March 10, 1997

The wall-to-wall carpeting muffled all sound lending an unreal quiet to the executive suite of Hampstead University Hospital. Only the furious clicking of the receptionist's computer keyboard broke the silence. Will Brubaker shifted uncomfortably in one of the faux Louis XIV chairs that dotted the reception area. He marveled silently at the contrast these offices made with his own enclosure in the basement of Cazenove Hall where was lodged the Health Education and Communication Center (HECC). He got to his feet and walked to the large Palladian windows from which he could look out over much of the nearby university campus and the city beyond. Suddenly his eye was caught by the flashing light on the top of an ambulance as it came down High Street approaching the main hospital entrance. From this height and though the sealed layers of the window panes, the piercing blare of the siren --which Will had always associated with the pain and anguish that had suddenly cut into someone's life--was muted almost to silence.

Restlessly Will rattled the change in his pocket as he considered the meeting before him. Will had been with HECC for almost two years since receiving his Ph.D. in Instructional Technology. He had been largely responsible for the transformation of the center from an afterthought of the medical center's imposing Health Information Systems section to a small but respected department in its own right. When his wife, Susan completed law school, they planned to move back to Seattle; but for now Will was happy supervising day-to-day operations of HECC. He got along well with the two full time designers and one administrative assistant who comprised his staff; and he enjoyed the diversity and challenge of the projects which piled up in the departmental in-box. Serving both the medical center and the university medical school, there was always plenty of work to do.

Therefore, he was somewhat puzzled and intrigued by the summons to meet with the assistant director for the hospital. The hospital operations of the university medical center had recently been taken over by Caduceus, Inc., a large Chicago-based health management organization. The state legislature, looking for ways to cut costs at public facilities, had approved the move to privatization. A complicated agreement worked out between the university and Caduceus over two years allowed Hampstead Hospital to remain allied with the medical school as a teaching institution but to be run as a profit making venture.

The first wave of down-sizing had occurred over the last six months. The effects had even reached HECC. Although the swelling number of calls for additional staff and patient training had increased the center's workload, Will's request for an additional full time position had been turned down. He was currently negotiating for a part time graduate student.

Finally the mahogany door to the hospital administrator's office swung open and a youngish man greeted Will. Aaron Seymour, assistant director of hospital operations, was new to Hampstead. He had spoken briefly with Will on the phone when arranging the appointment but had ducked Will's request for specifics. Now Aaron ushered him into the inner sanctum. "Glad you could make it. Come on in and meet everyone."

"Welcome to the team." Marcia Sheridan, executive director of hospital operations, arose from behind the antique desk, and came across the room, hand outstretched. "I've heard such good things about you. Your work on the diabetes education project was outstanding."

Will was flabbergasted. So this was the legendary Marcia Sheridan. He had not realized she would be involved in this meeting. Ms. Sheridan, who gave up a vice presidency at Caduceus home office to manage Hampstead, was both revered and feared among the hospital personnel who had dealt with her. It was rumored that she had come incognito to several of the clinics to check out the operation. No one was sure of this but changes had been made and some transfers and early retirements announced in certain departments following these alleged visits. She had a reputation for being sharp, direct, assertive, with an eye to the bottom line. Will could see now that, in addition, she could be personable and gracious. She was also younger than he'd expected. Before he knew it he was sitting on the sofa, drinking tea and trading stories about Seattle, where "Marcia" had apparently spent some time ten years earlier.

The social amenities were concluded when the intercom buzzed in Mitch Huddleston, the lawyer for Caduceus-Hampstead and Dr. Abdul Hamid Kasim, director for the main hospital clinical lab. "Whoa," thought Will to himself, "what's going on here? A room full of heavy hitters and one instructional designer?"

Will noticed that Huddleston sat slightly apart from the rest of the group and did not contribute to the conversation that followed. Marcia, too, appeared to be more of an observer as Aaron opened the meeting by describing a proposed design project which he indicated would require Will's immediate attention.

The project appeared to be a redesign of a training procedure for users of robot blood analyzers, RBAs, which were now located at various stations throughout the hospital: the emergency room, the operating/recovery room, the coronary care unit, the acute care unit. "As you may know, Will," Aaron explained, "we are dedicated to point-of-care delivery of lab work. It is a part of our concept of patient care teams. The idea is to decentralize the lab and take lab testing as close to the patient as possible. Using the latest in electronic technology and robotics allows our laboratorians to become more active members of the patient care team."

Hamid Kasim's face remained impassive at this last assertion, but Will wondered how well this team concept worked in actuality.

"The use of the robotic blood analyzers on the floors has dramatically cut the time from the doctor's initial request for the blood test to the return of the results to the patient record," continued Aaron. "What we need from you is a design for standardizing the training of the floor personnel who use the RBAs."

"How was the training done in the past?" queried Will.

"When the RBA is installed, replied Hamid Kasim, "we send a lab technician to the station to demonstrate for the nurses and anyone else interested how to use the machine, the exact procedures to go through. Then there is a laminated set of instructions affixed to each analyzer."

"If it's that simple, you probably don't need a whole instructional design...," Will suggested tentatively.

"But, Will, that's exactly what we do want," intervened Marcia pleasantly. "A full blown instructional design. Just like the one you completed here." She reached over and picked up a thick notebook from the corner of her desk. Will was surprised. It was one of his own design project reports.

"From the top, if you please... To start, a full needs assessment, including analysis of needs and alternative solutions, along with your recommendations for instructional goals and solutions. We'll follow with a complete instructional design and evaluation--the whole ball of wax," continued Marcia leafing through the report. "Ultimately, we will need demonstration of staff competence with the RBA. Of course, you will have the full cooperation of the hospital staff, including lawyer Huddleston, here. We will expect you to keep us up to date. We'd like to have the needs assessment by March 31st. Keep in mind we're all a team here. Aaron will meet with you later this afternoon to go over some of the details" Her smile was dazzling. "Thanks, Will. We are so glad to have you on our team."