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.

We considered several factors before forming a response to the general question:
What do the different users need to know?

• Nursing assistants and orderlies need to learn how input RBA data and samples if they are going to be required to use them.

• Nurses might just need a refresher course on how to input RBA data and be reminded of the systems benefits. They may require more extensive training on interpreting RBA results. Nurses may require a refresher course on using the hand-held devices for capturing patient data.

• Physicians need training on the hand-held devices for capturing patient data. Physicians might also require training on interpreting RBA results.

• Do some users have to understand the principles of blood analysis?

• Do some just need to know the hardware/software interface?

• Do those that understand the principles of blood analysis, but don't use the RBAs often, just need posters/print devices to model the task? * Do those that have little of no understanding of the principles of blood analysis, but need to use the RBA routinely, require more comprehensive, automated training?

• Does everyone need training of some sort on the RBAs? Should everyone know how to use them at the same skill level?

GENERAL QUESTION
What Will did and didn't do that would strengthen his study:

A key concern is that Will did not go out and observe how the staff works together in everyday situations. Observational studies may have helped identify the barriers to using the RBAs effectively and addressed competency issues. In gathering these observations, Will needs to be mindful of the motivational issues impacting the workplace and gain the staff's trust. Will could conduct his observations by "shadowing" hospital personnel, perhaps working alongside them. This would give him a better sense of how the staff interacts with one another and the equipment. For example, doctors complained about not getting the reports that they had asked for. There are several possible causes: not asking for the test, not reading the report correctly, not documenting the test request correctly, misinterpreting the request, or poor competency in operating the RBA.

Will also did not review the existing reports to see how they were completed versus how they should have been completed. This might have shown the level of competency that staff demonstrated in completing the forms. He might also have to examine the form itself to determine if it is too complicated or difficult to complete in an environment where time is of the essence and patients require emergency medical treatment.

If these observations held true: staff were not operating the equipment correctly and the forms were difficult to use, then skill development, training and form redesign would be required.

Our response to the team-specific question incorporated several elements:

• Provide education for those who lack both the understanding of principles and skills.

• Provide information for those who need to know about the RBAs.

• Provide poster/print-based training (job aids) for those who understand the principles and have the skills, but may be a bit rusty. For them, we will prompt through visual aids.

SPECIFIC QUESTION for PSU TEAM, by Allison Rossett

Your recommendations include significant training and an EPSS housed in each Roberta. This raises questions about education and information and the differences. For each of the employees most involved with Roberta, indicate what needs to be trained and what needs to be supported via information, automated and print or poster based. Please provide sketchy prototypes and a rationale for the way you parse this solution.

SPECIFIC QUESTION

Hands-on operational procedures, such as putting samples into RBAs, setting controls for testing samples and maintenance activities are critical to the correct operation of the RBAs and require specific skill competencies. Therefore, training and practice sessions will be provided for all RBA operational tasks.

Job aids (paper-based during pilot testing, EPSS final) will be used during the training session. Each job aid will have a step-by-step checklist required for each maintenance procedure. Simple pictures will be provided as reminders to the person completing the maintenance procedures. If there are minor changes to any of the procedures informational posters will be placed behind the RBA to notify maintenance personnel of changes. Checklists will be revised and communication memos will be distributed to each shift when the changes takes place. If the EPSS is housed in each RBA, then the checklists and all notifications of changes in procedures will be automatically displayed on the EPSS screen when the maintenance cycle is initiated.

Summary of Recommendations:

Employee Training Required Information Support Media

Doctors Report requests Interpretation Job Aid

Nurses Report interpretation Full operation Hands-on Operational changes

EPSS

Posters

Lab Techs Maintenance proc. Full operation Hands-on Job aids
EPSS
Updates on functions
Memo

Shift Leaders Full operation Hands-on Updates
functions
EPSS

Information

Meetings

EPSS screen designs would be difficult to sketch since we do not have access to the existing screens. However, we would suggest that all the screens be developed or revised to mimic the correct sequence of events in running test samples. A "Help" function should be avaialble that provides procedural, diagnostic, or troubleshooting information to the operator, at his/her request.

The maintenance function should be clearly diagrammed on the screen with each part of the analyzer labeled and referred to during the maintenance procedures. Again, the Help system should be available to support the operator during the maintance cycle.

Reports generated by the RBAs should better indicate results outside the normal range and should be avaliable to help interpret results if viewed on-line.

Overall, the EPSS should make the RBAs more "intelligent" for the user; walk him/her through the testing and maintenance procudeures correctly, provide feedback and help when a problem arises, and support the overall testing requirements.