What have you got to learn?

Lots, if it’s with on-line education

Riddle: What part of your business has been cut by an average of 75% and yet is required by 100% of your staff? Answer: Employee training. It’s not much of an answer though. It just creates another host of questions:

-Where do I get the money for training?

-How can I keep my agency running if I can’t even afford to train my employees?

And therein lies the problem, says Bert Rawald, vice president of Dallas-based m3 The Healthcare Learning Co. "While we still expect employees to be skillful and to arrive at their place of employment with the necessary skill sets . . . training has taken a real setback in funding, especially in home care." No surprise then that computer-based training (CBT) — or on-line training — is growing in popularity.

An increasing number of companies are discovering they can little afford the combined cost of classroom training and lost employee time yet even the most basic jobs require a fair amount of technical know-how.

Enter on-line education. It may be the wave of the future, but at this time, not many companies are offering classes held over the Internet. However, notes Luther Cale, director of marketing for HealthStream, a Nashville-based on-line education company, given the option, "we’re seeing more and more customers run to the Web as fast as they can." Instead, what is becoming increasingly popular is the use of CD-ROMs and customized courses offered over a company’s internal network.

A wide range of offerings

"Computer-based training comes in a variety of sophistications from a simple page turner you’d do in Microsoft Word to very sophisticated, full multimedia with narration, moving graphics, color, embedded questions to create interactivity, and a database for recording the competency scores," explains Rawald.

The majority of CBT is delivered on a standard desktop PC, he says, noting that it need not be at the office, but could just as easily be the employee’s home computer. For those taking the office route, he says "if they have a LAN [local area network] it can be delivered over the local network, or if the agency is part of a larger organization and has an Intranet, it can be delivered that way. Typically, the courses are loaded on the hard drives so employees don’t have to keep up with CD-ROM," he says.

Whether you install the course on individual PCs or over the company network, there are still further choices, he adds. "You have static courses where you buy the CD, install it, and you can’t change it. . . . Then the other type is actually more like a software license in that the course is dynamic. For example, we upgrade them with any OSHA [Occupational Safety and Health Administration] or HCFA [Health Care Financing Administration] changes and it has an interactive database for record keeping. More people are going to the latter because they want to prove competencies and add things to courses."

Home care? Of course

On-line learning may be the next best thing since the binary system for companies looking to keep their employees up on the latest releases from software like Microsoft and Excel. But is it really applicable to fields such as health care? Both Cale and Rawald think so.

HealthStream deals exclusively with on-line medical education and at last count offers 21 programs targeted at the health care professional, some exclusively for home health. Rawald’s company offers 40 courses for the medical profession, 10 of which are geared specifically to home health. Other groups — private companies as well as professional associations — are following suit. (See related story, p. 80.) According to Cale, on-line education, in general, is a $6 billion business with a large portion devoted to health care.

The home health care course catalog is broken down into two groups, explains Rawald. First there is continuing education for skill assessment featuring courses on such topics as "employee safety in the home or workplace environment and patient safety. Then there’s ergonomics with things like working safely with your back and then there are things that are almost corporate requirements, such as corporate compliance and customer service."

Still further, he says, are mandatory education requirements, which because of the redundant and standard nature of their content, are ideal for computer-learning formats. With corporate requirements, he says, "you have the OSHA-required courses with topics such as airborne transmission precautions and fire safety. Then you have the Joint Commission courses . . . such as age-specific competencies and patient rights."

The beauty of on-line learning lies in its simplicity. The employee simply sits down in front of the computer, clicks on the icon (or pops in a disk), logs on, and starts working. Some companies have built-in customization options so that a customer may tailor a particular course to suit its needs and objectives or even customize a unique curriculum for an employee.

More complex offerings include streaming graphics or short video clips, which can demonstrate, for example, the proper procedure for changing a dressing. HealthStream recently broadcast a laparoscopic hysterectomy over the Internet from which a course was developed. Cale sees this as a "neat bellwether for the future of health care education."

Why do it?

For home care agencies, the savings from such an arrangement are clear and immediate, says Rawald. Taking the CBT route, he says, is half the cost of traditional classroom training.

With CBT, he says, "agencies can save about $25 per employee per course, so for the average agency today that’s $20,000 in savings at the absolute minimum. It’s hard to determine exactly the cost [of classroom training] if you include instructor’s time, materials, payroll, and mileage to class, but it’s easy to see the savings."

Savings aren’t the only incentives for moving toward on-line learning. Management and employees alike can be well served by the format. Depending on the program and the software company, management can use a variety of options in tracking its staff’s educational progress.

"The agency can pull up standard reports which show the agency’s status by branch and by department and see what their compliance percentage is at any given time," Rawald says. "They can pull up student progress reports and see where the students are and who hasn’t completed the program. The savings in administrative time are huge."

Most programs offer some type of transcript information whereby supervisors can determine in minutes who is deficient in what compliance courses and what scores they received in the classes they have completed.

Agencies can also determine their own competencies, he adds, based on the importance of the course. For something like preventing the transmission of bloodborne particles, he says, you would want everyone to score 100%, but with something like back safety an agency might consider those in the 80th percentile as having passed.

For companies with a more substantial education budgets than those of most home care agencies, highly specialized courses can be developed much like the one created by HealthStream on advances in immunotherapy. "We did a CD-ROM with hyperlinks so they could build a community around the specific topic," explains Cale.

Employees benefit as well from computer-based training. By allowing employees to work at their own pace and at times which they choose, studies have shown that retention rates have increased. Rawald says he has read of studies which said students using CBT show 56% greater learning capability overall than when compared to learning in classrooms and that retention after six months is 25% to 50% greater than that of traditional learning methods.

Computer vs. classroom

This, he agrees, contradicts conventional wisdom, which has long suggested that the give and take of a classroom environment stimulates learning and enhances retention. But the success of on-line learning makes sense, he says, "when you think about the problems of varying degrees of education and language skills encountered in a classroom. Thirty percent are bored, 30% don’t get it, and for 40% it probably works. With computer-based training, those challenged by language or education can repeat sections and go back to review.

"Equally important is that it’s so respectful. It’s not embarrassing if you need to repeat a section, and you can take it over and over again until you pass. Or if you have had many years of experience and could almost teach the course, it’s respectful of your time. This is so important in the changing philosophy of home care," says Rawald.

Despite its benefits, on-line education is not the panacea that employers would like it to be. One of it’s most attractive features — the ability to study whenever you have a spare moment — is also one of its largest flaws. "In the work environment, you can’t really sit down and study for three hours so you might find yourself interrupted a lot," he adds. To combat the problems consistent interruptions bring, m3 has designed 25-minute courses with lessons of five minutes each. Users can bookmark their place so if they are interrupted, they can go back to it.

Nor is computer-based training ideal for unique clinical skills training where you need the interchange of employees to build best practices, Rawald says. Cale backs this up, adding that "we don’t see it as the answer to everything. It gets to the point where we have to see that this isn’t a substitute for something like teaching a language where you need in-person classes."

Whether the computer-training format ever takes off in home care is something that remains to be seen. However, Rawald, who spent a good portion of his career as the founder and owner of a hospital home care management company, foresees a bright future.

He predicts that "within another year or two, once things have settled down and the survivors have figured out that they will survive, 40% of those agencies will have this education. This format efficiently answers the home health care workers’ question of tell me, How can I do a better job and give better patient care?’"