Healthcare and e-learning in the US

Healthcare in the US has surprisingly low levels of training spend with many hospitals facing with shrinking budgets, an unsophisticated infrastructure but a highly technical and diverse audience and 24/7 operations. However, they have lots of external training requirements – especially in health and safety.

Joint Commission for Accreditation of healthcare Organisations (JCAHO), an accreditation body that requires documented annual training. Then there’s the Office of Inspector General (OIG) where compliance is backed up with huge penalties on fraud and abuse allegations. Hospitals therefore need compliance plans and need to adhere to National standards. Clinical professionals also need annual training. It is imperative that they receive annual training. The Risk Management Issues are enormous, especially around professional liability and malpractice issues.

It was HIPAA (Healthcare Insurance Portability and Accountability Act of 1996) that brought patient privacy issues to the fore. This is a big deal in the US where you need to take health insurance information from one employer to another. The final privacy ruling was published fall of 2002 and all healthcare employees had to be trained by April 14 2003 on patient privacy. However, the specifics only became available in September 2002. Everyone had to be trained quickly with serious threats for non-compliance.

Many looked at traditional options and train the trainer, paper, CD-ROM and video were all used, but a number used e-learning. The arguments were pretty compelling. The subject matter was operational knowledge and solutions had to be scalable. The classroom was inflexible and not scalable. The content had also to be sustainable, as there have been changes in the regulations. Getting the HIPAA policy out took several months putting a squeeze on the time available for training. Assessment was also important. Most classroom-based training measured attendance, not attainment. The fact that e-learning was trackable was a real benefit.

Benefits included:

• 24/7 access
• accessed from home and office
• objective assessment
• shortcuts for those who know
• more responsibility on the learners
• real-time reporting on compliance
• easy to update (sustainable)
• consistent
• could customise
• pre and post test assessment

An interesting side-effect was the organisational change that came in the wake of these regulatory e-learning initiatives. Hospitals are not really learning organisations but the e-learning helped some acknowledge the need for accessible, flexible, decentralised learning.

Problems included:

• resistance to mandatory training (whether classroom or e-learning)
• access to PCs and the internet was a problem, especially for care staff and nurses who don’t use PCs on a daily basis
• speed of such access was a problem as high media require high bandwidth
• security, namely firewall and virus protection
• high levels of English as a second language
• basic literacy problems with wide range of reading ability

Pushing accountability down into the organisation was a benefit through decentralised education resources. Another key issue was the commitment of senior management.

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Reliable vendors were needed that could provide robust and reliable systems as it was not possible to do this in-house. Hospitals also wanted to use this investment for other types of training. Tracking of both classroom and online training was necessary. Electronic attestations or certificates were important. Reminder email proved useful in getting people to take the courses.

HIPPA compliance audits led to the use of an online competency assessment tool. This included individual and departmental competence assessment. This included issues such as; Is patient data being communicated out loud? Are patient records visible to others in the room? Are privacy screens being properly used?

PDAs were also used for these competency assessments. The compliance officer in IASIS Healthcare could see all data in real-time. Baylor with 14,000 employees used e-learning to deliver all compliance training in less than 8 weeks. Top end data was then provided for all employees by profession (job-specific) then broken down into individual hospitals or sites. Baylor estimates a saving of $500,000 on HIPPA compliance costs alone with a longer-term potential of much more.

Cost reductions compared to classroom alternatives were clear, especially the expensive labour replacement costs for nurses and physicians. The administrative savings are also considerable on scheduling, tracking and reporting. The investment also had other potential future training savings. This is an investment in the intellectual capital in the organisation, a key issue, as senior management had not seen this as important.

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This was a focused and relevant. The lessons for healthcare in the UK are that this can be done, has been done and the benefits are clear.

Pricing:
As this is mission critical training don’t give the client an incentive to avoid training by making it a ‘per user licence’. Base price on:

• number of employees
• system
• sites
• content required
• ASP model with a one-time implementation fee
• annual fee for updates
• time and materials for repurposing and customisation

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