It was in the national and international news: five patients at our hospital were given the wrong dosage of medicine, and three of them died. What a dark day for healthcare. When I received the request to train clinicians on a new medication administration process, I worked hard to understand the expected outcomes from the project. I focused on creating stellar learning experiences that addressed the knowledge and skills gaps. Students were passing their assessments during class, and I was excited for the outcomes.
Leadership had agreed the goal was to obtain a 90 percent compliance rate. When I accepted a compliance report two weeks after go-live, I had reached 66 percent. What happened? Determined to find out, I went to the units and asked nurses to demonstrate that they knew how to use the system as trained. They knew. When I asked them why they were not following what was taught, they replied, “Look, we are really busy, and unless someone tells us we have to pass meds this way, we are not going to do it.”
So, where had I failed? I failed when I designed the training for learning instead of best results.
Traditionally, designing training is all about satisfying the identified learning objectives. That is an academic approach, but in healthcare informatics, the goal is not just to design training but to design training for best results.
Design in CollaborationDesigning training in a vacuum may bridge a gap in knowledge, skills, or attitude, but it rarely leads to a big change in results. Work with your leaders to identify the desired outcome. Is it an improvement to patient outcomes? A change in process that improves workflow? Or perhaps a change in the documentation that provides continuity of care? Having a true understanding of the end goal is imperative. Next, when you roll out training, the supervisors and managers must understand the change needed and their roles in helping to drive that change. In my opening example, staff learned how to use the new software but failed to do so because they were not held accountable on the unit.
Revamp Your Learning Objectives Into Performance ObjectivesOnce you have identified the needed outcome, determine first what performance is needed to obtain the outcome then identify the gap in knowledge, skill, or attitude. When writing your learning objectives to address knowledge, skill, or attitude deficits, turn them into performance objectives. Here is an example:
- Learning objective. The learner will be able to document in the system correctly and at the right time.
- Performance objective. The learner will be able to document in the system so that the right medicine is passed at the right time in the right dosage to ensure safe passage.
Adding the performance expectation moves the learner from a learning mindset into a learning and doing mindset. Adults are much more apt to comply when they understand the expectation and the why.
Design Beyond the Classroom or E-Learning ExperienceEven with adding the expectation and the why, little changes unless that change is supported or driven in the work environment. Be sure to provide tools at the point of need. Also include the managers and supervisors so they understand their roles in driving the performance if any hope of change is to occur.
Use Evaluation to Drive ResultsWhen designing training, include formative and summative evaluation techniques in your design process. Get input from prospective learners and their leadership. Is the process or skill being taught realistic in the work environment? Are there roadblocks in the way that need to be addressed?
Next, ask your seasoned facilitators what is working well in the class and what is not. Are they hearing comments about implementation that will impede performance? Remove obstacles and make changes early.
Once participants are back in their work environment, do you see signs that performance is happening? If not, why? What can you do to remove obstacles? What tools can you provide supervisors and managers to help drive performance and accountability?
In my opening example, once I knew performance was not happening, I asked the managers if they were holding people accountable. They wanted to but could not enforce unless they followed each nurse as he or she passed medicine, and they didn’t have the bandwidth. So, I worked with Information Systems. to create a system report by unit and by person to show who was passing and documenting medicine as prescribed in training. That simple tool made all the difference.
When creating training, we often focus solely on learning but need to expand our focus to learning and performance.