+
Best of Strategies for
Healthcare Learning
Best of Strategies for
Online Training Best Practices for Healthcare Staff
Health Care Compliance Strategies, Inc. (HCCS)
BEST OF STRATEGIES FOR HEALTHCARE LEARNING
By David Rosenthal, Vice President, HCCS
David Rosenthal is Vice President of Marketing and
Strategy at HCCS. David has many years of
experience developing, marketing, selling, implementing
and planning technology and eLearning solutions.
Contact
Phone: (877) 933-4227
Email: dmr@hccs.com
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© 2012 Health Care Compliance Strategies, Inc.
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Table of Contents
5 SKILLS FOR THE 21ST CENTURY HEALTHCARE WORKER………………………………………………………………………………...7
TRAINING TO CHANGE STAFF BEHAVIOR, PART 1………………………………………………………………………………………...…10
TRAINING TO CHANGE STAFF BEHAVIOR, PART 2………………………………………………………………………………….………..13
TRAINING TO CHANGE STAFF BEHAVIOR, PART 3…………………………………………………………………………………….…..…17
TEN REASONS TO CONSIDER A LEARNING MANAGEMENT SYSTEM……………………………………………………….………21
IF YOU BUILD IT, THEY WON’T COME…………………………………………………………………………………………………….…………25
“YEARLY” VS “ANNUAL” NURSE MANDATORY TRAINING………………………………………………………………………….…..29
THE TRAINING PILL……………………………………………………………………………………………………………………………………….……32
DO YOU KNOW WHAT YOUR STAFF KNOWS………………………………………………………………………………………………..…35
VAN HALEN, BROWN M&MS, AND YOUR TRAINING PROGRAM………………………………………………………………..…38
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© 2012 Health Care Compliance Strategies, Inc.
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HCCS started the Strategies for Healthcare
Learning newsletter in 2008. The purpose of
this free newsletter is to provide assistance to
healthcare administrators and educators that
have responsibility for staff education and
training. The newsletter is focused on best
practices in online training for compliance,
regulations, standards, best practices, policies
and procedures.
I would love to hear your thoughts about this
eBook and ideas for future newsletter articles.
Please email me directly at dmr@hccs.com.
If you would like to receive future versions of
the free Strategies for Healthcare Learning
newsletter, please sign-up at
www.hccs.com/newsletterSignup.php.
Sincerely,
In the past decade, an understanding of the
elements required to produce and deliver
quality online education has evolved rapidly.
Most organizations now recognize the value of
online training created with proper
instructional design methodology. But there is
still a long way to go.
David Rosenthal
Vice President, HCCS
dmr@hccs.com
This eBook brings together some of the best
articles from the past 5 years. I hope that you
find the information useful and fun.
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© 2012 Health Care Compliance Strategies, Inc.
www.hccs.com
Effective Compliance Solutions from HCCS
Online courses available from HCCS
General Compliance Suite






Professional Compliance
Corporate Compliance
HIPAA Compliance
HIPAA for Health Plans
HIPAA Compliance for Business Associates
The Deficit Reduction Act: False Claims Act and
Employee Protections
 Nursing Facility Compliance
Research Compliance Suite




Grants & Contracts
Human Subjects
Conflicts of Interest and Research Misconduct
Professional Relationships and Data Issues
Workplace Compliance Suite
 Preventing Sexual Harassment for Healthcare
Organizations
 Identity Theft Prevention
 Preventing Conflicts of Interest
© 2012 Health Care Compliance Strategies, Inc.
Click here for a free demo
Quality Improvement Suite
 The Joint Commission Accreditation Process and
Tracer Methodology
 Patient Safety
 Reducing Medication Errors
 Bioterrorism and Disaster Preparation
 Infection Control
 Organizational Performance Improvement
 Competency for Quality Care
 Patient Rights
 Patient Education
 Documentation for Quality Care
Other Regulatory Libraries





Patient Care and OSHA
Patient Experience / Satisfaction Interactive Movie
ICD-10 Billing, Coding and Documentation
Social Media Compliance
AACN Essentials of Critical Care Orientation and
Nurse Manager Orientation
 Continuing Nurse Education, Long Term Care and
Home Health Aide
To view the current HCCS
online course catalog, go to
www.hccs.com/courses.
www.hccs.com
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877.933.4227 www.hccs.com info@hccs.com
5 Skills For the 21st
Century Healthcare
Worker
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© 2012 Health Care Compliance Strategies, Inc.
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5
Skills For the 21st Century
Healthcare Worker
Healthcare facilities are fast paced, stressful work
environments. Staff members are being asked to do more and take
on additional roles to meet the growing demands of patients,
administrators and government regulators. To effectively meet
these demands, healthcare workers need to improve their existing
skills and acquire new 21st century skills.
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Here are five skills that we should look to instill in every healthcare
worker.
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Critical Thinking
Critical thinking is often identified as one of the most
important skills a healthcare worker can possess. Every
situation and patient in a healthcare facility is unique and
healthcare staff must think on their feet and use their
critical thinking skills to achieve a successful
outcome. Teaching this skill is not easy, but some new
experiential courses have shown great promise in helping
staff to think critically. These courses show staff new ways
to approach situations and how their actions impact
patients, patient families and other staff members.
Be Willing To Speak Up
Know when to ask questions. Patient safety and the
reduction of medical errors requires participation by all staff
members and the willingness to question
processes. Organizations need to empower staff members
to question the actions of all participants, even physicians
and administrators. Organizations that support this
behavior will see a positive increase in the quality of care
delivered to patients.
Communication
In spite of the one-way nature of email, text messaging and
social media, two-way communication has never been more
important. To avoid errors and to properly care for
patients, proper communication among caregivers is
critical. Every function in a healthcare environment can be
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improved with good communication. Clearly defined
procedures can play an important role in improving
communication. However, many facilities have tried to use
procedures as a replacement for communication. In the
end, human beings treat other human beings and there is
no substitute for open and honest communication to ensure
understanding.
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5
There are a multitude of skills needed by today’s healthcare
worker. The demands are only going to increase. Ongoing training
is one way for staff to keep up with 21st century demands.
Customer (Patient) Service
Many healthcare workers have great compassion for
patients. But compassion and customer service are not the
same. Most healthcare workers have never had formal
training on patient satisfaction/patient experience. The
culture of an organization can negatively or positively
impact staff and the way they respond to patients, their
families and each other. Non-clinical staff such as clerks
and environmental service workers may have little
understanding of the impact they can have on the patient
experience. And patient experience has a great impact on
the bottom line because payment incentives in Value Based
Purchasing programs are based upon patient experience
scores (HCAHPS) and those incentives are only going to get
larger over the next several years.
Cultural Awareness and Sensitivity
Society is becoming increasingly diverse. Patients come
from all races, cultures, religions and walks of life. Studies
are showing patient outcome disparities caused by cultural
differences and misunderstandings. Sensitivity and
understanding of cultural practices is good business and is
being mandated in several states.
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Training to Change
Staff Behavior
Part 1
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Training to Change Staff Behavior – Part 1
Methods for Changing Behavior
Most healthcare staff training programs are designed to impart
knowledge on a particular topic to a particular staff segment. The
training is often geared around policies, regulations or standards
that must be integrated into a worker's daily routine.
Examples of this are training programs on patient safety,
compliance, quality improvement, and HIPAA. Typically, the
training involves procedures the staff is expected to know and
follow – don’t talk about patients in the elevator …wash your hands
using this procedure….how to handle emergency room
patients…how to handle an angry customer, etc. There is no time to
look in a policy manual. This information must be second nature.
To change behavior, providing information is not enough.
Educators in physician training have known this for years and have
combined informational learning with behavioral learning. Would
you want to be examined by a physician who has been trained using
only study guides and books? Probably not. That is why physicians
go through residency and intern programs. In addition, many
physician training programs are now using simulations to foster
behavioral change in a risk-free environment.
So how can we deliver online
training to staff that not only
transfers knowledge but also
changes behavior?
Many educators utilize adult learning principles. These state that to
truly be effective, learners should see, hear and interact with the
training. Behavior-changing training builds upon these principles.
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Elements of behavior changing content include:
Multimedia – Audio, video, slideshows and other elements
engage learners and increase retention. This provides much
higher recall and retention than text-based content.
Real-Life Scenarios –Reveal potentially new behaviors
and/or the consequences of typical but ineffective
behaviors. True-to-life scenarios elicit emotional responses
in learners which is one of the keys to effectiveness in
learning. An emotional response paired with information
embeds learning more deeply into memory. Consider the
possible difference on a learner's behavior between a)
reading a policy on HIPAA and b) watching a scenario where
an employee gets fired for inappropriately viewing
someone's health information. Which would likely have
greater effect on changing behavior?
example of interactivity that is often implemented incorrectly is the
"Game Show" we sometimes see in interactive training. Healthcare
employees are used to achieving certifications and taking tests. An
interactive exercise that does nothing more than check knowledge
of facts or information can receive a very negative reception and
may appear to be a waste of time. If implemented poorly, this may
turn off many learners, especially in a healthcare environment
where time is extremely tight. A proper interactive exercise intent
on changing behavior should require problem solving, not just
knowledge. It’s not as simple as combining a game with a quiz to
test knowledge.
In Part 2 of this article we’ll look at the MOST important parts of
implementing training to change behavior: The 3Rs of Behavior
Changing Training.
Simulations – An opportunity to make choices and practice
new behaviors in a non-threatening, risk-free environment.
Interactive Problem Solving – When combined with the
elements listed above, this is where behavior change is
impacted.
When possible, behavior-changing training should contain elements
that engage the learner's senses and provide thought-provoking,
real-life situations and solutions. Learning must not be passive;
learners must be involved in their own learning.
Simulations/Interactivity should be directly tied to the learning
objectives – too often, it is just a dressed-up assessment. An
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Training to Change
Staff Behavior
Part 2
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© 2012 Health Care Compliance Strategies, Inc.
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Training to Change Staff Behavior – Part 2
The “3Rs” of behavior change
In Part 1 of this article, we reviewed various elements of training
content that have the greatest impact on changing behavior. We
looked at how multimedia content combined with real-life
scenarios, interactivity and problem solving form the building blocks
of effective behavior-changing content.
to tests frequently delivered to measure the effectiveness of
training programs), there is no doubt that the vast majority of staff
members would have achieved a very high, “passing” grade on that
assessment. Staff members would have appeared “competent” on
an assessment test even several months after the desired behavior
ceased.
Next we’ll introduce the “3Rs” of training for behavior change and
look at the first two in depth. In the following article, we’ll review
the third “R” in greater detail.
Some time ago, a healthcare provider undertook extensive training
to change the behavior of their staff. The intent was to improve
their ability to meet the needs of their clients. Staff members
incorporated the training into their daily routine and behaviors
changed. The training lasted about 6 months and the results were a
huge success! Or so they thought.
During the time they took the training and for a period afterwards,
staff behavior changed for the better and the results could be seen.
But it was only temporary. It soon became apparent that the
behaviors they had worked toward and put so much effort and
resources into were quickly fading and the staff was returning to old
habits.
Interestingly, if you had given the staff a multiple choice
“assessment” test on the information learned in the training (similar
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So what happened? They followed all of the methods outlined
in Part 1 of this article. They had the knowledge. Why did the
behavior of the staff members start to revert back?
To change behavior, providing information is not enough.
Despite using solid behavior-changing content and training
methods, once the training stopped, the desired behavior began to
fade over time. To help prevent this, any significant attempt to
change behavior with training should use what I call the “3Rs”.
The “3Rs” of training to sustain behavior change are:
Repeat – Provide recurring, updated training vs. a one-time
event
Remind – Online and offline tools to help staff remember to
apply information long after the actual training
Review – Assessments to measure behavior change (much
more than just a quiz)
Regardless of the method of delivery, every training program will
benefit from these “3Rs”. A good example of this type of training is
Medicare/Medicaid compliance education. Most large healthcare
facilities have implemented annual compliance training* (Repeat),
use posters, emails, handbooks and other offline tools (Remind) and
use audits and assessments (Review) to evaluate behaviors and
make adjustments as needed.
Below is a link to an example of a
reminder tool HCCS provides to
compliance officers who have
implemented annual HCCS
compliance training in their facility.
HCCS delivers new messages every
other month to our clients.
One Minute Compliance Learning Sample
*90% of all respondents to the Health Care Compliance Association annual compliance survey
state that their organization provides compliance training at least annually
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One-time only training sends a subtle message, “We are doing this
training because we have to, not because it is important enough for
us to truly change our behaviors.” The HIPAA regulations require
significant behavior change. While the letter of the law states that
HIPAA training is “required” to be delivered only one time,
organizations that follow this “requirement” put themselves at risk
because it is virtually impossible to change long-practiced behaviors
when staff does not “Repeat” training.
display, the limited set of messages appear to have little effect on
smoker’s behavior.
In Part 3, the final article in this series, we’ll look at the third R –
“Review” and an important role for educators around this third R.
When training and reminders are
not delivered on a regular basis,
staff members may view training
requirements as a nuisance –
something to get done with.
Reminders can come in many forms but for maximum effectiveness,
they need to be changed often and made highly visible. Humans
become immune to messages that are not changed or are
repetitive. Cigarette warning labels are an example of a reminder
with a good intent but an outcome that falls short. The government
got the reminder part correct and used rotating messages to
attempt to keep the message fresh, but at this point, after years of
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Training to Change
Staff Behavior
Part 3
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© 2012 Health Care Compliance Strategies, Inc.
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Training to Change Staff Behavior – Part 3
In Part 1 of this article, we reviewed various elements of training
content that have the greatest impact on changing behavior. We
looked at how multimedia content combined with real-life
scenarios, interactivity and problem solving form the building blocks
of effective behavior-changing content.
In Part 2 we looked at the first two of the “3Rs” of training to
change behavior. The 3Rs are Repeat, Remind and Review.
In this final part of this article, we will take an in-depth look at the
third “R” – Review.
Reviewing or assessing staff is the most critical step in proving
effectiveness of training and whether there has been an impact on
behavior. However, many organizations don’t go far enough with
their assessments (Reviews) to properly show effectiveness.
Here is a scene we are all familiar with –
A mother walks into a bakery with her young son. The man
behind the counter offers the child a cookie, which the child
accepts. After a moment of silence the mother says to the
child, “What do you say?” The child says, “Thank you.” The
man behind the counter smiles and says, “You’re welcome.”
The mother smiles and walks away, happy that her child has
been polite.
Let’s examine this scene in more detail.
If you ask most parents who have been in this situation, they would
say that their child exhibited appropriate behavior by saying “Thank
you”. But, what really happened here?
1. It’s clear that the child in the scenario knew that he was
supposed to say “Thank you” when the person behind the
counter offers him a cookie.
2. In spite of this knowledge, the child did not say “Thank
you.”
3. The mother then performed a test or “assessment”. She
asked “What do you say?”
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4. The child has the knowledge of the proper behavior and
says “Thank you”, but did not exhibit the behavior on his
own accord.
5. The mother walks away proud that her child has “passed
the assessment” and demonstrated the proper behavior –
even though the mother had to elicit the behavior.
Now isn’t this similar to the way we train healthcare staff? We
A quiz or test is a necessary part
of any proper training
assessment. But this type of
provide knowledge as to how they should behave, and then we give
them a test to make sure that they understand how to behave.
Assuming they pass the assessment, we walk away satisfied. When
the behavior is not exhibited, we pull out the reports to show that
the staff member passed an assessment and wonder how this could
have happened.
Recently, I took a 360 degree assessment. Here is how it worked: I
filled out a series of questions about myself online and performed a
self-assessment. Then, these same questions were given to my
boss, my peers and my direct reports. Each of them answered the
questions online anonymously. The information from the
assessment is collected and a report generated. The results of the
assessment are analyzed and I get feedback that indicates areas
where I exhibit appropriate behavior and areas where I can
improve. This type of information could never be obtained from
just the self-assessment alone.
There are three primary ways to assess behavioral change.
assessment is designed to prove
Observe staff member employing the behavior
(Competency assessment)
that training was given and
understood, not as an indicator
Review outcomes (Patient satisfaction survey, Quality
measures, etc.)
that behavior has changed.
Different types of assessments are
required to show behavior change.
Review documentation that may exhibit the behavior
(Audits, Data, etc.)
When assessing the impact of healthcare staff training it’s
important to assess people and information “affected” by
the training.
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For example – for customer service training, you might survey
patients and co-workers. For physician documentation training, you
might survey coders and audit actual samples of documentation.
For patient safety training, review quality measure rates such as for
falls and medication errors and use competency assessments to
observe and assess staff in the field.
There are various tools available to assess behavioral change:
Assessment Tool
Purpose
Quizzes and tests
Assess knowledge
Competency
checklist
View Sample
Performance
evaluation
View Sample
Observe behavior in the
field. Direct competency
observation
Review and “grade”
behavior and examine
areas for improvement
Collect data and
observations from
affected parties
Indirect assessment of
competency/behavior
through review of
documentation and data
Survey
View Sample
Audits /
Measures
© 2012 Health Care Compliance Strategies, Inc.
www.hccs.com
The assessment tool to use for each training initiative should be
carefully considered based upon the results desired.
Training to change staff behavior is a multi-layered activity. It
requires the use of repeatable engaging content, reminders to keep
information top of mind, and assessments of the behavior in actual
use. Following these principles will result in an educated,
competent workforce that will reduce risk, improve patient care and
have a direct positive impact on the quality of your facility.
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en Reasons to Consider a Learning
Management System
\
\
Ten Reasons to
Consider a Learning
Management System
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T
en Reasons to Consider a Learning
Management System
Selecting the right Learning Management System (LMS) for online
training is an important decision. Organizations often start out with
simple requirements that quickly balloon into a large list of features
that can lead to a costly and difficult selection process and
implementation. After a long implementation process, costly
features often go unused and the administrative burden increases.
Departmental administrators begin to look for ways to avoid using
the LMS. This is the exact opposite of what was intended.
ability to publish PowerPoints, Word Documents, PDF files,
HTML pages and also more robust full interactive online
courses created with an authoring tool.
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At its most basic, a LMS is a centralized software system that allows
an organization to create, publish, assign, distribute, track and
report on training activity.
There are many good reasons to implement a LMS. Below I list 10
basic reasons why organizations should consider implementing a
LMS for online training. You should be able to identify several of
the needs before moving to an Enterprise-wide Learning
Management System. Then, stick to the fundamentals when
implementing the system.
How many of these fundamental learning needs fit your
organization?
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3
You want your staff members to have one place to go to
determine and access their training requirements
A LMS typically provides a unique page for each staff
member where they can review all of their training
requirements and all of the training they have
completed. Each staff member is kept abreast of their own
requirements with a simple software interface.
You need to present courses from different vendors /
content authors
Content authors like HCCS often provide a “portal” for
healthcare facilities to deliver and track HCCS developed
courses. However, as soon as a facility wants to bring in a
course from another vendor, a Learning Management
System should be used to provide a single point of access
and reporting. The vast majority of online courses from
content authors follow a set of standards (SCORM or AICC)
that allow learner information from the courses to be
tracked in a Learning Management System.
You want to create your own online training courses
The ability to create, publish, assign, distribute and report
on courses you create yourself is the number one reason
that organizations select a LMS. Usually this includes the
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Ten Reasons to Consider a LMS
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You have too many training activities and too many staff
members to track manually
There comes a point in most facilities where the number of
training activities and/or the number of staff members
becomes unmanageable with traditional paper methods
and spreadsheets.
You want to relieve the administrative burden from your
staff developers and allow them to concentrate on training
creation and risk assessment/reduction
The time required manually assigning and tracking training
and sending reminders to staff can be enormous. Often,
limited training staff resources would be better utilized by
focusing on high risk areas in the organization that can
impact the bottom line of a facility. A LMS can greatly
reduce the time required for these administrative tasks
freeing up training staff to focus more on their mission of
educating staff.
You want to empower departmental staff/administrators
to create their own training
If you have administrators, physicians, nurses and others
that have a need to get information and training out to
specific groups or departments within your facility, a LMS
may be the perfect vehicle to accomplish this. A LMS can be
setup to allow limited administrator functions (such as
course publishing) for specific individuals or departments.
You need to deliver a large number of online courses
Nurse CE education, a library of video training, and
computer skills are all examples of online training libraries
that can consist of dozens or hundreds of courses. Usually
1. You want to create your own online training
courses
2. You want your staff members to have one
place to go to determine and access their
training requirements
3. You need to present courses from different
vendors / content authors
4. You have too many training activities and
too many staff members to track manually
5. You want to relieve the administrative
burden from your staff developers and allow
them to concentrate on training creation and
risk assessment / reduction
6. You want to empower departmental staff /
administrators to create their own training
7. You need to deliver a large number of online
courses
8. You want to create exams to test knowledge
9. You need to track offline training activity
10. You want to provide your staff with both
mandatory and optional training choices
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an individual learner only requires access to a subset of the
library. A LMS allows administrators to assign and deliver
specific courses to specific users and track the results.
8
9
10
You want to create exams to test knowledge
At times, administrators may want to test the knowledge of
staff to determine if training is warranted, for job
advancement or for other reasons. Most Learning
Management Systems allow for the creations of tests and
the automated collection of the results. In addition, created
tests can be associated with an online training course and
be required to get full completion credit.
organization. The results can be an improved workforce,
greater job satisfaction and higher retention.
So, is it time for an LMS?
You need to track offline training activity
Although eLearning is being used frequently, there are
many organizations using classroom trainers and offline
tools for all or a portion of their training initiatives. This
includes classroom education, videotapes, seminars,
conferences, workbooks and other offline formats. A LMS
can assign and track these activities and be used as a
registration system. This provides one centralized system
for offline training activity that can be easily accessed by
both the learner and the administration.
You want to provide your staff with both mandatory and
optional training choices
Learning Management Systems provide choice and
opportunity. Many organizations give staff that want to
improve themselves the opportunity to take optional online
training like management skills or technology classes. Staff
can self-select from a library of content licensed by the
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If you Build it,
They Won’t Come
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If you Build it, They Won’t Come
In the classic 1989 movie “Field of Dreams”, Kevin Costner’s
character, Ray Kinsella, plows his corn field under to build a baseball
field in a remote corner of Iowa. Most people think he has lost his
mind as he follows a disembodied voice that tells him “If you build
it, they will come.”
Despite approaching bankruptcy of the farm, Ray follows through
on his dream, builds the field and refuses to sell the farm. In the
final scene of the movie a stream of cars as far as the eye can see
appears with one purpose, to see the field that Ray has built.
So what does this have to do with training and your role as a
training administrator?
Annie Kinsella: If you build what, who will come?
You’ve spent countless hours searching for, selecting and
implementing the best training course for your staff. You’ve got it
loaded and ready for access. You send out the email to the staff
letting them know about the training and how to access it.
Then you wait and what happens?
Generally? Not much.
cajole, nag, remind again, track, convince, encourage, bribe,
threaten and remind again. So what can an administrator do to
help ensure timely training completion?
If only it was like the movie, build it and the staff shows up eager to
complete their training assignments. Instead we need to remind,
Ray Kinsella: Where'd they come from?
Shoeless Joe Jackson: Where did WE come from? You wouldn't
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believe how many guys wanted to play here. We had to beat 'em off
with a stick.
First, include others in the rollout of training courses. Empower
department heads or liaisons to spread the word about the training
initiative. Hold a special “kick-off” meeting for these influencers
where you introduce new courses and explain the importance of the
training to the staff and the facility. Show a demonstration of the
course and when the liaisons leave, arm them with information that
enables them to login and complete the training. Ask them to
complete the training in a specific period of time and indicate that
you will be monitoring their effort. Instruct them to let their
departments know that the training is coming.
Make these meetings "an event" .. bring in lunch!!! .. and who
knows, soon you may find that others are upset that they haven’t
been invited to your training “kick-off parties”.
Voice: Ease his pain.
Carrots! Carrots are incentives you can provide to encourage staff
to complete a training course. Carrots do not have to be expensive;
they just have to be something that people want.
Food is often a significant carrot to use – examples are providing
food in the training room, setting up a pizza party for the
department that has the highest percentage of individuals that have
completed training by a certain date or providing a party for all
when a certain percentage have completed the training
requirements.
Other possible carrots include prize drawings for everyone that
completes the training. Prizes could be a Starbucks gift card, Lottery
tickets, movie tickets, cafeteria meal (food again!), or even a $35
Ipod shuffle. For example - The first 1000 people that complete the
training get entered into a drawing to win an Ipod Shuffle. I’ve seen
facilities where they’ll rush to training to win that Ipod.
Terence Mann: I'm going to beat you with a crowbar until you go
away.
Ray Kinsella: You can't do that.
Terence Mann: There are rules here? No, there are no rules here.
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Sticks! Sticks are penalties that staff are notified will occur if
training is not completed in the prescribed period of time. Sticks
have to be wielded carefully and as a training administrator you
must be sure that you have upper management support to
implement sticks. You must be willing and able to follow through
on the penalty.
Sticks are serious business and can often impact an employee’s
work schedule and paycheck. Not all facilities or administrators can
implement all sticks effectively in their culture. One example is to
make training completion statistics a formal part of an employee’s
annual performance review. Other examples of sticks in use today
at facilities are withholding of paycheck, no performance review pay
increase until training is completed, prevent staff member from
scheduling shifts and my personal favorite, providing the names of
non-completed staff to upper management.
To effectively influence staff to complete their training
requirements in a specific period of time requires creativity and
persistence. Getting the staff involved and providing incentives and
disincentives can help make your training efforts a home run.
If all goes well, to paraphrase a great movie –
“People will come. They'll come for
reasons they can't even fathom. They'll
turn up your driveway not knowing for
sure why they're doing it. They'll arrive
at your door as innocent as children,
longing to be trained.”
Voice: Go the distance.
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“Yearly” vs “Annual”
Nurse Mandatory
Training
early" vs "Annual" Nurse Mandatory
Training
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“
vs “Annual” Nurse
Y early”
Mandatory Training
Many training administrators at healthcare facilities are under the
impression that the most effective way to deliver Annual Mandatory
training is to provide it all at once. Their reasoning is that nurses
(and other staff) are extremely busy and the best way to avoid
complaints and meet their training requirements is to get the pain
over all at one time.
"Annual Mandatory" training does NOT mean "annual delivery"!
The "Annual" in "Annual Mandatory" training means that the topics
to be covered are to be completed every year in a twelve month
period. It does not mean that they must be completed at one time
per year.
Healthcare facilities should re-examine why they are delivering
mandatory training in the first place and stop delivering mandatory
training as a one-time event. Delivering training in this manner
sends a message that says –
“ATTENTION STAFF: THE TRAINING YOU ARE ABOUT TO
RECEIVE IS NOT VERY IMPORTANT (BUT IS REQUIRED).
GET THROUGH IT AS QUICKLY AS POSSIBLE AND COMPLETE
A TEST SO THAT A REPORT CAN BE PRODUCED SHOWING
THAT YOU WERE TRAINED. ACTUAL LEARNING OR
RETENTION OF THE INFORMATION IS NOT NECESSARY.”
At some hospitals, the nurses understand this and no longer bother
to complete their annual mandatories. Why should they spend
their time when they know that the administration puts no value on
the retention of training information?
One medical center's idea of "Annual Mandatory Training" is an 80plus page policy document covering everything from infection
control to security to environmental hazards to radiation. Retention
of this information is abysmally low, in part because the content is
not engaging, and in larger part because very few people actually
read through the material. The message is "We know you are not
going to read the 80 pages. Complete the test at the end and we’ll
leave you alone.”
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Don’t be fooled by “higher” staff satisfaction
If your facility is providing training annually as a one-time event
then the primary concern of staff is “how long will it take me to
complete this training.” In that scenario, ANY reduction in time to
complete the training will lead to increased staff satisfaction with
the training. This should not be the first concern of training
administrators. While staff satisfaction is certainly important, other
issues such as subject matter expertise, retention of information
and application of the information trained on should be the primary
drivers of education.
Changing the training culture
The first simple step may be to change the name of your training
from “Annual Mandatory training” to “Yearly Mandatory training”.
Admittedly a minor difference but it then allows for additional
changes to your training program.
Taking two days of a staff member’s work time annually to provide
mandatory training is difficult for today’s time strapped employees.
However, providing staff with training for 30-60 minutes every
month or every quarter would not only be simpler to fit into staff
schedules but would have the added benefit of making the training
more effective and allow for various methods of delivery. After an
initial adjustment period, staff would treat the training at least on
par with scheduled meetings, paperwork and any other important
administrative tasks that they need to complete during their work
week. Mix in some nursing CE courses and you could increase
employee satisfaction while providing high quality education.
on all of the staff requests,
but including some “want
to know” training courses
in the training cycle with
“need to know” courses
can engage your staff in
the process and contribute
to the culture of training.
The change to regular
ongoing vs. annual training
can trigger a cultural shift
that could earn your
facility a reputation as a
first class facility that cares
about its staff, their
continued knowledge and
their ability to care for
patients. The result of this can be an increase in quality with higher
participation in quality improvement initiatives, greater patient
satisfaction and better care.
Mandatory training can and should be more than just a way to
satisfy The Joint Commission and to meet requirements of policies
and regulations. They are an integral part of how a facility runs and
can lead directly to Quality Improvement and an improved patient
care environment. To accomplish this, begin by sending the right
messages to your staff regarding the importance of training.
Involve your staff in the training process by soliciting their opinions.
A survey to determine areas where staff would like to receive
training can be very well received. You may not be able to deliver
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The Training Pill
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The Training Pill
The scene is a classroom in the staff education department. The
Director of Staff Development is speaking to a group of nurses.
To understand the consequences of this type of decision, let’s turn
the “pill” scenario around. Suppose that The Training Pill was not
for the staff but instead was designed for the training administrator.
“This year we have a new option for training. This is
The Training Pill. Just take this pill and I won’t bother
you again for another year. It won’t hurt, it will be
quick and you’ll be done with your training
requirements for the year.”
Imagine if there was a pill that you could give to your staff
and INSTANTLY they would have all of the training knowledge they
needed for the upcoming year.
I run into training administrators all the time that are searching for
this pill. They want to find a quick, effortless way to train their
staff. If this pill existed, many training administrators would line up
to get prescriptions for their staff.
Organizations try to emulate this “Training Pill” by selecting training
that can be completed quickly. All training administrators are
struggling with the time required to properly educate staff to meet
annual regulatory training requirements. Some administrators are
willing to sacrifice the quality of the training for lowered seat time.
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Looking for training based primarily on time and effort involved
while ignoring the educational value is similar to saying to a training
administrator, “I can provide you with a pill that will INSTANTLY
generate reports that show that your staff was trained. How many
would you like?”
Any reasonable training administrator would ask, “Would the staff
actually be trained?”
“Well, no. But you would have the reports showing that they were
trained.”
To which the training administrator would respond “What would be
the point of that? That would be deceptive. In addition, it would
put my organization in jeopardy from potential compliance issues.
Finally, it would not improve the skills or abilities of my staff. Why
would I want that?”
Why indeed would you want that? Yet, that is effectively what
many organizations are providing to their staff when they offer lowquality, ineffective training.
Training initiatives, even annual mandatory initiatives, must begin
with objectives and desired outcomes.
Without these elements, you will be building an environment of
poor quality, low expectations, unacceptable outcomes and
unintended consequences. Your training initiatives will never be
taken seriously by the staff and ultimately, your organization will
suffer.
The United States Office of the Inspector General is clear in their
compliance guidance detailing the “Seven Elements of a Compliance
Program.” Element number three is “Conducting Effective Training
and Education.” Furthermore, the United States Federal Sentencing
Guidelines, used by Federal courts, states:
The organization must take reasonable steps to
communicate periodically and in a practical
manner its standards and procedures, and other
aspects of the compliance and ethics program,
…….. by conducting EFFECTIVE training
programs ……….
The Merriam-Webster online dictionary defines "effective" as -"producing a decided, decisive, or desired effect."
Training initiatives, even
We all wish there was a shortcut, a pill, or a magic word that could
instantly impart knowledge. But of course, it doesn’t exist. Using
sub-par training to save time will expose your organization to
financial, legal and patient care risks. Examine your nurse,
physician, compliance, OSHA and other mandatory training. Are
you being effective or are you attempting to deliver a “pill” that
doesn’t exist?
annual mandatory initiatives,
must begin with objectives
and desired outcomes.
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Do You Know What
Your Staff Knows?
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Do You Know What Your Staff Knows?
Do you have an environment that encourages staff to report
regulatory violations? Are you confident that your staff will notify
you of improper or illegal activity they are aware of in your
facility? How do you encourage staff to participate in risk
reduction?
The days of turning a blind eye or
hoping an issue will go away are
over.
Administrators need to uncover improper or illegal activity as early
as possible to minimize damage. It’s better to know about a
problem in advance than find out about it from an outside
inspector, an auditor, or worse – a lawsuit. The longer it is allowed
to continue, the more damage there can be to your
facility. Additionally, your facility is open to outside scrutiny and
possible public damage. In most cases, facilities have an
opportunity to resolve issues internally before they reach
governmental or legal status.
Here are a few areas to look at that can encourage your staff to
assist in uncovering improper activity:
1
Staff must BELIEVE that they can provide information
about a perceived violation and that their identity will be
kept confidential. This includes efforts to protect their
identity during the investigation and sensitivity to the fact
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that information provided could reveal the accuser if not
handled properly. Having a policy in place that says that all
information will be kept confidential is just step one. What
procedures do you have in place to ensure confidentiality?
2
3
4
Staff must BELIEVE that they can report violations without
fear of recrimination or harm to their reputation or career.
Along with confidentiality, this is the greatest barrier that
must be overcome to have a staff that is willing to expose
wrong-doing.
Internal investigators and auditors must acknowledge
personal conflicts of interest. Friendships, business
relationships and family relations should be considered and
investigators may need to remove themselves if there is
even a perceived relationship that could impact the fairness
of an investigation. This can be especially difficult in a
smaller facility where everyone knows everyone. Outside
assistance may be required to maintain impartiality.
Staff must SEE that reports are taken seriously,
investigated, and action is taken when wrong-doing is
uncovered. However, you don’t want to expose anyone by
releasing specific information. One way to handle this could
be with an annual scorecard – There were 75 reports of
improper activity, 75 reports were investigated, 35 were
dismissed, 12 were handled with a discussion with the
accused that led to a behavior change, 23 accused were
provided with additional training and 5 of the accused were
dismissed for improper behavior. Another way to handle
this is to provide individuals who report violations with
inquiry numbers and a website where they can check the
status of an inquiry. Many 3rd party hotline services provide
this benefit.
5
6
Remind staff that they can just as easily get into trouble
for knowing and not saying anything as they can for saying
something. They will be held responsible for activities they
knew about but did not report. It is the duty of every staff
member to report improper activity.
Listen to your staff member before they go to a higher
level to be heard. Don’t wait for the state Medical Board or
other association to investigate a report. It is imperative
that your facility launches its own investigation when a staff
member reports a violation.
Checking your position around each of these items can help develop
a safer and more transparent work environment which can reduce
risk and improve patient care.
If you do uncover wrong-doing, the government encourages
voluntary disclosure and self-reporting.
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Van Halen, Brown
M&Ms, and Your
Training Program!
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© 2012 Health Care Compliance Strategies, Inc.
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V
an Halen, Brown M&Ms, and Your
Training Program!
Look for brown M&Ms. If you find them, you’ve got a problem.
There is a legendary rock & roll story that during the 1980s, the rock
group Van Halen had a clause in their concert contracts that
stipulated that the band would “be provided with one large bowl of
M&M candies, with all brown candies removed”. Some people
think that the story of the M&M clause is made up, an urban
legend, but actually, it’s true!
This clause has been widely heralded for years as evidence that rock
musicians were pampered, self-important, and narcissistic.
Well, the band members may very well be pampered, selfimportant, and narcissistic, but it’s not because of this M&M clause
in their contract. The reasoning behind it had nothing to do with
pampering and everything to do with safety. Literally, the brown
M&Ms signified a potential risk of death or injury for the band.
Here is the explanation from David Lee Roth in his 1997
autobiography.
Van Halen was the first band to take huge productions into tertiary,
third-level markets. We'd pull up with nine eighteen-wheeler trucks,
full of gear, where the standard was three trucks, max. And there
were many, many technical errors - whether it was the girders
couldn't support the weight, or the flooring would sink in, or the
doors weren't big enough to move the gear through. The contract
rider read like a version of the Chinese Yellow Pages because there
was so much equipment, and so many human beings to make it
function. So just as a little test, in the technical aspect of the rider, it
would say "Article 148: There will be fifteen amperage voltage
sockets at twenty-foot spaces, evenly, providing nineteen amperes . .
." This kind of thing. And article number 126, in the middle of
nowhere, was: "There will be no brown M&M's in the backstage
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area, upon pain of forfeiture of the show, with full compensation."
So, when I would walk backstage, if I saw a brown M&M in that
bowl . . . well, line-check the entire production. Guaranteed you're
going to arrive at a technical error. They didn't read the contract.
Guaranteed you'd run into a problem. Sometimes it would threaten
to just destroy the whole show. Something like, literally, lifethreatening.
So there it is – the brown M&Ms had an important purpose. They
were an easy way to determine if the contract had been read and
followed.
Now you may not have something as obvious as brown M&Ms, but
what are your signposts that regulations, policies and procedures
are being followed? What are the signposts in your organization
that indicate whether your staff has taken your training or policies
seriously? What are the risks to patients and to the organization if
they aren’t?
Before you start looking for brown M&Ms, think about the way that
you deliver information. Unlike a contract for a Van Halen concert,
you have a choice as to how information is presented to your staff.
No brown M&Ms? Most likely the contract had been read and all
specifications were followed.
It’s not practical to put a 50-page text
Brown M&Ms in the bowl or no M&Ms? Trouble!
document in front of a staff member and
What else had been ignored? If a light structure falls or there is an
electrical fire due to non-compliance the safety of the band and
those that they employ are in jeopardy.
say “read and follow this”. The content
needs to be organized into digestible
portions and made engaging and
interesting.
The M&Ms were a signpost for safety.
So what does this have to do with your training program?
Think about the mountain of information that your staff needs to
understand to stay in compliance with Federal, State, City, local,
organizational and professional regulations and standards. It’s easy
for staff to cut corners, skim over some information or not pay
attention.
It’s not practical to put a 50-page text document in front of a staff
member and say “read and follow this”. The content needs to be
organized into digestible portions and made engaging and
interesting.
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The language cannot be legalese. Most staff members will not
respond well to legal terminology. One defense against apathy is to
provide engaging training that appeals to the senses.
How can you determine if your training is effective and your policies
are being followed? Start with engaging training and then look for
the brown M&Ms. If you find them, you may need to rethink how
you educate your staff.
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© 2012 Health Care Compliance Strategies, Inc.
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Contact Us
Health Care Compliance Strategies, Inc.
30 Jericho Executive Plaza
Suite 400C
Jericho, NY 11753
Phone: (877) 933-4227
Web: www.hccs.com
Email: info@hccs.com
If you would like to receive future versions
of the free Strategies for Healthcare Learning
newsletter, please sign-up at
www.hccs.com/newsletterSignup.php.
About HCCS
Our mission at HCCS is to help healthcare institutions
survive and thrive by reducing the burden of
regulatory requirements and improving the quality of
patient care. We accomplish this by providing
EFFECTIVE compliance training and tracking solutions
which enhance job performance, improve patient
outcomes, and promote compliance with ethical
legal, and accreditation guidelines. In this way,
healthcare institutions can focus on their core
mission of easing discomfort, healing, and saving
lives.
Acknowledgements
HCCS would like to thank the following individuals for
contributing to this eBook:
Like this eBook? Please share it.
 Lise Rauzi, VP Content Development, HCCS
 Debbie Newsholme, Director of Content
Development, HCCS
 Jennifer Stoop, Marketing Projects Manager,
HCCS
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