Expert Perspective from Bev Garcia, Instructional
Designer and Computer
Applications Consultant/WWW Designer for Manatts Inc., Highway and
Airport Construction, in Brooklyn, Iowa. She helped to collaboratively
design and teach Design and Production of Media: Computer-Assisted
Instruction graduate courses in the College of Education at The University
of Iowa for three years. She's taught students in secondary schools for
nearly 20 years and 15 years ago wrote two instructional textbooks that
are still in use today. She can be reached at:
bev@netins.net
My first response to this case is that training is not the solution. The
Blame Game is alive and well in this Rx case study. Although training is
suggested by the hospital authorities as the perceived solution to prevent
future lawsuits, doing a complete needs assessment may show that
standardized training is not going to rectify opportunist clients with
unethical lawyers who sue doctors and medical equipment companies. (Even
if the equipment were at fault, it was sold imperfect and would misread
8-10 times out of 325-350 trials.) Will, the Instructional Designer,
conducted numerous interviews to possibly reach his conclusions. "It might
not be exactly what they were expecting." He may step on some toes as he
exposes the negative attitudes within the organization. Quality Control (QC)
is just a term; it is not implemented in reality. There is a breakdown in
internal communication and lack of respect for staff, doctors, and
policies.
What you have just read above is the short response. What is below is
evidence for those conclusions.
Aaron's e-mail seems to presuppose that training is the solution.
Additionally, he expects Will to be a magician. "Marcia and I know how
thorough you are and you'll be able to fix this problem in a snap!" These
unrealistic expectations will create some friction when he presents the
needs assessment report due on March 31. At this point, Aaron and Marcia
are part of the problem, not part of the solution with that attitude. Training
is not always the solution. In this case, organizational
malfunction--dysfunction--seems to contribute to the problem.
The patient was comatose before procedures began. In an interview with Dr.
Kasim, he states that the patient would not have lived no matter what.
However, he does mention negative attitudes towards training, "Of course,
that is nothing to the complaining that goes on when they must go to the
hospital stations to train personnel to use the new machines. I don't blame
them. The nurses and doctors are not always very pleasant. I have often
tried to hold little workshops for them but hardly anyone comes to these.
They are always too busy."
Exceptions to hospital rules also seem to be prevalent. Doctors ignore
hospital policy and label their patients' blood samples as "stats" when no
medical emergency exists. Technicians are unfairly overburdened. Even if
robots are used to improve medical analyses, training does not compensate
for unethical behavior on the part of doctors. For example, "'Stats' are
supposed to be used for life-threatening emergencies only or when treatment
decisions must be made quickly. It is the stated policy. But every doctor in
this hospital thinks that his patients are a priority and this Gillespie in
particular is, you know how you say, a pain in the butt about it. Sends
everything "stat." I have tried to explain the situation to her but it did no
good." Costs aren't cut since stats cost more than regular blood analysis.
Also, Human Resource personnel like Charlene are not often remediated by
training even if she needed to learn how to use the RBA. In other words, a
lack of integrity on the part of personnel does not warrant training on
equipment. Dissatisfaction among staff, backbiting, disrespect for each
other, and blaming the policies for cutting costs seems to permeate the
negative atmosphere at the hospital. Training on equipment does not relieve
the underlying problem.
The RBA procedure seems to be relatively simple, indicating that a one-time
training session is not the solution, but instead to practice on the job with
blood samples: "A lab tech walked over to a computer monitor and touched
the screen. A set of numbers came up and the technologist studied them for
a moment then touched the screen in several places. The screen flashed
and went blank. The lab tech resumed what she had been doing. That's all
there is to it. The results of the blood test have been posted to the patient's
electronic chart." Hamid's pleasure in this technological feat was clear.
Will asked, 'If it's so simple, why do the results need to come to this lab
at all?'"
"Ah," Hamid replied, "it is CLIA regulations. The Clinical Laboratory
Improvement Act sets the standards for how clinical labs are to be run
and these rules say that only qualified laboratorians can approve test
results. With this technology it may not be necessary eventually, but for
now we must be following the rules."
Training new users on RBA (Roberta) also may be aided by revamping these
poorly written laminated job aids. Clear, single-step listing of procedures
for each screen design with Will's screenshot may help. "A picture is worth
a thousand words." Rewrite these directions, incorporating principles of
consistency and simplicity in layout with bold text for headings, and vertical
subsection numbering of each. Begin all with verbs. (All but one line is
consistent.) These directions from Screen 4, for example, need revision.
4.Screen 4 (Test Selection) Select test(s) from list
Open sampling port door. Place blood tube in arm between marks on
tube. Gently push tube into arm until grasped by RBA. Close sampling port
door.
Touch "Begin Test" on screen
When screen says "Testing Completed," open sampling port door. Press red
button on left wall of compartment to release tube. Remove tube and close
port door. Discard remaining contents of tube according to established
precautions. Place tube in Used Specimen Containers box.
Touch "Clear" on screen. When green light on front of RBA is lit, the
machine is ready to process another test.
Initial training on the RBA seems to be the responsibility of Gary
Beavers."One of my jobs is to go out on the floors and do the calibrations
on the RBAs. They have to be calibrated every 8 hours so that the tests
they perform are accurate. The worst thing is the floor staff doesn't know
beans about how to keep the machines within tolerance and they don't want
to learn. "It's not their job" and the state regulations say that only lab
technicians have do these quality control calibrations. But you'd think they
would want to understand how it works, wouldn't you?" ..."I have to train
them to use the RBA's in the first place which means that any time someone
new comes on the floor I have to drop everything and go teach them how to
use the machines correctly. It's really not that hard. We made up a check
list for them and put it on the machines. If they would follow it, it would
be a snap."
"If they would follow it"--neither doctors in general or staff seem to
place a priority on following policies and procedures for Quality Control
and customer satisfaction. From this case study, IDs may identify one
important principle they need to clarify when working with project
managers: Avoid rushing into a training program based on the request of
authorities. This genesis of the request for training seems to be an attempt
to bridge a possible gap. Training in this case is not so much related to
learning RBA procedures, as much as awareness of ethics and interpersonal
relationships. One book that Will might suggest to authorities to identify
communication barriers is Boundaries and Relationships by Charles L.
Whitfield, M.D. and another, Further Along the Road Less Traveled by M.
Scott Peck, M.D. for reversing the negative cycle of blame. For this
particular Rx Instructional Design Case Study, consult these two authors
rather than an instructional designer! Wise instructional designers know
their limits and know when to refer others to more appropriate
resources.
