Helen

= =  **Helen M Wood**   **A00277669**   **helen.wood@waldenu.edu**   **Lead & Manage Ed Tech (EDUC - 7103 - 2)** = = = =  **Rita Conrad** = = = =  **Walden University** = = = =  **June 20th 2011** = = = =  Replacing a learning Management System = = = =  Mayo Clinic ﻿Rochester = = = =
 * Replacing a Learning Management System**

**Problem Summary:**
The problem that has been identified is that the nurses are not completing their online competencies and assignments within the required time frame.There are various reasons for this not least of which is that a fall-out of budget constraints and the hospital restructuring of the 1990s has seen a reduction in hospital educational budgets to support orientation, and ongoing in-service training and continuing education for nurses and intructors. The online competencies and assignments are required for the hospital to maintain it accreditation.

**Background of Organization:**
Mayo Clinic developed gradually from the medical practice of a pioneer doctor, Dr. William Worrall Mayo, who settled in Rochester, Minn., in 1863. His dedication to medicine became a family tradition when his sons, Drs. William James Mayo and Charles Horace Mayo, joined his practice in 1883 and 1888, respectively. From the beginning, innovation was their standard and they shared a pioneering zeal for medicine. As the demand for their services increased, they asked other doctors and basic science researchers to join them in the world's first private integrated group practice. Although the Mayo doctors were initially viewed as unconventional for practicing medicine through this teamwork approach, the benefits of a private group practice were undeniable. As the success of their method of practice became evident, so did its acceptance. Patients discovered the advantages to a "pooled resource" of knowledge and skills among doctors. In fact, the group practice concept that the Mayo family originated has influenced the structure and function of medical practice throughout the world. Along with its recognition as a model for integrated group practice, "the Mayos' Clinic" developed a reputation for excellence in individual patient care. Doctors and students came from around the world to learn new techniques from the Mayo doctors, and patients came from around the world for diagnosis and treatment. What attracted them was not only technologically advanced medicine, but also the caring attitude of the doctors. Through the years, Mayo Clinic has nurtured and developed its founders' style of working together as a team. Shared responsibility and consensus still provide the framework for decision making at Mayo. That teamwork in medicine is carried out today by more than 55,000 doctors, nurses, scientists, students and allied health staff at Mayo Clinic locations in the Midwest, Arizona and Florida. Over view of the Education Program at Mayo Clinic Rochester: Mayo Clinic (Rochester) has been finding answers to people's health problems for more than 100 years. Mayo Clinic, Saint Mary’s Hospital and Rochester Methodist Hospital form an integrated medical center dedicated to providing comprehensive diagnosis and treatment in virtually every medical and surgical specialty. Patient care at Mayo Clinic is supported by advanced programs in medical/nursing education and research.

2010 Statistics
Mayo School of Continuous Professional Development (MSCPD) has a distinguished history of teaching physicians, nurses and other allied health professionals the latest, most advanced medical and surgical practices. Mayo Clinic, in fact, has been training medical professionals from throughout the world for more than 100 years. Mayo Continuing Nursing Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Established in 1974, The Accreditation Program of the American Nurses Credentialing Center recognizes organizations (or components of organizations) that offer high quality continuing education for nurses. The Accreditation Program contributes to healthcare quality and professional nursing practice by providing a voluntary peer review process that defines standards for organizations that elect to apply for accreditation. The Accreditation Program accredits individual educational programs designed to validate nursing skills or skill sets through the Nursing Skills Competency Program (NSCP). The NSCP provides assurance for consumers, organizations and regulating bodies that nurses are competent to perform an individual skill or set of skills. It also accredits individual educational programs that yield or validate a nursing skill. A hospital can use this accreditation to substantiate the skills of its nurses to accrediting bodies, third-party payers, and consumers. Manufacturers or distributors of commercial healthcare products can communicate their commitment to ensure appropriate use of their products by the healthcare provider.
 * Staff physicians and scientists || 2,016 ||
 * Residents, fellows and students || 2,789 ||
 * Allied health staff (clinic and hospital) || 27,544 ||
 * ** Total ** || ** 32,349 ** ||
 * Accrediting organizations and regulatory bodies**

Stake holders and Decision Makers
The ultimate people affected by my plan will be the patients that the nurses care for but there will definitely be others affected as can be seen by the following table

//Criteria// A typical LMS can take months, if not a year or more, to implement and can cost hundreds of thousands of dollars. Getting it right is critical.
 * Stake holders are those people who will directly, or as representatives of teams, be affected positively or negatively by your project. In identifying stake holders, you want to assemble a cross-section of the organization that will provide input into defining, prioritizing, and evaluating requirements. || //Stake holders to Involve// ||  ||
 * Is your LMS project specific to one department, or is it global? || * Head of the department that will be affected. If the LMS implementation will be global, a sample will be needed from the largest impacted departments. ||
 * Does your LMS content target specific groups of end users, e.g., Registered nurses? || * Super-users from these groups. Pick those who can help evangelize the changes when they are launched.
 * Trainers from those departments or groups. ||
 * Is your LMS project part of a larger project or program? || * The program manager or head of the entire program. ||
 * Will your LMS project affect people’s jobs, roles, hours of work, etc.? || * A representative from human resources. ||
 * Will your LMS project change vendor or other contractual relationships? || * A representative from the legal department. ||
 * Will your LMS content use branding guidelines, corporate content, or existing marketing materials? || * Brand steward, director of marketing, etc. ||
 * Will your LMS project require new hardware, servers, or technology changes? || * Head of information technology (IT). Sometimes IT has specific groups focused on hardware and server infrastructure. ||
 * Will your LMS project require custom software development? || * Head of information technology. Sometimes IT has specific groups for application or software development. ||
 * Will your LMS affect private or secure data, such as customer data, employee data, or financial data? || * Privacy or security officer. ||
 * Will your project affect business processes outside of the LMS? Does your learning/training approach change other business processes? || * Heads of departments who run these processes.
 * Business analyst or process experts who can review and approve changes to general business processes. ||
 * Does your LMS performance affect how employee job performance is evaluated? || * Head of human resources. ||
 * Does this project have executive visibility or global impact? || * Senior-level executives, especially as a project sponsor or steering committee. ||
 * Is this project being rolled out to multiple locations, countries, or languages? || * Representatives from each location, language, or country. ||

**Performance Gap: Cause Analysis:**

 * N**urses are assigned online competencies and assignments on January 1st each year through our current Learning Management System. The expectation is that all nurses (100%) will have completed these on or before June 1st of the same year. Currently only 40 % of the nurses are acheiving this level in the reqired timeframe

What is the gap between where the organization currently is and where they want to be regarding the problem stated? States as the following:

**Actual Current Performance.**
.
 * N**urses are assigned online competencies and assignments on January 1st each year through our current Learning Management System. The expectation is that all nurses (100%) will have completed these on or before June 1st of the same year. Currently only 40 % of the nurses are acheiving this level in the reqired timeframe. The assignments and competencies are designed by nurse educators who have little or minimal experience or training of online design.

**Desired Performance.**
The desired performance would be that 100 % of the nurses would complete their appropriate online competencies and assignments by June 1st every year.

**Performance Gap.**
The difference between the actual and desired performance is that on an annual basis 60% of the nurses are not completing their online competencies and assignments within the allotted time frame.

**Cause Analysis.**
The people that were interviewed think that this problem has developed for the following reasons: Focus groups for nursing staff and nursing leaders were held. Greater than 340 nursing staff and more than 60 nursing leaders provided feedback concerning Mandatory/Required training, modalities of training, issues related to achieving training and future considerations.
 * The Clinical Nurse Specialists/Nurse Education Specialists Supervisors also met and discussed concerns with implementation of projects by the CNS and joint educational efforts with NES colleagues. This group determined that having a “matrix” or “tiering” system to aid in identificationof types of education methods along with recommendations for priority andaudience would assist in making decisions regarding education for theDepartment of Nursing. This group recommended a tiering education workgroup convene to look at the matter.
 * During chart reviews with Human Resources inpreparation of Accreditation, it was recognized that our current LearningManagement System reports do not allow for indications of what training meets which criteria for training. We have no mechanism to identify learning content with requirements.
 * An event occurred in which it was noted that an employee did not have recent completion of BCLS/ACLS training. This report requires the Nurse Supervisor to enter the reporting system: Business Objects at frequent intervals. There is no current reminder system or relevation to the Supervisor if outdated licensure exists.
 * During the recent Magnet review process, it was identified that obtaining data meeting Magnet criteria were difficult to obtain from our current system due to constraints of the Learning Management System and the ability to search text within the system

**Goals.**
Nurses at Mayo Clinic in Rochester enjoy many educational opportunities. Master's-prepared Nursing Education Specialists offer ongoing broad-based and specialty classes. These courses include practice, education, research and leadership topics, preceptor classes, charge nurse classes, and a research symposium series. Many classes are offered for contact hours, and some are offered as American Nurses Credentialing Center (ANCC) accredited contact hours. In a typical year, Mayo offers more than 1,100 programs with 35,000 participants.

**History.**
Mayo School of Continuous Professional Development (MSCPD) has a distinguished history of teaching physicians, nurses and other allied health professionals the latest, most advanced medical and surgical practices. Mayo Clinic, in fact, has been training medical professionals from throughout the world for more than 100 years. Mayo Continuing Nursing Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. The Magnet Recognition Program® was developed by the American Nurses Credentialing Center (ANCC) to recognize health care organizations that provide nursing excellence. The program also provides a vehicle for disseminating successful nursing practices and strategies. Recognizing quality patient care, nursing excellence, and innovations in professional nursing practice, the Magnet Recognition Program provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive. Mayo Clinic Rochester is one of the few institutions in the nation to recieve Magnet recognition for the second time this year. //A recent salary survey of 1,400 nurses showed that "Nurse leaders in Magnet hospitals earn more (4.8%) than their colleagues in non-Magnet facilities . . . Facilities with Magnet recognition often require their nurse leaders to be educated at higher levels, evaluated on performance outcomes relative to nurse-sensitive patient outcomes, and significant contributors to the community. These requirements may lead to the necessity of paying at higher rates to attract and retain top performers."//

**Mission and Vision.**
To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.The needs of the patient come first through the eduction and service of their nurses.

**Three Intervention Strategies**
After reviewing and assessing the performance gap and the cause analysis in relationship to the goals, mission and values of the Mayo Clinic Health system it became apparent that while the initial problem statement is indeed accurate there are many components that are contributing to this problem. The interventional strategy to purchase a new learning management system suggested by the Education and Professional Development department could result in the institution facing the exact same problem it currently has.

Low end interventional strategy.
The low cost interventional strategy would be to create a curriculum for both Nursing Education Specialists and Nurse Managers which would initially support a formal systematic training for each group to learn how to use a learning management system to the fullest and best advantage of the customer (the nurses). This education would focus on highlighting the differences between required and mandatory institutional competencies.

Middle end intervention strategy.
The middle end intervention would provide what was initially referred to by the focus groups as a tiering mechanism whereby the leadership who have received the initial education from the low end intervention and would undertake further instruction from their different perspectives. Educators would continue to learn and develop design aspects of their programs and be required to be competent annually by submitting a program they have presented in the previous year. Managers would have a similar competency demonstrating their knowledge of Magnet and Joint Commission Accreditation requirements as well as National Safety Goals.

High end intervention strategy:
The high end interventional strategy would follow the proposal recommended by the Education and Professional Development department and that would be to purchase a new Learning Management System (LMS). The LMS would need to fulfill all the requirements identified on the list compiled by the department (see attachments).

**Justification for Intervention Strategy**
I have chosen the middle end interventional strategy because it incorporates many of the requirements of the staff, both nurses and educationalists in solving the problem that the department is currently suffering from. One comment that was consistently stated was that there is a lack of formal, systematic training on the use of the current learning management system (LMS). Secondly there was a statement that there is inconsistent, inefficient use of technology within the department and within the system as a whole. Other comments include that information provided for staff, managers and educators is incomplete, that there is little guidance available and that educators do not consider knowledge of the LMS to be their responsibility. All of these comments make it difficult to encourage accountability in staff. Technologies: according to Christensen (2004), the main reason that successful and apparently well-run organizations can and do fail is that they fail to recognize the distinction between sustaining technologies and disruptive technologies. Sustaining technologies are those that improve the performance of established products. They are often developed by successful companies, the leaders in their fields, for and in close collaboration with their most important and lucrative clients. In other words, they are often the result of those successful firms' following the excellent business practice of listening closely to their customers. Technologies, in the sense that Christensen uses the word, may refer to either "hard" technologies that result in new types of physical goods (e.g., hard disk drives), or "soft" technologies that result in new ways of organizing work or providing a service (e.g., new systems of pricing, inventory, or production). It is my belief that as a department we need to sustain the program that we already have and build on that basis to make use of it more efficient and to better serve our customers. I believe that by using the LMS that is already in place this will be the least disruptive approach to solving the problems that are being experience.Recently at a high level meeting of the Nursing Executive Committee (NEC) two significant announcements were made. The first announcement being that a high percentage of the Mayo Clinic Health System has adopted our current LMS. The second announcement was that approval has been granted for the hiring of four new Nurse Educational Specialists whose role as yet is undetermined. At a subsequent departmental meeting it was suggested by our administrator that the role of one of these new position might be that of technology designer and educator. Another suggestion made was that by having a greater institutional adoption of our current LMS it might be possible to use leverage to have the manufacturers of the system incorporate some if not all of the functions that are listed in the comparision document compiled by the current users. This announcement also means that funds for purchasing a new LMS will not be available. The low end interventional strategy while it does encompass some of the problems outlined in the comments but does not incorporate any kind of follow up to ensure that the users of the system would continue to develop their skills. Also as a change agent I would realise that this is a requirement of our current position and as of yet it is not being undertaken resulting in apathy and a lack of accountability on the part of our educators because they do not have to produce any projects or evidence that they have completed this task. The high end intervention strategy even before its rejection by the NEC would not have been a choice I would have made due to the fact that while a new LMS may have incorporated some of the required features of the focus groups it would not have had all of them in it's functionality and the educators and Nurse Managers would have still been required to train to learn it's functions.
 * The Manager’s Many Roles**

**Project managers role:**

 * In order to ensure a smooth adoption and successful transition for this project mt role as project manager would require many steps. Initially I would ascertain** the project specification which should be an accurate description of what the project aims to achieve, and the criteria and flexibilities involved, its parameters, scope, range, outputs, sources, participants, budgets and timescales. The next step would be to form my team and plan the project **communicating the project plan to not only my team but to other interested groups and individuals. Once agreement has been reached regarding the actual plan we as a team would then delegate Project actions and tasks. My primary role during this phase of managing the project would be to inform, encourage and enable the team and motivate. Throughout the project it is essential to check, monitor and review the projects progress, I have found in the past that this is best completed at predetermiined stages. Once the training program is in place as a project team we will need to review and report on the project performance and make any necessary adjustments.**

**Resource management techniques:**
Plan the various stages and activities of the project. It is necessary to involve a well disciplined team in the planning. It can be useful to work backwards from the end aim, identifying all the things that need to be put in place and done, in reverse order. Additionally, from the bare beginnings of the project, use brainstorming (noting ideas and points at random - typically with a project team), to help gather points and issues and to explore innovations and ideas. Fishbone diagrams are also useful for brainstorming and identifying causal factors which might otherwise be forgotten. For complex projects, or when you lack experience of the issues, involve others in the brainstorming process. Thereafter it is a question of putting the issues in the right order, and establishing relationships and links between each issue. Complex projects will have a number of activities running in parallel. Some parts of the project will need other parts of the project to be completed before they can begin or progress. Such interdependent parts of a project need particularly careful consideration and planning. Gantt Charts (particularly useful for time management) and Critical Path Analysis Flow Diagrams are two commonly used tools for detailed project management planning, enabling scheduling, costing and budgeting and other financials, and project management and reporting.

Delivery system management techniques:
The delivery of the intervention strategy will be accomplished using the Blackboard platform in conjunction with face to face sessions at Unit Profession Days. We will also use the Unit web pages to explain the process.

Information management techniques:
Once to educational programs have been launched

Project management techniques: Explain your role as project manager for this intervention strategy. Resource management techniques: Describe the resources that will be used for this intervention and how they will be tracked. Delivery system management techniques: Identify the medium for the delivery of the intervention strategy and how the technology will be implemented within the instructional context. Information management techniques: Describe how information related to this intervention strategy will be stored, accessed, and processed. This may include information that l be used for evaluation of the intervention. Supporting documentation for your budget, including links to Web sites where purchases can be made and the costs of implementation. Describe the formative evaluation plan you will use. Include your formative evaluation instrument in an Appendix. Describe the summative evaluation plans you will use. Include your summative evaluation instrument in an Appendix.
 * The Manager as Change Agent**
 * Financial and Budget Information.** Tentative budget for your intervention strategy, along with supporting documentation; consider technology purchases, personnel training, additional support, and other considerations specific to your proposal.
 * Project Assessment.** Describe how the project objectives will be evaluated.

References Chevalier, R. D. (2007). //A manager's guide to improving workplace performance.// New York, NY: American Management Association Christensen, C.M. Anthony, S.D.& Roth, E. A. (2004) S//eeing What's Next: Using the Theories of Innovation to Predict Industry Change// Retrieved from [] Januszewski, A., & Molenda, M. (Eds.). (2008). //Educational technology: A definition with commentary.// New York, NY: Lawrence Erlbaum Associates, Taylor & Frances Group. Laureate Education, Inc. (Executive Producer). (2010). The Many Hats Leaders Wear. Baltimore, MD: Author Nursing Management Salary Survey 2005.Lippincott Williams & Wilkins, Inc. Vol36(7), July 2005, 18-27.

Why become Magnet reconised? Retrieved from []

**Appendice**. Appendix A: Formative Evaluation

Appendix B: Summative Evaluation Instrument

Appendix C: Interview Questions

Appendix D: Interview Transcripts or Summary

Appendix E. Budget

Appendix ?: Detailed and appropriate technical information for implementing your intervention

Appendix ?: Layout sketches, if relevant

Appendix ?: Specifications of equipment and purchases

Appendix ?: Data charts and graphs, as relevant

Appendix ?: Resources that support your proposal