The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of Ausmed Education.
The Irony of Mandatory Training
This year I mark 30 years of working as a registered nurse in health and aged care. For 20 of these years, I have been fortunate to brand myself as an educator. I was drawn into the education genre because at my very core, I am a pragmatist who likes nothing better than to see the point of doing something. I prefer to understand why something is important before committing my time and energy. Conversely, and for this reason, I cannot stand tokenism, and to be more precise, I have a deep and long-standing resentment for the oxymoron that is broadly known as mandatory training. I put it in the same category as maths fun day.
So, the irony that I have found myself developing and reporting on more mandatory training programs than the average bear has not escaped me. Sadly, it pains me to write this. Still, the reality is that being able to show off colourful (yet meaningless) mandatory training dashboards has become the “holy grail” for the compliance-driven health, disability, and aged care sectors in Australia. Let's get real, tick-a-box assessments and multiple-guess memory tests are not so handy at 3 o’clock in the morning, but they just might impress the auditors enough to pass the accreditation. Ouch indeed.
Compliance vs. Learning
How did we end up here? Rhetorical, I know. We all know how this happened. It started out innocently. Policy – good. Procedures – also good. Standards – Yes, absolutely. Legislation – make it mandatory, excellent. Cue the National Safety and Quality Health Service (NSQHS) Standards (Australian Commission on Safety and Quality in Health Care 2024), the NDIS Practice Standards (NDIS Quality and Safeguards Commission 2022) and the soon-to-be-implemented Strengthened Aged Care Quality Standards (Australian Government Department of Health and Aged Care 2023).
The Challenge of Proving Compliance
The challenge that providers must solve is how to prove compliance with the standards without it costing more money than available in the training kitty. Ahh, not so easy. Multiply the number of standards requiring evidence of compliance by the number of people in the workforce who must be assessed (sometimes yearly). Suddenly, we’re talking very agitated bean counters. The answer of course was to make the training mandatory, cram it into one day, and while we’re at it, make it snappy so workers and their completion results can be churned out fast. Enter the algorithm of online course + multiple choice quiz = compliance. Easy. Except it’s not. We could not be further away from the principles of authentic learning if we tried. Bloom’s taxonomy with its intent of providing learners an opportunity to acquire, retain, and use new information by activating the cognitive domains of knowledge, comprehension, application, analysis, synthesis, and evaluation (Bloom et al. 1956) doesn’t quite fit within a multiple guess memory test, aka multiple choice quiz which relies on lower order thinking skills of memorisation and rote learning (Bibler Zaidi et al. 2018).
Competency Assessments and the Quest for Authentic Learning
In the frantic pursuit of evidence for compliance, many providers have resorted to adding competency assessments into the mandatory training landscape. However, as argued by Canales and Drevdahl (2022), without valid and reliable testing, competencies are usually nothing more than statements to guide practice rather than measurable outcomes for improving the health or welfare of individuals or groups. Personally, I have yet to understand what exactly it is that competency assessment is trying to achieve given that workers in health, aged and disability care sectors have already demonstrated the requisite knowledge and abilities to carry out their expected roles. I know I’m not the only one who can spot a box-ticking exercise when I see one.
Seeking Better Solutions
The solution to this god-awful place we have found ourselves is hidden in plain sight. We’ve known it for years. We haven’t done it because it will take more than just leadership, it will take courage. What if we had the courage to stop insisting our personal care assistants complete a quiz on food choices and instead, maintain an aged care resident’s weight by providing residents their choice of food at a time they want to eat (Australian Government Department of Health and Aged Care 2023)? How about the courage to report (with a view to reducing) treatment delays (NDIS Quality and Safeguards Commission 2022) rather than quizzing transport drivers on their knowledge of escalation systems? Now that I think about it, what about the courage to use data from pressure injury audit results (Australian Commission on Safety and Quality in Health Care 2024) to ensure surgical positioning aids are available in each theatre rather than a quiz on manual handling?
None of this is new of course, and I don’t believe for one minute that any leader in an organisation is so wedded to the mandatory training option that they have dismissed all other viable solutions. No, the reality is that in our highly regulated, compliant, and data-driven health, disability, and aged care worlds, mandatory training is here to stay.
Improving Care
I believe we are well overdue for a national quality improvement approach to tackle the actual grassroots issues in health, disability, and aged care rather than pretend we’re doing just fine when very clearly, we’re not. We need the courage to stop fooling ourselves that annual mandatory training constitutes valid or reliable competence and shift the focus to actual improvements in care as our evidence of compliance.
Moving from Compliance to Competence
Recognising the imperative shift from mere compliance to genuine competence, especially highlighted by the Strengthened Aged Care Quality Standards, Ausmed is exploring this topic in an upcoming New Aged Care Standards Webinar Series. 'Moving from Compliance to Competence' will look at the transition towards competency-based learning, underscoring the critical shift from traditional compliance metrics to an outcomes-focused evaluation.
Register now to gain invaluable insights into identifying and measuring outcomes (the enforceable element of the new Standards). Ausmed is excited to share insights, best-practices, and new ideas to pave the way for L&D teams to reassess and elevate their current mandatory training practices towards achieving tangible improvements in care.
References
- Australian Commission on Safety and Quality in Health Care, 2024. The NSQHS Standards. [Online] Available at: https://www.safetyandquality.gov.au/standards/nsqhs-standards [Accessed 28 February 2024].
- Australian Government Department of Health and Aged Care, 2023. The Strengthened Aged Care Quality Standards – Final draft. [Online] Available at: https://www.health.gov.au/resources/publications/the-strengthened-aged-care-quality-standards-final-draft?language=en [Accessed 28 November 2024].
- Bibler Zaidi, N. et al., 2018. Pushing Critical Thinking Skills With Multiple-Choice Questions: Does Bloom’s Taxonomy Work?. Academic Medicine, June, 93(6), pp. 856-859.
- Bloom, B. et al., 1956. Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook I: Cognitive Domain. New York: Longmans, Green.
- Canales, M. & Drevdahl, D., 2022. A Sisyphean task: Developing and revising public health nursing competencies. Public Health Nursing, Volume 39, pp. 1078-1088.
- NDIS Quality and Safeguards Commission, 2022. NDIS Practice Standards. [Online] Available at: https://www.ndiscommission.gov.au/providers/registered-ndis-providers/provider-obligations-and-requirements/ndis-practice-standards-0 [Accessed 28 February 2024].
Further learning
Want to learn more about improvement science? Check out these free-to-access resources:
- An Illustrated Look at Quality Improvement in Health Care
- Institute for Healthcare Improvement
- NSW Clinical Excellence Commission
- The Australian Institute of Health Innovation
Should you have any thoughts, suggestions, or feedback on this article or your experience with the mandatory training, please email Zoe Youl with your reflections or any queries you might have. Your input is not only welcomed but essential in shaping our approach to continuous learning and development.
Author
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Kath Sharples
Kath Sharples is a specialist educator, her expertise is in work-based professional development and operational/strategic education leadership across private and public healthcare organisations, higher education and aged care. She has international experience in the strategic planning and delivery of innovative approaches to continuing professional development and the translation of evaluative research into evidence-based best practices. Kath founded Health Education Consultants Australia (HECA) in 2017. She is a Fellow of the Higher Education Academy (UK).
