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ATD Blog

The Missing “E” in Healthcare Learning

Thursday, April 9, 2020

In the term “e-learning,” the “e” is typically short for “electronic.” But with the changes in our workforce and culture, other words “e” may represent include:

  • emergent
  • engaging
  • efficient
  • everyone
  • everywhere
  • entertaining
  • easy
  • empowering.

The ideas these words convey are a far cry from our first meager electronic learning attempts where we took PowerPoint slides full of information, automated them, and called them “e-learning.” Back then, we may have accomplished “electronic,” but we certainly didn’t accomplish much else. Despite how far we’ve come, there is one “e” we often fail to include: EVALUATION.

Electronic learning may be a necessity today because of either actual distance or social distancing, but regardless of the reasons learners engage, we want them to like the electronic experience, and we want them to learn something. Unfortunately, we rarely attempt to measure these outcomes beyond registrations, anecdotal reactions, and maybe a few true-false or multiple-choice questions at the end of an electronic learning experience.
I am always amazed that although healthcare focuses on evidenced-based patient outcomes, we fail to focus on evidenced-based learning outcomes. Even when we do assess learning itself, which I find surprisingly few healthcare learning departments do, learning is no longer enough. Our healthcare organizations need true outcomes in the form of behavior change, and in our rapidly evolving world, they need them now more than ever. To stay relevant in the healthcare learning community, we need to prove our value by changing behavior. And we can’t know if we’re changing behavior without measuring it.

Implementing Kirkpatrick’s Four-Level Training Evaluation Model profoundly increased the value I brought to my organization. Before implementing evaluation, I didn’t know if I was making a difference and neither did my leaders. I could tell my leaders how many people I trained, how many completed online courses, and how many participated in learning chats. But my organization wanted proof of results from my efforts.


My journey wasn’t completely smooth. At first, I approached evaluation the same way as before. I measured learning reaction and provided an assessment, but I struggled to get to behavior and organizational outcomes. I attended an official Kirkpatrick bronze-level certification class and quickly learned that I needed to begin with the end in mind (outcomes), decide what behaviors I needed, determine what learning needed to occur to support those behaviors, and choose the best format to use to facilitate that learning.

I have to admit, even when I felt I was changing my focus to beginning with the end in mind and training for the right behaviors, I still found a critical breakdown between learning and behavior. Although I was measuring beyond learning, I still failed to cross the bridge to effectively changing behavior. What I learned from my experience was crucial: Behavior doesn’t magically happen just because you measure it.


I went back to my Kirkpatrick training for inspiration and support. I found that I was still focusing too much on learning instead of behavior and outcomes. You see, while I felt learning was my responsibility, I had been taught behavior was the responsibility of the managers. Although this is inherently true, when I learned to partner with managers to provide them the tools they needed to reinforce behavior and to move beyond the classroom (whether physical or virtual) to encourage and support behavior with my participants, I found the divide between learning and behavior began to disappear. And when behaviors started happening, outcomes and results naturally followed.

This experience reinforced to me that learning is a process, not an event. It was with practice that I was able to show my worth to leadership through actual measurement. It has been truly liberating to move from an order-taker in a training department to a business partner who helps leadership obtain outcomes.

So, for me, the “e” that was missing from learning was EVALUATION!

About the Author

Linda Hainlen is the director of business development at Sedona Learning Solutions, a Kirkpatrick Certified Facilitator, and an international author. She served as director of learning solutions for IU Health in Indianapolis, IN for 18 years.

Linda has over 25 years of proven experience as a training manager--including real world experience applying the Kirkpatrick principles. “Utilizing the Kirkpatrick Business Partnership Model truly transformed my results and elevated my division at IU Health to a strategic business partner in the organization. I am passionate about working with other organizations to help them elevate their results through partnering and obtaining sustainable outcomes.”

Linda is an engaging facilitator and presenter, who authentically and successfully connects with audiences by bringing concepts to life through sharing her own experiences from working in a highly regulated industry. Her practical and genuine approach inspires participants not only in thinking but in applying their newfound knowledge and skills.

Under Linda’s leadership, her division at IU Health was awarded the highly prestigious ASTD Best award in 2011. Linda has been published several times, including a white paper co-written with Jim Kirkpatrick on the topic of healthcare. Her ATD Infoline on “Designing Informal Learning” made the top 50 best sellers and was translated into 83 languages. Linda has been a speaker at several international conferences and has worked with companies from around the world to improve their effectiveness and achieve measurable outcomes. Industries served include higher education, corporate learning, nuclear, and healthcare. Sedona Learning is currently the only US Kirkpatrick Partners affiliate.

1 Comment
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Linda, I can't think of a better time to share how evaluation contributes to top quality patient care and good outcomes. Thank you for sharing your wisdom so generously.
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