For Educators · Competency

Not every competency criterion carries the same level of risk.

When an action directly protects the employee, the process, or the patient, failure to perform it correctly may matter more than the overall score.

Safety-critical performance deserves safety-critical expectations.

Some Performance Can’t Be “Almost Right.”

Two healthcare professionals in surgical scrubs, masks, and protective eyewear working in a sterile environment. One is holding surgical scissors, the other is observing and taking notes. There are medical equipment and supplies in the background, with a focus on safety and process improvement in healthcare.
Two healthcare professionals in surgical scrubs, masks, and protective eyewear working in a sterile environment. One is holding surgical scissors, the other is observing and taking notes. There are medical equipment and supplies in the background, with a focus on safety and process improvement in healthcare.

Competency Scoring

Imagine a competency with ten performance criteria.

One is performed incorrectly.

9 / 10 = 90%

That looks like a passing score.

But what if the missed criterion involved:

PPE?

DEVICE CLEANING?

CYCLE SELECTION?

STERILIZATION MONITORING?

PACKAGE INTEGRITY?

The number along doesn’t tell you whether the performance was safe.

A Passing Score Can Hide the Wrong Failure.

Infographic illustrating that 90% of passing scores do not reveal which criterion was missed, with checkmarks on criteria 1 through 9, and a warning shield symbol for the safety-critical criterion 10, marked in pink.
Infographic illustrating that 90% of passing scores do not reveal which criterion was missed, with checkmarks on criteria 1 through 9, and a warning shield symbol for the safety-critical criterion 10, marked in pink.

Total Score ≠ Whole Story

Safety-Critical Criteria

Start With the Consequence of getting It Wrong.

A criterion may deserve safety-critical status when incorrect performance could directly compromise:

The Label Should Reflect the Risk.

Not every important criterion needs to be designated as safety-critical.

Risk ≠ Complexity

Safety-critical criteria are not necessarily the hardest steps in a procedure.

A step may be:

QUICK.

ROUTINE.

EASY TO DEMONSTRATE.

PERFORMED EVERY DAY.

…and still be critical because of what happens when it is missed.

a Simple Step Can Carry A Big Consequence.

Don’t rate importance by difficulty.

Rate it by the potential consequence of incorrect performance.

A balanced scale with safety goggles on one side labeled "Simple Step" and a shield with icons and the words "Employee Patient Process Device" on the other side labeled "Serious Consequence." The caption emphasizes that small, routine steps can have a significant impact on preventing health and safety risks.

Competency design

Make Critical Performance Visible.

A competency should clearly identify the behaviors the evaluator actually needs to observe.

Instead of relying on a broad criterion such as:

“Performs the process safely.”

Define observable performance.

For example:

Weak

Uses appropriate PPE.

Stronger

Selects and wears PPE appropriate for the task and anticipated exposure throughout performance.

Or:

Weak

Operates the sterilizer correctly.

Stronger

Selects the required cycle and verifies cycle parameters before initializing the process.

If it matters enough to evaluate, make it observable.

Related learning:

Make the Risk Visible

The Evaluator Shouldn’t Have to Guess.

Safety-critical criteria should be identifiable within the competency tool.

A simple visual system can work:

SHIELD ICON
Safety-critical performance.

STANDARD CRITERION
Required performance that contributes to overall competency.

The purpose isn’t to decorate the form.

It is to make clear that certain failures require different response than an ordinary scoring deduction.

Critical Criteria Should Look Critical.

A competency validation form for instrument cleaning shows performance criteria with checkboxes for scoring. A pen with 'PROCESS' written on it is clipped to a pink sticky note that says, 'Define. Observe. Document. Protect.' On a large poster, it states, 'One form. Two types of criteria,' differentiating 'Standard Criterion' and 'Safety-Critical Criterion.' It highlights that not all criteria carry the same risk with the words, 'People. Process. Patients. Always.'

Scoring

Safety Shouldn’t Disappear into the math.

If a technician performs well across most of a competency but misses a safety-critical action, strong performance elsewhere should not automatically cancel that failure.

3 + 3 + 3 + 3 +1 ≠ “GOOD ENOUGH”

A scoring system should establish what happens when safety-critical performance is not demonstrated.

That might require:

STOPPING THE VALIDATION

COACHING OR REMEDIATION

REPEATING THE PERFORMANCE

REVALIDATING THE AFFECTED SKILL

DELAYING INDEPENDENT PRACTICE

The response should be defined by the organization’s competency system and the significance of the performance gap.

Diagram illustrating a safety risk assessment process with five criteria, four scoring 3 out of 3, and one safety-critical criterion scoring 1 out of 3. The total scores (13 divided by 5) equal an average of 2.6, with a passing threshold question at the end. The graphic emphasizes that missing a safety-critical score can change the outcome. It includes icons for identifying risk, defining expectations, and responding to gaps, along with the RIE process logo and the slogan 'Learn. Apply. Make a Difference.'

Assessment Thinking

What are we actually assessing?

A technician completes the entire process correctly except for one safety-critical step.

The final score exceeds the competency threshold.

Ask:

Did the technician demonstrate the required performance?

Did the technician recognize the safety-critical decision independently?

Would the same performance be acceptable without an evaluator present?

Does the total score accurately represent the risk you observed?

The score is evidence. The performance is the decision.

Evaluator Intervention

“They Did It After I Reminded Them.”

That tells you something.

It does not tell you the same thing as independent performance.

If an evaluator has to intervene to prevent a safety-critical error, document what actually occurred.

An infographic comparing three different outcomes in a medical or technical context: independent, prompted, and intervention. It shows three illustrations of healthcare workers wearing masks, gloves, and scrubs, each demonstrating different levels of action. The infographic emphasizes the importance of documentation and proper procedures.

These are different forms of evidence.

Don’t document independence you didn’t observe.

Safety Overrides Observation

Competency validation isn’t a test of how far an error can go.

An evaluator should not allow unsafe performance to continue simply to see whether the technician eventually recognizes the problem.

When intervention is necessary to protect:

THE EMPLOYEE

THE DEVICE

THE PROCESS

THE PATIENT

STOP THE PERFORMANCE.

Intervene appropriately.

Then document what was observed and determine the next step.

Observation never outranks safety.

After a Safety-critical miss

Don’t automatically start over. Fix what the evidence found.

A missed safety-critical criterion identifies a performance gap.

The next step should address that gap.

Depending on the situation, remediation might include:

A step-by-step guide on how to improve skills in a medical or technical setting, titled 'From Gap to Growth.' It includes four steps: 1. Miss - Identify the Gap, 2. Understand - Clarify the Expectation, 3. Practice - Build Confidence, 4. Reassess - Confirm the Improvement. Each step features an illustration of healthcare professionals wearing masks and gloves, using medical tools and discussing procedures. The guide emphasizes continuous improvement, confidence building, and learning from gaps.

Remediation should be targeted, not punitive.

Look Beyond the Form

One successful demonstration answers one question.

Competency validation can provide evidence that a technician can perform a defined skill under observed conditions.

Readiness asks something broader:

Can the technician apply that performance consistently, independently, and in real work?

Safety-critical performance matters in both.

A technician may demonstrate a safety-critical step during validation but still need additional evidence before being considered ready for independent practice.

Competency is evidence. Readiness requires a pattern.

DESIGNING YOUR OWN COMPETENCIES

Before you mark it critical, ask:


01

Could incorrect performance create a meaningful safety risk?

02

Could the error compromise the device, process, sterile barrier, employee, or patient?

03

Would I allow the technician to continue independently after observing this failure?

04

Can the evaluator clearly observe and document the required behavior?


If the answers indicate that failure cannot reasonably be averaged away, the criterion may warrant safety-critical treatment.

use the designation deliberately.

The Big Idea

The Form Is Not The Competency.

A competency form organizes evidence.

A score summarizes evidence.

Neither replaces professional evaluation of the performance that actually occurred.

Identify the Risk.

Define the behavior.

Observe the performance.

Document the evidence.

Respond to the gap.

Safety-Critical performance should never disappear behind a passing score.

For Educators

Build a Stronger Competency System.

Competency Validation

Move beyond completed forms and design validation around observable performance.

Competency vs. Validation

Separate demonstrated skill from readiness for independent practice.

5-Minute Huddles

Bring focused process and quality conversations to your team.

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