Kennedy, M. (Feb, 2017). Training Beyond Task: Organizational Policy Implications for Competency Development. Online Journal of Nursing Informatics (OJNI), 21(1). Available at http://www.himss.org/ojni
A recent exchange with a change management professional regarding the planned deployment of a health information system presented me with the opportunity to reflect on prevailing practices and policies around how we design and deliver training for new systems. The project we discussed is part of a large scale deployment of an integrated health information system and involves multiple sites, departments, divisions, and thousands of end users, The change manager was strategizing about how to constrain the scope of training to meet the approved budget and time allocation, and trying to tease apart what is “essential” training.
Within and across contemporary healthcare organizations, managers and administrators face intense pressures on budgets and human resources and often find the challenge of backfilling staff to enable attendance at training events to be a significant obstacle. Given the challenge of balancing razor-thin budgets and ensuring that team members have access to essential training, the policies that guide the design and delivery of such training are proving to be increasingly important. Whether embedded into procurement policy to direct the quantity or quality of training to be provided as a mandatory component of the overall procurement process, or integrated into the suite of organizational policies governing continuing competency and training programs for staff, these beliefs and organizational directives have long-term implications beyond the immediate training mandate.
Further, such policies have the potential to position external trainers and change managers as influential decision-makers, without having the concurrent responsibility for long-term workforce growth (Kennedy & Moen, 2016). Policies that favor only “essential” training directly affect the knowledge, skills, and adoption incentives to use a new system in a competent, meaningful way that will capture, display, exchange, and query meaningful information for use in clinical care. Policies that focus on short-term management undermine broader contextual knowledge and collateral understanding, which support long-term success and workforce capacity development.
There is a plethora of excellent publications on training design and delivery, such as those available from Canada Health Infoway (2012). These publications promote the necessity of providing a broad foundation in which to contextualize new training knowledge. In the absence of a foundation that includes core fundamentals (CASN, 2012) and broad informatics skills as early components of all training programs, the training experience and outcome is essentially reduced to a series of rote tasks – as long as someone can predictably repeat the specific tasks on the keyboard or user interface, their training is considered “complete.” This approach robs end users of the opportunity to advance their industry knowledge and entrenches gaps in knowledge that undermine the creation of an informed workforce.
This, however, is not what leaders and administrators need from employee training programs. They need end users, after completing training, to understand where this new solution fits into the overall e-strategy for the organization, what kinds of comparable applications and functionality will be used, and the scope of policies governing practice and use within the new application environment (e.g., password policies, bring your own device to work, permission to use confidential files outside of the organizational facilities, and so on).
Healthcare leaders and nurse executives have an obligation to foster the development of an informed workforce (Kennedy & Moen, 2016). Notwithstanding the fact that every hour of training has both direct and indirect costs, the opportunity to provide foundational, incremental informatics knowledge should not be excluded. It can be considered both strategic and opportunistic to embed foundational knowledge development into available solution training. This approach can create tangible value in terms of time-savings and fiscal economy, and avoids trying to economize to the point of having to create individual opportunities for comparable knowledge development. Deconstructing training to the lowest common denominator of performing a specific task or a series of drills does not equate to the development of a competent and informed workforce.
It is time to challenge the concept of value for money when training is reduced to completing the minimum mandatory functionality versus supporting the long-term development of informed competency.
Margie Kennedy, PhD, RN, CPHIMS-CA, is the chief nursing informatics officer and managing partner, clinical informatics, Gevity Consulting Inc.
Canadian Association of Schools of Nursing (CASN). (2012). Nursing informatics entry-to-practice competencies for registered nurses. Ottawa, ON: Author. Retrieved from http://www.casn.ca/2014/12/nursing-informatics-entry-practice-competencies-registered-nurses-2/
Canada Health Infoway (Nov 2012) Organizational change management and training. Toronto: Author.
Kennedy, M. A. & Moen, A. (2017). Nurse leadership and informatics competencies: Shaping transformation of professional practice. In J. Murphy, W. Goossen & P. Weber (Eds.), Studies in Health Technology and Informatics, 232, 197-206. Amsterdam: IOS Press. DOI:10.3233/978-1-61499-738-2-197