How much is too much training?
I’m divided in this, but lean towards only brief training, just enough to inform them, rather than enough to practice.
On one hand, it pays to understand why change in general is necessary and specifically, why the change that you’re about to implement is necessary. Often I see professionals who spend time with the person sat in front of them (and so they are patient-centred) but ignore the mass of people also requiring the same service. It’s not that they can’t see the queue (whether a real standing queue or a waiting list), it’s that if they recognise the queue then they realise that they can’t serve everyone to the same level. For some, it’s a question of professional ethics, where their professional body demands that they treat the person in front of them to the best of their ability, regardless of the needs of others. There are good reasons for that approach.
Usually, someone, e.g. a manager or budget holder, recognises the capacity issue and so increases the eligibility threshold or reduces the professional time available for that treatment. This is an attempt to average it out. However it misses the point that some treatments take time to work, if you half the time available, then you may get zero results, not 50% of the results had you allowed the necessary time for full treatment. It also leads to a worsening service as the capacity gets further reduced through a series of cuts, so that wouldn’t be the answer that we’d choose given a choice.
More fundamentally, the communities that the local and regional health providers serve are different to those that existed 30 years ago and the changed communities have different needs. So, it seems obvious that we have to adapt the service to meet the changed needs.
On the other hand, the health professionals are just that; professionals in health. There will be some with additional skills; some complementary, some tangential. I wouldn’t expect health professionals to be experts at change. However they do need to be aware of the change and why they have to contribute. As do we all, no matter what job we perform, no matter which sector we work in.
By recognising the above issues, we can more easily understand why we have to continually change. It’s a matter of adapting to needs. However that doesn’t feel like it requires a formal training in the guise of a university module, more an hour or so during induction combined with some questions during the interview to assess their attitude to change. I expect the professionals to know the service best, so they should be best placed to change it rather than having budgetary changes applied without thought to impact on patients.
To get this message across and gain acceptance and commitment from the group, I usually go through the need for change at the start of any change programme and definitely before each intervention.
One area where I think some training could be useful is in negotiating and debating how services will change. The changes will happen, but being able to influence the changes could be invaluable. Oddly enough though, it’s probably not the health professionals who need the training, instead it’s for anyone who’s trying to change the service, e.g. performance improvement staff, HR/OD, commissioners, etc.
I think the reason for my varied opinions above is that I see a difference between management and change management. I acknowledge that management techniques should be taught in advance as well as broad concepts of changes management, whereas the required, more detailed parts of change management can be taught as required.
I don’t believe we should conduct changes without speaking to the end customer. Taking on the role of patient, I’d much prefer the consultant to have spent their time learning how to treat patients, rather than learning how to manage change. Let’s permit some degree of functional specialisation, with front-line professionals continuing to be good at what they do and change professionals helping them create/design the service that the patients need.
However, I recognise that many front-line professionals either don’t have access to change professionals or do have access but that they’re not listened to. Hence the need for a book that’s applied for front-line staff.