UNIT 11 TRAINING NEEDS ASSESSMENT IN HOSPITALS

Objective
After reading this Unit, you shall be able to:
1. Carry out Training Need Analysis;
2. List Principles and essentials of Training;
3. Learn training and development techniques.
Structure
11.1 Introduction
11.2 Designing A Training Programme
11.3 Training Need Analysis.
11.4 Essentials of Good Training
11.5 Training Principles
11.6 Techniques Used to Determine Training Needs
11.7 Phases in Training Process
11.8 Training and Development Techniques
11.9 Training Operations
11.10 Tips to Make A Successful Training Program in Hospital
11.11 Summary
11.12 Key Words

11.1 INTRODUCTION

After having understood the importance of any training programme, the next important
question for the management lies on conducting the same. Training is an abstract kind of
managerial function; whose advantages are not evident immediately. So, the management must
plan it very carefully. Training is an important managerial function and involves all the steps
that are the characteristic of other managerial functions. Some of the critical questions
regarding training activity before the management are:
• Whether training should be undertaken at all?
• What objectives is the training activity likely to satisfy?
• Who should impart the training?
• Do we need a separate department for imparting training to the managers?
• How training should be imparted to the trainees?
• How should the results of training be measured?

11.2 DESIGNING A TRAINING PROGRAMME

Some of the typical steps in designing a training programme are:

• Identification of training needs.
• Setting training objectives.
• Organizational set-up for training
• Training operations.
 • Evaluation of training.
Identification of Training Needs
The present time is the age of change... In order to remain competitive, people must learn newer
skills and keep themselves updated. This calls for a constant training. The process of change
has influenced even the process of training itself. Earlier the people were acquiring training
through apprenticeship and vocational courses, which are not enough in the modern era of
industrialization. It is necessary to identify the training needs because of the following reasons:
• Adoption of new techniques in an organization and introduction of modern working
methods. For example, Computerization of the Patient Records has been done in many
hospitals. The staff needs to be trained to handle the newer gadgets.
• Although it is often said that workforce is cheap in India, but they do not measure up
to the global standards in terms of productivity. Poor performance by the workers as
reflected by low output, lack of initiative, incompetence, and bad decisions. This
requires their systematic training.
• Wide gaps exist between what workers should be doing and what they are doing.
• Analysis of the strengths and weaknesses of an organization may pinpoint the areas of
weaknesses, which need to be handled seriously through training. Ex-Training of front
desk staff in soft skills.
11.3 TRAINING NEED ANALYSIS

Training needs can be identified through the following types of analysis:

• Organizational analysis
- Analysis of objectives
- Resource utilization analysis
- Climate analysis
• Task analysis
• Manpower or Human Resource Analysis
Organizational Analysis
Organizational analysis is basically a systematic study of an organization’s objectives,
resources, resource allocation and utilization, growth potential and its environment. Its purpose
is to determine where training emphasis should be placed in the organization for increasing
organizational effectiveness. Organizational analysis involves the following elements:
Analysis of Objectives: The long-term and short-term objectives and their relative priorities
should be properly analyzed. Specific goals for various departments should be stated which
will serve as means for achieving the overall organizational objectives. The management would
have to examine what are the specific training inputs that would contribute towards the
achievements of these objectives.
Resource Utilization Analysis: The allocation of human and physical resources and their
efficient utilization in meeting the operational targets should be analyzed. In order to examine
the need for training, it should be found out whether adequate number of personnel are available
to ensure the fulfillment of the goals or not. Also, it is important to know whether the personnel
performance is up to the required standards.
Climate Analysis: An organization’s climate reflects the attitudes of its members with regards
to trust, loyalty, openness, commitment to organizational goals. Analysis of an organization’s
climate determines whether the environment, when analyzed in different departments is
conducive to the fulfillment of their goals. This will help in knowing areas where training is
needed to improve the climate of the organization.
Task Analysis
It is a systematic analysis of jobs to identify job contents, knowledge, skills and aptitudes
required to perform the job. Particular attention should be paid to the tasks to be performed,
the methods to be used, the way employees learn these methods and the performance standards
required of employees. Questionnaires, interviews, personnel records, observation and other
methods can be used to collect information about jobs in the organization.
In task analysis, the focus is on the job or task. Task analysis requires the study of various types
of skills and training required to perform to the job effectively. For example: -the task of patient
registration process with a view to reduce waiting period
Manpower Analysis
The quality of manpower required by the organization must be carefully analyzed. It must be
done in the light of both internal and external environment of the organization. The economic,
social, technological and political environment of the organization should be properly scanned
to determine the quality of human resources desired. To achieve these quality standards,
specific training needs should be determined on the following lines:
• specific areas where individuals need training,
• the capability of present workforce to learn new skills and behaviors,
• the time frame within which training must be imparted, and
• job designing and redesigning, introduction of new work methods and technology.
Stating Training Objectives
Once the training needs are identified, the next step is to define specifically training objectives
and to decide upon the methods to be adopted to achieve these objectives. The overall aim of
any training programme is to increase organizational effectiveness. However, each training
programme must also have specific objectives
For example, specific training objectives for House Keeping Staff will be
• Correct use of cleaning and disinfecting materials in correct concentration.
• Segregation, Collection and disposal of Biomedical waste as per Bio Medical Waste
Management Program.
• Use of Personal Protective Devices.
• Infection Control
11.4 ESSENTIALS OF GOOD TRAINING

• Training programme should be chalked out after identifying the training needs or goals.
It should have relevance to the job requirements.
• It must be flexible and should make do allowance for the differences among the
individuals as regards ability, aptitude, learning capacity, emotional make-up, etc.
• It should prepare the trainees mentally before they are imparted any job knowledge or
skill.
 • It must be conducted by well-qualified and experienced trainers.
• An effective training programme should emphasize both theory and practice. It should
help in acquiring knowledge and its practical applications.
• It should have the support of the top management as it can greatly influence the quality
of training.
• The support of the top management towards training.
• The amount of investment, which an organization wants to make.
• Volume of the training programme.
• Continuity of the training programme.
• Flexibility of a training programme.
• Lastly, an effective training programme should be supported by a system of critical
appraisal of the outcome of the training efforts.
Organizational structure
The exact position of the training department must be specified in the organizational structure
of the company. Training, being a staff function has a risk of being sidelined in a large
organization. Some of the typical structures of training department can be:
As A Part of The Personnel Department: In most companies, human resource development is
entrusted upon HRD/Personnel department. In such situation, the training department would
function within the authoritative control of the HRD manager. Usually, the new employees
undergo an orientation/induction programme, which is organized by this department. Usually,
the training imparted by this department is more generic in nature.
In the Form of a Matrix Organization: The training manager might not be a specialist in all
functional areas. While imparting sophisticated training, the common practice is to take a
trainer from the functional department. For example, in training of technicians in new MRI
machine the Radiologist is asked to give the training.
Training by functional heads: When training is not a very regular exercise, even the functional
heads, such as HODs might undertake the task of organizing the training programmes. They
plan and organize the entire programme themselves.
11.5 TRAINING PRINCIPLES

Readiness to learn: the trainee must want to or have the intention to learn.
Reinforcement: provide positive rewards for certain acceptable behaviors because trainees
are most likely to repeat response patterns, which give them some type of positive reward.
Immediate confirmation: trainees learn best if reinforcement is given as soon as possible
after the training response. For example, a promotion or an increment at the conclusion of
training processes.
Feedback: provide feedback on learning results as to whether the results of a learning
process are correct or not.
Active practice: learning by doing is more effective than by reading or passive listening.
Spaced practice: learning task spaced over a period of hours or days are more effective than
being concentrated into one period.
Whole learning: learning is better when an overall view of what the trainee will be doing is
given to him than just go immediately into the specifics.
Sequence: materials to be learned should be developed or presented in stages; moving from
the known to the unknown, simple to the complex, and part to the whole.
Instructional materials: use audio-visual aids as they help learner/trainee to learn more
effectively and retain materials learnt longer than reading and/or listening.
Recognize plateaus: that is, during the training process, employees reach a stage where they
make very little or no progress. At this point, the trainer should take a break and/or encourage
trainees to prevent a feeling of despair or a desire to give up
11.6 TECHNIQUES USED TO DETERMINE TRAINING NEEDS
An effective training programme must be one planned to improve or correct identified areas of
weaknesses among employees. Several techniques are available in determining training
needs. Gilbert (1967) developed a commonsense approach to identify areas of training
needs of employees.
He summed up his approach in a formula thus:
D= M – I
Where,
D = Deficiency in the employee
M = Complete list of behavior necessary for mastery of the job.
I = Knowledge of behavior necessary for the job which the
employee already possesses.

According to Nwachukwu (1988), by identifying the behavior required to perform a job and
finding out what an employee lacks, training can then be concentrated in areas of difficulty.
Klatt, Murdic and Schuster (1985) have suggested ten techniques for identifying training needs
of workers. These have been summarized as follows:

• Interview with potential participants by the manager or career counsellor in order to

identify areas of training needs.
• Questionnaire survey conducted on employees and manager.
• Analysis of personal inventory files.
• Management (managers) request.
• Observation of on-the-job behavior communications, workflow and relationships on
the job.
• Job analysis and job competencies, which lead to the development of job
specifications and reveal that a worker does not meet the job specifications, set for the
job.
• Tests.
• Outside consultations may be invited to review the T and D programme and make
recommendations.
• Group problem analysis. Here managers concerned with problems meet to identify the
specific problems and causes. Often, training of employees is a major part of any
solution.
• Assessment centers used for evaluating employees for promotion, placement and
further Training and Development.
• Others include discussion with immediate boss.

11.7 PHASES IN TRAINING PROCESS

An effective training system must involve several phases and steps. (Mathis and Jackson,
1985) have developed a model of training system based on the training model developed
by Godstein (1974). The former model has been adopted here because of its simplicity and
comprehensiveness. This model is made up of three major phases with specific steps. They
are:
Phase 1: The Assessment Phase
This phase involves the following steps:
- Determine training needs, i.e. identify areas of weaknesses.
- Identify and specify training objectives.
- Develop and set the criteria against which training success is to be measured.
- Pre-test trainees to determine their competence and areas of deficiencies.
Phase 2: The implementation phase
- Select training methods specifically aimed at weak areas.
- Conduct training.
** Monitor training
Phase 3: Evaluation phase
It focuses on measuring how well the training accomplishes the desired objective(s). You
compare training outcome against criteria.
** Monitoring of training services as a bridge between the implementation phase and the
evaluation phase.
11.8 TRAINING AND DEVELOPMENT TECHNIQUES
After the employee training and development needs have been identified, actual training
must be engaged in. This involves choosing a training and development method. There are
several training methods to choose from. These methods have been variously classified into
different categories. Campbell and his associates (1970) developed one of such taxonomies
wherein training and development techniques have been classified as:
• Information presentation techniques
• Simulation methods, and
• On-the-job training
Information presentation techniques
These techniques include the following methods:
Lectures: Lecture is a method of teaching. It is an organized talk, giving formation about
a specific subject matter to an audience or a class. It can be used for a small or a large
group of trainees.
Conference: This is an organized meeting for the discussion or an exchange of views
about an issue or problem.
Correspondence courses
Motion pictures: This refers to cinema films.
Reading lists
Closed-circuit television (and videotape)
Systematic observation (closely akin to modeling)
viii. Programmed Instruction (PI). It is a method of guided self-learning which provides
trainees immediate feedback and step-by-step learning.
Computer Assisted Instruction (CAI): As the name implies, CAI involves the trainees’
learning by interacting with a computer.
T-group training: T-group is also called sensitivity training, encounter group and
laboratory training. It is a technique for learning about one’s self and others. It is done by
observing and participating in a group situation. The individuals usually meet in groups
over a certain period, during which they attempt to enhance their awareness both of
themselves and of social processes.
Laboratory education: This involves more complete programmes of training experiences,
which may include, in addition to the basic T-group, short lectures, role playing, group
exercises designed to illustrate problems in inter-personal or inter-group behavior, and the
likes.
Organizational development: This involves systematic long-range
programmes of organizational improvement through action
research. Action research includes:
• Preliminary diagnosis
• Data gathering from client group
• Data feedback to the client group
• Data exploration by the client group
• Action planning
• Action
The cycle then is repeated continuously.
Simulation methods: These include:
The case study method:
This is a widely used oriented development technique in medicine, law and business
schools. The case study method involves the examination of an organizational event or
series of events or problems, actual or hypothetical. These situations usually involve
statements that reveal problems or opportunities that must be recognized, identified and
solved through strategic decision. The case study approach adds realism to the classroom
and offers the trainee the opportunity to apply concept, principles and theories of
management. It therefore helps to improve the analytical thinking, problem solving and
decision-making ability of the trainee. In the case method, representative organizational
problems are presented on paper, usually to groups of trainees who then are required to
identify problems and offer solutions. Individuals learn from each other and receive
feedback on their own performance.
The incident method:
This technique is like the case study method, except that trainee is given only a sketchy
outline of an incident. They have no question the trainer and when they think they have
enough information; they attempt a solution. At the end of the session, the trainer reveals
all the information he or she as and trainees compare their solution to the solution based on
complete information.
Role playing:
Role-playing is a developmental technique that requires the trainee to assume a role,
character or function of another in each situation and act out behavior associated with that
role; it is thus as appreciation of the factors in a certain situation.
Programmed group exercises:
This is a hybrid technique that incorporates many of the elements of the case study,
multiple role playing, programmed instruction and sensitivity training. Trainees examine
their responses first as individuals, then with members of their own groups and finally with
larger group and with the trainer.
The task mode:
This involves the construction of a complex but easily built physically object and a group
of trainees is assigned the task of duplicating the model, given the proper materials. Certain
trainees are then allowed to view the object. Common problems are then discussed as they
arise, and solutions are reached through group discussion.
The in-basket technique:
This is a behaviorally experienced learning method. It involves short work assignments
for trainees.
Business games:
These are computer-based business games that often have to do with labor/management
negotiations. In such games, a player takes the role of either management or union and the
computer takes the other role. The trainee and the computer bargain on such items as wages
and benefits (Mathis and Jackson, 1982).
Assessment centers:
The assessment center is not a physical location. Rather, it is a set of individual and group
activities in which several candidates participate. It is a multiple method group selection
technique. They help identify areas in employees that need development and are useful for
selecting managers. Mathis and Jackson (1982) provides a vivid description of what
assessment centers are as one off the-job development methods:
Candidates may participate in a wide variety of exercises that are work samples of
managerial situations that require the use of managerial skills and behaviors. These
standardized exercises could be management games, leaderless discussion groups, and an
in-baskets over a several-day period. Trained observers watch the candidates’ behavior in
detain and record impressions. Each assessor writes a report on each candidate, which is
given to the candidate’s superior to use in selection and promotion decisions. The reports
often identify guidelines for further development of the assessed employee. At the end of
the procedure, the assessors or judges must come to agreement on a cumulative rating for
everyone, related to job requirements, considering all the selection activities.
Managerial modelling:
There is an old truism in personnel management development that says managers tend to
manage as they were managed. That is, modelling the behavior of other managers just as
children learn by modelling parents and older children makes much of management to be
learned; they are quite comfortable with the process by the time they grow up.
On-the-job training methods
These methods, as the name implies, are used with organizations and are directly job
related. They are the most common training and development methods used by
organizations. They are used both in skills training and in management training and
development. The advantages of
this method is:

• The employee is using the same machine, equipment or materials, which he will be
using after the training.
• He is being subjected to the same environmental constraints under which he will
have to operate.

• What he produces while learning is a contribution to the day’s effort (Nwachukwu,

1988).

Mathis and Jackson (1982) have identified five common advantages of on-the-job
methods as follows:
• Effective training can be tailored to fit each trainee’s background, attitudes, needs,
expectations, goals and future assignment.
• Off the-job training cannot usually be tailored as well as to the exact measurement of each
trainee.
• The importance of learning by doing is well recognized in on-the job training.
• On-the-job training is not as time consuming.
• The employee’s development is influenced to a large extent by the immediate supervisor
and is likely to go along with the supervisor’s expectations in an on-the-job training
situation.
• When an organization relies mostly on off-the-job training, supervisors do not feel that their
obligation to develop their subordinates is a primary one. They tend to neglect it. On-the-
job training focuses a supervisor’s attention on subordinates’ development.

On-the-job training methods include:

Orientation training
Apprenticeships:
Apprenticeship training is best used in training manual skills as in learning how to give an
injection. An apprentice programme involves on-the-job experience by an employee under
the guidance of a skilled and certified worker.).
Internships:
This is one type of cooperative job-experience training. It is a form of on-the-job training,
which usually combines job training with classroom instructions in medical colleges. In a
typical internship, students receive educational credit for the on-the-job experience to
acquire knowledge and skill (ibid).
On-the-job coaching:
 This is one of the on-the-job development techniques. It involves the daily instruction of
subordinates by their immediate superior. It is a continuous process of learning by doing.
For coaching to be effective the trainers should provide trainees with frequent and
immediate feedback and a healthy and honest relationship must exist between subordinates
and their supervision or managers
Special projects:
They take various forms. For example, conference leadership. This requires that the trainee
organizes and chairs problem solving conferences. A typical example of this is Junior
Executive Boards. This allows promising middle-level managers to experience, firsthand,
the problems and responsibilities faced by high-level executives in their organization.
Ordinarily, the board can study any problem faced by the organization and to make
recommendations to the Senior Board of Directors.

Continuous understudy assignments:

It is a recognized fact that organizations need to have trained people ready to assume key
high-level positions. This is because necessary understudy and assignments are used for
this purpose, and to promote ‘home grown top executives. An understudy relieves senior
executives of selected responsibilities, thereby allowing the understudy to learn certain
aspects of the job and the executive’s style of handling it
Vestibule-training:
This is exclusively a training method. It involves duplicating exactly the materials and
equipment used on the job but takes place in an area off the production line or away from
the actual job situation.
Job rotation:
It involves shifting employees from one position to another similar one within the
organization. The objective is to give the trainee an appreciation of the problems in the
different departments and the opportunity to learn from the different superiors. When
properly handled, job rotation encourages a deeper and more general view of the
organization.
Assistant-to-positions:
The assistant-to-position is a staff position immediately under a manager/senior doctor.
11.9 TRAINING OPERATIONS
From the operational angle, the following activities must be undertaken to conduct a training
programme.
Selection of the Trainees
The proper selection of trainees is very important factor that determines permanent and gainful
results. A trainee must be provided the training which he really needs. Sometimes, the
employees perceive training as a paid vacation. This might lead to wastage of the entire effort.
So, proper screening of the candidates for training improves the effectiveness of the training a
programme.
While giving training to an employee, the first step is to attempt to place him at ease. It is
generally seen that many people are somewhat nervous when approaching an unfamiliar task.
In addition to minimize any possible apprehension, the trainer should emphasize the
importance of job, its relationship to the workflow and the importance of rapid and effective
learning.

Training the trainer

The trainer is a key figure of any training programme. Before he is entrusted upon with the task
of undertaking the training, he must be judged whether s/he him/herself is competent enough
to do the same or not. The firms might engage a qualified instructor from inside or outside the
organization. However, many insiders are not good instructors because they might not possess
the ability to teach the skill. The trainer must have professional expertise to fulfill his
responsibility. Therefore, it is desirable that the trainer must have knowledge about the job for
which he is going to instruct the trainees. He must be able to suggest solutions to the practical
problems faced by the trainees.

Training Period
The duration of a training programme depends upon the skill to be acquired, the trainee's
learning capacity and the training methodology used, For example, a simple orientation
programme for clerks may require an hour a day over a period of one week, while a course in
computer programming may be require two hours a week for 10 weeks. The use of training
aids usually helps to reduce the training time. To maintain interest and secure maximum
accomplishment, no single session should last longer than two hours.
Another issue is whether the training should be given during working hours or after the working
hours. If the training is given during working hours, the productivity may suffer, and the
organization will have to pay for this time. But if the training is arranged after the working
hours, the employees may not be able to make full use of training programmes because they
might be tired already. For effective training, the training manager should reconcile these
situations.
Training Methods and Materia
As was mentioned in that lesson, the choice of any training method depends upon the specific
objectives of the training programme and several other factors.
To increase the effectiveness of training, some written material is usually desirable as a basis
for instruction, review and reference. The training section may prepare the training material
with the help of line supervisors to be used for different jobs. A complete outline of the whole
course should be made with the main topics included under each heading. The training material
should be distributed among the trainees well in advance so that they may come prepared in
the lecture class and may be able to understand the subject quickly and may remove their doubts
by asking questions from the instructor.
Evaluation of Training
Management of training would not be complete without proper evaluation of training. Training
is a very costly and time- consuming process. It is essential to determine its effectiveness in
terms of achievement of specific training objectives. Individuals like to know how much they
learnt or how well they are doing. The sooner employees know the results of a quiz or test, the
sooner they can assess their progress. The sooner employees receive positive feedback from
the trainer, the less time they will waste.
Self-graded tests and programmed learning kits provide the necessary feedback to a person on
his progress on a subject. This principle does not necessarily mean frequent testing, but the
more immediate the feedback on learning the more motivating it is likely to be.
Evaluation of training would provide useful information about the effectiveness of training as
well as about the design of future training programmes. It will enable an organization to
monitor the training programme and to modify its future programmes of training. The
evaluation of training also provides useful data based on which relevance of training and its
integration with other functions of human resource management can be examined.
Training Effectiveness Training effectiveness is the degree to which trainees can learn and
apply the knowledge and skills acquired during the programme. It is influenced by the attitudes,
interests, values and expectations of the trainees and the training environment. A training
programme is likely to be more effective when the trainees want to learn, are involved in their
jobs and have career plans. Contents of training programme, and the ability of trainers also
determine training effectiveness to a certain extent. Some of the criteria to measure training
effectiveness are the trainees’ reactions, their extent of learning, improvement in job behavior,
and the results at the job.
11.10 TIPS TO MAKE A SUCESSFUL TRAINING PROGRAM IN HOSPITAL

• Create a training program suiting all different categories of staff: - One should
ensure that your employee in their different roles and different skill group (from
housekeeper to CEO) can comprehend the training completely.
• Make the training program interactive through group work and quizzes.
• Embrace computer-based training modules.
• Personalize information so that it is specific to your hospital. Ex-in Hospital
Infection control training, should reflect the practices and data of your hospital.
• Ensure training reflects changing skills like Value Based care, Patient centered care.
• Consider the employee demand/perspectives for training (content, time)
• Evaluate effectiveness

11.11 SUMMARY
Any approach to training and management development programmes must start with the
identification of training needs. Its policies, objectives and techniques must be clarified.
This is bound to improve service to patients and will, in the long run, improve the image of
the hospital and its employees. The objective of training is increasing the efficiency of
employees and their development for future promotion and better service to patients. The
training programmes must be well planed and evaluated periodically.

11.12 KEY WORDS

Organizational Analysis
Organizational analysis is basically a systematic study of an organization’s objectives,
resources, resource allocation and utilization, growth potential and its environment.
Resource Utilization Analysis
The allocation of human and physical resources and their efficient utilization in meeting the
operational targets.
Task Analysis
It is a systematic analysis of jobs to identify job contents, knowledge, skills and aptitudes
required to perform the job.
Formula for identification areas of training needs of employees.
D= M – I
Where,
D = Deficiency in the employee
M = Complete list of behavior necessary for mastery of the job.
I = Knowledge of behavior necessary for the job which the
employee already possesses.