From the CEO’s desk: When access is uncertain, competence matters more

Change is a constant in complex systems, and how people respond to change often determines whether efforts to make improvements result in the intended outcomes. Remember when self-checkout stations first appeared in stores? Systems designed to improve efficiency and get customers out the door more quickly initially introduced a sizeable amount frustration, especially when no alternative was available. Lines slowed, processes felt unfamiliar, troubleshooting errors seemed harder, and customers were suddenly responsible for tasks once handled by trained staff members. Eventually, these systems became more routine as people gained experience and learned how to navigate them successfully. For those of us who work in health care, we all have stories about similar moments when a new system was introduced to improve daily work processes but instead came with a learning curve that led to unexpected barriers to optimal outcomes. These moments include the introduction of new surgical workflows, changes in documentation platforms, or the adoption of new technologies in clinical practice. In each case, even well-intended improvements can temporarily increase the effort required to perform the work safely and skillfully. There is a useful behavioral principle that applies across these experiences. When systems change, even the most incremental increases in the effort required to complete a task can alter behavior. People may procrastinate, avoid the task altogether, or choose an alternative path that feels easier. In applied behavior science, this phenomenon is often described as response effort. When the cost of a behavior rises, whether that cost is time, money, confusion, or the need to learn a new skill, the behavior becomes less likely to occur, particularly when the perceived benefit or outcome feels distant or minor. Health care systems regularly experience similar transitions, but with far greater complexity and consequence. Across countries and care models, health care professionals navigate persistent pressure points related to cost, access, workforce capacity, and change. While these pressures vary by context, their effects on professional practice and patient care are widely shared. For example, when intake processes incorporate new technologies that make tasks more complex for patients, response effort increases in subtle but meaningful ways. A health concern that once prompted timely care may be delayed simply because the steps required to seek treatment feel harder than before. Over time, reduced engagement in preventive care and delayed treatment can contribute to greater reliance on emergency services, increasing strain across health care systems.Together, these dynamics make workforce preparedness and adaptability an even more important area of focus. When patients eventually seek care after avoiding a new or more difficult system, they may present later and with more complex needs. Health care professionals must be equipped to deliver efficient, evidence-based, and high-quality care under challenging conditions. In this context, competence is not a static expectation; it is a stabilizing force. Supporting practitioners in developing and maintaining the skills needed to adapt to evolving practice environments is essential to patient outcomes and system resilience. Change, particularly in health care, must be viewed as a constant. In my experience, the organizations and teams that are most successful intentionally communicate, educate, and support their workforces to build the skills needed adapt to new systems, technologies, and expectations that will continue to evolve, with or without them. Credentialing plays an important role in this effort. For practitioners, credentials signal that skills remain current and trusted despite changes in systems, technologies, and care models. Credentials reflect demonstrated competence, adherence to established standards, and a commitment to maintaining knowledge and skills over time. For employers, credentials support informed hiring and workforce development decisions. For patients, they provide assurance that those delivering care have met recognized benchmarks for competence. At the same time, organizations that develop and support credentialing programs face their own system challenges. Many credentialing organizations operate as nonprofit entities with a longstanding mandate to do more with less. This reality requires careful resource management so that earned revenue can be reinvested in the profession and the public they serve. These pressures also sharpen the skills of leadership teams, reinforcing the importance of efficiency, relevance, and value. Technology can help close these gaps. In many areas where administrative burdens were once costly, technology has expanded organizational capacity and allowed credentialing organizations to focus resources where they matter most: on the quality, relevance, and defensibility of credentials. All credentialing models must remain legally defensible, psychometrically sound, and grounded in best practices for assessment. The credibility of a credential rests on trust and is built through transparent governance, validated assessments, and a clear connection between credentials and professional practice. In many ways, this brings us back to familiar experiences with system change. When self-checkout stations were introduced, success depended not simply on installing new technology, but on recognizing the learning curve and supporting people through the transition. Over time, what initially felt inefficient became routine as expectations, skills, and systems aligned. In health care, the stakes are far higher, but the lesson is similar: when work changes, competence must be supported intentionally rather than assumed. As health care systems continue to evolve, credentialing organizations play an important role in promoting workforce stability. By supporting a capable and adaptable professional community, credentialing contributes not only to individual professional development but also to the quality, safety, and accessibility of care delivered to patients. This journal is intended to support thoughtful, evidence-informed dialogue at the intersection of workforce preparation, credentialing rigor, and patient outcomes. Peer-reviewed research is central to that dialogue, strengthening the empirical foundation that informs practice, credential development, and decision-making across health care environments. As an open-access publication, the journal seeks to broaden the dissemination of research findings, supporting accessibility for practitioners, educators, credentialing organizations, and researchers across diverse settings and regions. As we publish this first volume, we invite practitioners, educators, researchers, and credentialing professionals to contribute scholarship that strengthens both rigor and responsiveness in how competence is defined, assessed, and sustained. While health care systems, roles, and technologies will continue to change, the pursuit of excellence must remain constant. Rigorous research, transparent peer review, and the open exchange of knowledge are essential to sustaining that commitment, and I look forward to the scholarly contributions and conversations this journal will support in the issues ahead. Respectfully submitted, Melissa R. Nosik, PhD, BCBA-D, CAE, ICE-CCP, SHRM-SCP Chief Executive Officer, Competency & Credentialing Institute Conflicts of interest statement The authors have no conflicts of interest to disclose. Funding source None.