The lack of job satisfaction and medical clinical competency among Junior Medical Technicians

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By MWO Ellie Dennis
Advanced Leadership Programme (ALP)

AIM/ISSUE

1. The purpose of this research paper is to explore and recommend strategies that MWO/CPO2 leadership at 1 CFH can employ to enhance job satisfaction and ensure ongoing medical clinical competency among Junior Medical Technicians.

INTRODUCTION/BACKGROUND

2. Within the operational framework of 1 Canadian Field Hospital (1 CFH), the Medical Technician (Med Tech) plays a pivotal role in maintaining operational readiness and supporting healthcare delivery within the Role 2 Bravo (R2B) medical treatment facility (MTF) and the CAF’s High Readiness Mobile Surgical Resuscitation Team (MSRT) Kits. Beyond their conventional clinical responsibilities, Med Techs are tasked to perform maintenance/warehousing duties, procurement of medical consumables, and logistical/administrative support tasks crucial for the facility's operation. However, the training that Med Techs receive focuses primarily on clinical care, pre-hospital care, and prolonged field care. Newly posted Med Techs are often unprepared for the shift from clinical to non-clinical tasks, which are essential for the operational effectiveness of the R2B. Under these employment conditions, they are unable to fully consolidate their recently acquired medical skills or further maintain them. Furthermore, the unit mandate entails supporting healthcare delivery, primarily through damage control surgery and damage control resuscitation, skills generally outside the scope of a Med Tech.

3. The primary focus within the unit is typically directed towards the day-to-day maintenance of the MTF. Unfortunately, this focus often overlooks the crucial human factor of fostering confidence and competence among Med Techs in their roles. Instead, members find themselves prioritised to organisational tasks such as warehousing and logistical duties, which in turn neglects the essential maintenance of medical knowledge requirements vital for integration into hospital team settings during exercises or operations. This imbalance in job priorities frequently prompts Med Techs to seek alternative opportunities, leading to requests for posting to a Field Ambulance (Fd Amb), CANSOFCOM, Clinics, or Voluntary Occupational Transfers (VOTs). These requests arise as members seek environments where they can feel adequately trained, work within their trade and scope of practice, and feel valued within their trade.

4. Historically, Med Techs at 1 CFH suffer from "skill-fade" in their clinical skills, leading to a lack of confidence and dissatisfaction with staying at the unit or within CF Health Services (CF H Svcs). This erosion of skills raises concerns about their ability to handle independent medical tasks outside the unit, progress to the next qualification level and support R2B operations alongside Physicians, Medical Specialists, and Nurses, which is not a skill set they were taught. This lack of confidence affects job satisfaction, the morale and well-being of the members, and the unit’s operational effectiveness.

5. Given these challenges, it is crucial for MWO/CPO2 at 1 CFH to develop strategies to enhance job satisfaction, boost morale, and ensure medical competency among Med Techs. Addressing these issues is essential for team cohesion, well-being, and the unit's effectiveness in delivering healthcare services and sustaining operational readiness.

6. The research question I have chosen to focus on is: What strategies can MWO/CPO2 leadership employ at 1 CFH to enhance job satisfaction and ensure ongoing medical clinical competency among Junior Medical Technicians, thereby improving operational readiness and healthcare delivery? This study will utilise an anonymous survey and interviews to gather honest and comprehensive data. The aim is to inform leadership of strategies to enhance job satisfaction and clinical competency among Med Techs, leading to improved operational readiness and healthcare delivery.

ORGANIZATIONAL MAPPING

7. In the complex environment of 1 CFH, maintaining medical competency among Med Techs is crucial, directly influencing job satisfaction and professional competence. The mind map (Annex A) illustrates the interconnected and interdependent elements affecting this issue. However, specific gaps in clinical competency have been identified, particularly in how policy, leadership, training, and communication interact to address these challenges within 1 CFH. The primary gap is the limited hands-on clinical experience available to Med Techs, who are often focused on maintaining deployable medical equipment. This gap hinders their ability to sustain essential clinical skills, impacting their readiness and confidence.

8. Two key policies that influence operational standards and professional expectations are the Maintenance of Clinical Readiness Program (MCRP) and the Med Tech Scope of Practice. The MCRP is essential for ensuring that Canadian Armed Forces (CAF) Health Care Providers (HCPs) maintain and enhance essential clinical competencies through annual training that might not be available at the Med Techs’ primary place of duty. This program supports CF H Svcs Gp HQ’s initiative for a Ready Force, emphasising continuous professional readiness (1). However, the implementation of this policy is influenced by leadership decisions regarding funding and task assignments. For example, if funding or placement opportunities are insufficient, Med Techs may be unable to attend essential training sessions or clinical placements, thereby increasing the gap in their clinical competency.

9. The Med Tech Scope of Practice is designed to provide an authoritative document on the practice of medicine for the applicable Qualification Level, outlining a set of comprehensive skills that the Med Tech is expected to know and perform (2). However, Med Techs at 1 CFH are tasked with maintaining deployable medical equipment and infrastructure while the Medical Specialist and Nursing Officers engage actively in the ongoing enhancement of their clinical skills, which only contributes to lack of feeling valued. This oversight by leadership, driven by operational needs, directly impacts Med Tech's ability to stay clinically proficient, as they often find themselves working in roles that do not align with what they signed up to do.

10. Effective leaders must set clear directions that align with the mission, ensuring that policies and mandates are not only communicated but also effectively implemented. This includes educating Med Techs about their daily tasks at 1 CFH to provide transparency and clarity. The ability of leaders to foster an environment of trust and open communication also significantly impacts job satisfaction of Med Techs. Unfortunately, gaps often exist between leadership objectives and the actual opportunities available to maintain and consolidate clinical skills due to factors such as funding, task availability, MCRP placements, and other training opportunities. To bridge the gap of clinical competency, leadership could integrate MCRP rotations into the members' yearly training standards, ensuring that Med Techs meet the directed requirements. Additionally, increasing funding for MCRP would ensure that more members can complete their medical readiness requirements.

ANALYSIS

11. To effectively analyse the issue of job satisfaction and medical clinical competency among Med Techs, I will use the CF Effectiveness Dimension of "Member Well-being and Commitment" and the concept of "Leading the Institution." This approach will help identify root causes and bridge gaps to “accommodate personal needs in professional development and career systems (3).”

12. Recognizing misalignments is crucial for institutional leadership. By examining how our Med Tech roles differ from those outlined in their training and standard policies, leaders can better understand the sources of job dissatisfaction and competency gaps. This understanding is essential for addressing these issues effectively.

13. Institutional leadership can play a pivotal role by:

Analysing Role Misalignment: Leaders must thoroughly examine how the current roles and expectations at 1 CFH differ from those in Fd Ambs or CF H Svcs Centers. This involves understanding the unique operational demands, geographical constraints, and daily responsibilities of Med Techs, which do not align with their traditional clinical skills or taskings.
Clarifying Expectations: Leaders need to clarify the differences in roles during training to set accurate expectations for Med Techs assigned to 1 CFH. This can help mitigate misunderstandings and align expectations with institutional realities.
Facilitating Professional Development: By recognizing the challenges Med Techs face, leaders can support initiatives that provide opportunities for professional growth, such as partnerships with nearby units or enforcing clinical readiness. While these policies are clearly defined to ensure that HCPs maintain and enhance essential clinical competencies through mandated annual training, implementation at 1 CFH is often hindered by unique operational demands and geographical constraints.

14. The CAF effectiveness framework identifies mission success as the primary objective, supported by three enabling objectives: member well-being and commitment, internal integration, and external adaptability. A deficiency in any of these areas can significantly impact the CAF's effectiveness. Enhancing job satisfaction and ensuring ongoing medical competency among Med Techs at 1 CFH can affect the "Member Well-being and Commitment" dimension. This dimension underscores the importance of members feeling fulfilled and competent, essential for maintaining high morale and commitment to the organization.

15. After conducting an anonymous survey (Annex B), it was confirmed that Med Techs at 1 CFH are extremely dissatisfied with their current roles, largely because their daily tasks do not align with their training and expectations as Med Techs. Instead, their roles resemble those of Material Management Technicians (MMT). Furthermore, they reported feeling somewhat or not confident in their medical skills, a direct result of not consolidating/using them regularly. This lack of engagement in their intended roles leads to dissatisfaction and diminished confidence in their professional abilities.

16. The misalignment between expected and actual roles has led to significant issues with commitment to both the unit and CF H Svcs. Over 75% of the Med Techs at 1 CFH have considered a VOT or voluntary release (VR). Additionally, about 23% of the members have already submitted a Notice of Intent to apply for Med Tech positions within CANSOFCOM or submitted their VOT/VR in the past year. The high rate of consideration for transfer or release is attributed to feelings of being misemployed, significantly affecting their sense of purpose and value within the CAF. Therefore, leads to low morale and reduced effectiveness, particularly when called upon to work within their trained medical scope of practice.

17. Our members' well-being and commitment are crucial for supporting the overall objectives and ensuring mission success. This dimension focuses on ensuring optimal working conditions, opportunities for personal growth, fair treatment, and job satisfaction. Prioritizing member well-being is essential as dissatisfaction can lead to poor performance, reduced morale, and decreased willingness to serve. As leaders, we have a responsibility to address these issues and advocate for our members' interests by enhancing employment opportunities, communicating effectively, and providing the necessary support.

RECOMMENDATION/CONCLUSION

18. To improve the effectiveness and integration of Med Techs, At the CPO2/MWO level, I propose to introduce a Med Tech-specific orientation and introduction packages aimed at enhancing communication and knowledge. The goal is to provide comprehensive information about the company, unit, and unique operational requirements of 1 CFH. This will also include training that forces on the roles Med Techs are expected to fill within the 1 CFH construct both in garrison and on deployment. Additionally, implementing mandatory weekly Med Tech training will ensure continuous skill development, knowledge sharing and team cohesion.

19. To improve job satisfaction and maintenance of clinical competencies at the 1-Up Command Level, I propose establishing partnerships with nearby units such as 2 Fd Amb which would be highly beneficial. This collaboration would involve sharing resources, engaging in cross-training, and exposing Med Techs to various experiences. Such initiatives would help prevent burnout and enhance professional development by allowing Med Techs at 1 CFH to gain traditional experiences while exposing Fd Amb Med Techs to field hospital roles. This approach would not only enhance job satisfaction and broaden skill sets on both sides but would facilitate an exchange of knowledge and foster a sense of community within their trade.

20. At the 2-Up Command Level, I propose implementing a one-year consolidation period for newly trained Med Techs. This period would involve rotations between CF H Svcs clinics and Fd Ambs, allowing them to gain experience in both clinical and field environments to consolidate their skills. This approach will also equip them with the necessary soldiering skills to operate effectively within various elements that CF H Svcs supports. Additionally, I recommend including Medical MMT training for members posted to 1 CFH to enhance their understanding of purchasing, warehousing, shipping, receiving, stock control, and the disposal of obsolete stock and equipment. This ensures that our members are better prepared and feel valued, reducing attrition and increasing job satisfaction, leading to a more competent and committed workforce.

21. In conclusion, addressing the professional issues faced by Med Techs at 1 CFH requires a comprehensive approach to enhance job satisfaction and maintain clinical competency. This report has highlighted the critical role that Med Techs play in supporting healthcare delivery and operational readiness within 1 CFH, while also identifying significant gaps between their training and actual duties. By implementing strategies at various command levels, we can bridge these gaps, improve the overall effectiveness, foster a sense of value and preparedness, reduce attrition, and increase job satisfaction. Ultimately, this will ensure Med Techs at 1 CFH are well-prepared, competent, and committed, leading to improved operational readiness and healthcare delivery within the CAF.

BIBLIOGRAPHY

1. CF H Svcs Gp Instruction 3100-22 Maintenance of Clinical Readiness MCRP Manual December 2023.pdf (mil.ca)

2. Scope of Practice
Medical Technician QL3
• Med Tech QL3 Scope of Practice (Mod 4) (PDF, 265 Kb) Medical Technician Qualification Level Three - Scope of Practice (mil.ca)
• Med Tech QL5A Scope of Practice (mod 1) (PDF, 302 Kb) Medical Technician Qualification Level Five A - Scope of Practice (mil.ca)

3. Canada. Department of National Defence, A-PA-005-000/AP-004 Leadership in the Canadian Forces: Conceptual Foundations. Chapter, Table 4-1 | Responsibilities of CF leaders as they relate to major functions and effectiveness dimensions, 4 pg 48