ing periods (some as brief as 3 days) only to function very inadequately, so that much of the rework fell back on nursing staff. The researchers note that training costs are high when addressed comprehensively. One 500-bed hospital spent $700,000 on its training in the first 2 years of its reengineering initiative. This hospital also performed a gap analysis to identify those roles not being performed adequately and to evaluate what additional training was needed. The reviewers conclude that such continual evaluation of training needs is important to implementing new roles and responsibilities effectively (Walston and Kimberly, 1997). As noted in Chapter 3, unlike NAs working in nursing homes, there are no federal requirements for the amount of training NAs working in hospitals must receive.

Benchmark Training Practices in Other Industries and Health Care

Worker training is not an issue unique to the health care industry. Many technology-dependent industries, safety-conscious industries, and industries that simply find themselves in a competitive marketplace understand ongoing worker training to be an essential part of doing business. Developing and managing human skills and intellect—more than managing physical and capital assets—is increasingly recognized as a dominant concern of managers in successful companies (Quinn, 1992).

High-reliability organizations spend more money than other organizations on training workers to recognize and respond to problems. Operators at Diablo Canyon Nuclear Power Plant, for example, work their regular shifts 3 weeks of every month. During the fourth week, they train for a wide range of unusual and potentially dangerous situations. This training keeps them alert to all the things that can go wrong. It also reinforces the idea that the organization is taking seriously the likelihood of errors, and the need for ongoing vigilance and action on the part of employees to detect errors before they result in adverse events (Roberts and Bea, 2001). Likewise, the International Atomic Energy Agency cites employee training as key to an organization’s safety culture (Carnino, undated). And findings from the aviation industry indicate that training needs to be ongoing and tailored to conditions and the experience within organizations. In the absence of recurrent training, attitudes and practices decay (Helmreich, 2000).

The American Society for Training and Development (ASTD) provides a voluntary benchmarking service for organizations across all industries to report their training practices and commitment of resources. In 2001, 270 public and private employers submitted data to the service showing an average training budget of 1.9 percent of payroll (“payroll” is defined as including wages and salaries but not benefits). The average for HCOs using the service was 1.4 percent. The range across all industries from 1996 to 2001 was 1.5 to 2.0. Organizations considered “leaders in training invest-

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