Do the issues described in the story below sound familiar? Consider what actions were taken in this case to improve the transfer of learning…

The local maternity clinic provides basic reproductive health services and is visited by many members of the community. Several health care providers have complained to the site supervisor that infections have increased among both staff and clients. In an effort to address the problems, the supervisor chooses a representative group of the health care workers at the site to form a team to conduct a performance needs assessment.

First, the team meets to discuss how to conduct an assessment that will identify the problems and enable them to agree on an outcome that will benefit the clinic.

Second, the team refers to national service delivery standards to identify the acceptable level of infections among staff and clients. A look at the records shows that, at present, infection levels are 40% higher than the acceptable level.

Next, the team searches out the root causes for this performance gap. They find several causes related to performance factors:

• No infection prevention (IP) standards are in place at the clinic — providers do not know what is expected of them
• Supervisors are not giving feedback regarding IP practices — providers do not know how well they are doing
• Necessary supplies, such as bleach, are lacking — the necessary tools are not in place
• IP practices are inadequate to protect clients and providers (e.g., hand washing is inconsistent and not done correctly; providers are not wearing gloves at the appropriate times) — providers do not know how to do their job
• Incorrect procedures are being used to process equipment — providers do not know how to do their job.

The team identifies and designs several interventions that address the root causes for high infection rates at the clinic: lack of supplies, lack of performance standards and lack of feedback given to clinic workers regarding IP. To improve knowledge and skills, the team decides to offer learning opportunities for key service providers in IP practices and to post job aids for hand washing and equipment processing at appropriate locations.

The team is now ready to implement these interventions. The supervisor arranges for several health care providers who play key IP roles at the facility to attend an IP course that combines classroom work with self-directed learning activities that will be completed at the clinic. In preparation for the course, the trainer recommends that the supervisor:

• share the performance needs assessment findings so the trainer can adapt the course to the identified needs and conduct any additional assessment of needs required specifically for the training intervention
• coordinate the training intervention with interventions that target other performance factors
• work with the site team to select the providers who can benefit the most from training and to begin setting expectations for improved IP practices at the clinic
• meet with the learners to discuss the objectives of the training and the expected outcomes that will be developed into an action plan during the training session
• participate in the final session of the course to become aware of the knowledge and skills the providers will be expected to apply at the clinic
• meet with the learners when they return from the classroom portion of the training to talk about how best to implement what they have learned. The learners will share an action plan they have developed and refined during the course describing specific activities to improve IP practices at the clinic, including sharing their new knowledge with co-workers
• post job aids that list key IP steps on the wall near the instrument processing area and sink.

The action plan also includes a schedule for completing self-directed learning activities. With assistance from the supervisor, the providers set aside a time and place to complete these exercises. They also inform the supervisor that in the next few weeks the trainer will be visiting the site to help them address any challenges they have encountered while implementing the steps in their action plan.

The supervisor and providers continue to monitor the quality of services, and within several months the number of infections has not only decreased but is the lowest it has been in years. These improvements translate into better health outcomes for clients and a safer environment for health care workers.