Roundtable Discussion: Gaining Proficiency in the Use of Complex Health Technology Requires a Multifaceted Training Approach.

Janet Stifter We are going through a large, complex technology changeover at Rush University Medical Center. Therefore, many of my remarks today may be somewhat colored by the experience we are having currently. I would say that there is a great deal of cognitive burden experienced by health professionals related to complex technology. When you are changing out devices and potentially going to another vendor, or sometimes even when you're upgrading a model with the same vendor, I don't think you can assume that the old and new devices will be “apples to apples.” For example, if I'm working with a bed, and I go from a bed from one vendor to a bed from another vendor, the way the mechanics work is not going to be the same and the capability in terms of reporting that's going to come through your electronic medical record (EMR) is also potentially not going to be the same. It's not an apples-to-apples kind of opportunity. There's a learning phase related to staff use of complex technology, but in some instances, there is also an unlearning phase. That's because I've been working, for example, with a certain ventilator in the past, and I know how to set the dials and the alarms. When I get a new ventilator, potentially from another company, I will have to unlearn what I was doing with the old ventilator and now relearn how to use the new piece of technology. The other concern leading to cognitive burden is the pressure in healthcare to be safe and to ensure high quality in terms of our outcomes. So, when you're working with complex technology, and you have the potential to harm somebody if you are not using that technology appropriately or safely, that's also a big burden in terms of really trying to make sure that you understand what you are doing and use the technology appropriately. In terms of what amount of proficiency is reasonable to expect when onboarding technology, that is another interesting issue that we have been grappling with as part of our current technology go-live at Rush. We have spent a lot of time talking to users at other organizations about some of the difficulties our team has been experiencing with use of this new technology and have found similar concerns at some of these other organizations. Over time, we've gotten the sense that there has been almost an acceptance that people will be proficient but not expert users in terms of being able to manage this device—that the use of this technology is not necessarily going to reach the highest levels of quality or safety. Again using the example of a ventilator: Is proficiency being able to identify the buttons and what they do? Or, do we set a higher standard related to efficiency and effectiveness for staff? What if staff is not able to reach that standard? What if I have a staff member who is potentially creating a workaround to make a piece of equipment more efficient or effective? This demonstrates how difficult it is to define proficiency, especially when you're looking at the fact that some of the technology we are working with is not always meeting the processes that the staff member needs to address. Therefore, we teach them the basics when the equipment comes in, and we competency validate them on the basics. However, to then reach a level beyond proficiency—to higher levels of efficiency or expertise—sometimes that requires addiRoundtable Participants