Practical Training: Applying the Science of Implementation
April 23rd, 2019 | Viewpoint
April 23rd, 2019 | Viewpoint
“Training” may conjure a rather tired image of a teacher in front of a classroom, lecturing about the “best” way to do a certain task. Most of us have been to trainings that seem useful at the moment but whose relevance fades soon after we leave. This leads some to ask, rightfully, does training really make a difference?
JSI has been learning from, adapting, and improving its approach to training and technical assistance (TA) for years. In our experience, training in the “traditional” sense described above, is never enough. But training can achieve desired outcomes when the training developer understands and addresses the challenges to implementation. JSI uses a number of strategies to translate training concepts and skills into improved (and sustained) practice.
Job aides take many forms—adaptable documents, spreadsheets, checklists, discussion questions—but all are used by people who are performing specific job functions. For example, as the Family Planning National Training Center (FPNTC), which serves Title X providers, JSI developed a Reproductive Goals & Counseling Flow Chart that family planning counselors can use to guide discussions with clients. As the Health Information Technology, Evaluation, and Quality Center, JSI developed questions to facilitate discussion among clinical, IT, and financial staff on using data to manage population health under risk-based contracts.
Over the past decade, JSI has facilitated dozens of learning collaboratives using an adaptation of the IHI Breakthrough Series Learning Collaborative Model, in which teams work on quality improvement projects and come together in person and virtually at routine intervals to discuss data, progress, challenges, and lessons. As the teams work through the process of implementation, these peer-to-peer exchanges focus on strategies that work on the ground. Following a defined, evidence-based approach to increasing chlamydia screening, for example, JSI facilitated a 9-month learning collaborative with 19 sites that collectively increased screening rates from 59% to 69%. Another strategy JSI uses to facilitate peer exchange is spotlighting successful practices, such as this case study about how Healthy Start programs increased breastfeeding rates, developed as part of the Healthy Start EPIC Center.
JSI builds on universal training and resources by providing individualized TA that helps organizations address system-level challenges and develops their capacity to address large, complex issues. In 2018, JSI as the FPNTC provided TA to 28 organizations, and 46% reported that the TA increased the capacity of their network staff; 43% developed new implementation tools; and 39% reported that TA resulted in new or updated organizational procedures. In one case, JSI worked with Carson City Health and Human Services to reduce the rate of no-shows at its family planning clinic. JSI facilitated a team-based activity to overcome technical and adaptive challenges. The staff agreed to try advanced access scheduling and modify clinic flow. Within 6 months, they had reduced the no-show rate from 34% to 23%.
A feedback loop between the target audience and the training developer is essential to helping trainees overcome implementation challenges. A training team must check in with the target training audience routinely through surveys, phone calls, evaluations, TA engagements, and other means to stay abreast of challenges and needs. Before developing any training, JSI conducts a needs assessment that is the foundation of the training plan, and from there, the feedback loop continues.
Our experience has shown that training can achieve desired behavior change when it addresses the target audience’s needs and post-training implementation challenges. Job aides, learning collaboratives and other peer exchanges, and tailored TA are three strategies that JSI applies to help end-users put training into action. To make these strategies successful, JSI stays apprised of user needs by developing a continuous feedback loop with trainees.
Written by Katherine Quimby
We strive to build lasting relationships to produce better health outcomes for all.