A study of the relationship between healthcare workers and their mandated learning

Introduction

Clinical governance systems and standards are put in place to ensure organisations and individuals comply with mandatory learning requirements, to maintain public confidence in healthcare systems and services, and to mitigate risks to patients. The rapidly evolving and complex nature of healthcare services, clinical practices and models of care requires an agile approach to learning. By requiring healthcare workers to continue their professional development over time, regulatory bodies ensure awareness of the need for lifelong learning, continuous improvement, and patient safety. Public reassurance is achieved through the regulation of health professionals engaging in continuing professional development, and organisations mandating workplace learning. Despite an obvious commitment to their patients, healthcare workers report that completing all of their mandatory training obligations within expected timeframes is challenging due to competing workplace priorities and demands.

Purpose

This study presents a unique perspective on the factors that influence the ability of doctors, nurses, and their multidisciplinary colleagues to complete mandatory training obligations in the context of a teaching hospital in Sydney, New South Wales, Australia. The participants are from a variety of professions and are broadly representative of the makeup of a contemporary healthcare workforce. The aim of the study was to explore the value and benefits of compliance for individuals and organisations, and to build on our knowledge in this area in order to make recommendations to optimise transfer of workplace learning and improve overall compliance with mandated learning.

Methods

To address the research question, a two-phase, mixed methods, cohort evaluation and interpretive description research design was used. The design included:

• Document and policy analysis;

• Literature review;

• Compliance reports;

• Collection of demographic information;

• Semi-structured interviews with two cohorts: early and late adopters (information was gathered at one point in time, across a range of participants who fell into one of these two cohorts). The purpose of this design was for the researcher to develop an understanding of the differences in outcome between the two groups (Ovretveit 2014); and

• Two focus groups with key stakeholders: members of the senior leadership group and educators.

The quantitative component involved an examination of the training compliance data collected by the organisation. The qualitative component consisted of 22 semi-structured interviews with nurses, doctors, and other members of the multidisciplinary team, and two focus groups with key informants, including clinical nurse educators, nurse educators, senior managers, and executives. The interview participants were purposively selected from two distinct cohorts of learners—‘early’ and ‘late’ adopters—allowing comparison between the two. The early adopters completed their learning within required timeframes, and the late adopters were yet to complete their mandated requirements, despite having had the same length of time to complete them. The interview and focus group data were analysed thematically, revealing the true complexity of the nature of learning and the requirement for mandatory training, which has remained mostly unexplored in this context to date.

Discussion

In cohort evaluations, participants can be chosen on the basis of high or low performance on some outcome metric to examine why some perform better than others, and of variables that might influence those outcomes. A cohort approach was ideal for this study, as it allowed the researcher to gain a unique perspective, insight and understanding of the experiences of healthcare workers from two distinct cohorts: those who had completed their training within a certain timeframe and those that had not, ‘early and late’ adopters of a new organisational policy requirement to complete state-mandated training.

A number of themes were identified from the data and included phenomena such as time and workload, prioritising patient care and services, relevance, culture, leadership, and support. Exploring these themes revealed a layering of perceptions, beliefs (both professional and personal), values, workplace cultures, and expectations that enhanced or decreased motivation, with clear differences emerging between two purposively selected cohorts of learners, ‘early’ and ‘late’ adopters. The analysis demonstrated that the cyclical nature of the organisation’s collective focus on mandatory training led to a high level of scepticism and cynicism in the late adopter group and left many in the early adopter group also questioning the value of the learning. This pressure of organisational compliance led to healthcare workers feeling stressed, anxious, and often resentful of what they believed was an additional (but avoidable) stressor in an already pressurised working environment.

The study enabled the researcher to gain insight into the active and ongoing relationship participants have with their required learning. The results provide evidence that the participants must negotiate a complex range of workplace factors that either facilitate or impede compliance. Also, important, and unique, was the understanding brought to the subject by the lived experiences of the two distinct cohorts of learners. These perspectives, from differing professions and backgrounds, have demonstrated how the active relationship between the participants, their work, role, and responsibilities as healthcare workers, and their organisational mandatory training, obligations are underpinned by personal and professional values and beliefs that influence motivation, attitude and, ultimately, compliance. What the participants perceived to be relevant and important for them, in the context of their role and their work, would ultimately determine their willingness to comply with all of their expected clinical governance obligations.

Conclusion

There are a number of organisational supports that can facilitate compliance with mandatory training, and some significant barriers to completion. How the participants respond to these is determined by their previous experiences, attitude, motivation, and approach towards mandatory training. In exploring the unique perspectives of the participants, strategies to overcome recognised barriers and improve compliance have also been explored and reported.

The distinct findings that differentiated the two groups, along with their commonalities, have enabled the researcher to make recommendations to inform organisational practice development and change. Recommendations include organisations enabling a paradigm shift in the language and culture that surrounds mandated workplace learning. Mandatory training requires a re-imagining to replace the dominant negative paradigm with one that is closely aligned with strategic imperatives such as patient and staff safety. A change of name changes meaning and shifts associations. Language is a powerful influence and replacing the name ‘mandatory training’ with ‘essential learning’ provides an impetus towards positive change in an organisation’s mindset, and the opportunity to shift a prevailing cultural milieu becomes tangible and real. This and other recommendations provide a new lens through which to view the phenomenon, and seek to offer insight, as well as a range of practical workplace strategies for those who have responsibility for the management of education and learning, clinical governance, and practice improvement across health services.