Thought Leadership Healthquake™: How to Make Learning Stick

Why doesn’t learning stick following training? One of the most common reasons is that the training wasn’t done properly. Others include: an apprenticeship model was used; there wasn’t appropriate follow up; and/or the “three times rule” wasn’t followed.

The business of healthcare is driven by training and retraining. Doctors, nurses, office staff, administrators, and billers are all trained along with hundreds of other job functions in the medical system.

Training is the backbone of successful medical care because so many new processes and technologies contribute to the most up to date care and administrative support. It’s a multi-billion-dollar business. Unfortunately, despite all the money and effort, a lot of what is taught doesn’t stick.

This failure of training prompted a Harvard Business Review article suggesting that training might be a waste of money. If it is, what can be done about it? How can training improve? What can be done to make it stick?

As patients become more demanding, the customer-facing part of a medical practice is being forced to learn new behaviors ranging from how to more effectively explain patient financial responsibility and to making patients feel valued. As insurance companies become more demanding, the support staff must get even more focused on following precise processes when checking and inputting patient data.

The easiest way to make sure training sticks is to watch people apply what they’ve learned until you know they’ve “got it”. Unfortunately, it takes time to do this, which is why many medical practices shorten this step with the predictable result that the learning doesn’t stick, the person who was trained often gets blamed, and the cycle starts again.

However, the cause of why it doesn’t stick often starts with the training itself. It can even start with a doctor who has the best intentions.

Most doctors didn’t go to medical school to run a business. They went to learn medicine. When faced with running a business, they often abdicate responsibility for running their business by assigning it to someone who says they’ve done it before, and the doctor isn’t usually qualified to check the level of that person’s skillset. There is an assumption that experience or enthusiasm translate into “conscious” management and training skills, which is seldom true. This means that necessary staff training might not be done properly the first time which almost guarantees it won’t stick.

Too often, “training” is simply a version of “watch what I do and then do it”. This apprenticeship system has been problematic for over 100 years, specifically because the apprentice often learns the “wrong” way to do one part of the process at the same time they learn the “right” way to do another and isn’t clear on the difference, mostly because the trainer doesn’t know, having turned their behaviors around the task into habit years earlier. It’s a recipe for disappointment on both sides.

Whether the training is technical skills (billing, coding, etc.) or people skills (customer service, etc.), it must be structured properly, starting with expectations.

The person being trained needs to know what’s expected of them after it’s over. If that’s not clear, the learning isn’t likely to stick because they won’t be able to frame how they intend to apply it while learning it.

Another step in having learning stick is to formally follow up on the training to see what is sticking and what isn’t. This means formally setting a time to review the application of the learning with the person applying it. For example, if the training has focused on accurately entering all patient data when the patient is at the front desk, but one step is being missed from time to time, the review can focus on what’s getting in the way of 100% accuracy.

There can be a number of causes and fixes but two of the most common are improper training or just not applying it. If the person was trained the wrong way and then reverted to earlier behavior, it requires “fixing” the training. Or, the person might not want to do what they were trained to do, and no one is doing anything about it – which is a management issue that can focus on why the person is giving themselves permission not to do their job. In this case, either or both the manager and the employee might be the cause of the problem.

Surprisingly, there are very few books on how to make learning stick. Even one of the best known, Make It Stick, misses one of the simplest and most effective ways to check whether learning is sticking. We call it the “3 times rule”.

If the person has been trained properly, watch them for the first 90 days after training until you have seen them do the thing you want them to do 3 times to your complete satisfaction without any prompting, coaching, or encouraging. Just watch. Once they have done it the way you want 3 times, the learning is sticking.

When we ask managers why they don’t follow the 3 times rule, we usually hear that it takes too much time. When we ask how much it costs to fix the same problem over and over or about how much money is left on the table because of ongoing mistakes, we hear versions of “there’s never enough time or money to train right but there’s always enough to fix it.”

For many practices, the best way to avoid this cycle is to outsource or to automate parts of the process. Outsourcing and automation will be covered in future issues of the Healthquake™ series.