Workflow learning and performance support are terms you may be familiar within a learning context. There are many articles that describe these terms, such as 5 Fundamental Ways Workflow Learning Differs from Training or Five Reasons to Use Performance Support. In this article I will describe a real-world scenario where these concepts are used in practice, and I will show you a video of a digital platform that implements them.

The healthcare industry has many areas where it can improve by changing methodologies on how work is performed. A use-case I am writing about today is in a hospital setting where a precision medical instrument such as an endoscope is reprocessed between patient uses. In the current state, reprocessing endoscopes follows the traditional learning path. A new employee is given a manual of the process, which for certain instruments can be 100+ steps including diagrams. They also have classroom training time on the process, which includes both practice and simulation.

When they don their personal protective equipment, they are covered head-to-toe with a gown, shoe-coverings, head-coverings, masks, shields, and gloves. Due to the nature of the activity, and since their uniform resembles that of an astronaut, utilizing a physical manual is not practical in order to preserve a sanitary environment. Therefore, this process is often completed from memory. In the past, healthcare organizations have tried wall poster job aids that at least cover the high-level processes but since there are many different types of instruments and they each have their own nuances for re-processing, the effectiveness of these job aids was minimal. A recent study performed by the hospital highlighted the need for good performance support regardless of the experience level of the sterile processor. Even employees that had been conducting endoscope reprocessing for 15+ years improved their performance.

Since the process was performed without good performance support, hospital administration did not have good data on the effectiveness of the process, or where it could potentially be improved. There is a huge cost if the very expensive instruments are damaged, or much worse if they are not cleaned effectively to prevent the spread of bacteria or disease between patients.

So how can this process be improved? One of the largest academic medical centers in the US sought to find out. They started developing the requirements for such a system in-house when their Chief Medical Informatics Officer (CMIO) learned that a digital platform was already being utilized in one of the safest industries in the world...aviation.

Many in healthcare (and in eLearning) have read the best-selling book The Checklist Manifesto: How to Get Things Right by Atul Gawande. Dr. Gawande is currently the CEO of Haven, the healthcare conglomerate formed by Amazon, Berkshire-Hathaway, and JP Morgan Chase, who are tackling the challenges in healthcare for their own companies. The book followed Dr. Gawande going to companies and industries where checklists were heavily used, like Boeing in aviation, to understand their methodologies. He then tried to apply these critical processes to his world of surgery and explore how they may reduce medical errors.

He was very successful in his quest, resulting in documented surgical procedures being published by the World Health Organization. Such checklist procedures are currently used around the world and have saved countless lives. From day one in aviation, checklists are ingrained in a pilot’s workflow to reduce human error. As pilots progress from student pilots to commercial pilots and then to transporting passengers, the checklists may change but adherence to them increases. As a pilot's workload gets more complicated and the lives that are in their hands (literally) increases, it becomes nearly impossible to remember every single step that must be completed on ever-increasingly complex machinery. Should healthcare be any different?

In the real-world scenario, the hospital CMIO set up a trial using an emerging digital technology platform called AmbiFi. AmbiFi’s roots are in aviation, workflow learning, and performance support, and scaled to other industry verticals including healthcare. There are already thousands of aircraft pilots utilizing an offshoot of the product called MiraCheck in the small confines and harsh conditions of an airplane cockpit. CMIO asked for a demonstration of this technology in multiple use-cases within the hospital. The requirements for a solution included:

  • Operating completely hands-free
  • Works offline without network access
  • Real-time data collection
  • Centralized dashboard
  • Ease of authoring content
  • Content agnostic
  • Device agnostic

The outcomes of the hospital test, using an application dubbed Mira (similar to MiraCheck) provided some amazing insights. Combining Mira’s vocal and visual instructions into an integrated experience helped to prevent overlooking steps or misunderstanding expectations. This video shows how the process worked during the pilot.

Unexpectedly, after going through the process a couple of times, the time to perform the procedure was cut drastically; from 35-40 minutes when completed from memory to 25 minutes. Providing structure helped to improve the process flow.

It is important to note that these findings were realized utilizing the current content for the process. Because data on every step is now collected, and utilizing the capability allowing users to provide instant feedback, further improvements and optimizations to the process will be made.

For new employees that need to learn the process, Mira provides true workflow learning and performance support. All of the steps are laid out for the employee performing the process, and when more detailed information is needed it can be instantly called up. This information can be text, an image, or a video giving further instructions. It provides both new and existing employees with the information they need, at the moment of need. It also allows them to learn the process within their workflow, which will drastically cut down on the time they need to spend learning outside of it. The cost and time commitment of dedicated resources to enable them to perform the procedure correctly will also be reduced. This gets to the heart of the meaning of workflow learning and performance support and how adopting such a system can help improve many outcomes from your own business processes.