Training And Development: A Choice Or A Necessity?

Dr Bidhan Das

Delivering consistent and quality healthcare services are ways to ensure customer satisfaction in the fast-expanding and highly-competitive healthcare industry. Factors like recruitment, retention, training and development of the workforce are gaining more significance as the need for quality and accreditation is being recognised. This is true, irrespective of the fact whether the worker is permanent, contractual or outsourced. While information technology, new diagnostic tools and intervention techniques have made things simpler, the need to appoint specialised manpower and train and update the existing staff at various levels of patient care have grown manifold. Hence, arises the need for a skilled and trained workforce in this human-intensive sector.

Good human resource management is a pre-requisite not just to select right people, but also to maintain subsequent high levels of performance. This is certainly not easy considering the fact that hospital workforce is a mix of people ranging from the highly-technical and specialised surgeons to the ground-level workers such as the housekeeping staff, F&B staff etc. Training is no longer an option that one can take or leave because within the changing world of healthcare learning is an absolute necessity for everyone! The meeting of learning needs is a joint responsibility of the individual, the manager and the organisation. It promotes not just attitude change, capacity and perspective building but also develops organisational competence. The process involves keeping abreast of current affairs; developing ones' ability to communicate and relate to others; monitoring and learning new/improved methods in the fields of expertise; keeping the professional qualifications current and up-to-date; and adapting to and adopting new organisational and business approach.

Training and development have to be a qualitative and quantitative activity, especially for those who are employed as junior doctors; nurses; technicians; front office, ward and F&B staff; housekeeping/ward attendants etc. Since these are the people who come in contact with the patient or his attendant first. Similarly, nurses are the frontiers in a hospital, who need continuous upgradation. They have to be constantly reminded of bedside manners. The working knowledge of computers is a pre-requisite that all nurses need to have in order to make online entries at all levels and departments in the modern HIS software. On the other hand, the middle-level managers need to be exposed to training programmes on themes like leadership skills, managerial skills, effective communication, body language, team building, motivation etc.

Although, it is imperative for everyone to accept the concept of personal development as part of his or her career and life approach, hospitals need to be committed to creating an environment where the staff is informed, valued and involved. Employee development should aim to provide a range of opportunities for horizontal as well as vertical growth of human capital. These interventions may include work-based learning, coaching, mentoring, personal development courses, open learning, comprehensive induction programme, BCC, NVQs, shadowing, job-swap, secondments, sabbaticals, career structures etc. However, not all development needs can be met in this way and where this is the case, needs may be met through the provision of internal and external courses, conferences and longer courses of study including e-learning and distance learning, leading to a qualification.

Why Have Training & Development?

Poor work performance can result due to many reasons, including task requirements that exceed human potential, insufficient infrastructure or equipment, unsatisfactory and frustrating work environments, inadequate selection processes, negative or unhealthy work culture, insensitive policies and management, and contradictory performance standards. Training might not eradicate these problems, but it can be a powerful force in overcoming those, which result from inadequate or poor application of job skills.

While training and development need to be placed at the core of improving patient care, it is important to make sure that the training set-up for the employees helps the organisation, and the people in it succeed and give the desired return on investment (ROI). Planning a training calendar can be a futile activity if training designs, methods and materials are not sensitive to the uniqueness of learners. It is therefore essential to understand how to design, develop and deliver efficient and cost-effective training.

Devising A Training Programme

Stage I: Assessment & Analysis

Step 1. Training Needs Assessment

Diagnose the problem; define solution and state conclusions to confirm the need for training. Try to isolate the conditions, policies, practices, or other elements that contribute to quality outcomes. There are many aspects to training needs analysis, but the essential activity involves: Determining what is required to complete the work activity; determining the existing skill levels of the staff completing the work, determining the training gap (if any). Training gap is the difference between required and existing skill levels. The word 'skill' is generic in this case - it includes the knowledge, skills, attitude and aptitude required to undertake the activity effectively and efficiently.

Several basic needs assessment techniques include direct observation, questionnaires, consultation with persons in key positions, and/or with specific knowledge, review of relevant literature, interviews, focus groups, tests, records & report studies, work samples, knowledge, attitude and practices (KAP) studies. Training needs analysis or assessment ensures that training addresses real and important business or productivity needs. It links training to real world results.

Step 2. Develop A Task List

List the tasks involved in the activity (ies) you want to improve through training, describing each in terms of an action and what it is to accomplish.

Step 3. Identify Participant Characteristics

This would include literacy levels, ethnic backgrounds etc. Profile the intended trainees according to their skills and knowledge, barriers to learning and variability. Several versions of training programme may be needed to accommodate different subgroups of participants in case of high variability.

Step 4. Specify Requirements, Resources, Constraints & Explore Training Delivery Options

Consider the benefits and liabilities of alternative ways of delivering training, including pedagogy, classroom instruction, on-the-job tutoring, distance and e-learning etc.

Step 5. Determine Key Outcome Indicators

Establish the criteria you will use to verify that your training has improved performance and has made the desired contribution to the organisational functioning.

Stage II: Design & Develop

Step 1. Select An Overall Instructional Strategy

Training methodology needs to be scaled upwards.

Step 2. Develop & Sequence The Instructional Objectives

List and sequence the specific objectives to be attained during training that represent the tasks, task components, or combinations of tasks needed for successful performance.

Step 3. Prepare A Training Development Plan

It describes the training strategy, course curriculum, practice exercises, training materials and feedback mechanisms for learners.

Step 4. Develop A Detailed Logistics Plan

Step 5. Prepare The Training Aids Such As Videos, Presentations, Charts, Storyboards etc

Step 6. Prepare The Reference Source, Participant Workbook, Instructor Guide & Do Try Outs/Test Sessions If Needed.

Stage: III: Deliver & Implement

Training should always enhance the learners' self esteem and empower them by valuing and respecting their knowledge and encouraging collective discovery of new knowledge and acquisition of skill sets. It should be creative, dynamic, flexible and challenging based on 'reality-testing'. The following table briefly highlights how the current participatory learning approach differs from the conventional training method.

Step 1. Select And Train Instructors

Determine how many instructors are needed, including backup instructors; select candidates; conduct training of trainers; and provide guidance on course delivery. Trainer development is another essential aspect if the learning needs of organisations are to be met.

Step 2. Continue Monitoring And Guiding Implementation

Step 3. Implement Follow-up On Training Activities

Post-training follow up supports the trainees implement the newly-acquired skill set, knowledge and ideas to continue the learning process initiated during the training programme. It may also help to assess the impact of the training programme and any retraining needs.

Stage IV: Monitoring And Evaluation

Systematic monitoring and evaluation at each step in the process of planning and delivering training is the only way to ensure a high-quality outcome. Evaluation is intended to provide timely, objective information that will demonstrate what the training did, and help detect, diagnose and overcome any problems that interfere with a training programme's success. The evaluation step also includes a re-assessment of training needs. The purpose is not to be judgmental but to modify, refine and restructure the existing programme or strengthen future training programmes.

Important aspects for post-training assessment of trainees include attitudinal and behavioral changes, conceptual development and performance changes. A post-training KAP study wherein knowledge is assessed immediately, attitudes within 1-2 weeks and practices within 3-4 weeks certainly proves beneficial to evaluate the overall acceptance, efficacy and impact of the training programme. The whole programme on the other hand is evaluated on the criterion such as achievement of training objectives, adequacy and meaningfulness of contents and curriculum, appropriateness of training methodology, sensitivity, competency and effectiveness of trainers, organisation and relevance of learning aids and equipment.

Valuable feedback can be obtained by combining different methods such as oral sharing, questionnaires, interviews, group discussions, observations, records or the use of scoring method.

Step 1. Implement Evaluation Of Training Outcomes

Cost Benefit Analysis: Training comes for a cost. Hence, a documentation of the cost involved vis-à-vis the return in terms of productivity has to be analysed.

Step 2. Design and Conduct Process Evaluations

Step 3. Diagnose And Remedy Deficiencies

Step 4. Prepare Report On Evaluation Findings

Report writing is an essential and basic strategy for later reflection and follow up. For the purpose of training, reports are usually process based, data based or research based.

Training & Development: The Current Issues

Although training and development can never zero down the attrition in any organisation, it is a significant contributor to an employees' job satisfaction, thereby reducing the attrition rate and increasing employee loyalty. Retention, motivation and development of high-end performers is a challenging but an often overlooked area in most hospitals. Top performers usually resist and reject any formal training within the organisation. Therefore, it important to motivate them by their inclusion in activities such as training the trainers programmes, journal clubs, grand rounds, coaching, mentoring, secondments, job exchanges, outreach and community events, management education programmess at universities, e-learning packages, stress management conferences, recreation and rejuvenation activities, sponsored tours etc. Highlighting their role in guiding and motivating the team leaders towards organisational goals can help them feel valued and respected.

While most international hospitals have a fully-equipped training and development centre that has a series of classrooms, discussions, seminar rooms, and lecture theatre with video conferencing , touch pad interactive systems, clinical skills centre, having dummies, an Information Technology Suite and most importantly a resource library with books, videos, audiotapes, self study packs, trainer guides, training equipment etc. Hospitals in India have yet to accept the philosophy that organisational success depends on keeping people up-to-date and skilled in the latest concepts and techniques. It is ironical that the top management in many organisations is still asking for a clarification and justification of funds allocated for training and development of the human capital. Adding to this, some of them even consider it as the top option for cost containment not realising its impact on employee motivation and organisational competence.

Existing training providers in most Indian hospitals may not have adequate expertise and capacity to cater to such a heavy and intensive training load (and thus if used for skills development for the reforms their teaching may be counterproductive to the process). Therefore, at an initial stage, special mobile 'capacity building' teams may need to be established (as in Zambia and the Philippines) to provide people with new skills that will eventually be institutionalised. However, excessive commercialisation, misuse of methods, insensitive training designs, reduction of training needs assessment to a ritual, no follow-up, missing standards of evaluation and stereotyped formats are some current training issues that most organisations will have to deal with.

It can be stated aptly that in the current scenario, training is no longer a choice but a necessity. A well-functioning training and development cell can also be used for generating revenue for the organisation by training members from other organisations. If well planned, it can be certainly beneficial for the individual; but for organisational success; training needs to be combined with effective HR planning, policy development, management and a positive organisation culture.

The writer is Director, Operations, Rockland Hospital, New Delhi