Lisa Gardner

Dear Coach May 2008

One of the most critical questions talent and learning professionals need to answer to close an identified performance gap is whether to build or to buy the expertise needed to design, develop, and deliver the most effective learning experience. This is not just an either-or decision. There are many variations, ranging from completely outsourcing to partnering with an external source for just some of the components. The decision not only affects the solution, but also the budget, personnel, support efforts, time involved, the results for the employees and ultimately the success of the organization. What do you need to know before the conversations start? What research do you need to do? What questions do you ask? Where do you start?Situations like this are a common part of the talent leader’s portfolio. Your starting point might be different depending on your industry, your size, your market position, the maturity of your learning function, and other factors. However, if you are part of a benchmarking consortium, such as the ATD Forum, there is a known pathway–ask your peers!Forum members have a variety of methods to gain information from a diverse group of peers, including sending a simple member-to-member survey, asking others at a small group cohort meeting, hosting a virtual roundtable for members to share and ask questions, and holding deep dives at interactive labs.At the 2023 Spring Lab in San Diego, members focused on the build-or-buy conundrum and took it a step further to collectively develop ideas, checklists, and questions to enable a perfect fit between a provider and customer, regardless of whether the provider is internal or external. Context was provided by a member and its external strategic partner sharing a case study. This included an overview of the challenge, the case they developed for using an external supplier, and the many techniques employed over the years to work together to enable success for the real customers—the employees.Using this scenario, the collective peer group of talent leaders from 19 companies developed a list of reasons for using external versus internal suppliers, used the Value Proposition Canvas tool to dive deeper into clarifying needs, heard from an expert on using burden rate (the cost to an organization of hiring and maintaining an employee beyond their wages) when cost is a primary factor, and, finally, developed a list of elements to consider when selecting an external provider.Reasons for considering an external supplier:Diversity of thought and known expertise related to solving the challenge lends credibility on the issue that might be missing internally.A partnership can expand the company’s network for ideas, people, and solutions; this might include mentorships.Time to market can be much faster.Processes established to easily show metrics and ROI if the supplier has a model or tool designed for that purpose.Content maintenance capability is a huge factor, and the supplier may have a dedicated team.Reasons for not using an external supplier:An external person or group not understanding the context of the organization, the need, or similar factorsChallenge of getting executive buy-inCost, especially when burden rate is considered a sunk costRisk factors if internal leadership changes, the vendor gets acquired by another company, or other unforeseen circumstancesInitial time investment to set up the contract, especially if it involves legal, compliance, contracts, IT, or other departmentsLack of specificity based on industry—for example, experience from banking not applicable to constructionThe group then developed a list of elements to consider when selecting an external supplier. As the small groups reported their ideas, there was large group discussion and experiences shared from the rest of the peer group. The host team with the case study, along with the strategic partner, supplemented the conversation by providing real-life examples.With this list of elements clarified and expanded, the teams brainstormed how to determine whether these elements were present. A sampling of the elements and response includes:Element: How might we know if the supplier’s offering will really meet our need?Suggestions generated:Ensuring internal clarity on the problem and need by using a tool like the Value Proposition Canvas or Cathy Moore's action mapping prior to engaging with themRequesting demos and asking for a pilot or examplesAsking what they would change from their standard format for your organizationAssessing how they engage and ask questions of you as a client (Do they probe to dive deeper?)Element: How do you know if the external supplier can serve as a thought partner within your context?Suggestions generated:Asking for a list of other clients the supplier has worked with and interviewing themWorking through a scenario you provide and seeing how the supplier respondsAsking broad, open-ended, what-if type questions and focusing on what is referenced, especially noting other thought leaders and researchAsking, “What in our relationship, as you understand it now, might incur extra work and therefore additional fees?”Asking for examples of times when the supplier has provided thought leadership and the results garnered (Is there a regular cadence for sharing experience and current thought leadership? For example, does the supplier have a regular web conference or blog or gathering of clients to share forward-thinking ideas?)Asking for a list of the books, articles, whitepapers, or blogs the supplier has published for the industry at large and a list of conferences or other venues where they have shared experiencesThe build-or-buy decision is huge. However, if the decision is to buy, it takes continued effort from both parties—the customer and the supplier—to build an ongoing strategic partnership that results in a perfect fit which in turn makes an impact on the organization. Connecting, collaborating, and sharing with industry peers is an excellent start.

Build Versus Buy: Lessons From Peers

With recognition in 2014, WakeMed, a health system that employs more than 8,000 people in the Research Triangle area of North Carolina, has garnered its fourth BEST Award. "Being a leader in education is a central part of our organizational values," says CEO Donald Gintzig."We believe it is important to continually push the bar and innovate to achieve excellence. Our commitment to education offers the platform to introduce the new skills, standardize processes, and accelerate improvements in quality, safety, and patient-and family-centered care," adds Gintzig.All told, WakeMed provides more than 160,000 hours of formal classroom training for staff annually, spending more than $2 million. Four education departments report to the senior vice president of human resources and talent development: nursing education, staff development and training, workforce development, and the Center for Innovative Learning. Established in 2006, the center was designed to build WakeMed's capacity for simulation- and technology-based education, and focuses on delivery via innovative technologies.Its director, Amar P. Patel, says that the four departments work together in an environment of collaboration that crosses the domains of clinical, compliance, and soft skills training. The senior leadership team and WakeMed's board of directors participate in an annual strategic planning process that generates enterprise-wide and function-specific learning needs, as do WakeMed's many committees and councils.The most critical business issue facing WakeMed during the past two years has been transitioning all patient records from paper to electronic format, then integrating them from disparate parts of the system into a unified health record. The volume is immense: WakeMed sees more than 230,000 patients annually in its emergency departments and delivers more than 7,700 babies each year. Additionally, WakeMed primary care and specialty care physicians who practice across the region see more than 327,000 patients annually.Before the universal adoption of the Epic electronic health record software, there were many different health record systems in use, according to Patel. Epic has been rolled out to the physician practices and will go live in the hospitals in February 2015.To prepare for the transition with the physician practices, multiple departments worked together to devise a carefully planned learning strategy, designing training plans to best meet the needs of all disciplines, clinical and nonclinical. Training was delivered 24/7 in a variety of ways, including online modules, instructor-led classes, self-paced learning, computer-based training, and train-the-trainer competency validation."With unified electronic health records becoming our single source of patient information, it will be crucial that all using the system have training and competency validation," says Patel.Harriet Stephenson is the director of nurse education for WakeMed; nurses have distinct and specialized education needs. One training initiative is designed to reduce errors in medication administration, a crucial patient safety issue. But to design a program that addresses gaps in knowledge and process, errors must first be reported."If staff do not report errors, how can we identify whether it is human error or system processes that need improving?" Stephenson asks.Rather than design a prescriptive, top-down training program, learning staff decided to leverage the value of storytelling and the connective power of personal experience to create a safe space for error reporting and encourage it. They launched an internal patient safety blog with stories specific to medication administration, shared anonymously by nurses who had made medication errors."They shared their experiences, highlighting that we should be aware how easily errors can occur," says Stephenson. The team also drilled down to see where challenges were, and determined that constant interruptions were a huge issue that could distract nursing staff and cause medication errors. Therefore, they implemented system changes too, including "red zones," actual red-outlined work areas where nurses inputting information are not to be disturbed. Patel says that reporting of errors has increased, while errors in documentation and order entry have decreased.WakeMed promotes and enhances social learning through blogs as well as other social media tools, continuously posting information in multiple mediums to provide education across all levels.A key patient care need is to get critically ill heart patients, especially from rural areas, directly into WakeMed's Heart Center. In its most innovative learning initiative of the past 12 months, WakeMed learning staff set out to see whether the transport process could be streamlined and shortened, thus improving mortality rates.Using a human patient simulator named Stan, Patel and his Center for Innovative Learning staff created a simulation-based learning initiative to document the admissions process, determine learning gaps, and understand the patient and provider experience. Stan, who weighs 160 pounds and cost $75,000, is capable of breathing, blinking, and dying; he can be given oxygen, CPR, and medication, generating more than 1,000 data points per minute. Stan's caregivers would call local emergency services, who would evaluate his condition, then request helicopter transport to the cardiac hospital two hours away. Helicopter transport can reduce travel time to 37 minutes at an estimated cost of $10,000. Once transported to the helicopter, Stan's condition would worsen progressively; staff would have to begin treatment by inserting a heart catheter."After the simulation, staff were able to clearly identify areas where additional education was needed and procedures they would like to practice before managing real patients," says Patel. "While we see cardiac patients every day, very few arrive by helicopter directly into the cardiac center. It was important for the organization to understand and improve this process and the patient experience."As a result of the simulation, WakeMed is able to decrease mortality rates, prevent delays in catheter placement, and improve efficiency. These efforts also supported a business goal: to increase the number of cardiac patients who come to WakeMed (already the busiest heart center in the state) from rural areas of North Carolina.View the entire list of  2014 BEST Award winners .