Comments from Judge Rob Foshay:

Great job! Only a few minor nits in the needs assessment. However, the recommended solutions aren't adequately ranked by overall risk and cost (direct and indirect).
Suggestions:

1. Legal--another possible solution would be to modify the machine to check login ID against certification records and prevent unauthorized use.

2. Acute care-- the attitudes of nurses and physicians were more mixed than reported here.

3. Robomedics -- I think the central issue with this company is that it's focused on the machine rather than its benefit. Thus, they don't really take into account the issues of integration of the machine into the hospital's work processes.

4. Performance gaps-- Good job! I would add attitude toward automation (willingness to use), and confusion/mistrust over the competing management messages and contingencies concerning improved care and reduced cost.

5. Alternative solutions-- It would be better to base revised procedures on an analysis of performance errors (rejected tests and recalibrations, and possibly unauthorized use).

6. Informing the community is appropriate, but I'd use testimonials more than statistics. Only certain kinds of managers believe in statistics; certainly not medical staff or the public.

7. The analysis of alternatives for incentive programs misses the point. The hospital is trying to optimize on two dimensions: patient care and cost. The problem is incentives based on measures which appear mutually antagonistic. The trick is to develop measures which reward optimization.

8. A simple way to eliminate the need for emergency procedures due to power failure is to put an uninterruptible power supply good for 20-30 minutes on the RBA.

Overall, the response of this team to the case was textbook adequate. The needs assessment table was especially inspiring and shows that the group understands not only the processes involved in conducting a needs assessement, but also how important such an undertaking is in projects of this nature.

I don't think the team adequately addressed the non-training problems within the case, as much of their focus was on solutions to the existing training efforts.

I believe the team also overlooked the importance of administrative involvement and support of their suggested solution(s) and changes. For example, without the strong support of the head of the nursing staff, the head of the medical staff, and the head of the clinical staff, the "ambassador teams" and "lead teams" would be doomed to failure. Even beyond the existing morale problems promulgated by the current training program and operating procedures, there is a strong need for teamwork "training" within and among all of the staff. The "lead team" concept might START with that.

I also believe this team identified one of their own shortcomings in their response to the common question: namely, that Will should have spent more time observing the entire process and delving deeper into the causes of staff unrest.

Your strength in the analysis is identifying the issues in the needs assessment. You could do more work in the analysis of the issues. An key example of this is in the Acute Care Nurses section. Your table is a good mechanism for providing this information, but the information in it could be better rendered. A good job is done in identifying performance gaps. In your response to the provocateur, you raise good questions about the information needs of various employees with varying level of responsibilities. Overall, you have done a fine job with your needs assessment.

I was very impressed by the quality of the analysis. The far-reaching, long-term issues of teamwork and communication were addressed, but not at the expense of the RBA training and support.

Specific comments follow.

1. Introduction

   The Rossett needs assessment model was used, uncredited. Although I am wary of using technical models to communicate non-specialists, the report included a short description of the purposes of a needs assessment, and an introduction to key terms of the model.

   Please be sure that all your data-collection methods are credited. Observations seemed not to have been mentioned.

2. Needs Assessment

   Good choice to maintain confidentality of interviewees. A short explanation to Marcia would be in order.

   To complement the table, I would recommend including a narrative that "tells the story" in more detail. One team used occasional quotes to illustrate perspectives or needs. This is surprisingly effective as a persuasive device. Marcia will get a clearer idea of the problem by listening to people's verbatim responses to their work situations.

3. Alternative Solutions

   Good description of cross-functional teams and the plan to „cascade¾ information to the rest of the workforce. The nominal group technique sounds like a promising introductory strategy for the workgroups, which could be dropped once people build trust.

4. Training and Communications Strategy. I agreed with the main goal here, but I would de-emphasize training and give more attention to work redesign and communication.

5. Inform community. Good point about there being some positive statistics to share with the media and the community at large.

6. Recommendations

   "Give lead team materials to 'train' others on the specific functions of the RBA..."

   I'm not sure I feel comfortable involving teams at this level of training. You should be able to build technical supports--EPSS, etc.--sufficient to provide basic training on RBA. The team¼s function would be more of monitoring and supervising, and helping the specific transition to the job category.

   I would also recommend a tutorial and assessment function within the EPSS that could certify RBA users.

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.	3.50
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.)	3.75
4	The team effectively *responded to* the relevant perspectives in this case.	3.25
5	The team distinguished between the training and non-training components of the problem.	3.25
6	The team effectively analyzed the needs identified.	2.75
7	The team identified appropriate alternative solutions for each need.	2.75
8	The team developed an instructional goal that was appropriate for the case.	3.25
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.	2.75
11	The team's specifications for personnel to be involved in the solution were appropriate.	3.375
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.	3.25
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.)	6.50
	Overall Average. Note that item #15 has been treated as two items to maintain a 4-point scale referent.	3.26