Healthcare and Medicine Reference
The way in which information is used is a function of the supervisor's
level of authority in an organization and his or her level of confidence
in the effectiveness of the applied information.
Part of the use of competency-based practice is the ability to indepen-
dently evaluate the information used and to test its validity in the con-
text of one's own practice.
Competency-based judgments are grounded in the Western notions of
professional conduct and professional roles, and are ultimately guided
by a common value system.
Practice wisdom, regardless of how long it has been thought to be
effective, often presents problems. O'Donnell (1997) cautions that prac-
tice wisdom is often a justification for beliefs and values that bond us
together as professionals but often fail to serve workers, clients, or organi-
zations since many of those beliefs and values may be comforting, but
they may also be inherently incorrect. O'Donnell likens this process to
making the same mistakes, with growing confidence, over a long number
of years. Isaacs and Fitzgerald (1999) call practice wisdom “vehemence-
based” practice, where one substitutes volumes of experience for evidence
so that it becomes, “an effective technique for brow beating your more
timorous colleagues and for convincing relatives of your ability” (p. 1).
Although we have come to value practice wisdom, all too often it has
been based on what the American Medical Association Evidence-Based
Practice Working Group (1992) refers to as unsystematic observations, a
belief in common sense, a feeling that a management degree and experi-
ence are a way of maintaining a certain level of effective practice, and an
assumption that there are wise and more experienced managers to whom
we can go when we need help. All of these assumptions are grounded in
a paradigm that tends to be highly subjective and is often manager-
focused rather than worker- and consumer-focused.
An example of competency-based management can be seen in the
research on the use of flextime. Most of us believe that flextime is a posi-
tive aid to workers who need flexibility in their work schedules that takes
into consideration the needs of child rearing, care of parents or sick chil-
dren, and other personal considerations that require flexibility in the
hours worked. However, a review of the literature suggests that flextime
has a particularly negative affect on health because it interferes with nor-
mal sleep cycles and social lives that are based on traditional work days
(9 5, for example). Giebel, Janßen, Schomann, and Nachreiner (2004,
p. 1015) write,
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