Hospital Education - We're Doing it Wrong

For a long time, hospital educators have whispered about our frustrations. We've known that engagement & retention of knowledge are lacking in our industry. We're working diligently, but our results are inconsistent & mediocre. 

"Nobody told me about that policy" 

"We need education on..." 

These are frequent comments we hear within months of deploying education. 

Hospitals are spending billions of healthcare dollars on staff education, but it doesn't seem to stick. 

Wait, billions?

A hospital nurse spends approximately 3.5% of worked hours participating in educational activities (Suby, 2009). Inservice and mandatory education, for hospital based nurses alone, is responsible for approximately $3.3 billion dollars of healthcare spending each year (Peckman, 2015 & Nursing Fact Sheet 2011).

And, hospital nurses are only between 58-61% of the nurse workforce (Nursing Fact Sheet 2011). Healthcare workers, in general, represent 12% of U.S. employment (Bureau of Labor Statistics, 2015). 

With healthcare costs out of control, we have a responsibility to assure education dollars are spent on effective processes and tools that improve staff knowledge, skills, and abilities (KSA’s) and improve patient outcomes. 


But it isn't really that bad, is it? 

Let's look at one study on fire safety in the operating room setting: 

The study examined pre and post training test results of experienced healthcare providers for fire safety in the operating room, and found that mean pretest scores were 66% (Fisher 2015). Post training test scores of 92.8% (Fisher 2015). Sounds great, huh? Success! 

Well, maybe not. Let's look at the data through the lens of annual training. These were experienced staff. Fire safety training is a required, annual event. If, after years of training, the experienced staff had pre-test scores of only 66%, we know they are not retaining the KSA's taught.

We are doing something wrong.

For billions of dollars each year, we can do better than 66% KSA retention. 
Think about it, is this an isolated example? 

Modifying Our Approach:

Once upon a time, we educated staff by handing out Self-Learning Packets and tests. That day has passed. 

Now, we assign computer-based training (CBT) through learning management systems (LMS), quickly & efficiently distributing learning modules. We can easily track completions and provide reports to hospital leadership and accrediting bodies. We can show passing grades to surveyors & demonstrate that a high percentage of staff have completed the required training.

That sounds great, but we know the numbers we report don’t translate to knowledge & competence. We know that staff often click-through the educational slides without reading or engaging with them. Click-through is especially prevalent during annual education due to the repetitive nature of required material.  In addition, these simplified learning modules rarely support critical thinking and clinical reasoning skill development. 

What’s missing?

What has been missing in hospital based education is systematic instructional design (ID). As experts in our fields, we fall prey to the common assumption of “If I teach it they will learn it.” We put our knowledge in a shiny package & then are disappointed if staff do not learn. 

We're missing the basics of ID, which, surprisingly, are similar to the Nursing Process:

http://denvercoloradotraining.com

While the process is similar to the nursing process, it doesn't seem to be used frequently in hospital education. Unfortunately, we often skip the Analyze, Design and Evaluate steps, and are prone to jump directly into Development & Implementation.

Analysis helps us to realize the true gaps in KSA’s. 

A quick analysis of hospital training, reveals that engagement is an issue. We spend a lot of time & resources on education that is disengaging, rather than engaging. We provide repetitive information, often in click-through formats, like PowerPoint embedded into our LMS.

“Oh look, another PowerPoint.”  Click….click….click…open test…guess at answers.

Death By PowerPoint

Without learner engagement we miss the mark on retention of KSA's.

Good education design is based on adequate analysis of organizational needs, learners' needs, and available resources. Without an analysis, we cannot adequately design training. Once designed, developed & implemented, we must return to evaluate the effectiveness of our training, making adjustments as needed. These are best practices in education. 

If engagement is the issue, how can we fix it? 

Returning to our Fire in the OR education situation, a modification to the education from standard CBT click-through to interactive modalities is a relatively quick & easy solution to increase engagement. Software, such as Adobe Captivate, can be used to create hard stop quizzes and choices within the education module. A well designed, interactive lesson brings some increase in engagement, but we can improve from there. 

Can Simulation Improve Retention? 

Looking to other industries, we can see the trends towards immersive training and serious games. These engaging modalities have shown to be superior for retention of key KSA’s (Chittaro & Buttussi 2015).

It is time to embrace the emerging technologies of virtual reality (VR) for improved engagement and retention. VR can be either 2D or 3D, animated or video-based. These exciting and immersive technologies are being used in military training, and other industries. The applications for our industry are boundless & exciting. 

At present, immersive technology comes with a hefty price tag that can feel out of reach. In the current climate of healthcare costs, we are all aware of the need to be good stewards of the resources we have. If each hospital, independently, attempts to convert to immersive technology, the price and labor costs involved would soar. Realistically, investing in immersive technology for staff education at the hospital level may not be wise.

How can we accomplish this leap to our future? 

We need to look at ways to collaborate & cooperate, capitalizing on each other's work and resources. Working together to create amazing, immersive education through well designed simulation that is easily modified from one set of KSA’s to another is a lofty goal. Cooperation and collaboration are often foreign concepts in the competitive world of hospital business, but our patients and our staff deserve our best efforts.

Can we do it? Are we ready to bring our profession into the immersive education age? I hope so! 

References & Rabbit Holes: 

Carlson J., Rice S., (2014) Safety advocates push to curb hospital surgical fires. Modern Healthcare. Accessed 6/21/2016 athttp://www.modernhealthcare.com/article/20140712/MAGAZINE/307129987 (Links to an external site.) (Links to an external site.)

Chittaro, L., & Buttussi, F. (2015). Assessing Knowledge Retention of an Immersive Serious Game vs. a Traditional Education Method in Aviation Safety. IEEE Transactions On Visualization And Computer Graphics, 21(4), 529-538. doi:10.1109/TVCG.2015.2391853 

Employment Projections: 2014-2024 Summary. (2015) United States Department of Labor Bureau of Labor Statistics. Accessed July 3, 2014 at http://www.bls.gov/news.release/ecopro.nr0.htm

Fisher, M. (2015). Prevention of Surgical Fires: A Certification Course for Healthcare Providers. AANA Journal, August 2015, Vol. 83, No. 4, pp 271-274. Accessed 6/22/2016 at http://www.aana.com/newsandjournal/20102019/prevention-fires-0815-pp271-274.pdf (Links to an external site.) 

Mehta, S., Bhananker, S., Posner, K. Domino, K., (2013) Operating Room Fires A closed Claims Analysis. Anesthesiology, V118, No5. p1113-1139. Accessed 6/11/2016 at http://monitor.pubs.asahq.org/data/Journals/JASA/930994/20130500.0-00024.pdf?resultClick=1 (Links to an external site.) 

Nursing Fact Sheet. (2011). American Association of Colleges of Nursing. Accessed July 2, 2016 at http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet

Peckham, C. (2015) Medscape Nurse Salary Report 2015. Medscape.  Accessed July 2, 2016 at http://www.medscape.com/features/slideshow/public/nurse-salary-report-2015#page=2

Suby, C. (2009). Indirect Care: The Measure of How We Support Our Staff. Creative Nursing, 15(2), 98-103.