Achieving measurable outcomes from learning takes time and effort. Although there are multiple frameworks for measuring outcomes (such as Kirkpatrick), you need to demonstrate both short and long term outcomes to keep momentum. Radishes may be all you have to show for a while, but you should be proud of them.

The radish may not be everyone’s favorite vegetable (definitely not mine). One of my colleagues shared this story about how important they are:

I attended a course on how to grow a vegetable garden. We spent quite a bit of time talking about different vegetables, the sun, soil and other factors. We talked about watering, weeding and care for the garden. At the end of the class, the instructor said: “Now the first thing I want you all to do is to go home and plant radishes.” I was confused. I don’t like radishes and neither do my kids. The instructor continued, “The reason we plant radishes is that they are easy and quick to grow. When everything else is just germinating, you will have green sprouting from the radishes and feel a sense of accomplishment. It is important so that you don’t give up on your garden while everything else is growing underground and the whole place just looks like a patch of dirt.”

In healthcare, we are often tackling complex problems that may take months or even years to improve. Radishes are what keep us going and prevent giving up on the learning initiative. Learning initiatives need to be treated like any business initiative. When you start getting results, you need to keep up the effort to ensure the perfect outcome. At the same time, you do not give up just days after launching a learning intervention, as you need to give it time to grow.

The challenge is that the radishes need to be relevant to the caregivers and patients, not just educators or management. Most educators follow Kirkpatrick’s (1994) framework (or a similar one for outcomes):

• Level 1 – Reactions – frequently referred to as ‘smiley sheets’ and reflect if the learners liked the process.
• Level 2 – Learning – Did the learners gain knowledge? (for more about assessment of knowledge see Learning Card 18: Learning vs. Quality Cop)
• Level 3 – Behavior – Did the learners change their behaviors in real practice?
• Level 4 – Results – What are the measurable outcomes from the initiative?

Unfortunately, both management and learners are very rarely interested in outcomes at the first or second level. Educators often use outcomes at level 1 or 2 to demonstrate that they did their job effectively. Measurement at level 1 or 2 can lead towards focusing on ‘butts in seats’ which contradicts the core principles of learning in healthcare (Learning Card 10: Principles for Learning in Healthcare). The ‘real’ outcomes to patients and caregivers are at levels 3 and 4, which are the hardest to both measure and demonstrate.

Growing radishes will first be seen at level 3. For example, if you completed TeamSTEPPS intervention, the first outcomes will be demonstrated by learners using the language of TeamSTEPPS (i.e. SBAR, CUS, etc.). The level 4 outcomes from a teamwork initiative (reduced safety events, infection rates, etc.) may be years before they are statistically significant. Celebrating the radishes and reinforcing the changed behaviors will help to change the culture while the outcomes are ‘catching up’.

Luckily, if you completed a thorough problem identification (Learning Card 11), your potential “radishes” will be outlined in the ideal state. At the same time, some of the quick wins may be incidental.

In working with a management team on trust and teamwork, all complained about the ‘steel table.’ The table was in front of the time clock, and staff would congregate there, blocking the flow of patients. Every day the management team had to work to keep the table and space clear. The solution was obvious; remove the table as the only thing it was used for was personal belongings while clocking out. The ‘table’ quickly became a radish, and story about how things could change.

Once you have your “radishes,” you need to celebrate. In a culture that is focused on the negative, celebrating small successes will help both the learners and the facilitators. If appropriate, share the “radish” with patients and others who visit the area. Include the boss in the celebration, both to show their support, and to gain buy in. It is amazing how much a pizza party to celebrate quick wins can change an environment.

Application experience

Participants: 8-12 (in pairs)

Time to complete: 30 minutes

With a partner, discuss a recent learning initiative you completed. What was the problem solved and the radishes? List outcomes and place them in each of the Kirkpatrick levels. Which radishes should you celebrate? What is the best way to celebrate the quick wins? Share your results with the group.

This part of a series called “Learning That Works” by Jason Zigmont, Ph.D., (jay.zigmont@gmail.com ). For a video on this topic and more information, visit http://L15.LearningInHealthcare.com . The principles above are part of the core content (Learning Card 15) of the Foundations of Experiential Learning Manual (http://FEL.LearninginHealthcare.com).

References

Kirkpatrick, D.L. (1994). Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc.