Lean Healthcare - Why training may not be the answer

The Train Drain: Why training may not be the solution

Training, education, seminars…these are often thought of as solutions to problems in not only healthcare, but all industries.  Check any A3 problem solving project and you’ll probably find one of these listed in the Countermeasures area.

The Lean Healthcare question for today is this:  Is training always needed or even helpful?

For the sake of this discussion I’m going to give you a “bye” if your problem’s solution lists training as complementary to changes in process, equipment, job roles, or any other significant systemic changes.  Whenever something is changed, education, or at the least, communication is needed to make sure that everyone understands and can perform to the changed requirements.   What we’re going to focus on today are those cases where the solution suggested is entirely and only education.

If you decide that education is the only solution needed to solve a problem, you have decided that the root cause of your problem is a people and performance problem.  You have decided that the human resources involved either can’t or don’t want to perform up to standard work.  You are in essence asserting that the system in which those people work is perfectly fine to produce the outcomes needed.

To the contrary, I would maintain that in most cases if we stop with an education-only solution we have not dug deep enough and we have stopped short of finding true root causes.  We have not asked why five or more times to find the true source of the errors, mistakes, waste, and problems.

As an example I am reminded of a large multi-specialty clinic that decided to educate everyone — again — on the importance of providing all patients with a printed after-visit summary and reconciled med list.  They did this without trying to find out why patients weren’t getting these documents.  Had they performed a little excavation on the problem, they would have found that the placement and capacity of the limited number of printers as well as flow issues made it virtually impossible for staff to deliver these documents to patients in a timely fashion.  For the sake of not delaying and dissatisfying patients, the staff often bypassed the requirement.

Educating again will do nothing to change the outcomes in this situation.

So, the next time you find yourself teetering on the verge of implementing a purely educational countermeasure, take a breath and ask yourself:  Have we dug deep enough for root causes?

  • Have we asked why, why, why, why, why to uncover issues related to work flow, environment, layout, equipment, materials, job assignments, materials, and so on?
  • Have we asked why, why, why, why, why to uncover the lack of helpful standard work documentation and job aids?
  • Have we asked why, why, why, why, why to uncover issues related to cultural performance barriers such as norms about deferring to physicians who bypass standard work and best practice?
  • Have we asked why, why, why, why, why to uncover whether we inadvertently reward non-performance by allowing some individuals to under-perform and punish performance by expecting others who are consistent and trustworthy to pick up the slack ?

Finally, if you find yourself truly believing that you have found the root cause and it is a knowledge or skill gap, ask yourself, “As of today, could the staff members perform to standard if their lives depended on it?”  If they could, you don’t have a root cause that education will greatly affect.  Look elsewhere for solutions.


Today’s blog was written by Blair Nickle, Sr. Manager at HPP.

For over 20 years Blair has dedicated her career to the improvement of processes, quality, safety, patient satisfaction, employee engagement, physician satisfaction, and financial vitality in healthcare organizations.  Her content areas of expertise include performance measurement and improvement methodologies, information systems implementation,strategic planning and deployment, project management, and human resource development.

Blair holds both a Master of Business Administration degree and a Master of Science in Library and Information Science degree from the University of Tennessee.  Her undergraduate work was performed at Emory & Henry College. 

2 thoughts on “The Train Drain: Why training may not be the solution”

  1. Another reason that training/inservicing ALONE is not effective is that training is a “Level One” reliability concept. A process cannot be made more than 85 – 90% reliable using only Level One concepts -we need to do root cause analyses to get at the actual causes, if an adverse event has occurred, as the author mentions – but we need to invoke FMEA and purposefully design our processes to be 95 – 100% reliable. Level Two concepts include making the desired action the default, forcing functions, becoming “equivalent actors,” etc.

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