What every manager should know about training. An insider’s guide to getting your money’s worth from training!

I was referred to the above book by two colleagues specializing in cabin crew training for the airline industry as a great quick reference and refresher on the topic by an authority on the subject, Dr Robert F Mager. By the miracle of Amazon it was with me two days later. At only 135 pages it is a quick read, focused on day to day action, not theory and research, and is a practical guide complete with ‘handy checklists.’ In my view it is well worth a read whatever the level you believe you have reached in understanding and implementing training.

Early in the book under Rule #3 the author states ‘ Skill alone is not enough to guarantee performance’ he goes on ‘just as surgeons alone cannot assure the health of their patients…… trainers alone cannot assure the job performance of the people they train.’

This particularly resonated because I do not believe it is necessarily, or even often, a lack of skill that leads to poor outcomes in healthcare. So what causes these failures in job performance?

Mager asserts that successful job performance requires four conditions; 1. Skill 2. An opportunity to perform. 3. Self Efficacy 4. A supportive environment.

If you accept that ‘we have the skills,’ though I would question whether we have the level of soft skills needed, then what about the other three.

An opportunity to perform; clearly clinical and nursing staff perform every day and with increasing specialization the chances are that staff will do many of the same things, if not daily, then certainly very frequently. That may lead to other issues such as over confidence but it should mean that ‘skills fade’ is not an issue as it is for many other professions.

Self efficacy; the belief that the individual can do what he or she has been trained to do to the point that often they will successfully push through barriers and obstacles that might defeat others will lower self efficacy. Generally I would say that experienced healthcare personnel have a high level of self efficacy and it may well be that this sometimes compensates for shortcomings in the next category.

A supportive environment; here I believe is the crux of the matter for healthcare. Senior leaders who shout at, ridicule and belittle colleagues; those who make it plain that safety procedures and training are a waste of their time; managers who expect speed and reward it regardless of outcome; institutions that punish those who report near misses, incidents and problems; red tape and a tick box mentality created by over regulation that has no relation to positive outcomes; groups of institutions that do not share safety improvements and challenges, these do not constitute a supportive environment. Regrettably ,to many healthcare professionals I meet and talk with, these are all familiar traits.

In my view unless these are dealt with across the entire spectrum of healthcare, with no excuses made even for the most valuable but difficult contributor, then there will be comparatively little progress made in improving outcomes and providing a patient safe healthcare system.

There is much more to this book, for example, how to decide if more training is needed or if there is a better and cheaper solution, how trained are your trainers, and how workplace ergonomics plays a vital role. The latter reminded me of a SESAM presentation of a few years ago by a health trust UK NHS member investigating a fatal incident on the ward. One of the key root causes was that, though designed and built in the same way, each ward stored its vital emergency equipment differently. The outcome of the enquiry was that each ward was reorganized on the same lines so that staff could rely on their previous knowledge. Creating that supportive environment in a very practical manner!