With Scotland’s third National Dementia Strategy being released at the end of June, health and social care workforce learning and development is still being highlighted as a priority. Out of the first strategy came Promoting Excellence : A framework for all health and social services staff working with people with dementia, their families and carers which is an educational framework written primarily for the health and social care workforce, which details what people working at different levels to support individuals with dementia should know in order to provide the type of care and support needed. Since the frameworks publication in 2011, many health and social care staff have been given training about the impact of dementia, and how best to support individuals living with dementia.
The problem is, as it always is with work related training, what is the transfer into practice? Most training serves to enhance people’s knowledge, but this does not always lead to changes in practice. Research has shown that typically only 30% of classroom based training makes its way to workplace practice, this falls to about 10% within in a year (Broad, 1997). In many studies on the transfer of learning specific to dementia care it has been concluded that the classroom portion of training is only a first step in changing practice or organisational culture (Kuske et al 2009, Bowers, 2008, Kuske et al 2006, Stolee et al 2005). In fact in most studies in which both learner knowledge and learner behaviour was measured learners demonstrated improvement in knowledge but not in behaviour. (Aylward et al 2003, Burgio et al 2002, Cohen Mansfield et al 1997).
Organisational learning and development is a priority for most health and social care services, and as such, it is an expensive part of service operation. So naturally organisations would like to get the best results from their financial investment. But do they know what factors improve levels of learning transfer? I didn’t until I did some research of my own. Here is what I found:
Saks and Belcourt (2006) did an investigation into transfer of training in which they found pre-training, mid-training and post training exercises to being important in increasing the level of training transfer. The role of the supervisor involvement in pre-training activities was also identified, as support from this role has been show as pivotal in the workplace environment for staff implementing changes (Cromwell & Kolb, 2004, Bowers, 2008).
Activities during training such as simulated experiences, use of multiple stimulus, and teaching of general principles have also been associated with effective training experiences (Baldwin & Ford, 1988) and use of feedback following training and follow up of training effectiveness are important elements of good training programs (Machin, 2002).
Post training activities which were identified as improving training transfer include organisational support through policies, practices and creating an environment of social support from co-workers and managers (Cromwell & Kolb, 2004). Follow-up sessions to discuss training or skills learned can also be useful in facilitating knowledge transfer (Baldwin & Ford, 1988). Opportunities to practice new skills in the workplace are also commonly identified in positive transfer of learning (Saks & Belcourt 2006, Machin, 2002).
It is enough to make a learning and development advisors’ head spin! But ultimately it comes down to a few solid facts. Training that is most likely to change practice is training that is embraced and received across all levels of an organisation, it is one that employs activities to reinforce the learning, and it takes place in workplaces that review and address their systems and policies to ensure that newly trained individuals can practice their new skills in a supportive work environment. It is also seen as a suite of activities designed to enhance practice (learning need identification, discussions and reflection during training, and post training follow-up).
Of course there is always the tick box approach to training which allows an organisation to claim to have a highly trained workforce, but which leaves little evidence of this reflected in the practices of the organisation. Good training is always an investment, but it is an investment in the future of the workforce, in the future of the service and in the present lived reality of people living with dementia.
Wendy Perry is one of the learning and Development Officers for the Dementia Services Development Centre, and is a tutor on their Best Practice in dementia care course which is an evidence based organisational training programme that covers the entire skilled level of the Promoting Excellence in dementia care framework.