How can you use evaluation to improve the effectiveness of your nursing education?

Podcast Transcript

Wayne: Hello and welcome to the very first episode of the Care to Learn Podcast. Each month we will sit down with interesting and influential professionals working within healthcare and education and talk about what makes training programs actually work.

My name is Wayne Woff, coming to you from Ausmed Education, and I’ll be your tour guide over the ensuing weeks and months.

We’re enormously excited to welcome our first guest to CPD Matters, Cynthea Wellings, who is the founder and CEO of Ausmed Education.

Founded in 1987 as a publishing company, today Ausmed is Australia’s leading provider of CPD education for health professionals and home of the award winning CPD App.

In today’s discussion we’ll touch on planning, evaluation and most importantly, translation to practice, and Cynthea will share some tips on how to ensure your education actually works.

So, let’s get into it.

Wayne: It’s terrific to welcome our CEO Cynthea Wellings to CPD Matters for our first podcast in the series. Welcome to you Cynthea.

Cynthea: Thank you.

Wayne: We’d like to kick off today with a little bit about your professional and business background.

Cynthea: I studied as a nurse and did my original work at the London Hospital. I then came to Australia and did a whole raft of things.

I got very interested in incontinence and was one of the founding members of the Australian Continence Foundation, which is an important organisation now.

Over the years I’ve always been passionately fond of nursing because I fundamentally believe that nursing is the professionalisation of compassion, and I think it’s very important to our community that we have that.

So my background, well, I was awarded one of Australia’s 100 Women of Influence several years ago and I’ve done courses at Yale and at Harvard in business, so I’ve sort of mixed nursing and business together all the way through my career. Recently, I’ve completed a Masters of Nursing in Nursing Leadership.

I’m very happy with where I’m at now and of course all through this I’ve woven working at Ausmed, which has been a great journey.

Wayne: And that journey at Ausmed started back in 1988?

Cynthea: 1987, it’s been a long time. Ausmed started when I wrote a book on urinary incontinence with a doctor. We sent it off to publishers in the northern hemisphere and we never heard back. So we self-published. And that was the start of the little publishing company, which in those days was called AECD Publishing.

I started to realise that while I was working with a lot of talented nurses, none of them were ever able to get published in books. It was almost impossible because there was really no outlet down here; there was just one small company at the time. So I started to publish some of my colleagues.

Over the years we changed from a publishing company to a nursing education company, in fact we published our last paper book several years ago which was on palliative care. So, throughout the journey of the company it’s been very interesting and very adaptive.

Wayne: And that journey has taken you through conferences and seminars and now to more a tech-based company in part.

Cynthea: Yes, I think the secret to survival is to be highly adaptive; being able to flex and adapt, but also to understand that disruptions can happen. You have to build an organisation that can’t control for all risk, but that can actually be adaptive so that when events occur you can adapt very quickly to minimise the impact of those risks, and always in the best interests of people.

Wayne: The other thing that we’d like to do now is just to start off with some warm up questions in the space that we want to talk about, healthcare and education. The first one of those, do you prefer doing online or face-to-face learning?

Cynthea: I think that’s an incredibly interesting question. I think our brains work very differently depending on the medium. For instance, if you’re reading something it likely activates a brain network that is very different to if you’re listening to something. And if you’re listening and looking then it is likely that different parts of the brain are activated again. So I don’t think you can compare one or the other. I think there’s a place for all types of learning, and I don’t think that any once size fits any one person all of the time. I think probably the best CPD is a mix.

Wayne: And across your extensive and very diverse career, what’s the best advice you’ve ever received about CPD learning?

Cynthea: I used to think it was to find out as much as you can as fast as you can. But I’ve actually changed that now because I think it’s no longer possible for a human brain to be a repository of fact. There are just so many facts and so much new knowledge coming out all the while, that at some stage you just have to acknowledge that that has to be held in a difference medium.

The days of the brain being that of a good memory alone, of people with the best memories getting the best jobs, is changing. My feeling now is that it’s all about intellectual sharpening. The future of education will be in encouraging people to think well, to know how to use facts and find facts, and to be very aware of what they don’t know. The future is for those people who know how to ask the right questions. Once you know what question you’re asking, you can find the answers. The answers are everywhere, but it’s formulating what you want to know and sharpening up on that.

Wayne: Terrific, I think that’s a great insight for our listeners. Now we’ll drill down a little bit more specifically, to look at an organisational perspective. So from that perspective could you give the listeners an overview of what a great education and training plan looks like?

Cynthea: I think that's a really interesting question. At the end of the day, we should be asking: does it work? What does it mean for the person who is receiving the results of that education? It is one thing to put knowledge into someone’s head, but if it resides in the head with no meaning then what value is that?

So, I think the next frontier is: what works? How can you provide education that resonates so that within minutes, or the next day, or the next hour it can be effectively used. And that is for us, the real challenge. There’s lots of reporting available to say that we provided all this education, but so what? If it didn’t work, what’s the point? And so I think we need to flip this on it’s head and instead look at the outcomes for patients. We need to answer the questions: how are we making a difference? And how is that linking with the up-regulation of knowledge within the organisation?

Wayne: So, just picking up on a couple of the points that you made there, do you think it’s fair to say that people at times play the volume game too much? The more that I get out there; the more that I ask people to do; the more that I give people; the more events they go to will automatically lead to better outcomes?

Cynthea: Yes. Vomiting education onto people is finished. That kind of thing just doesn’t work. I think what works is when you stimulate people to have voice; you stimulate people to challenge; you stimulate people to think about the 'so what?'; 'how does that work?'

Last year we conducted research where we analysed 1000 evaluation forms from our seminars which asked three main questions:

1. What one change would you make as a result of what you’ve learned?
2. How will your patients benefit from what you’ve learned?
3. What barriers do you perceive will prevent you from putting into place what you’ve learned?

It was just extraordinary how many similarities there were in the answers. Even though the 1000 seminar evaluations that we looked at reflected seminars that had occurred in Perth, Brisbane, Melbourne, Sydney; they were from seminars relating to palliative care, neonatal programs, leadership programs; So they were right across the board. But the kind of issues that were raised were reasonably similar.

One particular thing that did come through in the second question was a great sense of nurses truly wanting the best for their patients. It was one of the most spiritually lifting research projects you could have done, to be honest.

The barriers, if I can just focus on that, were also quite consistent. Time was a big barrier. Nurses and midwives definitely perceived that time is a big barrier to putting into place new knowledge. Another barrier that came up a lot was push-back from other staff. The inference there, in my opinion, was: 'If I know about a new way of being, as a result of taking myself out of my work environment and learning a new way of doing something or a new way of practicing, and then I go back to my work environment where no one else has been exposed to this, it is difficult for me to then put that new knowledge into place. The pushback will be hard because my colleagues don’t know about it’. This was a big concern. There were others, but we really looked into this barrier. At Ausmed, we are now working on providing education that can cut through some of these barriers and so be truly effective, because unless it’s effective, what’s the point?

Wayne: So just to tease that out a fraction more for our listeners, in terms of the evaluation conversation, in terms of the translation and the improvement of practice to the benefit of the client or the patient, it would be fair to say that the quality and the depth of the evaluation, the analysis and the actual benefit of that education is hugely important?

Cynthea: Yes. I think one of the interesting things that we discovered was that the evaluation tool should not just ask: ‘What did you learn?’ At the end of the day, unless what you learn can be used, then so what?

What we’ve been doing at Ausmed is playing around with our evaluation tools and asking people to envision what will change as a result of what they’ve learned. We think that by envisioning and planning in the learner's mind how the change would look can then extend into the future.

The difficulty that Ausmed has is that we can evaluate at the point of closure of the event or a few months later, even, but it’s all self-reporting. We can’t actually see what changed in the work environment as a result of our education. We can only go on what people report, and that’s a real weakness for us. But that would not be a weakness for a facility where it’s much more measurable.

The work that Bernadette Melnyk is doing at the Ohio State University on translation to practice and the use of mentoring, is finding that using a mentor to help a learner translate new knowledge into practice is a great way to build confidence. Confidence is a huge issue in terms of translation to practice. And that certainly came out in our research as well.

Wayne: So it would be fair to conclude our discussion on evaluation and translation into practice by saying that particularly at an organisational level people mustn’t see that that evaluation process isn’t the end point, but that there’s a logical extension of the evaluation findings that must be acted upon otherwise it will be ‘so what?’

Cynthea: I think that’s a really good point Wayne because if you are going to invest in ongoing education, it needs to work. Education is such a costly thing: you’ve got people off wards and you’re paying for the quality of the education. And if it makes no difference at the end of the day, then there’s no point in doing it.

The evaluation is critical. It’s not just a report on how many people turned up. In our experience, evaluation a wonderful way to assist in the translation of knowledge into practice simply by changing the mindset and expectation of the learner.

But then, as I say, that’s just the beginning of the journey. The next part of the journey is handing over the findings from the evaluation to the organisation and asking: 'How are you going to ensure this knowledge will be translated into practice, up-regulate the standard of care that you’re providing and be able to demonstrate that education has been effective?'

Wayne: We’ll conclude our podcast today with a final few questions. The first one, I probably have a pretty good insight into this given the discussion that we’ve just had, what’s the one question that you would always ask on an evaluation form or process, whether it be online or in writing, what’s the one question you would always ask?

Cynthea: I think the critical question is: 'So what?' It’s all well and good to be able to list 3 medicines that interact with warfarin, but so what? What’s going to change as a result of what you now know? If you’ve established that there’s a need for the education, that you’re closing this gap by providing that education. At the end of the education, how are you actually going to close that gap? How are you now going to ensure, and how are you going to measure, that that gap was actually closed? And was it closed? Is education enough to close that gap? Probably not; in many cases education may not be the answer. It may be that the policies and procedures need to change or that the system has to have better resources, or that there’s not enough sufficiently educated staff on board to actually provide the comprehensive care that’s required. Education per se is never going to close that gap. So it’s really understanding what the nature of the gap is in the first place and then evaluating to see whether you did in fact close it.

But I caution here, because our research has also shown that if you just focus on needs and gaps, then you’re missing out on the broad perspective of discretionary education which can elevate levels of emotional intelligence and enrich the provision of care. For example, if you’re in aged care you provide education on falls, dementia, correct use of medicines in aged care et cetera. But what about PTSD? That may not seem like an educational imperative in aged care, but it may be critical to a great many of the people who are in a given facility. So I think the discretionary education is really what makes the difference in that quality factor. If you just focus on mandatory education you’re going down a very dark tunnel of reductionist thinking.

Wayne: So I think we can take from Cynthea’s answer there that the evaluation form that focuses on the chairs, the coffee, whether you like the speaker or not might have a little less value now than it previously had. The second question, which I think will be of interest to a number of our listeners: what’s your top tip for engaging reluctant learners?

Cynthea: That’s a really interesting question. I believe that everyone is inherently curious. I think that the one-size-fits-all approach is not the answer. The idea is to get underneath and figure out what the motivational buttons are. And there is not but one; it’s complex. People are becoming more and more complex now, and they have so much choice and so much distraction. And so I think you’ve got to do it well, you’ve got to do it slow, and you’ve got to do it rigorously. But the payback downstream, in my opinion, is self-evident.

Wayne: And I think that also reinforces in a healthcare environment, in a nursing environment the need to personalise, whether it be with our clients or whether it be with our staff. And we don’t address those issues at our peril.

Final question: What’s your favourite personal learning tip?

Cynthea: I think slow and steady, day by day, brick by brick. I personally spend at least an hour a day learning new things. I am intently curious.

Wayne: I think, ladies and gentlemen, that is a perfect point at which to conclude our first edition of the Care to Learn Podcast with that point about curiosity and lifelong learning, and we thank Cynthea for her great discussion today, her great insights. We hope you enjoyed this enormously, and we look forward to bringing you episode two coming up soon.

Click here to watch Cynthea's lecture on evaluation that she delivered at the What Great Nurse Educators Do! Conference in December 2017.