| A Blended Learning Solution Successfully Implemented at a Healthcare Solutions Providerv by Ceil Tilney
Originally published in the January 2004 Issue of Link & Learn. 
Background
In the following case study, Ceil Tilney outlines her experience working with her client (for the purposes of this case study, referred to as "The Organization," in order to maintain anonymity), who develops software to help medical providers manage outpatient information. The Organization's customers include ambulatory surgery centers, rehabilitation therapy clinics, and surgical hospitals, among others.
The market for healthcare information systems is highly competitive, so education can be a powerful differentiator. With this in mind, The Organization began in 2001 to develop a blended learning solution for its customers. This article describes the solution that The Organization developed, the challenges they overcame to deploy the solution, and the lessons they learned about using technology to support learning.
The Learning Solution
The solution that The Organization developed uses blended learning techniques to ensure maximum learning. The B-L-E-N-D-E-D learning process works like this:
- B egin training by designating customer "champions." Prior to implementation, product champions at each clinic are identified and required to complete a suite of self-paced, interactive, online tutorials designed to simulate the everyday use of the product (see the next section for a discussion of the tutorials).
- Once prepared, the customer's trainers conduct a week of intensive L ive, traditional, classroom training for the champions, at either The Organization lab or customer site.
- The Organization delivers E -learning through virtual classroom training to the ultimate end-users at the customer's site. The live online sessions introduce the product that the customer is about to implement. At the conclusion of the Virtual Class, instructors also introduce end-users to the Web Based Tutorials (WBT).
- N ew end-users complete the appropriate WBT prior to the "go-live" of the software. This is the "teachable moment" - with product implementation looming, learners are motivated to learn the skills they'll need.
- D -day ("go-live" date) finds the trainer/implementer on-site to work one-on-one with users. This final coaching ensures that the skills they've mastered in the Tutorials transfer smoothly to actual use.
- E -learning ensures a cost effective means of continued training:
- Thirty-Day Follow Up Training - a trainer conducts a virtual class meeting to address the higher level questions that have developed over the initial implementation process.
- A catalogue of formal virtual classrooms is available for content that may not be used every day and requires a higher level of learning (cost analysis, inventory) and refresher courses.
- Web Based Tutorials are used continuously for new employee instruction.
- Fax blasts keep our customers informed as to the latest tutorials and virtual classroom catalogue.
- For D ay-to-day operations, the champion, or super-users, provide the ongoing coaching that users may need after implementation is complete and the trainers have left.
The blended solution has increased the productivity of the instructional staff substantially. For example, for a recent product upgrade, five trainers were able to upgrade 5,000 users in over 1,500 sites within ten weeks. And the virtual classroom (WebEx at present) has made it possible to train customers in as many as 200 clinics over a single two-week period.
The emphasis on self-paced learning has also paid off. In a recent two week period, 800 learners completed over 6,000 lessons on their own, taking advantage of the 24/7 access to content.
Using WBT Tutorials for Product Fundamentals Training
Central to The Organization's blended learning model is a library of tutorials available to learners 24/7 for self-paced instruction and practice. The tutorials simulate the every day use of the product. The Organization uses the tutorials in a variety of ways during the training process.
First, requiring demonstrated success with the tutorials prior to class ensures that all learners have a baseline of common knowledge, so that the live class can move forward in unison. Working through the tutorials also gives learners the chance to come up with questions they bring to class. Finally, learners who have difficulty during the live session can use the tutorials to review basic concepts.
Once the product is available, learners are less likely to use the guided practice offered by the tutorials, instead accessing the product directly, so it's important that learners be exposed to the tutorials before they get their hands on the actual product.
The Organization's reporting system provides records to the clinic supervisors a week prior to "go live" to ensure compliance. And learners who haven't performed to their supervisors' satisfaction on the tutorials can be directed to work through the practice sessions again.
Using Blended Learning for Quick Response Training
The Organization uses WBT in the process above to provide customer training on finished software. As with many software development organizations, its software is dynamic, with frequent upgrades and new functionality often incorporated into the final product. It's neither cost-effective nor time-effective to create polished tutorials around unfinished content.
Yet customers need to be ready to use The Organization's software the instant it's available, regardless of how little time there is between software development and deployment. The Organization uses blended learning to provide rapid response training to its customers.
Working under the direction of the learning services organization, trainers create recorded WebEx sessions or Qarbon Viewlet demos to cover rapid product upgrades. The Organization makes these recordings available on the same site learners use to access WBT. While the WebEx modules or Qarbon Viewlets don't include the assessment capabilities of the tutorials, they do provide up-to-the-minute information learners can use to help their mastery of the frequent upgrades.
In order to satisfy different learning styles and client needs, The Organization also hosts live instructor-led sessions on its virtual classroom. These task-focused sessions are made available to learners via an online catalogue they can access from their normal training site. Easy online registration is also available.
Effective Assessments
The Organization's learning materials provide two ways to measure performance. Learners can complete knowledge tests, and they can demonstrate product mastery in guided and unguided practices in the WBT.
In evaluating learner performance with each type of assessment, The Organization discovered that success on the knowledge tests was no guarantee of ability to use its products. In fact, learners who were experts in the product were often unable to pass the knowledge tests. Rather than "fix" the knowledge tests, The Organization relies most heavily on the unguided practices or simulated quizzes as the best predictors of learner performance on the job.
The practices ask learners to complete a typical activity using the software. The activity is first described to the learner, then the learner follows a set of steps to complete the activity, and finally the learner is asked to complete the simulated activity with minimal information. By gradually introducing the learner to the required skills, and by requiring an increasing amount of independent thought with each pass through the skills, the practices have a high degree of success in predicting actual mastery of the required skills.
Because there are many possible paths learners can take to complete an activity in real usage situations, The Organization could either have made the simulation robust enough to account for all possible paths to the correct solution, or be generous with the amount of "error" it would allow in a passing performance. In other words, what might be an "error" in the sense that it's not the process the simulation expected the learner to use might be a valid process within the context of daily use.
Because of the cost associated with simulations with many branches, the client chose to use a 70% level for passing. Customers have been satisfied with the performance of users who pass at that level.
Using Assessment Results
The simulations included in the tutorials are comprehensive enough that customers whose users successfully complete the simulations can be confident in their ability to use the software in their daily work. Some customers have gone so far as to require users to pass the unguided practice sessions as a condition of continued employment.
In general, the company recommends that clients offer learners incentives and implementation strategies to complete the practices rather than punishment for failing to do so. Depending on The Organization's preferences, incentives have ranged from simple to lavish.
Simple User Access and Learning Management System
The single web page that The Organization created for learners to easily access all e-learning provides links to the WBT and recorded content. Learners also go to this page to find a catalogue of instructor-led virtual training and online registration forms.
The Organization uses a simple LMS to manage, access and track performance. The LMS maintains records of learner performance on simulations within the tutorial content. It also maintains records of scores in the separate knowledge tests for those customers who want knowledge test results in addition to performance measurements.
It's important to keep reports simple. The more complex the reports, the more difficult it is to compare results across facilities. And the more complex the reports, the more difficult it is to ensure accurate results from the LMS. The Organization elected to ensure 100% working and accurate reports that are consistent across clients.
Similarly, to ensure useful reports, The Organization developed uniform content naming standards. Otherwise, learning objects across curricula may have the same names (e.g., "Practice"), rendering report interpretation impossible.
Since different groups within the company create content, The Organization requires each to conform to the naming convention standards the e-learning team developed. Along with content naming, The Organization also created standards for a few, basic pre-defined fields in the learning database: learner email, learner facility, learner name, and client name are among the fields that The Organization uses in addition to the course name.
The Organization uses the LMS to generate the following reports:
- By clinic or customer facility
- By learner name
- By learning objects accessed
- By curriculum (pre-defined collections of learning objects)
- By completion percentage
- By completion scores
The LMS lets The Organization control how much information is available to each customer. So, for example, the administrators on The Organization's e-learning team can generate reports on all client activity, while administrators at an individual customer can only generate reports on their own learners.
Resources, Costs, and Schedules
Developing, deploying, and maintaining the blended learning solution is a complex process, but The Organization did not add staff to support blended learning. The existing staff of trainers, The Organization's "interactive group" (intranet site professionals), and education liaisons who had previously supported the traditional ILT work with the five-person Education Services team.
Trainers are typically the project SMEs. The interactive group posts the content internally, and supports reviews, as do the liaisons. One technical resource supports the virtual classroom - both technology and content. As demand for virtual classroom sessions grows, The Organization is moving to staff a virtual classroom for each new product line.
A rigorous project management process makes it possible for this small group to manage the development, deployment, support, and administration of both WBT and virtual classroom training. The project management methodology that the client developed is the subject of a separate paper, but some general comments are instructive here.
In the early stages of solution development, The Organization outsourced the WBT to a third-party development house. They were careful to choose a vendor - EDTLearning - that could provide them with the capability to edit and update content themselves. Thus they were able to benefit from the experience and speed of the established vendor, and benefit from training internal staff to use the WBT development tools to create content as the blended learning became more entrenched.
Learning from an external vendor was also cost effective. The initial project, while expensive per-hour-of-finished-content, was faster and less expensive than hiring the team that would have been necessary to build the content from scratch in-house. While the initial project was in process, in-house resources worked with the vendor's developers, mastering the development tools which the client also licensed from the vendor to use on its own.
Moving from all-outsourced to projects using the development vendor's tool brought costs down by more than 50%, without sacrificing quality or schedules. Once The Organization had the expertise in-house to use the tool effectively, they were also able to customize it, making it even more useful as a content development and deployment tool. The Organization continues to use the vendor's technical expertise where appropriate.
Conclusion
Using an intelligently-deployed approach to blended learning, The Organization is able to reach more learners more conveniently in less time than would have been possible with classroom or self-paced WBT alone. And because blended learning is far more scalable than classroom training, The Organization's learning team is also positioned to meet increased demand without adding staff.
One of the leaders of The Organization's learning services transformation, cautions that it's not enough to have the right model. Execution is important too.
In particular, she found that it's key to re-educate classroom trainers about optimum use of blended learning. Inclined to just "toss WBT over the wall" to their customers, trainers learned to create a context for learners that would motivate them to use the WBT. Adding the human element to the self-paced learning greatly increased results.
My contact also points out that it's important to educate your management team about the complexity of the learning development process. It doesn't take a lot of time for instructor/SMEs to put together their own PowerPoint materials for live classes. It does take time to design, program, test, and deploy powerful online content that can stand on its own without an instructor to explain it.
Finally, she says it's critical to identify the minimum subset of standards to enforce across all learning development projects - and to make it easy for people to conform to the standards. The Organization uses standards for its online content, including standards for the interactive simulations that form the basis for the assessments. There are also standards for recorded WebExes and for Qarbon Viewlets (which are more interactive than WebEx, and provide a bridge between completely finished WBT and WebEx information sessions).
Because the rules are explicit and easy to follow, anyone in The Organization can produce content that's instructionally sound. Using blended learning, they've moved training out of the training department and into an integral role in the company overall.
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Ceil Tilney is the Regional Vice-President for the Western Region at Linkage, Inc., a global organizational development company that specializes in leadership development. She specializes in performance management and technology, building learning strategies, and stakeholder management. She has worked with clients in a diverse range of industries, including professional services, high technology, healthcare, financial services, and consumer goods. Previously, Ceil was part of the Professional Services Group of SmartForce, a leading provider of learning solutions. She was the Director of Education Services at BenefitPoint, a benefits insurance dot.com, a role she also held in Oracle's Field Sales organization. She also spent five years at Microsoft, working with clients to design, develop and implement large-scale training programs. She has advised clients on employee, technical, and sales training, leadership and management development, corporate university strategies, and e-learning plans. Ceil earned an MBA, an MA in Organization Development, and an MA in English. She has received the SPHR designation and is certified to administer the MBTI.
Contact - tel: 510-823-3464; e-mail: CTilney@Linkage-Inc.com; web: www.LinkageInc.com.
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