This is a true story about changing the paradigm in the head and heart of someone who believed training was the best solution to drive performance. This person is my wife, a long-term medical professional with many years of training, both delivering and receiving, during her career; a tough audience to be sure. My approach was spur-of-the-moment and turned out to be an unplanned dry run for an upcoming breakout session at a performance support conference. Shock and awe ruled the day. Sometimes you cannot break a paradigm, you must blow it up…with a chorizo sausage.
Here’s how it went down…
The down-lights were all turned on and illuminating the island in the middle of our kitchen when my wife turned the corner and saw me immersed in a creative moment. The red wire had just been inserted into the sausage when she stopped in her tracks; hands firmly planted on her hips with that this-better-be-good look on her face; and she let fly, “What the heck are you doing?”
My reply only provoked my bride, “Making a point!”
With arms folded she replied with no hesitation. “Right…with a sausage.”
“Not just a sausage, babe, an IES!”
I knew she did not want to get sucked into what was happening, but she rose to the bait. “What the [bleep] is an IES?”
“An improvised explosive sausage…an IES!”
The most meaningful part of her response was non-verbal; the words that accompanied only served to validate with the slow, disbelieving wag of her head, “You are a very disturbed puppy, my friend!”
Hands in the air in mock defense I replied, “Hey, before you judge me, ask yourself how many days of your life will pass before the image of this chorizo sausage wired to an old wind-up alarm clock is wiped from your memory?”
“Probably never!” she replied, again with no hesitation.
“And that is the point I’m making…a shocking…hard to forget…point!” I explained.
“Okay, so…you have two wires running from a freaking sausage to…”
I interrupted. “A red wire and a blue wire to be exact.”
Temperature began to rise. “Whatever! What point are you trying to make with a sausage wired to…”
I interrupted again. “A chorizo sausage.”
Okay, off the rails she came. “Don’t make me hurt you with that chorizo sausage, boy! Pray tell…what point are you trying to make?”
“My point is simply this…and it is a shockingly simple point…and it is a point that is extremely hard to make…and most of all, it is a point that must be made…and once made…cannot be dismissed as irrelevant,” I began.
“This is about enabling the workforce to make the right decision to DO something…to do something RIGHT when the stakes are high…when failure is not an option…when under the gun to perform flawlessly…to enable a worker to make a decision as simple as cutting the red wire or the blue wire.
This whole bizarre image I’m creating is intended to make the point that deciding which wire to cut is something everyone in our workforce must do every single day of our work lives…and the best results are achieved when we cut the right one. In my job, we have a responsibility to ensure only the right wire is cut…every time…and more importantly…recognize the proven fact that Training by itself ain’t gonna get us to that point!”
“She rolled her eyes and said, Okay, genius…if training’s not the answer what is?”
In an attempt to appease her, I conceded a truth. “Training still plays a role, sweetie, but we both know that what we teach is only as impactful as our ability to remember it long enough to use it. Right?”
“Yeah, yeah, but I’ve never had to disarm a freaking sausage…excuse me…a chorizo sausage in my entire life.”
Staying after my point I said, “And I agree with that…and would venture a guess that you probably never will. But…how many times do your nurses at the hospital confront an urgent issue with a critically ill patient where their decision holds patient safety and positive outcomes in the balance? Under what critical circumstances are they under the gun to make a judgment call where they have to successfully navigate through a red wire/blue wire decision moment?”
She became a little defensive to my line of questioning and said, “We train our nurses very well for situations like that.”
“Certainly, you do, but mistakes do happen, don’t they?”
“Well sure, but rarely,” she confessed.
“Exactly…but they were perfect enough to get through their most excellent training though weren’t they…and even after your best efforts to train them, are errors, no matter how rare, acceptable?”
She exhaled, blowing bangs up in the air from her forehead. She knew I was making a point, and those are rare moments indeed, so I pressed onward while I had the momentum.
“And that’s MY point. The best training cannot guarantee the right color wire gets cut because training includes so much additional information that no human being can remember it all. Don’t we wish things were as simple as red wires and blue wires? But they’re not, and it’s getting worse. Just look at your new EHR system. More complexity. More change. Greater velocity of demand. Humans cannot possibly remember everything we throw at them during training. Training does exactly what training is supposed to do, but AFTER training, when memory fails, is cutting the wrong wire acceptable?”
“There are five moments of need. The first two are where your nurses learn NEW things and dig deeper through additional training to learn MORE or to enhance their knowledge, and you guys do an excellent job of that today. Then your staff goes to the floor and must rely upon whatever they managed to remember. When memory fails and the moment to APPLY that degraded knowledge comes along and a red wire/blue wire moment is encountered, a critical decision must be made…often under duress and critical time restraints. What happens when they cannot remember?
“They ask the charge nurse,” she said.
“Exactly, and if the charge nurse is engaged with another nurse and cannot respond…and the urgency “clock” is ticking… [and I patted the old wind up alarm clock to make my point] …they ask another nurse, right…they rely upon tribal knowledge…or worse…they guess, am I right?”
She did not answer. The wheels were turning.
“Training can only address the first two of five moments of need. The other three moments happen after training at the Point-of-Work, and to make matters worse, what they’ve learned during training begins to degrade as soon as they leave the classroom, and at a very rapid pace.
What we need to do is supplement the ability to remember…and equip your nurses with that capability to remember…at their individual moments of need at the bedside…do I cut the red wire or the blue wire?
Training as it’s designed today cannot go to the bedside, but there is nothing preventing us from supplementing the knowledge that gets lost. We just need to be intentional about what we want those nurses to remember when it comes time to cut the right color wire. We have to be intentional about designing the support necessary to address their post-training moments of need that only manifest at the Point-of-Work where cutting the wrong wire can spell catastrophic results.”
She turned on her heel knowing her paradigm had just been blown up and reached into the pantry and pulled out a can of seasoned black beans, placing it on the island next to the ticking chorizo with some authority. “I hear what you’re saying, sweetie, and I agree with you, but I have only one request. After you’ve disarmed that sau…that chorizo sausage…fix us something to eat. Your point has made me hungry.”
The Point of Failure
Ridiculous? Yeah, maybe a little…maybe a lot to some of you, assuming you got this far in the post.
Point-of-Work is where Training fails our workforce. Training alone is not enough to sustain workforce capability. Point-of-Work is out of scope. Point-of-Work is not covered in the training charter. Point-of-Work is not part of the training paradigm. BUT…it should be…and that’s the paradigm shift this little story is intended to illustrate.
Point-of-Work IS part of our learning performance ecosystem and that has implications on how we [L&D] step out to discover, design, develop and deliver the appropriate blend of assets to cover all workforce moments of need. The can only be accomplished if we understand the attributes affecting performance with a Point of Work Assessment methodology.
We cannot permit Point-of-Work to become the point of failure and that’s going to require blowing up some status quo training paradigms. Consider lighting the fuse with us on the new POINT-of-WORK Performance Support Solutions networking group.
Is anybody else hungry?
Thanks for reading and take good care!