The Adoption of e-learning Where we came from … Where we are today … Where we are going …

1. The Adoption of e-learningWhere we came from …Where we are today …Where we are going … Linda Brody, RN Clinical Director, Learning Strategies BLS & ACLS Nancy Hudecek RN, BSN, MS Clinical Director, Quality Improvement and Patient Safety

2. basic definitions … learn • Main Entry: learn Pronunciation: \lərn\ • Function: verb Inflected Form(s): learned \lərnd, lərnt\ ; learn·ing • Etymology: Middle English lernen, from Old English leornian; akin to Old High German lernēn to learn, Old English last footprint, Latin lira furrow, track - 12th century • transitive verb1 a (1):to gain knowledge or understanding of or skill in by study, instruction, or experience<learn a trade> e-learning (NOT elearning) • Delivery of learning, training or education programs by electronic means. * Derek Stockley 2003 • Involves the use of a computer or electronic device or equipment (e.g.: mobile phone, CD, DVD) in some way to provide training, educational or learning material.

3. The Adoption of e-learningWhere we came from … Pre 1979: “THE TRAINING DEPARTMENT” Training/teaching consisted of live sessions w/ • the glaring light of the overhead projector • the beep of the filmstrip/cassette tape combo • the smell of colored poster board markers • the purple mimeographed handouts • the 5 inch thick - 20 lb binders of information … that could wipe out an entire old growth forest in a single meeting

4. The Adoption of e-learningWhere we are today … Post 1979: a new concept was evolving: “HUMAN RESOURCES” • This concept will bring with it more specialized trainers, specific areas of HR that address training needs based on department needs, professional needs and yes, even individual needs. • Today when we talk training in the medical world, we talk about things like: • 6 month orientation programs filled with … many types of learning • defined goals • measured outcomes • use of competency models * • preceptors with strategically outlined training plans • fully implemented training scenarios using simulation algorithms with high fidelity computer based manikins • annual continuing education • targeted remediation programs • etc • We have webinars and blogs and podcasts and wikis … now we are getting ahead of ourselves .....

5. Where we are today …e-Learning Ladder*

6. Where we are today …Training Delivery Methods 2005-2008

7. Where we are today …Who Uses E-Learning?

8. Where we are today …Who Uses E-Learning? At institutions of higher education: • 3.5 million+ students are participating in on-line learning at institutions of higher education.[4] • Students generally appear to be at least as satisfied with their on-line classes as they are with traditional ones (The Sloan report, based on a poll of academic leaders). • Many higher education, for-profit institutions, now offer on-line classes. By contrast, only about half of private, non-profit schools offer them. • Online education is rapidly increasing, and online doctoral programs have rapidly developed at leading research universities.[5].

9. Where we are today …Trends in e-learning related to the Healthcare Industry

10. Trend #1:For Healthcare, the top priorities for 2009 are related to training: • Clinical staff training • Improving program effectiveness • Integrating performance management / competency management initiatives Source: Bersin & Associates, 2008.

11. Why e-Learning in Healthcare Education and Workplace? Excellence Excellence In every stage, e-learning positively impacts education & workforce excellence. E-learning is everywhere … • Returning Students Retention and Growth • Competency mastery and • recognition • Coaching and mentoring • Creating a learning community • Student/Employee Satisfaction • Flexible schedules for learning and • practice • Access to training opportunities • Cycle time for retooling skills • Access to best practices information • Recruitment • Attract students / Compete with • other schools • New recruits lack certain skills • Speed to baseline competency • Orientation learning curve

12. Building Workforce ExcellenceHealthcare Organization and Education Issues

13. If the good news is … training is everywhere … and being acknowledged more than ever … • Status of training in hospitals is increasing—as workforce development is linked to improved patient care. • Nursing Research, Jan-Feb 2008 • Online education program improved cardiac examination skills better than clinical training alone. • Journal of Hospital Medicine, April 2008 Here is the potential bad news … spending and resources are down in these areas ….

14. Trend #2: Per Employee Expenditures are DownTraining Spending Per Learner by Industry

15. Trend #2: Per Employee Expenditures are DownTraining Staff per 1,000 Learners by Industry

16. Trend #2: Per Employee Expenditures are Down Training expenditures per employee in healthcare $690 (2008)    $860 (2007)    $400 (2006) Training investments per employee in healthcare 1.55% of payroll (healthcare) compared to 2.15% of payroll (across all industries) Training hours per employee in healthcare 31.2 hours (healthcare) compared to 37.4 (average across industries) Cost per learning hour in healthcare $1,387 (healthcare) compared to $1,660 (average across industries)

17. Trend #3: Patient Safety Drives Demand for Training Physicians, pharmacists, and nurses rate education as the #1 factor for having an impact on patient safety in hospitals. American Journal of Infection Control, Feb. 2006 Infections decreased from 7.8 to 2.3 per 1,000 patients following nurse education program in pediatric cardiac ICU. Pediatrics, May 2008

18. Trend #4:JCAHO Competency Requirements Influence Training Demand “Competence to perform job responsibilities is assessed, demonstrated, and maintained.” JCAHO Standard HR.3.10 Learning outcomes are increasingly tracked & related to core skill competencies. Orthopedic Nursing, May/June, 2006

19. Trend #5: Content continues to improve • Leading professional association content is starting to go online. • Courseware is more interactive & engaging. • Courseware is “chunked” into just-in-time modules, optimizing adult learning principles • New pedagogies enhance critical thinking

20. Create Publish View Trend #6: Rapid content development & distribution is on the rise Across industries, education managers report that 94% of their training programs are time critical. Bersin & Associates, December, 2005

21. Trend #7: contrary to popular belief … e-learning remains constant Across all industries, online learning (vs. live) remains constant … at around 32%. The percentage for healthcare is right at the industry average of 32%. *

22. Trend #7: e-learning is providing huge cost savings and other benefits Case studies ….

23. The bottom line … the cost savings & other benefits of e-learning implementation MedCentral Health System – Mansfield, Ohio • Reported annual savings of $10,000 in paper and development costs alone Greenville Hospital System – • Reduced their number of regulatory training hours by over 70% in one year • Compliance rates jumped from 88% to 98%. • Cost savings improved 71% in the first year The Children’s Medical Center – Dayton, Ohio • Achieved an internal record of 97% completion rate for mandatory education • Average time taken to finish a course decreased from 1.5 – 2 hours to 50 minutes; a time savings of over 44% Williamson Medical Center – Franklin, Tennessee  • Met 100% of their Joint Commission training requirements • Reduces their training costs by approximately 60%.

24. Case Studies related to specific e-learning courseware HCA & Prenatal Safety Education 225,000 births annually and $120 million dollars in annual medical malpractice losses at risk. • They deployed a prenatal safety initiative which included education and training for all nurses and physicians caring for patients in labor and delivery. • They saved $67.5 million annually in medical malpractice-related costs per birth ($300 per birth) and improved outcomes for 1,100 births annually. • Their high severity medical malpractice claims were reduced by 54%. • Their results were published in the May 2008 edition of the American Journal of Obstetrics and Gynecology. Clients who are adopting the HCAHPS Patient Safety Improvement Library • have improved their staff’s ability to differentiate specific factors and behaviors that result in low and high patient perception of care by 73% • 72% of their staffs plan to change their practice, having successfully determined specific changes to improve the patient perception of care • successful adoption of improvements has increased HCAHPS scores from 7-22%.

25. Case Studies related to specific e-learning courseware • OhioHealth System piloted a transition from instructor-led BLS training to the AHA computer-based HeartCode BLS program. • Their results were so compelling, they have since transitioned most all training to this method.  • They have documented savings of more than 40% over traditional instructor-led programs in addition to more effective CPR.  • The improvements in CPR effectiveness include better ventilation rate and duration; better compression depth, rate and number; and increased completeness of chest recoil. • St. Thomas Heart Hospital has won national recognition as a top performer for their rapid response teams (RRT) as they were among the best in class, and their cardiac care considered top notch. • However, the nurses on their medical/surgical units were not making effective use of the RRT.  • Following training of all the staff nurses on two units • 55% of the staff planned to change their practice • there was a 24% improvement in the staff’s ability to recognize the warning signs of decline • there was a 30% increase in calls to the RRT • 0 incidence of failure to recognize warning signs of decline • 2 fewer codes per 25 staffed beds.

26. Trend #8 Future of the “Learning Profession” is going in new directions WHERE ARE WE GOING … ? Podcasts Pod=iPod / cast=broadcast, aka webcasts, netcasts, learncasts Send audio/visual content over the internet for portable playback on an iPod or a PC. It’s known as a form of “Edutainment” Strengths: replay anytime, anyplace, good quality imaging/sound Wiki “Wiki wiki” means __________???? A web page that can be viewed and modified by anybody who is provided access. Provide asynchronous communication and collaboration. Strengths: allows for collaboration, simplicity Weaknesses: Control of Content Blogs Web+log = Blog Website that contains chronological, dated entries about a given topic. Some blogs allow for comments and feedback. They often contain links to other sites. Blogs reflect the voice of the writer. Strengths: They can offer discussion forums, provide explanation, how to instructions. They can easily be updated and can therefore contain current information. Communities Educators are leading innovation

27. Open Discussion Items …Q & A What are you currently doing with e-Learning? What new technology/courses/processes have you added in recent months/years? What new “ways” have worked well/what has been most challenging? Are you using webinars, blogs, wikis? How do you share information among your peers at your facility, regionally, across the country, worldwide? What is on the horizon for you in terms of new types of training?