Jane Bozarth, in the January 12th post on her blog, Training Day, writes about surgeon Atul Gawande’s article in The New Yorker magazine titled The Checklist. This is the story of how simple procedures instituted in the intensive care units (ICUs) of hospitals to remind nurses and doctors of the “minimum expected steps in complex processes” and providing them with the supplies they need and the authority they need has dramatically reduced the number of infections and deaths and has reduced costs to each hospital by millions of dollars.

Every one of the doctors and nurses in these ICUs had been taught, at some point in their careers, the right procedures for preventing patient infection. However, for a variety of reasons, they had not been following protocol: “not enough time”; “lack of resources”; “this is the way we’ve always done it.” Sound familiar? More training wasn’t going to help. The performance improvement solution was a combination of a job aid (checklist) and changing the role of nurses and administrators on the unit.

Maybe you aren’t making life and death decisions everyday, but the barriers to applying learning and improving performance in most organizations are basically the same as in the ICU. Part of the problem is memory recall and part of the problem is how the organization functions. Training is a waste of time and money if we are not paying attention to these other aspects of the learning and application process.

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