Coaching and Practice Improvement

Does learning lead to practice improvement?  I have done some learning research, and I used to think that learning was the really important thing.  If we carefully designed our instruction to maximize learning, that meant that people would be able to use that knowledge to in their work. 

Experience and a much broader view of the learning literature though, has taught me that improving people’s work performance is not always simply about learning.  Sometimes, helping people perform better at work is like helping them change their behavior.  And behavior change is hard.  Smokers all know that they’d be better off quitting, and we all know that losing weight is as easy as exercising a little more and eating a little less.  It’s actually using that information and knowledge that’s the hard part. 

Recently, I've been thinking of performance improvement a little more like behavior change.  It often takes more than just a learning session or two to make an improvement and there may be times when people need a lot more than just learning a new skill.  They may need a little more help and coaching to use their new skills in their jobs.  

A recent paper (JAMA, 2010;304(15):1693-1700) discussing the adoption of surgical safety procedures shows the effect of coaching after the learning intervention.  The surgical teams learned to use new safety techniques by a three step process – planning for the change at the facility, a one-day training where the teams got a chance to practice their new skills, and follow-up coaching by phone.  The intervention was successful. 

The interesting thing was the effect of the coaching.  Teams that got more coaching had had better scores on safety measures in a clear dose-response effect:

Of interest is the dose-response relationship between the number of quarters the training program had been implemented and the rate of surgical mortality. As facilities implemented longer, their rate of surgical mortality decreased further. This suggests that it is critical not only to provide training but also to ensure that the tools are fully integrated into the surgical service. The year-long follow-up was helpful in ensuring that OR clinicians adopted the training tools and changed practice patterns.

Improving performance may sometimes involve more than just teaching people new skills, you may need to help them adopt those new skills as well.