Comments from Judge Rob Foshay:

The analysis shows a good balance of attention to the organizational/management issues, the specific RBA performance issues, and RoboMedic's issues. Missing are the legal issues. The cost/risk analysis was inadequate in the needs assessment. It was added in response to the question, but still seemed to focus mostly on direct financial costs.

Suggestions to the team:

1. Good articulation of the issue of competing contingencies from management concerning good care and reduced cost. You might add that this is perceived as inconsistency and therefore lowers trust and morale.

2. Another way to address the RoboMedic issue is to state that they are focused on the machine rather than its benefits. Hospital management needs to convey the wake-up call to them.

3. The team appears to have taken for granted the management and legal assertion that their sole concern is training. Nonsense! A major concern is to have a legal defense against accusations of misuse or unauthorized use. This places emphasis on certification and on procedures to prevent unauthorized use, as well as training. For example, it would be easy to automatically check login ID against certification status records.

4. Since management seems to be used to TQM terminology, it would be helpful to use that throughout.

5. I doubt that RoboMedic can take sole responsibility for promoting the machine's value to the community. That's too narrow a focus for a PR campaign. The hospital needs to promote use of technology.

6. Congratulations on calling for analysis of error and recalibration causes! Somebody needs to decide if this level of error is acceptable or not. If it is (as the lab says), there is no performance problem!

7. Use of multimedia computers to train and practice may be overkill. I'd do the training with a redesigned job aid or EPSS, and the certification with a simulator.

8. I wouldn't recommend financially compensating staff for training--only for certification.

9. Feedback is always required in an incentive program, and may be enough to improve performance without overt incentives. The trick is to find the right performance measure. What are your suggestions, or how would you find them out?

10. The suggestion/complaint box is probably not worth the trouble. Much better is the team performance improvement initiatives recommended.

In many respects, I agreed with this team's response to the case. The suggestion that a "Quality Standardized Training" program be initiated would appear to be quite workable. The use of Focus Groups to help establish teamwork also seems plausible, but this could backfire if staff are unwilling to change attitudes.

There are some solutions that I might take issue with. One of these is the concept of financial compensation for training and incentives. If training is conducted during shift hours, there would be no need for financial compensation. The use of incentives would not be needed if the staff attitudes were "adjusted." An issue in the case that none of the teams addressed adequately was the notion of staff attitudes (toward their jobs, toward administration, toward one another). These are significant shortcomings in a hospital setting. In the case of this team, perhaps the "alternative" suggestion that more teamwork training take place should be moved to the top of the list and integrated into the suggestion that staff be trained in teams. Role clarification and appreciation of other steps in the entire clinical process would result.

One of the team's non-training solutions also identified a problem related to the RBA's. As I read the case when it was first posted, I jotted down a note that perhaps RoboMedics is largely to blame for some of the staff resentment. In their haste to get the most recent software and hardware versions installed, RoboMedics appears to have failed to provide adequate training and documentation to the hospital! Perhaps the hospital should require that documentation and training be provided onsite whenever updates are installed. This was the only team that even came close to suggesting this.

Your responses were well reasoned and well presented. Good job of breaking information down into manageable units within the document. Headings made sense, and made it easy to find the information. In your response to the provocateur, you do a good job of pointing out the discrepencies between the common and specific questions. I think that while you do point out the difference between training and non-training needs, you tend to rely more on training than other interventions.

While you make a good case for the use of "all this training," you need to be mindful of your tone in the response--there are points where it may be counter productive to be aggressive. I am a bit unclear on the organization and utility of your cost benefit analysis, and I have to seriously question whether or not your analysis of CBT ("Mock up of interface with common interactions can be easily designed in house.") is accurate. Designing in house and developing in house are two different things, and I think I recalled that your resources were thin to begin with. Congratulations: you did a commendable job.

I thought several team responses hit the critical points, but I thought this report showed the best overall reasoning and support for recommendations. I particularly liked the concise and balanced tone of the writing. Very persuasive! Specific comments are provided below.

Data Collection

You made reference to the full dataset--observations, interviews, records, etc. That's good. You want the reader to understand that your report is well-based, even if every claim is not directly linked to a data source.

Also, it was critical for you to maintain people's confidentality, in spite of management's request. This you did tactfully and effective.

Key Issues and Perspectives

I liked your use of quotes throughout. This works so much better than bland generalities. It gives concreteness and specificity to the presentation.

Goals and Solutions

1. Better Patient Care...

   I would recommend adding a word:
   "In addition the teams will generate RECOMMENDED policies regarding technology...."

   As pro-worker as I tend to be, I acknowledge the need for management to work in concert with teams to finalize policy.

2. Recommended non-training solutions....

   Your analysis of how to improve the relationship with RoboMedic was particularly strong. That relationship could be a strength under the right kind of agreement; right now, however, it's a major source of stress. RoboMedic should be paying the hospital if they can help smooth the transition to the work setting through improved job aids, procedures, etc. These support materials could then be implemented across RoboMedic's customer base.

   I like the recommendation to create vertical teams (across job categories) for training and team analysis. I agree with the provocateur, though, in questioning the multiple levels of training--teams, job aids, CBT tutorial. That seems somewhat redundant. I'd recommend parsing out the tasks a little more clearly, something like:

   • Work teams as a continuing mechanism for improving communication, supporting quality, and linking training to the work setting;
   • Improved RBA job aid for everyday performance;
   • Short CBT tutorial retracing the job aid, for new staff and refreshment. This CBT program is probably the best place to include a test for certification.

   This way, I can see a place for each intervention. Some a long-term, some a one-shot, some serve a certification function, etc.

   "Offer incentives for prompt and accurate posting of lab results and other duties..." Be careful here. It's easy to fall into a behaviorist rut where everything has an incentive attached. This can inhibit creativity, team, and overall energy. People shouldn't have to always be working for a brownie point; there's no way to create a fully rewarding system through external rewards.

   I like the frank admission that we don't know from the available data why RBAs occasionally fail. Your proposal to do a more detailed study looks reasonable.

   The machine redesign recommendations on the last page ("include an error message....", etc.) is great. RoboMedics should pay you for that kind of consultative advice.

   I admire the maturity, balance, and straightforwardness of this report. If I were Marcia, I would take this report, do some serious self-reflection, and come back to the company with a sweeping new initiative to address team functioning that goes far beyond RBA training. Then I would keep you as my troubleshooter, all-around problem solver, relying less on Aaron for that function. In other words, you did great!

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.	3.75
2	The team effectively *addressed* the important issues in the case.	3.50
3	The team *defined* the perspectives of relevant stakeholders in this case (e.g., administration, doctors, nurses, nursing assistants, lab staff, patients, public, etc.)	3.125
4	The team effectively *responded to* the relevant perspectives in this case.	3.50
5	The team distinguished between the training and non-training components of the problem.	4.00
6	The team effectively analyzed the needs identified.	3.75
7	The team identified appropriate alternative solutions for each need.	3.50
8	The team developed an instructional goal that was appropriate for the case.	3.75
9	The team recommended an appropriate overall solution.	3.25
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.	3.00
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.	3.75
13	Overall, the team's Needs Assessment was appropriate for the case.	3.50
14	The team effectively addressed any additional issues raised by the Provocateurs.	3.50
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.)	6.75
	Overall Average. Note that item #15 has been treated as two items to maintain a 4-point scale referent.	3.49