Our health care world is being inundated with dramatic changes in insurance coverage, glimpses of health care reform, experiments with new patient care delivery methods, and diminishing health care dollars. We believe it is time to take a step back to focus on the essential element to organizational survival, a competent workforce. Before institutions leap into change, they need to examine their system as it presently exists. This process will involve assessing and understanding their changing patient populations as well as the roles and skills of their patient care providers. Managers will be the key to this detailed assessment process. They will need to analyze their employees skills and duties against the care that the patient requires. This analysis will provide the necessary information needed to effectively move resources when, where, and how the patient needs them. Using this data from the worksite analysis, managers must assess competency, develop more effective utilization of personnel resources and determine new ways of delivering care. An accurate evaluation cannot be accomplished until managers know how to assess and maintain a level of competency appropriate for the patients they serve. The success of any organization will depend on the ability of the manager to develop a competent work force that transcends traditional health care roles. The focus of the health care organizations in the future will be on the patient population and their needs, not on professional turfs and occupations. This manual will assist the manager through the entire process of assessing and building a competent workforce.