I’ve been lucky be part of some great teams, from work teams to video production teams to on-line learning development teams. I’ve also been on teams, both formal and informal, who function specifically to improve learning and performance. The formal teams comprised training teams and faculty, but the informal teams proved more interesting to me as examples of knowledge networks.
Working at the Brown Schools, I helped develop a risk management program for dealing with our patients’ aggressive tendencies, titled “Management of Aggressive Behavior,” or MAB, for short.
Now, no system has ever been developed to deal with aggression that is 100% effective. But we did develop techniques of intervention that served to de-escalate dangerous situation and safely intervene at an appropriate level to prevent injury to anyone involved. MAB was certainly not perfect, but it did reduce the number and severity of injuries due to patient aggression.
However, as with so much of training, there was the issue of training vs. practice. The standard refrain goes something like that, “Never mind what they taught you in training — here’s what we really do.” To reduce the variance in technique and abuse or injuries due to deterioration of the proper techniques, we recruited an MAB instructor for each of our 7 living units (each had a slightly different patient population).
These unit-based instructors served to bridge the gap between classroom and practice. On their units, they could explain the techniques, and coach workers on proper implementation. And we met as a group regularly to adjust our techniques according to what our unit-based instructors were seeing as effective. Our MAB Instructor Faculty helped gather together the knowledge necessary to continue to improve our program.
When I worked for the state at the Texas Department of Mental Health and Mental Retardation (TXMHMR), I directed a state-wide learning analysis of the over 20,000 direct care workers serving the mentally ill in Texas. I travelled to 13 state psychiatric hospitals and centers to talk with MHWs (Mental Health Workers), their supervisors, trainers, and hospital administrators about how they learned what they needed to know to do their job.
A pilot learning analysis was performed at one site, requiring 3 personnel working over a 3-day period: 9 worker-days in all.
This exceeded what we could budget per facility for a statewide study, so I streamlined the process to focus on the most pertinent data obtained in the pilot study. Our re-worked data collection process involved 2 people working a day and a half, or 3 workdays, for a reduction of 2/3 labor costs. To implement this, I worked w/ the Staff Development Coordinators from the hospitals, pairing them up. For example, Vernon State Hospital and Wichita Falls State Hospital are 60 miles apart. For a day and a half we conducted interviews, focus groups and document reviews at Vernon, with the SDC from Wichita Falls acting as my assistant. After that, we went to WFSH where the Vernon SDC assisted in data collection.
I was startled to discover an almost total lack of sharing of information and experience between the SDC pairs, basically people performing similar tasks in similar settings rather nearby Just getting the pairs of SDC to see each others’ work settings seemed revelatory to them. They knew each other, sure, through statewide HR activities, but not to a point of sharing knowledge or relying on each other. Through the months of data collection, I involved a dozen different data collectors. The informal knowledge sharing that occurred naturally built lasting relationships that helped all concerned.
The state hospitals in the Texas mental health system were all due for accreditation by JCAHO, a process that tends to terrify hospital administrators of any stripe, and psychiatric hospitals fit rather poorly under those standards. What this amounts to is a growing anxiety as inspection time approaches.
Yet, most of our hospitals were really in pretty good shape — they just needed to know that. I was startled to find they were not talking with each other about the upcoming inspections, so I arranged a short series of conference calls among the Directors of Nursing and Nursing Educators I dubbed “J-NET.”
We seeded discussions with some visual aids about process of inspection and improvement, and elicited questions and concerns from the various participants (about 8-12, generally). They began to share solutions as well as concerns and soon, the shared level of knowledge had risen to a point of allaying concerns. By the time the first hospital hit their inspection, we could convert it to a sharing of actual experiences. Did the J-NET make a difference? I think so, and the participants did, too. In the end, all of our hospitals received renewed accreditation status.
Knowledge is a bit like magic in that it seems to avoid proper definition or classification. We speak of understanding and knowledge and wisdom and we sound a little like kids describing cloud shapes in the summer sky. We can, however, expand our personal knowledge when we share information and learning and ideas to grow formal and informal knowledge networks.