Knowing how adults learn is key to successful staff training

Future holds more accountability for access employees

Providing effective staff training - traditionally one of the biggest challenges an access manager faces - is destined to become more crucial than ever before. Along with the explosion of information that continues to swamp all industries and professions comes the strong likelihood, some say certainty, that access personnel eventually will be required to meet federal guidelines to be part of the financial process of health care.

"If you recognize the fact that your employees are going to have to be certified in the future, and they will, the time-honored training methods are not going to pass muster," says Jack Duffy, FHFMA, corporate director of patient financial services for ScrippsHealth in San Diego. "If you interview employees in terms of how they're educated, the dominant method is by'tribal custom,'" he points out. "They sit next to another employee for a short period of time - an hour or maybe a day - to learn how to register patients, and there is no concept of demonstrated skills." When he asked the lead Medicare biller at his own organization how she was trained, she said she'd had about 20 minutes of training on how to send out bills and, when they came back, how to try to figure out what was wrong, notes Duffy. If the software program edited the bill, or the biller got it back from Medicare, she'd make another guess.

Understanding how adults learn, Duffy contends, is essential to meet the health care industry's training and education demands of the 21st century. That message was brought home to him when he - a veteran of about 100 seminars - for the first time attended a session at which the educator didn't allow his listeners' minds to be anywhere but on what he was teaching.

That educator, Louis Phillips, EdD, emphasizes this kind of listener involvement is necessary to "change a person's hard-wiring. When you're trying to get people to change their behavior, the way they perform, that's very difficult to do with training," says Phillips, a Greenville, SC-based education and training consultant who works primarily with professional organizations. "You're asking a nurse to perform certain duties she's never been asked to perform before, something a physical therapist did in the past. And she's been hard-wired - her attitude is ingrained - that this is not the role of a nurse."

Yet educators often are expected to train people, to change their habits and attitudes, in some unrealistic time frames, notes Phillips, who spends much of his time "educating educators." Suppose you have four hours to train people to a whole new customer service orientation, he suggests. "About all you can do in four hours is expose people to new information. You can't develop the level of competency and efficiency that's really needed."

Educators get caught between disseminating information and changing performance, which are two different things, he says. "Many hospital educators think if you just disseminate information, it will change performance, but that takes much longer. The question I tell [health care educators] to ask is,'Do you want [employees] to be exposed to it, or do you want proficiency?' To break a habit, to change a person's hard-wiring, takes a considerable amount of processing by learners."

So much content, so little time

The second major challenge is deciding what's most important in training, Phillips says. "There's so much content and so little time that educators have trouble figuring out what's essential and give too much content."

An educator trying to get across the concepts of total quality management, for example, tends to give an overview of the situation, talk about the customer a lot, and discuss what's currently being done vs. what needs to be done, Phillips says. Instead, he suggests, it's probably more important to start with where each worker is in the workplace and to talk about customer interactions, so there's a personal connection right off the bat.

Require learners to synthesize and summarize how they currently operate, which leads to involvement or engagement with the audience, he advises. Phillips, however, subscribes to a different definition of "involvement" than most educators. "They think a learner needs to be actively doing something you can observe. That's too limited. I mean active involvement of a learner's mind."

Training doesn't come easy

The health care environment is one of the most difficult environments in which to train, he notes, because of the different learning styles of health professionals. Even in a seemingly homogenous group, such as registrars, "how you learn and how the person sitting next to you learns is quite different."

There are two absolutes, Phillips suggests:

· Every learner comes with one basic question, "What's in it for me?"

· Each learner processes information in light of his or her own background knowledge and experience.

"The key to getting learners to connect and process information is to make it relevant to their own real world," he says. "That's why with adults, teachers and trainers have to put learning into context. If I'm listening to information on which managed care company to call, I'm going to think about how I normally use that information day in and day out. Does the new information go against that, or does it support what I'm doing? There may be a specific case I need to discuss with the instructor."

The whole purpose of active involvement, Phillips points out, is to allow people to make that connection, to have a clear understanding of what new information means to them.

"What we've done in the past is shovel content on people, thinking that the more we shovel, the smarter they will be. Just the reverse happens. People get overloaded quite easily and have trouble sorting out what really is key. Cut back to what's absolutely essential, focus on key terms, and allow the audience to process that to the extent that it becomes natural to them and changes their behavior," he advises.

Shift to performance models

Where an adult continuing education class differs from a college course, Phillips points out, is that the instructor needs to know at the end of the program whether he has accomplished what he wanted to accomplish.

Because learning outcomes are key, the educator must shift from a traditional content model to a performance model, he says. That is, if the instructor says she will teach listeners how to fill out a chart, by the end of the session she will actually observe them interpreting a chart, Phillips explains. Here's the procedure he follows in his own classes:

1. He provides information about why the content that goes in a chart is important.

2. He checks the learners' comprehension by asking questions, having them tell him the answers, and leading a discussion that lets him know whether they understand the information.

3. He walks them through the process of filling out a chart.

4. He has them fill out a chart themselves, thus "weaning" the learners from him to "totally them."

The No. 1 reason people don't transfer what they've learned from the classroom to the workplace is lack of confidence, he contends. "People do not want to go back to the workplace knowing something halfway. They won't do it unless they feel they can be successful doing it.

"Where do you get that confidence? By practice in the classroom. The majority [of educators] don't do this, and that's true across all professions that I'm familiar with," he adds.

(Editor's note: For more information, contact Phillips at the address listed on p. 87.)