As stated by Brian Niccol, CEO of Chipotle for QSR magazine, the brand’s automatization’s radar scans for those “jobs people don’t love doing.”

The restaurant chain also launched a new Learning Management System, the Spice Hub, where restaurant employees can enhance their skills through gamification, social learning, personalized learning paths, and instructor-led training. 

Chipotle ended 2021 in need of 20,000 employees, who should fill its 200 restaurants. Like most of its competitors, Chipotle raised wages as the first step in employee attraction. But that is an initiative that only makes the company keep up with the market. Since the entire restaurant industry is struggling, Chipotle needed to do something more for its employees. That is how Chipotle promotes its differentiator: equitable access to education and mobility. 

Chipotle partnered with Guild Education, a private company that helps companies manage their education assistance benefits, to carry out a national Back-to-School campaign. It aims to attract and maintain interest in school for those employees that can either balance work and online schooling or decide to follow a path of on-campus education. Leveraging its educational benefits in the national campaign, Chipotle’s recruiting team has received 7,500 total applications.

Evaluating employee performance

Broadly, an employee’s performance is periodically evaluated by a representative of the company. The evaluation should result in new goals for improvement and rewards for desirable results.

Chipotle replaced its annual performance review with more regular review sessions. Its performance review now comprises at least four meetings per year. During these sessions, managers ask employees four questions. The so-called 4×4 conversation contains the following questions:

  1. What are your most significant accomplishments since we last met?
  2. What are the most important things you will focus on before meeting next?
  3. What obstacles are you encountering right now?
  4. What can I do better or differently as your manager to support you?

This type of review and the questions themselves consider the employee as the owner of the evaluation. Employees give feedback to the company and challenge themselves with new objectives.

The employees’ performance can be acknowledged through benefits, recognition, compensation, and rewards. Since the beginning, Chipotle has rewarded its employees with prizes. If prior, the employees were rewarded with free menu entrees, now, Chipotle employees can win multiple Chipotle goods and a variety of discounts from Chipotle Partners.

As a result of all Chipotle restaurant chain’s efforts to retain employees in 2021, they managed to:

  • Internally promote 90% of restaurant management roles 
  • Promote almost 19,000 team members
  • Offer free and confidential Employee Assistance Program (EAP) services to all Chipotle Employees in need of mental and emotional support
  • Achieve a Human Rights Campaign Corporate Equality Index score of 100
  • Establish an inclusive, award-winning culture

At Chipotle, the company’s values have been agreed upon altogether with employees. The leadership team defined an initial set of values that were later discussed with employees. The fact that the leadership team involved all employees in such a decision empowers them and increases their loyalty.

Culture is from the beginning communicated and present in all interactions inside a team. One of the first ingredients of culture reinforcement is investing in people. Increasing communication within all organizational levels and enhancing collaboration can strengthen teams, leading to an increased retention level and a high-performance culture.

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How Can Competency-based Education Improve Employee Performance?

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Competency-based education (CBE), according to the non-profit organization EDUCAUSE, enables students to advance their development based on their learning capacity, skills acquisition, or competency improvement at their own pace. This learning journey could happen in almost all types of environments.

CBE creates opportunities for learners and employees to nurture integrated performance-oriented capacities that can help them handle different challenges. This strategy is designed to accommodate various learning styles and can result in more efficient learner outcomes.

CBE would not work well without high-quality trainer’s training. Trainer’s preparation is a critical component of successful CBE deployment. Trainers must learn how to assess learners and tailor learning experiences to their needs. They must have a thorough understanding of the CBE process, techniques for tailoring learning experiences, mastery-based assessment, and the critical role of technology in learning customization.

Developing competencies standards is a crucial part of CBE. It helps sustain skills at the enterprise level by defining an ideal competent performance to measure a worker’s actual performance. The competency criteria can be tailored to a specific country’s setting and confirmed through a local method. The ILO (2021) recommends considering the following factors when creating a local validation strategy:

  • The industry’s size and geographic dispersion (so representative businesses can participate)
  • The industry’s diversity (i.e., the technology utilized and the products produced)
  • The worker’s profile (to guarantee that all competencies are included)
  • Validation costs and validation time

They must be aware of the differences between CBE and traditional education (TE) while developing competency maps, assessment goals, learning speed, grading, and promotion. They must also understand the importance of assessment in adapting training.

CBE in Healthcare

Healthcare institutions and organizations are being confronted with a number of challenges, including developing clinical approaches and a scarcity of resources. On the other hand, healthcare providers are expected to use care skills effectively and put theoretical knowledge into practice (Eijkenaar et al., 2013; Goudreau et al., 2015). However, a growing amount of research from several countries demonstrates that the clinical performance of healthcare systems is not up to par (Eijkenaar et al., 2013).

Below is a case study demonstrating how CBE works, its effectiveness, and its application to professional practice. It includes a population of physicians, nurses, medical students (residents or interns), and nursing students. CBE courses were offered to improve the clinical performance of medical and nursing students, physicians, and nurses. Traditional education was provided to the control group, and the clinical performance of the study population was the outcome.

The study “The effect of competency-based education on clinical performance of health-care providers: A systematic review and meta-analysis” aimed to evaluate the influence of competency-based education on the clinical performance of healthcare providers. The study takes into consideration the need to develop an intervention to improve the clinical performance of healthcare providers.

The criteria for inclusion were clinical or quasi-experimental trials; physician/nurse or medical/nurse participants; an age range of 18–65 years; adoption of the CBE approach; measurement of clinical performance of the participants using concrete tools of performance assessment; presentation of the results quantitative scoring; and the use of traditional teaching methods for the control group. The exclusion criteria are the use of a combination of CBE and other educational modalities, the lack of a control group, and the measuring of the participants’ theoretical knowledge or non-clinical abilities.

The study used six international electronic databases: PubMed, Ovid, Cochrane Library, Web of Science, ProQuest, Scopus, and Google Scholar. The national electronic databases IranMedex and SID were also used to conduct a systematic review and meta-analysis. In addition, the study comprised other studies that were related to the research goals. The Cochrane Collaboration’s Risk of Bias Tool was applied to assess the studies’ quality.

According to the random-effects model, CBE could improve the clinical performance of health care professionals in the intervention group compared to the control group (SMD = 2.717, 95 percent CI: 3.722 to 1.712). 

Competency-based education can help health care practitioners improve their clinical performance. Meanwhile, high turnover rates, decreased job satisfaction, increased presenteeism, poor patient safety, and increased medical errors are consequences of a lack of clinical skills and competencies

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