Epic Think Tank
Health and e-learning
Part 3: Looking for 'quick wins'
Various candidates for an early focus for e-learning with the
NHS were discussed. These ranged from identifying bodies of medical
knowledge that it seemed would readily lend themselves to a 'learning
objects' approach - such as anatomy - to issues within the structure
of the NHS, such as primary care.
Changes in the skill mix between nurses and doctors are making
news. It's a big issue: nurses constitute the single largest part
of the workforce and are also the group with the highest staff turnover.
In the field of first contact triage for primary care it was proposed
that pressure on resources could be reduced by up to 65%; however,
getting there would involve changing not only the behaviours of
doctors, but also that of patients.
Some of the most intractable problems faced by the NHS are cultural.
Previous strands of the discussion had touched on e-learning's potential
as an instrument for change. Now Induction was highlighted by several
around the table as providing an opportunity to address issues of
culture change at the very root.
The NHS has 100,000 new starters every year, but induction has
never been delivered effectively in the organisation. One of our
panellists described his experience on taking over the management
of a sizeable health facility when, attending the welcoming procedure
for a new intake, he was horrified at the cynical anti-management
attitude conveyed by first line supervisors. Surely, here was a
chance to make a real impact on the culture by influencing fresh
minds on their first day of their first ever placement positively
- rather than negatively.
It was admitted that an induction programme cannot single-handedly
produce a culture. However, situated at the gateway to the organisation
as it is, induction could provide an unrepeatable opportunity to
articulate and explain the NHS 'value base' to employees at the
moment when they are most receptive. After all, most people who
choose to work for the Health Service do so 'for reasons beyond
the pay cheque'.
The contribution of Epic on this point was that induction programmes
are often seen in e-learning as a highly effective target for a
'quick win'. There are many best practice examples of induction
programmes such as Cisco's, which go beyond the too prevalent notion
of induction as a sort of 'morphine patch' to alleviate the pain
of joining an organisation, and become 'a springboard for all sorts
of other structural things'.
However, dragons guard the gates of all magical opportunities,
and tackling such a high profile target was seen to be fraught with
dangers. Not least of these was the possibility that coming out
with an induction programme that was perceived as superficial would
expose the whole e-learning initiative within the NHS to ridicule.
Induction in particular could become an 'ingenuous conceit'. The
internal constituency most to be feared in this regard was doctors,
notoriously resistant to being 'managed' and cynical in general
about change initiatives. Clinicians represent only a small proportion
of the total NHS workforce, but in a sense they set the value system
for the whole NHS.
The reality is that when it comes to doctors, the Service does
not recruit its own staff: this critical responsibility is given
over to colleges, universities and in some cases to social and family
networks. Historically, and to an admittedly declining extent, the
decision to become a doctor has been less one of vocation than of
caste. Things may have changed a great deal since the days of Sir
Lancelot Spratt (of Richard Gordon's 'Doctor' books); but the particular
culture of the medical college, where students learn to walk and
talk like doctors before, in some cases, acquiring even a whiff
of medical knowledge, is still very much with us.
This particular structural 'given' introduces a significant limiting
factor to NHS management's ability to influence organisational attitudes
in a root-and-branch way. So clearly, any significant learning initiative
that addressed culture change in the health services would have
to be 'doctor-proof'.
Here, experiences drawn from instances of successful induction
programmes proved instructive. The son of one of our panellists
taking up a production job in broadcasting had mixed views, initially,
about the web-delivered induction programme he was presented with
on arrival. However when, two weeks later, staff illnesses meant
that he needed to book a crew out on the road without his line manager's
assistance, he found the procedural information he needed in the
induction programme. A good induction programme becomes a source
of permanent reference, and, in providing useful advice and support
exactly when it is needed, plays its part in shaping positive behaviours.
All our panellists agreed that an e-learning programme won't work
just because it's 'sexy'. It has, above all, to be useful. If the
programme can give learners something that will make their working
lives easier or better straight away, then they will use and value
it.
The Open University, probably one of the greatest successes in
post-war education, was widely ridiculed at its inception (and for
a long time afterwards). However, 'it scored because the people
who used it thought it was great' (it also got people through degrees
at about one tenth of the cost experienced in traditional higher
education).
Yes, any e-learning initiative would have to prove its usefulness
to the most sceptical members of a large and multi-faceted audience
- but it was finally agreed that controversy is the nature not only
of the NHS, but of the world we live in, and those who wish to challenge
orthodoxies must accept this as a feature of the landscape.
In making e-learning initiatives defendable however, launching
a few products of high quality - and carefully managing the expectation
- was seen as the best overall strategy for establishing quick wins.
Next>>
Background
Part 1 Challenges of 'e' to tradition
Part 2 Opportunities and practicalities
Afterword
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