COMMON QUESTION for ALL TEAMS, by Allison Rossett

Will was surprised when he got an email requesting his presence in Marcia's office. When he gave her the document, Marcia had thumbed through it, read the exec summary and turned right to the recommendations. She'd nodded with satisfaction.

So Will figured he was finito with that project. No problem if she wants to chat, he thought to himself, noting that he and Marcia were real tight.

Marcia wasn't alone when he was eventually shown into her office. Sitting at her large conference table was a woman who looked vaguely familiar, but he couldn't place her. She had a copy of his assessment in front of her.

Marcia said, "This is Dr. Gwen von Hinghis. Gwen heads up Education, Training, Technology and Performance Systems for headquarters in Chicago. You've probably heard about their brilliant work on EPSS for customer service. Gwen made all that happen and the CEO has come to depend upon her. Maybe you've seen her articles in professional journals? I asked her take a peek at your needs assessment. I knew you wouldn't mind.

Gwen got right to the point: "Well, Will, I can see what you were driving at here and I appreciate the array of sources you tapped, but I think you kind of let the people at Cadaceus run the needs assessment and dump what they wanted on you. They expressed joy and sorrow about Roberta, but I don't think you got all the information you need. And if you're going to do much training, did you get at what it is that different employees need to know and be concerned about? To create all that training, bet you'd have to do still another needs assessment.

Marcia tells me you're a recent PhD so I'm surprised that your inquiry doesn't reflect more cognitive and constructivist perspectives. Surely that makes a difference in needs assessment, don't you think? Could you take another whack at it with some of this in mind? I know that Marcia will appreciate it, and I will too.

This thing has to be right, you know. We're eager to see where you get to. Right, Marcia?

Will was stunned. He'd enjoyed nothing but kudos in his career, and now this. Well, he was going to think about it and tackle it. Where could he turn for help? He had a little money for consultation...

Help Will. Strengthen his study in ways that reflect your opinions of what he did and didn't do PLUS Gwen's concerns.

DATE: April 18, 1997

TO: Marcia Sheridan, Exec. Dir. Hospital Operations
Gwen von Hinghis, Dir. Educ., Training, Technology & Performance Systems

FROM: Will Brubaker, Health Information Systems

RE: Common Questions Regarding Recent Needs Assessment

Based on the valid issues raised at our last meeting, I would like to respond to the general questions you both had regarding the recent Needs Assessment undertaken at the request of the Caduceus-Hampstead University Hospital Administration. The following bold headings identify the issues that had been raised.

Skewed Needs Assessment

An authentic needs assessment occurs naturally in a meaningful context. By both interviewing and observing the medical staff in operation, I think we were able to maintain a balanced approach to the Needs Assessment. It is also important that the staff realize that their concerns and interests are being considered in any intervention. This builds a platform of support for the possible interventions, minimizing start-up time and establishing consensus with all participants, aligning the various professional and task goals of the staff.

I share your concern that we accurately identify the problems affecting performance. An accurate assessment not only leads to the appropriate solution, but also saves time and unnecessary costs. To avoid skewing the Needs Assessment toward the perspective of the medical staff, I consciously used both observation and the concerns of the Administration as a way of triangulating the information obtained to ensure its accuracy. The triangulating of information was used to avoid being misled by perceived problems from any level.

Inquiry Reflecting Cognitive & Constructivist Perspective

There was also concern that my inquiry did not reflect more cognitive and constructivist perspectives. I feel that the assessment process of interviewing and capturing the individuals reflections on what was interfering with their ability to perform various tasks encompasses the principles underlying both cognitivism and constructivism to engage the staff in being part of the solution. If we concur that the basic elements of constructivism involve the following points, then upon reflection you will find that each element is incorporated within the intervention that involves Action Learning:

• Dynamic process that requires the active engagement of the learner

• Learner has ownership for their own learning and for the problem, while the instructor is responsible for creating an effective learning environment

• Uses authentic activities

• Awareness of learners views gives window to their knowledge and their reasoning that helps facilitate their learning needs

• Knowledge must be constructed by the learner and cannot be supplied by the instructor

• Learning takes place within the larger tasks

• Not a copy of reality, but a reconstruction of reality by the learner who experimentally probes for the solution

• Learning takes place through social negotiation that results in a holistic view of learning & forces them to see the perspectives of others

• Learners must reflect on both what was learned and the learning process which in turn furthers their own professional development

Missing Information

You raise a legitimate concern that there may be information missing, and also that we may have overlooked the different needs and concerns of the employees. This then raises the question that a further needs analysis may be needed. Due to the urgent nature of the Administrations request for a needs assessment, the methods used for gathering the information were streamlined and may appear shallow in approach. But by recognizing that the employees have to take ownership of their work problems and in implementing viable solutions, the process of Action Learning can effectively deal with the specific individual training needs of employees, along with the various problem solving skills that need addressing. The recommended intervention of initiating Action Learning teams totally embraces the principles of both the cognitivism and constructivism to the benefit of offering holistic (systemic) solutions, and at the same time developing the professional problem solving skills of ! the staff that enables them to address future problems.

EPSS

Prior to our meeting, I had not been aware of Dr. Hinghis affiliation with our hospital, and recognizing both her expertise and the benefits of integrating EPSS with the RBA, I would wholeheartedly recommend that we consider EPSS as an intervention for the RBA training. Based on my current understanding of the design process involved in EPSS, this may take approximately 2-3 months before implementation. Therefore, as a short-gap measure, I also recommend that we develop a quick Train-the-Trainer to get those currently using the RBAs to operate at a standard level of acceptance. This intervention will only take one week to design and pilot, and within the month we should be able to provide training to those in need.

Dr. von Hinghis may wish to explore this possibility further with the manufacturer of the RBAs to determine the feasibility of partnering with them in developing the prototype. This would not only reduce development costs to the hospital, but extend the reputation of research expertise of Caduceus-Hampstead University Hospital among other medical institutions, as well as directly benefiting their staff training.

SPECIFIC QUESTION for NIU TEAM, by Sandy Balli

Marcia and Dr. von Hinghis were both startled by Will's recommendation for FIVE training interventions. Marcia did not have enough money in her training budget to cover all that, and von Hinghis added that corporate couldn't supplement much either. "Will, could you priortize all this training!" Will thought about it. Given the current situation, which training intervention is most critical and why? What additional information could he gather to help focus and streamline his training interventions?

DATE: April 18, 1997

TO: Marcia Sheridan, Exec. Dir. Hospital Operations
Gwen von Hinghis, Dir. Educ., Training, Technology & Performance Systems

FROM: Will Brubaker, Health Information Systems

RE: Specific Question Regarding Prioritizing Interventions

My initial list of five recommended interventions was intended to provide the Administration with solutions that addressed both the short-term, as well as the long term needs of the hospital. Based on economic constraints, I would like to resubmit the following amended interventions for reconsideration:

1. RBA Training/Train-the-Trainer (Short-term intervention).
   The amount of training involved in this would basically take one week of train-the-trainer with the following week(s) used to train staff up to the standard specifications of the current RBA model. This would address the immediate concern regarding RBAs and would be easy to implement and cost effective. With the new information that has come to light in the expertise of Dr. von Hinghis and her background in EPSS, I would recommend that for an EPSS support tool be designed to bring staff up on any changes on future models of the RBAs as a long-term intervention. The administration may find it economically beneficial to partner with the RBAs manufacturer as a way to minimize production costs in developing the EPSS.

2. PLeadership Skills Building (Long-term intervention).
   Strong leadership skills are needed by the Administration to communicate and model the changes currently impacting on the employees. The confusion, inconsistency, and lack of employee motivation can be attributed to a failure of integrating the hospitals mission statement and goals with current policies and administrative actions. Strategies need to be developed for bringing about the changes, but in such a way that builds consensus with the professional medical and nursing staff of this hospital. This would minimize the transition period of change and maintain the high standards that have made this hospital an exemplary model in patient care. As stated in the original proposal this intervention is a bedrock to the success of any other intervention.

   The costs involved for this intervention can be minimized by first doing a follow-up assessment identifying the leadership strengths and gaps, and then specifically addressing those skills identified as needing further development. Specific interventions can range from working with a mentor to self-study to attending workshops or seminars available commercially or on campus. The budget allocation currently used for the professional development of administrators may be used to support this training intervention. Using the gap analysis results allows the Administration to strategically align their monetary resource with the appropriate developmental activity more efficiently and effectively.

3. Action Learning/Team Building (Long-term intervention).
   The most critical intervention, generating the most impact on motivation and problem solving skills of the employees is the intervention that initiates an Action Learning team. This would incorporate the elements of cognitivism and constructivism that would better develop the professional skills and needs of the hospital staff. This would also minimize the time away from actual work and team assignments, allowing the teams to integrate the problem solving skills directly into their daily tasks. This would also have the longest impact on the performance quality of the staff with the lowest amount of dollar investment. (4-6 months facilitation of problem solving skills and making resources available.)

   You will note that this shorter list of interventions does not recommend the computer and communications interventions that were previously recommended. This does not imply that these interventions are no longer necessary, but they can be addressed in the Action Learning teams. The Action Learning process gives employees the opportunity to come to their own conclusions if they need computer and communications training, and when to integrate those skills in their own problem solving steps. Formalized workshops in computer and communication skills will not be necessary with Action Learning teams; only those individuals who recognize the need and importance to their work area will pursue that intervention which can be accomplished through a variety of ways at minimal cost (e.g., self-study, tutoring, CBT, etc.)

   The recommendations listed above are fundamental to bringing about the strategic skills needed by the hospital staff, and can be implemented concurrently or in sequence (starting with the short-term intervention with RBAs) as funding sources are allocated.