Comments from Judge Rob Foshay:
The team did an excellent job of picking up on the key teamwork and
technology acceptance issues, the job design issues, and the work space
issues. The recommendations for players to be involved in the task forces
were appropriate.
Suggestions for improvement:
- The team did not suggest either a fault tree analysis of possible
procedure errors in use of the RBA, or analysis of actual errors to
determine causes. It appears to have taken at face value the assertion of
the lab that the number of rejected tests and recalibrations needed is
acceptably low and need not be addressed.
- It would have been helpful to management to directly address the issue
of competing management signals and rewards related to the dual goals of
patient-centered care and reduced cost. This issue would certainly emerge
from the proposed solution strategy, but it could have been flagged now.
- Training and retraining on the RBA is not a cost-justifiable solution
for so simple a problem. Better would be use of some combination of job
aids, EPSS built into the machine. Design would be driven by the error
analysis.
- The team missed management's need for a legally defensible solution to
the RBA operation issue. An obvious solution strategy would be:
- a) construction of a simulator to certify correct operation of the
machine,with particular attention to the points raised in the error
analysis
- b) installation of a periodic recertification requirement
- c) since the RBA automatically enters its results into patient records, it
almost certainly requires the operator to login. It would be simple to
check that login against the certification status of authorized operators,
thus eliminating the problem of unauthorized/untrained operation through a
simple redesign of the work environment.
- d) fatigue and stress due to emergencies are probably an issue in operation
of the machine. Therefore, certification should include a test for fluency
(automaticity) by tracking response times to assure minimum cognitive
processing time.
- Use of CBT for addressing only the knowledge component of the technology
strategy is almost certainly an inappropriately costly strategy. The
knowledge issues here are pretty simple. The big issues have to do with
attitudes and understanding the change in management signals regarding cost
saving and patient centered teams. This probably requires some
combination of attitude/motivational change strategies, of which CBT might
be a part.
- Since training/team development time is a major problem, suggest to
management a different scheduling system which would free up a few hours a
week for team development and training, or some kind of an
incentive/compensation system for teams to do this on their own.
- The team missed the problem of too many STAT orders, probably due to a
combination of change management issues.
- The entire power failure procedure problem could be eliminated by
addition of a 20-30 minute uninterruptable power supply to the RBA. Cheap,
and no training or procedure development required. I'm surprised the
machine didn't have it already--most hospital equipment does these days.
- The issue with Robomedics is a little deeper than described here. It's
a typical technology company, focused on its machine rather than on
realizing the benefits of its use. Senior hospital management needs to
step in to require a change in this orientation.
Comments from Judge David Graf:
This Team identified the major issues in the case. However, the manner of presentation of the team's response left a lot to be desired. The points made by the team could have been presented in a more cogent manner and should have included a bit more detail. I would ask the team to compare their presentation style with those of the other teams.
More than the other teams, this team focused heavily on the need for attitudinal change within and among the hospital staff. I felt that this was an important element of the case that was not adequately addressed by the other teams.
Comments from Judge Marshall Jones:
I like the way this team clearly distinguished this as a needs assessment and not the design of the instructional materials. Your writing style is very direct and to the point. You have done a good job of incorporating the recommendations and the alternative solutions in a manner that has the look and feel of an integrated solution. You have done a good job in pointing out both the existence and the issues involved in attidudinal objectives. Your solutions/recommendations seem reasonable, but we will not know if they worked until people actually get on the job.
This is a commendable effort.
Comments from Judge Brent Wilson:
I thought this team did a good job of balancing technical and teambuilding solutions. Several comments follow.
Gap 1
Don't mention names! In spite of management request for named sources, it is extremely important that you maintain confidentiality of negative responses. This is a major indiscretion; I hope you can take that report back and fix it.
The need for vertical teams across job areas is critical. I am glad you pointed this out first and made it a priority. The disparity between the firm's stated goals and its hierarchical, command-driven operating style is difficult to confront, but a good needs analysis would face up to it.
The idea of a pilot team is fine. But I would look first to informal opinion leaders, and not technology advocates. I don't have quite the confidence in Dr. Kasim. His professionalism is unquestioned, but his credibility to move others towards technology is in doubt. I'm afraid he suffers the "early adopter" syndrome, where people tend to dismiss his views because technology seems to come too easy to him.
Gap 2
This gap is not well-conceived and articulated. We have a gap between perceptions and practice; a gap between management and labor; a gap between idealized attitudes and real attitudes, both internally and within the community at large. This is all kind of fuzzy and mixed up in the analysis.
There is actually a logical flow between Gaps 1 and 2. Working teams, both horizontal and vertical, should enjoy some empowerment to determine the second gap's agenda. In other words, the organization needs to come to a position concerning technology's value. Your analysis seems to take its value as a foregone conclusion. I wouldn't rush that; let teams and workers come to that conclusion through a process of reflection and interaction, with encouragement from management. Technology doesn't mean much if people aren't working together. First things first.
I'm particularly critical of your recommendations to "accelerate technology introduction wherever possible." This sounds like a dangerously naive stance. Some of the technology in the hospital is nothing more than beta testing of poorly designed tools. Do we really want to push this on our teams uncritically and unselectively? Palmtops may be in the future, but again, they need to be integrally tied to working teams' daily operations; thus, again, the logical transition from Gap 1 to Gap 2. These details have not been worked out in your report or in any available analysis. They will get worked out as people begin communicating better.
The recommendation of an "instructional modules" seems a stretch. You've admitted this gap to be an attitude problem. Do you really think an instructional module will make the difference, with the objective of being able to "identify ways" technology can help?
I would recommend something like this: Some sort of video or demonstration may be useful in conveying a vision of what the technology can achieve. People need an understanding of what they're working toward. I agree with you that this sort of knowledge is highly conceptual (as opposed to procedural or highly factual). People need to understand the general idea, as well as implications for their daily work, one following the other.
I would recommend establishing the teams first as working groups, then tackle specific issues like this once they have formed. Either a video or carefully designed demo can serve as a starting point for discussions and planning among integrated teams. I agree with you that all patient-care staff should participate in these teams, and in the technology/RBA training.
Gap 3
I appreciated your observation about the unintended outcome whereby med-tech staff are further removed from professional interactions.
I agree that clear specification of appropriate personnel is critical to avoid litigation and maintain quality control. I would have been tougher on getting well-designed technology into use. Somebody needs to wake those nerds up and get them improving their product, or they'll be out of business by a competitor who takes such things seriously!
Good analysis on physical location and other mechanical/logistical details. This section was solid.
Overall, very good job. In-depth thinking, good balance, good commonsense. Almost no direct connection to the professional literature, but good analysis nonetheless.
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Judges' Ratings
Note: These item ratings have been averaged across all four Judges.
|
|
Item #
|
Item
|
Average Rating
|
| 1 |
The team *identified* the important issues in the case. |
3.25 |
| 2 |
The team effectively *addressed* the important issues in the case. |
3.25 |
| 3 |
The team *defined* the perspectives of relevant stakeholders in this case (e.g., administration, doctors, nurses, nursing assistants, lab staff, patients, public, etc.) |
3.00 |
| 4 |
The team effectively *responded to* the relevant perspectives in this case. |
3.00 |
| 5 |
The team distinguished between the training and non-training components of the problem. |
3.25 |
| 6 |
The team effectively analyzed the needs identified. |
3.00 |
| 7 |
The team identified appropriate alternative solutions for each need.
|
3.25 |
| 8 |
The team developed an instructional goal that was appropriate for the case.
|
3.00 |
| 9 |
The team recommended an appropriate overall solution.
|
3.00 |
| 10 |
The team identified all major project risks and allocated project resources appropriately to manage the risks, while avoiding over-resourcing of low-risk project components.
|
2.50 |
| 11 |
The team's specifications for personnel to be involved in the solution were appropriate.
|
3.25 |
| 12 |
The team effectively integrated relevant professional knowledge into their response.
|
3.25 |
| 13 |
Overall, the team's Needs Assessment was appropriate for the case.
|
3.25 |
| 14 |
The team effectively addressed any additional issues raised by the Provocateurs.
|
3.25 |
| 15 |
On a scale of 1 to 8, with 1 being 'poor' and 8 'outstanding,' rate the overall quality of this team's response to the case study and provocateur questions. (This item weighted double, with an eight-point response scale.)
|
6.00 |
|
Overall Average.
Note that item #15 has been treated as two items to maintain a 4-point scale referent.
|
3.09 |
