Wednesday, February 28, 2007

Playing Games:Gauntlet

I spent a quality evening with a couple of friends playing Gauntlet on Xbox.

Remember: I haven't been much of a gamer over the past 15 some odd years, so my comfort level with the Xbox controller is not very high.

Fortunately, my friends spend more time than is probably healthy in front of this technology - so they had already built 4 characters to indestructable levels.

Gauntlet is a role-player game. Characters are given a series of tasks to complete. If they successfully complete the task - they move to the next level.

Of course, to complete the task, you have to kill lots of monsters.

Part 1 of my game strategy - pound lots of buttons. This successfully killed lots of monsters in a very impressive manner. My character, a Valkyrie, jumped, spun in a circle, and whacked people with a sword while screetching "Hyaah." There was some magic things that she did too - though I'm not certain how I managed to trigger those actions.

(picture of the xbox controller from

Part 2 of my game strategy - keep up with the other 2. The joystick on the xbox (3 - upper left hand corner) allows you to move your character while killing monsters. Essentially - I became a berserker. Running around... killing things at random....

Of course, when in the midst of extreme exertion, a girl's got to eat. So while running around and killing things, you also have to grab food and money. This is where unfamiliarity with the nuances of the controller hurts. I spent a lot of time trying to maneuver the Valkyrie over food (while still mashing the "kill" buttons, of course). It usually took 2 or 3 attempts for a successful pickup.

What I found most interesting about this game was how it fostered teamwork.

First - the screen would not move forward unless ALL members of the party were within a certain proximity of each other. If one member was lollygagging (or killing extra monsters), the others had to wait.

Second - to teleport - all members had to be near the teleporting areas. This task was made extra interesting for my friends due to the newbie (me) who couldn't get her character in the right place.

Third - certain tasks required a level of team planning. One task required us to convince the big monster to destroy the pylons holding the little monsters. We found that running around in circles, occasionally using the healthiest one of us as "bait" worked nicely....

15 minutes and 1 beer into the game, the most experienced person became the "general". He fell into this by default since the rest of us were focused on mashing buttons and navigating. This role mostly consisted of him screeching "Run this way!" for the better part of 3 hours.

Still, it was interesting watching him plan and communicate strategies for keeping the rest of us alive and getting to the next level.

Admittedly, most of the tasks in Gauntlet are not terribly complicated. Kill all the small monsters and you kill the big monster. But I could easily see games like this as being good communication and leadership exercises.

How do you get 4 people to cooperate on a task? Even if it is killing monsters.....

Monday, February 26, 2007

An Ode to My Parents

Stephen Downes, in his response to Steve Hargadon's post on Academic Rigor, enumerates the ways his parents celebrated "academic virtues."

Like Stephen, I was very lucky to have parents with open and curious minds. Yeah, they read newspapers and books and all that. Most importantly, they were about experiences.

- Dad made it a point to take us to festivals. Particularly the Carribean festivals in DC. We may not have appreciated it at the time, but the exposure to the colorful costumes, calypso, and different foods made me more willing to seek small community festivals in the towns I've lived in. I learn more about food and culture at these festivals than I ever would in a book.

- Mom loved to take us to the historic homes in the area. Interestingly, she was about the homes off the beaten path. Gunston Hall, Oak Hill, Woodlawn, Claude Moore Colonial Farm, and the like.... Sully Plantation was her favorite. They would hold regular "Colonial Days" where kids could learn about life in colonial times.

- The folks dragged my brother and I to the Smithsonian on a regular basis. We are so lucky to have free, world-class museums in DC. I am still a huge fan of the Natural History Museum's bug room.

- Mom is an adventurous cook. She made it a point to cook foods from different cultures and turned these meals into cultural lessons. Many of these meals came from Time-Life's Foods of the World series. I would read the entire series cover to cover at least once a year from ages 9 - 15. During those readings, I would find myself cooking at least one of the recipies. Usually cookies :' ) It's to my mother's credit that she even let me near those books - her cookbooks are some of her most precious posessions.

- We used to celebrate at least 1 evening of Hanukkah and 1 evening of Passover each year with family friends. If my parents had friends who celebrated other faiths, we would have joined them too. As I've gotten older, I've been very fortunate to have friends from a wide range of faiths that invite me to celebrate important holidays. Again, I learn more from those experiences than from any book.

- Dad continues to be my most ardent supporter in any academic endeavor. He was the one who set the "2 master's degrees with long gaps in between" model that I have followed thus far.

I consider myself incredibly fortunate to have parent who implicitly understood the importance of "modeling" behaviors and providing opportunities for learning and growth without forcing the issue.

I suspect that those experiences drove me to study history (for longer than I probably should have), encouraged me to continue my education (both formally and informally), and helped to develop my fidgety mind.

Thanks Mom and Dad!!!!!!

Perspective Smacks Us In the Head

Right now, most of us are getting over, coming down with, or fighting a cold.

Our system administrator had a small nervous breakdown - which put her out for a week. Don't blame her since she lost about 1 month's worth of work with the last build.

One of our other team members has been fighting high blood pressure related issues and returns from his appointments with horror stories about being poked and prodded with various needles. He HATES needles.

Another team member is fighting through tremendous pain from last month's car accident. She's been working through a fog of pain-killers.

But the event that made us take pause was the news that one of our trainers has breast cancer.

She found out during the course of her annual exam 2 weeks ago.

As part of that exam - she had a mammogram. The mammogram found a lump about 1 cm deep in the breast tissue. Nothing that could be felt by a standard breast exam. The radiologist, in his report, stated that there was a very high probability that it was malignant.

A day or so later, she went for a biopsy - which confirmed the cancer. is scheduled for next week. She knows that she has to have radiation treatments. She won't know about the need for chemotherapy until after the surgery - when they can get at her lymph nodes.

This is one of those times where I am very grateful that I work in health care. We KNOW who the best doctors are, know what resources we have at our disposal, and can pull favors in situations like this. We also can find out exactly what is happening without having to wait for the doctor to contact us. And since we work with these people every day - we're not afraid to ask questions or say "no" to treatments that don't make sense.

All that knowledge still can't temper the fear. Despite the resources at her disposal, her medical education, and the support of her co-workers, she was very shell-shocked for most of last week as she ventured through this very scary process.

For the rest of us - it made us seriously re-evaluate what we are doing and why we are doing it.

Losing one of our best trainers for the course of this project - though painful - is not the important part. Supporting one of my best work friends and # 1 confidant is.

The other stuff can wait......

Wednesday, February 21, 2007

Gamers make better surgeons.

....Dave Munger,at Cognitive Edge, found the following:

A new study has confirmed that surgeons who spend more time playing video games are faster and make fewer errors than those who spend less time with video games:

"Surgeons who had played video games in the past for more than three hours per week made 37 percent fewer errors [in the Top Gun course], were 27 percent faster and scored 42 percent better overall than surgeons who never played video games. Current video game players made 32 percent fewer errors, were 24 percent faster and scored 26 percent better overall than their non-player colleagues," the authors write. Those in the top one-third of video gaming skill made 47 percent fewer errors, performed 39 percent faster and scored 41 percent better on the overall Top Gun score than those in the bottom one-third.
It's not clear from this summary of the data whether the difference between current and past gaming behavior is significant, but it's interesting to note that while past gamers were 42 percent better overall, current gamers were just 26 percent better. If this difference is statistically significant, it means the best surgeons were those who played in the past, but don't play now.

I would be very curious to see whether that Nintendo Wii game, Trauma Center:Second Opinion has an even more direct impact on surgeons.

Tuesday, February 20, 2007

Practicing Subversion

Much of what the free rangers espouse will require deep-seated culture change within the organizations many of us work within.

I hinted in a recent post that one possible technique for overcoming the obstacles a lot of us face when applying informal / free range learning strategies may be quiet subversion.

OK – maybe not so quiet since I’m writing about it...but I’m betting that my co-workers don’t read this blog.

If you are a co-worker of mine reading this blog...please don’t share our secret...

Here are some of my current subversive tactics:

1) Secretly building new skills. My co-workers think I’m just a trainer, but I’ve been secretly learning HTML/CSS, Flash, php, Captivate and other skills to take over the world create more effective educational experiences.

2) Blogging: Through writing blogs, I process the madness around me. If you didn’t guess, my opinions and perspectives are mine and mine alone (unless I’ve cited someone – in which case, it’s their opinion and perspective). My blogging is not sanctioned by my organization or sponsored by foundations, corporations, or individuals. As an unanticipated side benefit of this blog, I have gained access to an A-list brain trust. These people inspire, cajole, commiserate and mentor as I try to undermine the status quo.

3) Finding tools to build toys: There are lots of neat tools and widgets being created out there. Some of them are for obvious educational purposes. Many aren’t. I rely on my network of spys fellow bloggers to help me find these widgets and think of ways of applying them to teach people stuff. This way, if someone goes…”Hey do we have a wiki?” (of course, not fully understanding what one is – it just SOUNDS cool), I can say “Yup – here’s what it can do...”

4) Planting toys in strategic locations: I like creating toys. Once I finish building a toy, I try to place it where it can be “stumbled” upon by my end-users. If someone “accidentally” finds one of these cool toys, I can gently encourage them to play with the toy. They may not play with the toy initially, but they know the toy is there and they are confident that they can always play with it when they want.

It’s the same strategy I use when I have to take the cats to the vet. I put the carriers out with either a familiar smelling pillow (for Chainsaw, my big kitty) or lots of catnip (for Spike, the feisty kitty). The carrier goes out the morning I have to take them for their appointment. They go in and out of the carrier – investigating. Eventually, they wind up in the carrier and the door magically shuts. BWAHAHAHAHA

If we are to free ourselves and our fellow chickens, we really need to treat it as a change management project.

Besides - we have many many years of habit to undo.....

He Made Me Sound Smart!

WOW! Tom responded directly to my confused comments on his blog! And actually made me sound smart!!!!!

And I fully agree with his following comment:

It's a question of letting go: "it's out there, go get it, take what you need and leave the rest, ask if you get lost, share what you find that will help the rest of us".

If you are reading me and do NOT have growing, changing, learning, creating on your feed reader - you are truly missing out.

This guy's good....

Monday, February 19, 2007

Freeing Chickens

As Harold Jarche points out, the conversations have been heating up recently in the bloggosphere around the notion of informal / free ranging chickens (...uh, I mean learning).

I read these essays with not a small amount of confusion, if only because my experience and reality seems miles away from the visions of Jay Cross, Stephen Downes, Tom Haskins, Tony O'Driscoll and others.

I think my confusion shows in my comments on some of these blogs.

Please pardon the following exhaustion and DayQuil driven rants. I've been fighting a nasty cold - but I gotta get this out....

1) I wonder whether, despite the noise in the management literature, CEOs and other managers are TRULY interested in having the training group as a strategic part of the enterprise. What executives seem to REALLY want is a training organization that allows their employees to learn what the executives want them to know by osmosis. No time in the classroom, no time away from their work, and to do it all for cheap/free.

Or even better....NO training organization since the employees are supposed to walk into their jobs knowing everything anyway - and figuring other stuff out through ESP.

2) I also wonder whether executives are truly interested in having a training group capable of encouraging their employees towards independent thought. Most organizations are organized by 20th century command and control principles: strict hierarchies, policies, procedures, etc. Despite platitudes about the need for innovation, creative ideas are squelched (lack of funding, lack of time, the creatively placed put-down....).

3) Even scarier - what if those employees want to learn something the organization DOESN'T (What are your financial numbers really........). Again - command and control.

4) And what if you are dealing with students / users / clients who are more familiar with this culture of fear....would they be willing to leave the "safe" confines of the fence and TAKE RESPONSIBILITY for their learning? How many times have you heard someone say "But the trainer didn't show me....." even though you gave them all of the tools for making the necessary cognitive leaps? (And why is it the more educated people in the population who say this more often?)

I suspect that the only way around these issues is through subversion.

Quietly building the tools and resources for the escape from the barnyard...away from the evil Mrs. Tweedy and her pie machine......

Convincing the fellow chickens that there is a better world...

This will be a slow process. I can only hope that we can all get clear on what that world looks like.


Chicken Pics from Harley McAdams at

Evidence of the Social Nature of the Web

IF I hadn't been convinced of the social nature of the web, I am now....

An old friend, who I hadn't talked to or seen in 10+ years managed to find my fish picture and posted it on his site/blog.

Beau's point was the contrast...of the web...of life. One life cut short. The other holding a fish.

Everything and Nothing.

Meaning and meaninglessness.

And how did I find this out? The magic of Google Analytics....

I'm thrilled that my friend followed his dream and became an award-winning journalist.

Sunday, February 18, 2007

A New Approach to Interactivity

Found this in my feed reader from Cognitive Edge.

You may recognize the cartoonist from the For Dummies series...

I wonder if spiders will work.....

Saturday, February 17, 2007

Blogging as Therapy

Timothy Johnson at Carpe Factum, in his response to why he blogs, said the following:

...Blogging has provided me with great therapy. Instead of internalizing the frustrating individuals, companies, and projects around me, they now become fair game for blog fodder. And I have to admit, there is so much inspiration out there for writing.

One reason why Dilbert is so popular.....

On a certain level, this is why I started blogging - the need to share my experience in hopes that it helps someone else. Or, at least, not feel so alone.

The eLearning bloggosphere, in some respects, reminds me of one large asynchronous group therapy session. A bunch of people sitting around a room dealing with an identity crisis and sharing their stories and thoughts in hopes of making some sense of it all.

The bloggosphere has served as better therapy than any shrink.


Thursday, February 15, 2007

5 EHR Training Tips

This article outlines some good strategies used to train users on electronic medical records.

In an ideal world - I would do the following:

1) Standardize first. Makes training a multi-specialty practice much easier.

2) Pick the right target . Look at your processes to determine who should get the bulk of the training time.

“When you look at the office practice, most documentation for the patient visit is collected on forms by the nurse,” says (Phyllis Schuck, CIO Pinehurst Surgical Clinic). “Then the physician walks in, reviews tests, interacts with patient, makes a decision, walks out, reads all documentation and summarizes in a note. Nearly 75 percent of the clinical documentation is created by someone other than physicians. That told me my target was primary support staff.”

3) Hire outside help. Of course, it helps to have finished software to train and outside help who know the product....

4) Use technology. The example cited used online tutorials as a prerequisite activity before the classroom training. (Interestingly, they did not cite the percentage of students who actually completed this training.) This is the approach that our vendor plans to use on their other clients. Long after our upgrade.......

Children's Hospital, for their ongoing IT training, developed their computer tutorials with an eye towards giving their end-users a safe, guided space to practice. I really like this idea.....

5) Don't overfocus. Just because the bulk of the work is done by a certain group of staff doesn't mean that others don't need to know the information.

It's useful to be reminded of the things you SHOULD be doing....

Big Bang Implementations

Our organization is involved in a cover story about big bang electronic medical record implementations.

The article has a very intelligent summary of training strategies
for these large HealthCare IT implementations. They stress the
importance of SuperUsers on the ground, multiple training strategies
(though I wish I had online training modules and 3 months to deliver
training before the go-live), and trainers who require no sleep and have
a high tolerance for pain.

The article also emphasizes the importance of testing:

Because big bang deployments have so many moving pieces, testing the
applications prior to go-live becomes paramount. Dissatisfied with its
testing, (one organization) waited nearly four years before launching
its EMR. The software, (the CEO) explains, was simply not ready for
prime time. *We delayed until we got sufficient upgrades so when we
went through the aggressive rollout we would not frustrate the
physicians,* he says.

I can only hope that this thinking is still in play at levels I am not

Wednesday, February 14, 2007

Working in Parallel

We are back into panic mode as the original unrealistic deadline is being kicked around as a target Go Live date.

We still do not have a fully functioning program.

The vendor’s Training Director is breathing down my neck for workflows, training documentation, and plans that do not exist because we still do not have a fully functioning program.

I spent time and money the past 2 weeks working on end-user functional documentation because the vendor did not have it until last Friday when they presented me with the documentation they had been working on.

On Monday, the vendor’s training director asked me why I worked on end-user functional documentation. I replied that it is very difficult to build training material without knowing how the program works (and, no, the software is NOT intuitive).

I also told her that we were running into issues with the program. She then had the nerve to say “Well, maybe you’re doing something wrong.”

Considering that the 2 visionaries of the program, the QA person, the primary programmer and designer, and their senior technical support staff have all been on-site and told us that there are large parts of the program still not functional, I can safely say that us not knowing what we are doing is a very small part of the problem.

I am very proud of myself for not screaming obscenities into the phone at that point.

When I started working on the end-user functional documentation, with the help of a subcontractor, there was no instruction manual of any sort. I had also been told not to expect any end-user documentation until well after our Go Live date. Since much of my training (as it currently stands) is based on teaching people to USE the software, I need the end-user functional documentation to build the other materials (trainers manuals, end-user quick references, online tutorials, customized workflow training, etc). End user documentation is tough to write when you don’t have a fully functional program.

I had also been directed to make the material general enough so the vendor could then use it at other sites. Since we still did not have a fully functional product, we also didn’t have a final configuration or anything resembling a workflow (including what the final user interface will look like), so I didn’t have much of a choice in my approach. The subcontractor was there for that week and that week only. I had to have her do SOMETHING. She wrote documentation on the functional parts of the not fully functional program.

This is one of the problems working in parallel. Duplication of effort. We have wasted 2 weeks worth of time and a few thousand dollars.

In any project, particularly software projects, certain things can’t happen in parallel. They have to follow the completion (or near completion) of certain tasks.

Training development needs to occur AFTER the product is mostly bug free. Otherwise, how do you know how it works?

Documentation and materials development, particularly customized end-user documentation, needs to occur AFTER the final configuration is completed. Otherwise, how do you know what it looks like?

Meanwhile, the clients (us) are getting the impression that the vendor’s training group (them) really has no clue about what is going on with the rest of the project.

Oldsters vs. Youngsters

It’s been a classic battle. The eager, ambitious youngsters (2 of the trainers) attempting to establish dominance over the experienced oldsters (me, the medicine trainer).

One of the youngsters spent most of Monday and Tuesday coming up with all of the things we SHOULD do for the training.

“We should have an extra class just on basic skills in the current product to get everyone on the same page.”

“We should have evaluations at the end of the class (we have 1 hour to teach everyone at least 3 hours worth of material).”

“We need to address everyone’s special instances and design that into the training.”

There was more, but I started tuning her out. As tactfully as I could (which was admittedly not very tactful), I informed her that she is adding to an already long to-do list and, with the current timeline, she is going to pull resources needed for other things. Namely, stuff we have already committed to and the development of dead-minimum training materials – trainers guides and end-user quick references.

Since there are 4 of us, we needed the “client” (the Director of Medicine) to break the deadlock.

Her take, the Oldsters are right.

After all this time (and many extra classes already), if they haven’t been practicing the basic skills now, an extra class won’t help.

We are not going to be able to design a formal course even worth evaluating. We also will not have time to incorporate the evaluation and, frankly, the docs won’t take it Furthermore, evaluation is going to be very easy. All you have to do is look at their faces.

The plan to emphasize the way things SHOULD be done will now change to a straight functional training. We will address special workflows during the support time.

It is understood that most of the real learning is going to take place during the support weeks following the Go Live. I know that the youngster was trying to minimize the amount of running around we will have to do during the support weeks. She was also trying to demonstrate that she understands how “training” works. However, as the oldsters keep reminding her – we do not have an ideal situation for developing or delivering formal training.

As I listen to the feedback from our end-users (“I won’t understand until I go back to the clinic and try this out”) and continue reading the research and blogs on learning, I am realizing that a little educational sloppyness is not such a bad thing. Our end-users will be forced to learn a lot on their own. Hopefully, within a couple of months, they can teach US a thing or two. And that will be a very good thing.

Monday, February 12, 2007

Fantasy Golf

These days, I hang out with people who are really interested in fantasy sports. They keep careful tabs on how their players are doing: points scored, injuries, statistics, and other things to take up mental bandwidth.

This has meant too many beautiful afternoons spent in front of the big screen watching sports. I like sports, but at the end of the day I always feel like I should have been doing something more productive.

Nevertheless, I decided to dip my toe into the fantasy pool by playing fantasy golf.

Why golf?

1) I only have to keep track of 4 people. Fantasy Football and Fantasy Hockey require you to keep track of lots of people in lots of positions. I would like to think I have better things to do...

2) I've been a ShotLink volunteer at local Champions Tour and PGA events for 3 years. It would be nice to recognize these guys beyond "Blue shirt, black pants, must be Padraig Harrington."

3) There is an element of dumb luck involved. Even for the pros - the golf gods are fickle.

4) I don't have to watch the tournament - just check up on stats Fridays and Mondays. I'd rather be out hitting balls in 30 degree weather than watching multi-millionaires on TV.

Yahoo Fantasy Golf focuses on how much the player will improve vs. last year. I think this keeps everyone from selecting Tiger Woods for all of their events.

After selecting 2 people who weren't even PLAYING in the ATT Pebble Beach Pro-Am last week (duh), I think I have a decent foursome for this week's Nissan Open: Adam Scott, Lucas Glover, Sergio Garcia, and Trevor Immelman.

And yes, I checked to make sure they were all in the field.

I was pretty happy with last weeks' performance - despite the fact that I have no clue what I'm doing.

Bat's Hackers are currently ranked 162,315 with a whopping 78 points for 1 tournament.

Go team!

Sunday, February 11, 2007

Adding Widgets

Google finally forced my hand and made me upgrade to New Blogger. I'll admit to not being entirely happy about this. I was perfectly happy with Old Blogger.

That said, I discovered that this forced upgrade solves some unimportant problems that I've been having.

1) Feedburner FINALLY works. I was never able to get the feed to work correctly on old Blogger. For the transition, I deleted the feed and re-added it. I'm using the RSS choice. ONce that is complete, cut and paste the chicklet found in the Publicize section of your Feedburner account into your Blogger Template. These are the directions

2) I hadn't bothered tagging any of my posts. Too lazy. The labels for this post section makes it easy to tag. Now all I have to do is come up with useful categories....

3) I can change the settings for reader comments and backlinks using the post options link below the editor.

4) I can see how many comments I have on each post in the editing section. I'm STILL surprised I have any.

I can only hope the end-users of the electronic medical record we use see the same sort of value in that upgrade....

Friday, February 09, 2007

When Will They Go Away?!?!?!

I've been having a hard time keeping up with my blogging (and general production) recently. Mostly because I have spent the past 3 weeks in non-stop meetings.

Vendor representatives have been crawling around our site in the name of "resources". That's fine... but I know I have hit the point where I just want them to go away so I can process our discussions and get some work done.

In his post on the Web 2.0 video (which I haven't had a chance to watch yet), Brent says what I've been thinking:

Creativity is not a team sport. (emphasis mine) The reason why Web2.0 is working is because nobody needs to explain their new ideas. They simply create it and put it out there, and see if it sticks. If it sticks...Yahoo buys you for 10 million.

This is also how creative innovation works. You simply do it and then show people. One guy/gal does it alone...or at best a small group of dedicated friends just get together and say, "wouldn't it be cool if...".

Sadly, it sounds like we have another group coming back next week. Maybe if I just hide in my cubicle and stay REAL quiet......

What Should We Be Asking?

Feburary's Big Question:

What Questions Should We Be Asking?

Does it work?

I mean that on a couple of different levels....
- Does whatever you designed fulfill the objectives? and
- If using a technology solution - is it bug-free and easy for the end user to navigate?

Is this the best we can do?

Is what you've developed (whether it is an eLearning solution, classroom materials, or a hybrid) the best way to teach your objectives given Time, Audience, Resources, and Restrictions? (I think I'll just call these considerations TARR. Maybe I can introduce a new acronym...)

Ask Matthew Nehrling's question to discover more about your organization's TARR requirements.

Is there another cool tool / method that would work better? (notice I did NOT say faster OR cheaper).

Mark Oehlert and Brent Schlenker are my current favorite resources for cool new things to play with.

I agree with Clark Quinn's eloquent assessment in his answer:

One of the things I keep seeing is that people are focusing on elearning tactics, while not considering how those tactics fit into a strategy. If you’re asking about how to better support conversations, you should make sure that you’ve got a culture that ensures sharing. If you’re asking about creating portals, you should ensure that your instructional design is up to scratch.

So I guess my short answer is that your first question should be if you know where you’re going, and if you do, you should be asking questions about the next step along the path. If you don’t know where you’re going, it doesn’t matter what you ask!

Monday, February 05, 2007

Experimenting with Letting Go

As I've mentioned before - I've been fighting with my inner control freak to allow the learners to tell me HOW they want to learn this new application. A tough task - but I'm finally starting to see dividends....

The trainers are receiving input from 3 groups:
- The Physicians Advisory Group: a cross-specialty group of 14 attending physicians selected for their willingness to champion the new upgrade and for their baseline computer skills. This group will serve as a physician resource during the upgrade and determine expectations and processes on an organizational level.

- The Pilot Clinicians Group: A fluctuating group of 5 - 20 general internal medicine doctors who have been using the electronic medical record the longest.

- The SuperUsers Group: A staff group who is tasked with first-level support during the upgrade and who provide input on staff-level workflows.

We've been pleasantly surprised at the level of engagement from each of these groups. The training team has stumbled upon a process for encouraging input from the learners:

- Gather the initial training requirements and restrictions. For the baseline: we were tasked to deliver all of the training required in less than 90 minutes.

- Develop the training the client asks for. They will never BELIEVE that it will take more than 90 minutes to learn something if you don't SHOW them. That little demonstration did more than any of my harping and griping.

- Pilot that training. The first time around, we piloted the training for 2 of the groups - the Pilot Clinicians and the SuperUsers (a truncated version).

- Ask for comments and recommendations for improving the training, making sure you communicate the restrictions and requirements as presented to you. This piece was the most eye-opening. The students start to take ownership of both learning and of the project. We got some excellent recommendations for solving our time problem and a lot more help than expected.

The docs and the staff are starting to spread the word about the new upgrade themselves without much prodding from the training group or IT. And the stuff I posted on our Moodle installation is looking to be useful after all.....

We still don't have fully working software, a set go-live date or final workflows - but we at least have an idea of what we can try next.

And, if all goes well, we'll have more time to develop materials and test more trainings. Change management can't be rushed.....

BTW: Tom Haskins has a GREAT post on giving control to the learners.

Sunday, February 04, 2007

Promising Trends in Health Care

I'm noticing a major cultural shift occuring in my health care organization.

Doctors, in general, tend to be very independent creatures. They work the way they want to work. More functional departments work together, but still stay within their own little specialty fiefdoms. "We're different" is the cry I have heard with every single Electronic Medical Record implementation and change management project I've been on since I started doing this 5 years ago.

The walls are breaking down.

Why now?

I suspect the docs see the advantage to seeing each other's notes. Reduced duplicate tests, a more comprehensive picture of the patient, better quality of care, greater patient safety, happier patients.

More crassly, I think the docs are finally realizing that electronic health records, computerized physician order entry, etc. are not going away. Insurance companies are threatening that if they don't adopt these technologies, they won't get paid. Money is very persuasive...

For the more recalcitrant, I think the CEO and Chief Medical Officer have sent down the command "Work together or else....." These guys are on contract so this threat is not idle....

Those of us who have been in the health care industry awhile are happily shocked at this turn of events.

I only write about it because this "working together" thing seems to be sticking.

Between more time and the fact that the clinicians seem to now want to drive this IT project - I think we have a fighting chance of succeeding with the upgrade.