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Being Stuck at Level 2 Is Like Kissing Frogs: Obtaining Evidenced-Based Learning Outcomes in Healthcare Premium Content

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Tuesday, December 28, 2010 - by Linda Hainlen

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Many education leaders have implemented terrific learning events and completed Level 1 and Level 2 evaluations. However, very few have truly obtained Level 3 and Level 4 results. This Level 2 plateau keeps many educators from "wearing the crown" of business partner in their organization. Are you stuck at level 2? Do you feel like you are kissing frogs but never getting the prize? That is exactly how I felt.

Working hard at kissing frogs

I had evidence that people attended and enjoyed our classes (Level 1) and had obtained knowledge (Level 2); however, I did not have evidence that I was truly obtaining outcomes (Levels 3 and 4). I work in the healthcare field and in medicine, we base our decisions on evidence and outcomes. To survive in this industry, I needed evidence-based learning outcomes. Without this evidence, I was working hard but I was not perceived as a true business partner. In essence, I was working hard at kissing frogs without obtaining the crown

I knew about the Kirkpatrick 4 Levels training evaluation model and had effectively been completing Levels 1 and 2. But how was I really going to get to level 4? I was on a mission.

Knowledge: how to obtain the crown

I reviewed the results of Brent Peterson's 2004 learning effectiveness study conducted at the University of Phoenix, which compared the amount of time spent developing training against the activities that truly contributes to learning effectiveness. The typical organization invests 85percent of its resources in the training event, yet those events only contribute 24 percent to the learning effectiveness of the participants. The activities with the largest impact to learning effectiveness were follow-up activities that occurred after the training event.

The typical learning investment pretty much mirrored our organization. I was providing some pre-event information to prepare my end-users, and I felt we were providing excellent events but doing almost nothing to provide follow-up after the event.

This next chart showing the results of the ASTD 2006 State of the Industry Report on the causes of training failure is also quite interesting.

According to the evaluation data below, only 20 percent of failure can be attributed to preparedness and 10 percent to the event itself. That leaves 70 percent to activities that follow the "event." This really coincided with the University of Phoenix study. Again, I felt I was doing a pretty good job of preparing end-users before they attended an event, and I felt our events were really quite stellar. So, that means I needed to concentrate on the "after event" activities to obtain outcomes.

My epiphany came while attending a Kirkpatrick Business Partnership Certification Program and learning about the Kirkpatrick Business Partnership Model (www.kirkpatrickpartners.com). The model emphasizes not only the four levels of evaluation but also beginning with the end in mind. I needed to understand what my stakeholders expected so I would know how to target what we were teaching and how to measure to know if I was meeting expectations. Only then would my kissing frog efforts gain me a crown.

Performance: frog to crown

With my next big assignment, I was determined to begin with the end in mind. (I had been asked to provide the learning event for a system and hardware implementation to ensure safe medication administration.) I sat down with my stakeholders and asked them what their expectations were. Their response was, "We need you to train x number of users on x program by x date." I rephrased my question. "Why are we doing this?" A nurse in my stakeholder group spoke up and said, "because we never want an incorrect dosage of medication to be given to a patient."

"Ah, you want your clinicians to utilize this software to reduce error rate," I said. I had found the frog and continued our dialog to negotiate what success would look like. We agreed that 90 percent compliance in utilizing the software would be our early indicator that our program was successful.

I was off and running. I understood that the nurses not only needed to attend our class offering and understand what was being taught but also implement this knowledge on the job. I could measure implementation by monitoring how many of the nurses actually utilized the new software. I would use company statistics gathered over the next year to determine the ultimate impact of increased patient safety.

We worked with our supervisors to prepare their staff for training and to ensure their attendance. Next, we provided a great learning event that received excellent marks and all users passed their assessments at 100 percent or received remediation until they could. To help with retention, our instructors spent four hours in the classroom a day and four hours on the unit providing after-the-event coaching. This proved to be a very valuable review and remediation opportunity. By streamlining our classroom content to include only critical information, we were able to free up instructor time for this valuable step.

Two weeks after the go-live, we measured the performance of critical behaviors to ensure that staff was really using their newfound knowledge. To our dismay, only about 60 percent were in compliance, which is way below our goal of 90 percent. We talked with learners to figure out what went wrong. They could perform the task, but they just weren't doing it. We were still kissing frogs. At least we knew we had failed, which gave us an opportunity to adjust. In the past, we would have stopped at Level 2 and would never have known if our efforts had made an impact.

Kiss that frog one more time!

With further investigation, we realized we had failed to properly partner with the supervisors. They could not tell who was using the new system except by visual confirmation, which was very time consuming. We met with the supervisors and created a report to show early adopters and stragglers. Once supervisors were armed with the tracking "rate of adoption" tool, they could hold their staff accountable.

When we ran the report again, all but two units were above the 90th percentile. The supervisors were now part of the team and contributed to the success of the training effort. At that point we had truly obtained buy-in and trust. Since then, supervisors have requested our assistance with other projects - we were no longer kissing frogs because we had obtained the crown.

Wearing the crown

As with any initiative, there were many factors that contributed to the overall success of the project. Learning can never take sole ownership of success; it is simply a partner in the success.

Using the Kirkpatrick Business Partnership Model truly helped us move beyond kissing frogs to the crown of evidence-based learning outcomes. This experience has raised the bar for learning in our organization. Our leaders now expect evidence on all four levels for every major learning initiative.

Are you ready to stop kissing frogs and start partnering for a crown?

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References

Kirkpatrick, James D & Kayser-Kirkpatrick, Wendy (2010). "Training on Triall: how workplace learning must reinvent itself to remain relevant." New York, NY; AMACOM

Kirkpatrick, Donald L. (1959). "Techniques for Evaluating Training Programs." Journal of the American Society of Training Directors.

American Society for Training and Development (ASTD) (2006). State of the Industry Report 2006. Alexandria, VA: ASTD publishing.

Peterson, Brent. (2004). Unpublished paper from Apollo Consulting Group. University of Phoenix.

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Linda Hainlen is manager of Clarian Learning Solutions; lhainlen@clarian.org .

Being Stuck at Level 2 Is Like Kissing Frogs: Obtaining Evidenced-Based Learning Outcomes in Healthcare

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