A methodology to design customized learning networks


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Workshop given at EAPRIL conference 2010, Lisboa, Portugal, 25.11.2007

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  • That is, we created such a learning network..called the handover toolbox and we are going to show you how we did this and we hope by sharing this knowlegde with you, you can learn from us
    And the other way around, that we can learn from you
    So we are all participating in an ad hoc learning network now
    And we hope that
    I will explain you this, bu showing you how we created such a learning network called the handover toolbox, which is a toolbox for training experts in the medical domain who have to provide a training in handover of patients between gp’s and hospital doctors.
  • Well, what will we be doing the folling 80 minutes..
    First I will shortly tell you something about the context in which we created the toolbox, and that is the handover project. After that Hendrik and walk with you through the methodology and through
    10 min. The HANDOVER project
    45 min. Methodology
    30 min. Discussion and questions
  • Who has been, or knows somebody who has been involved in a medical error?
  • Near misses and adverse events, mainly caused by miscommunication or communication errors
  • We investigated that question within the HANDOVER project, gotether with our partners. And we used a lot of very diverse methods to get to a solution..
  • All these methods used, we will show and discuss with you today, explaining you our methodology..and helping you a bit to see how you could apply this to your own research.
    Maybe you know already some of these methods and some of these methods have been used in business
  • for the qualitative analysis of large bodies of textual, graphical, audio and video data.
    I guess most of use are familiar with this type of data gatthering and gaining insight in the
    Not only the medical professinals, but also does who are experiencing the effect
    Not only the teachers but also involve the students
    Take a multiple perspective
  • Used often in business (flow charting)
    Proces improvement methodology
    Step 1: Determine the Boundaries
    Where does a process begin?
    Where does a process end?
    Step 2: List the Steps
    Use a verb to start the task description.
    The flowchart can either show the sufficient information to understand the general process flow or detail every finite action and decision point.
    Step 3: Sequence the Steps
    Use post-it notes so you can move tasks.
    Do not draw arrows until later.
    Step 4: Draw Appropriate Symbols
    Start with the basic symbols:
    Ovals show input to start the process or output at the end of the process.
    Boxes or rectangles show task or activity performed in the process.
    Arrows show process direction flow.
    Diamonds show points in the process where a yes/no questions are asked or a decision is required.
    Usually there is only one arrow out of an activity box. If there is more than one arrow, you may need a decision diamond.
    If there are feedback arrows, make sure feedback loop is closed; i.e. it should take you back to the input box.
    Step 5: System Model
    Draw charts using system model approach.
    Input - use information based upon people, machines, material, method, and environment.
    Process - use subsets of processes in series or parallel.
    Output - use outcomes or desired results.
    Control - use best in class business rules.
    Feedback - use information from surveys or feedback.
    Step 6: Check for Completeness
    Include pertinent chart information, using title and date for easy reference.
    Step 7: Finalize the Flowchart
    Ask if this process is being run the way it should be.
    Are people following the process as charted?
    Do we have a consensus?
    What is redundant; add what is missing.
    The purpose of process mapping is to use diagramming to understand the process we currently use and ask what is expected of us; what should we be doing to provide better customer focus and satisfaction. It will identify what best practices we need to incorporate and find appropriate benchmarks for measuring how we can arrive at better ways of communicating our services. As Dr. George Washington Carver put it – "It is simply service that measures success."
  • Who has ever heard of Ishikawa diagrams?
    Ishikawa diagrams (also called fishbone diagrams, cause-and-effect diagrams or Fishikawa) are diagrams that show the causes of a certain event -- created by Kaoru Ishikawa (1990)[1]. Common uses of the Ishikawa diagram are product design and quality defect prevention, to identify potential factors causing an overall effect. Each cause or reason for imperfection is a source of variation. Causes are usually grouped into major categories to identify these sources of variation. The categories typically include:
    People: Anyone involved with the process
    Methods: How the process is performed and the specific requirements for doing it, such as policies, procedures, rules, regulations and laws
    Machines: Any equipment, computers, tools etc. required to accomplish the job
    Materials: Raw materials, parts, pens, paper, etc. used to produce the final product
    Measurements: Data generated from the process that are used to evaluate its quality
    Environment: The conditions, such as location, time, temperature, and culture in which the process operates
  • The previous methods were performed, using empirical data, provided by the professionals and the patient
    Cognitive mapping can be used to organise the information found in literature on a certain problem
    To identify emerging topics and thinking patterns in the literature about teaching and learning aspects of handover, cognitive mapping
  • handover practices  Ishikawa diagrams
    Problems experienced with handovers  Ishikawa
    Solutions to handover problems  Ishikawa
    Training is needed…but on what?
    Patient roles differing between countries ─ Active/passive
    Barriers to handover
    ─ Unclear communication in handovers
    ─ Attitudinal aspects; wrong expectations/lack
    of knowledge of each others’ microsystems
    ─ Lack of information on patients’ medication
    Facilitators to handover
    ─ Direct contact between professionals
    ─ Shared IT platform systems
    Many literature on solutions, but not on how to train
  • There are many ways to identify the needs of users, such as usability testing, interviewing users, discussions with business stakeholders, and conducting surveys. However one technique that has grown in popularity and acceptance is the use of personas: the development of archetypal users to direct the vision and design of a web solution.
  • There was another memorable Sunday night as Barca beat Mallorca to stay at the top of the Spanish La Liga keeping the distance of 2 points ahead of the archenemy Real Madrid. As one of the Barca socios, Maria Gutierez <change the name; it can be a man> is happy with the Barca performance and result, but back to home she is starting to think of the new professional challenge she is facing. As a coordinator of the continuous education in the Institute of Medical Care for Municipal Personnel, Public Health and Quality Unit, she, was asked by the management to organise a training on handover. Maria does not need to be convinced that it is a very important topic but although she has about 10 years experience in quality of care and safety patient , she has not got any experience in training handover. She is not sure yet that handover should be a special subject for training. Maria will accept the challenge but will try to convince the management of the institute that handover should be considered within the more general framework of patient safety.
    Before starting to think about the content and design of the handover training, Maria needs to resolve one crucial issue: how to make this training attractive for the personnel. Her experience shows that material incentives such as compensations in terms of time and money work well. Increasing chances for career development through the Carrera profesional (where you also can get an increase in salary of about 400-500 EUR) is another option and in this respect certification/diplomas should be specially mentioned. Maria would like however to use some other channels for boosting motivation. For example, she would like to emphasise on the responsibility of every professional to constantly improve her/his qualification. To attract the attention of more people, the training should sound practical and closely related to the work people do. If they see a real practical value of the training to their work, they would come. And Maria has a trick that has always worked: make people to think they are special, to believe they have been selected for this training among many other candidates.
    For the content of the training, the first thing to do is to collect information. Maria would certainly use her experience on teaching communication and patient safety, but she also would look at all available information about the topic, with a special attention on currently running projects.
    For the structure of the content, there are a number of topics that are mandatory. Communication is one of them. Maria is a member of the association Communication and Health, so she knows how important communication for handover is. Knowing the processes, individual and groups workflows in handover and the coordination of handover activities is another important topic. The need for common and concise protocols for communication and coordination of handover processes can be included in the communication and coordination topics, but it also can be a separate topic.
    One issue that often gets insufficient attention, according to Maria, is professional responsibility of the staff involved in handover. It is not about “my patient” or “your patient”, she says, it is about a patient who needs to get the best quality of care. Maria recalls a case, which she has used in patient safety training and which example she would probably use in the handover training. “When I worked in primary care and we had a patient admitted in the hospital, we visited the hospital to make sure that the patient was all right. It was so unusual that when we went there all doctors and nurses were looking at us wondering what we are doing there thinking that we didn’t understand our role. We simply wanted to communicate to them all the information we had available in primary care about this patient. “
    What concerns the design of training, Maria is
  • although there needs to be some
    standardisation of handover practices a
    standardized training
  • Iedereen heeft andere ideeen over een toolbox, hoe deze eruit moet zien.
    Blackboard, Moodle, omgeving met een e-learning cursus, alleen een checklist.\
    Same values and aims
  • Based on writing personas and interviews a list of functionality options is created.
    Based on this list you compare potentional online environments
    After selection of the most suitable online environment, this environment is adapted to the needs of its users
  • Emerging: iedereen voegt iets toe
    Zie animatie. Bij een gewoon netwerk volgt 1 lerende 1 pad. Maar in een leernetwerk volgen verschillende lerenden verschillende paden. En sommige connecties zijn groter dan anderen. En zo ontstaat steeds meer
    Anotate = editten
    Producers and consumers. Actieve lerenden die ook bijdragen
    Met name consumeren
    Een leermanagementsysteem
  • A methodology to design customized learning networks

    1. 1. A methodology to design customized learning networks How we designed a training toolbox to develop customized trainings in handover…
    2. 2. What do we want to do in this workshop? Show you how you can design a learning network to help training specialists develop a customized training
    3. 3. Take back home at least one interesting method or idea for your own research
    4. 4. Overview  The HANDOVER project  Methodology  Next steps to be taken
    5. 5. The project
    6. 6. The HANDOVER project Shorter hospitalizations, more frequent patient transitions  high demands on the quality of clinical handovers • Missing information • Incomplete information • Delay • Wrong address referra hospit discha primar after c primar emergency elective referra hospit discha primar after c primar emergency elective Referral from a GP to a hospital Discharge from a hospital to GP
    7. 7. Failures in communication..
    8. 8. If handover is problematic.. what is then the solution?
    9. 9. Methodology 1.The problem 2.The training 3. The toolbox 4. The Evaluation Training needs analysis Questionnaire Interviews Interviews Focus group Proces mapping Literature review Requirement analysis PMI – rating MethodsPhase
    10. 10. Phase 1. Problem analysis and solution generation Question Why are handovers problematic and what could we do about it? Aim of this phase Identification of facilitators and barriers for effective handover
    11. 11. Methodology 1.The problem Interviews Focus group Proces mapping Literature review MethodsPhase
    12. 12. Interviews and focus groups • 222 interviews with medical professionals and with 92 patients • Focus group with medical profesionals – Experience with problematic handovers – Possible solutions Qualitative analysis - Categorisations - Code-book - Atlas.ti - Open source: Weft QDA
    13. 13. Proces mapping A process map visually depicts the sequence of events to build a product or produce an outcome. decision activity start/end
    14. 14. Pt’s medication list Referral report
    15. 15. Could you use the process mapping for your research / practical issues? E.g.,Why do (my) students not update their portfolio (regularly)
    16. 16. Systematic review – Ishikawa diagrams Cause-and-effect diagrams of fishbone diagrams Show the causes (i.e., factors) of a certain event. Causes are usually grouped into the following categories: • People • Methods • Machines • Materials • Measurements • Environment
    17. 17. Systematic review – Cognitive mapping To identify emerging topics and thinking patterns in the literature about the topic of interest (i.e., teaching and learning aspects of handover)
    18. 18. Can these methods be useful for your research? To whom were these methods new?
    19. 19. Conclusion phase 1 High diversity of - handover practices - problems - solutions Training is needed…but on what and how?  More insight into the training as a means to train the diverse solutions
    20. 20. Phase 2. Content and design of the training Question What are the needs and preferences of the trainees (i.e, medical professionals) regarding the content and the design of a training? Aim Gain insight into the training needs of the trainees
    21. 21. Methodology 1.The problem 2.The training Training needs analysis Questionnaire Interviews Interviews Focus group Proces mapping Literature review MethodsPhase
    22. 22. Questionnaire on training 96 Medical professionals (prim/sec. care doctors/nurses) Questions on content and design of the training (NL,ES,SE,PL) CONTENT • How important is it to include the following topics in the training? - Communication skills - Tool use - Awareness - Allertness - Other, namely.. • What factors contribute to the succes a training? Open question
    23. 23. DESIGN Would or wouldn’t you advise the following design/delivery options 4 hours of training 1 day of training Several days of training Homogeneous group Heterogenous group Small groups Large groups E-learning Training on the job Tasks Examinations Yes I would No I would not
    24. 24. Semi-structured interview 19 Training specialists in the medical domain (NL,ES,PL) Questions pertained to – Background – Content of the training – Design/delivery of the training – Promotion to attend the training – Evaluation of the training – Preconditions / promoting transfer
    25. 25. Writing persona Creation of an archetypal user of a website that represent the needs of larger groups of users, in terms of their goals and personal characteristics. They help guide decisions about functionality and design Although personas are fictitious, they are based on knowledge of real users
    26. 26. Maria, barcelona (ES) Coordinator of continuous education institute Maria does not need to be convinced that handover is a very important topic but although she has about 10 years experience in quality of care and safety patient, she has not got any experience in training handover. She is not sure yet that handover should be a special subject for training. She thinks that the institute needs to put necessary structure, regulations, guidelines policy, and tools in place. A culture of safe handovers needs to be created.
    27. 27. What are the characteristics of your target group? Could you use a writing persona for your research?
    28. 28. Conclusion phase 2 Diversity of training needs and solutions  A standardized training is not suitable We will need something like a TOOLBOX for training specialist. So they can build the training themselves
    29. 29. Phase 3. Creation of the toolbox Questions • How should the toolbox look like? • What should be its content? • How should it be structured? • How to meet the needs of the users? Aim Develop an environment in which training specialists can find all kinds of solutions to create themselves a training that fits the needs of their trainees
    30. 30. Methodology 1.The problem 2.The training 3. The toolbox Training needs analysis Questionnaire Interviews Interviews Focus group Proces mapping Literature review Requirement analysis MethodsPhase
    31. 31. Requirement analysis 1. Writing personas 2. List of functionalities 3. Comparison of potentional online environments 4. Customization of the selected environment
    32. 32. Conclusion phase 3 A toolbox is also not fully adequate..  it does not address the awareness of the target group for the diversity of the problem A learning network is more suitable to reach this aim.
    33. 33. Features of a learning network • Distributed learning environment • Emerging content • User-created content  Prosumers: Producers and consumers • Users blog, rate, anotate, tag, and share • Support of informal and professional learning • Information filtering Most important features of this LN - the sharing of knowledge and experiences - customizing solutions for problematic handovers to local needs and conditions
    34. 34. Result phase 3 The European Handover Learning Network (a.k.a. Handover toolbox) …which we will show you in a minute
    35. 35. Who is involved in a learning network? Why aren’t you involved in a learning network?
    36. 36. Phase 4. Evaluation Question What is the first impression of the toolbox of experts in the medical domain? Aim Gather feedback to further improve the handover learning network
    37. 37. Methodology 1.The problem 2.The training 3. The toolbox 4. Evaluation Training needs analysis Questionnaire Interviews Interviews Focus group Proces mapping Literature review Requirement analysis PMI – rating MethodsPhase
    38. 38. Plus Minus Interesting rating Look at and listen to the presentation of the Handover learning network Meanwhile…create notes on P: Plus M: Minus I: Interesting Write down everything that comes to your mind, generate as many ideas as possible, do not filter your ideas
    39. 39. Conclusions • Work in progress…
    40. 40. And then now…the toolbox Please apply the PMI-rating P: Plus M: Minus I: Interesting
    41. 41. Use Case scenario Role: Training expert on patient safety unit in Heerlen Hospital Task: Create a training for handover for the GPs Subtasks: 1.Explore possible interventions 2.Create a training outline with topics and activities Deadline: YESTERDAY! Hint: Look at the Handover Training Toolbox
    42. 42. Users of
    43. 43. Use Case scenario Deadline: YESTERDAY! Result: Peter found enough information for his task. In addition, he extended his professional network and started his own group on handover training for GPs. In this way he extended his reputation in the field. Hint: Look at the Handover Training Toolbox
    44. 44. Next step to be taken How to structure the handover learning network toolbox…
    45. 45. OBRIGADO for your attention ;-) Wendy.Kicken@ou.nl or Hendrik.Drachsler@ou.nl