08 August 2008

E-learning and online performance support at Moorfields Eye Hospital

Moorfields Eye Hospital is an NHS Foundation Trust. It has a worldwide reputation for its specialist acute eye services, and its main hospital building on the City Road, just north of the City of London, is a well-known landmark. In addition the Trust has twelve smaller outreach sites mainly within the greater London area that offer a local service for acute eye complaints.

Moorfields employs 1,300 staff, of which 250 are medical clinicians, including some of the best-known names in their field, and another 300 are trained nurses. The remaining staff fulfils a range of positions including clinical support, administrative support and manual roles.

Ian Mercer, the Learning and Development Manager at Moorfields, has a background in IT Training. He describes the biggest problem facing his job as staff release: "Developing the non-clinical skills to do the job is not always seen as important as getting the job done - there is always a compelling operational requirement to deliver services to patients". Clinical development, professional development and skills updating for doctors and nurses will always receive attention and lie outside Ian's responsibilities. His challenge is to ensure that all staff develop their management and interpersonal skills so that they are prepared and ready for enhanced responsibilities, and that they can use the hospital's IT systems to their full potential.

In a modern hospital, IT systems are an essential tool. Some 90% of Moorfields staff use a PC in their day-to-day work and the remainder have access through internet cafes. Microsoft office systems (Word, Excel etc) are universally used and there is a developing intranet. In Ian Mercer's words, "E-mail is the source of communication and the intranet the source of information".

Systems learning

This case study concerns a major innovation to support the development of skills on the central IT system. The patient administration system (PAS) is used throughout the hospital to manage the patient journey: it records basic data, admissions and progress. PAS systems, in different variants, are central to all hospitals and have a number of component sub-systems. There are other major IT systems in use at Moorfields - for example a finance system - but none approaches the pervasiveness and critical importance of PAS.

Traditionally, staff training was achieved through a series of classroom modules delivered by IT trainers. These are still a feature of the training provision. A new initiative was introduced in Spring 2007 when a new e-learning and online performance system was deployed through the purchase of an authoring tool, 'MORSE'. At that time, there were significant changes about to take place both in the Moorfields case records systems element of PAS and the finance system. Combined together these provided both a challenge and an opportunity.

According to a newsletter distributed to staff at the time:

"The impetus for MORSE was the huge IT rollout and process change system that is Moorfields Care Record System (MCRS). This software is changing, but so are many of the processes and even some roles. There is a lot of information to take in, and to suddenly start doing everything in a different way after the system went live is a tremendously high expectation for all the hundreds of people involved."

Behind this sentiment are two related issues. First, there is recognition that, at a time of major system change, IT support and IT training professionals are simply not in a position to respond to learning needs. The immediate priority will be to ensure that the system is running and day-to-day administrative activities can continue. The second issue is an ongoing recognition that staff at all levels will need to take personal responsibility for their IT needs. "They need to acquire greater skills and become less reliant on IT support. We want to move away from a situation when their first and only response is to ring IT support and ask them to solve it".

E-learning and online performance support

MORSE is an authoring tool - a commercial product produced by a commercial supplier, Knowledge Solutions. It has been used at Moorfields in two different, but related ways - both so far have been used to support PAS.

Stand-alone e-learning modules

50 modules have been authored and deployed by Mala Trivedi, a senior IT trainer in Ian Mercer's team, who has worked with internal subject-matter experts at the hospital. Each module is short in duration, lasting about five minutes and some of the modules contain demonstrations; an on-screen illustration of how a task can be performed. Module examples include: 'searching for a patient', 'registering a patient', 'referral to a General Practitioner'.

E-learning modules are available to all staff and can be accessed through the intranet at any time, although initially they were developed for staff use during the roll-out of the MCRS/PAS system changes.

Online performance support

A more interesting application of MORSE, however, lies in the online performance support and Ian Mercer believes this is where the greater potential lies.

Using a different feature of this authoring facility, Mala Trivedi and her team have produced over 100 drop down cue cards which are linked with particular aspects of PAS. The system works as follows:

'A small friendly owl is a feature of the top right hand corner of the user's screen. When the 'owl' recognises the software being used - as is the case in all PAS applications - it changes colour or lights up indicating that immediate guidance is available in the form of a cue card. The user can click on the owl and see a short list of explanations, tips or guidance, some of which link to e-learning modules. The cue card would be less than 100 words. It can be seen that the initiative to access the guidance is a decision that is taken by the user: it is 'pull' not 'push'.

The Moorfields' learning team is currently considering introducing a variation so that when a minor update in system capability or procedures take place, the owl will automatically generate a message on the new system change and user guidance when the user accesses the relevant PAS screen. The main advantage is that the support is delivered only to those users who need it, at the time they need it.

Progress and potential

Both Ian Mercer and Mala Trivedi are cautiously optimistic about the future of online performance support. Its potential is considerable and it ticks a number of boxes as it is: relevant to the organisation's requirement; offers support immediately in the right context and at the right time; and it encourages people to become less dependent on traditional IT support.

However, there is an ongoing task to be undertaken to gain user support and confidence. In October 2007 Ian Mercer undertook an interim evaluation into the effectiveness of MORSE; this involved detailed interviews with 19 users across Moorfields. The main conclusion was the need to put support measures in place if the potential of the system is to be achieved. This was particularly the case when a new system is rolled-out. "It needs to be fully integrated into a project plan and supported by the project team". For example:

"The wider go-live support team also needs to fully understand the role of MORSE so that they can guide users towards it during go-live. Users are then in a better position to take full advantage of the support"

Planning and integration are essential to effective use. However, the most critical detriment is user attitudes:

"The primary concern in any rollout should be the users. Therefore, sound change management is essential to address negative attitudes and cultures. Otherwise these will dominate the project and undermine the effectiveness of support facilities such as MORSE".

User attitudes are also the critical determinant in the ongoing use of online performance support. It is evident from the above case that the technical use and development of the authoring tool did not create any difficulties for the Moorfields learning team. The central questions behind such an innovative approach are: 'Will they use it? Will they find it helpful?' Ian Mercer feels positive and will deploy MORSE in other applications. However, different training methods including the off-the-job course will remain in place as deployment progress and the learning team gain more information and experience on the use of online performance support.

Related link:http://www.cipd.co.uk/helpingpeoplelearn/_mrflds.htm