Information Technology Training in Primary Care by Alpay et al.


The article “Information technology training in primary care” by L. Alpay, L. and A. Russell describe the role and importance of information systems and information system’s training in primary care settings. The authors pay a special attention to changing demands and needs of patients and multidimensional approaches used in primary care. The main problem is that primary care nurses have no access to information systems training so they do not apply new knowledge and technological innovations to their work. The article describes PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) project and its advantages for a primary care setting.

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The article vividly portrays that the managerial challenge in this situation is to figure out how to minimize the financial and human costs of making the necessary organizational alterations and still maximize the speed of the implementation so that the corporation can begin to realize productivity benefits. The following pages address that dual challenge and suggest managerial strategies for meeting it. For healthcare, it is clear from research that information systems success is a function of an organization’s innovative ability as well as its ability to efficiently produce what it has created. The old flexible-versus-efficient formula will not work because primary care units do not have resources and information systems to update their skills and introduce innovations. The needs of modern healthcare are: first, they must innovate high technology products. Second, they must innovate their processes, because success depends heavily on more and more sophisticated healthcare techniques. This imposes a dynamic tension on the primary care units to be simultaneously clearly structured for efficiency while adapting to organizational modifications required by changes in their technical and conditions. The old organizing formulas do not work because they underestimate the complex set of activities with which high technology organizations must simultaneously contend to be successful, and thus for which they must be organized simultaneously. The old formulas will not work for a second reason.

In order to analyze and evaluate the results of the PRACTIS project, questionnaire method was used. A questionnaire was administered to a small sample of nurses. Each protocol was separated into meaning units. That is, each response written by each participant was divided into a series of expressions, which, if read consecutively, match the original protocol. Next, each meaning unit was condensed to its central theme. The central themes were combined and form the final formal step in this qualitative analysis, namely for this sample of nurses. To summarize, a review of the data allows for a description of the nomothetic characteristics of the phenomena. The nursing and educator groups are united to form a single unit here because the analysis of the protocols renders any differentiation arbitrary at this exploration phase. The subjects in this study emphasized the positive benefit from information systems training: they felt good, relaxed, and positive; had unity of mind and emotions; and were glad to be alive. It also provided for an emotional release to ease stress, anxiety, and tension and to cover up nervousness until subjects could regain a coping strategy. This method was effective and allowed the researchers to examine attitudes and effectiveness of the project.

Thus, it would be possible to use observation methods and analyze perception and understanding of training by nurses. Face validity is a low-level estimate of validity, appropriate only as a last resort or when no other validity estimates can be obtained, for three reasons. Participant observation (in which the observer is obvious to and involved with the subjects) is less valid than a questionnaire would be for sensitive data. Second, the observer’s expectations affect what he or she sees and reports, reducing the validity of the data. Observations would help to support survey results or reject their validity. The weaving and sifting of categories of variables to formulate the relationships among them allows for, at least, a claim of subjectivity on the part of the researcher and, at most, a gross misinterpretation of actual facts (Pearlson and Saunders 77).

The strength of the study is that it covers several aspects of training and its impact on nursing staff. Skill in performance is the criterion of learning in industrial jobs, and such skill requires an efficiency in motions and perceptions that can be acquired only through practice; it is not instantaneously acquired but develops. We are dealing in industry with relatively complex perceptual-motor tasks, the execution of which must become increasingly proficient and must finally be fixed in habit at a high level of performance. This process is not to be confused with the eliciting of a few simple motions, requiring little or no skill development, to satisfy a performance criterion little concerned with degrees of excellence. The value of practice, indeed its indispensability, is indisputable; but to be of maximum value the practice should be done under guidance. The instructor’s role must therefore go beyond the beginning modeling, for the purpose of priming the performance, to a continuation of the coaching function as the trainee engages in actual performance. Of course, additional explanations and demonstrations are usefully employed, as the employee’s performance improves, to emphasize the remaining refinements to be achieved. But when the trainee undertakes the task and its refinements, the instructor should be actively engaged in cueing the trainee in regard to upcoming acts and in responding to what is done with specific feedback information on errors (accompanied by further demonstration if the difficulties are complex) and with reinforcement (recognition and approval) of good or improving execution. In this shaping process, the instructor should eliminate cues as observed performance shows decreasing need for them; should continue feedback (including reinforcement) on a consistent schedule until the performance is generally good; and then should shift to an intermittent schedule of reinforcement for the purpose of helping ensure persistence. The coach’s objective is to give needed help but gradually to shift the burden of picking up the feedback indications to the trainee (Pearlson and Saunders 87).

The weakness is that the research is that it does not take into account people responsible to training implementations. The responsibilities for creating and implementing a training and development program in an organization vary along a continuum. At the far right end are training and development specialists who have no supervisory responsibility and conduct programs, primarily of an orientation nature, for semi-skilled to skilled employees. At the far left-hand side are training and development professionals who supervise a large staff in a department responsible for all training and development efforts for all levels, including top management, in the firm. This type of responsibility is also likely to have a strong organizational development flavor to it. In the middle is probably where most training and development professionals operate. They have some supervisory responsibility for a small staff and are concerned with developing and conducting training and development programs for supervisors, clerical, and skilled staff. After bringing staff back into the present and once again elaborating ideas, staff evaluates the various options that are present and develops an anticipatory recruiting strategy for dealing with work force changes of the future. Your strategies may focus on either training current personnel to be more adaptive in the future, or you may focus on an increase in manpower scanning efforts, which you decide is critical to recruitment and selection in the competitive future. The important process within this step is to consolidate the various perspectives on the problem and to generate strategies that take into account the dynamics that have previously been identified.

The other strength is that the researchers evaluate and examine learning process and stages of training. The learning stage is a consideration in the spacing of practice. It would be unwise, for example, to terminate a practice period at a point when the trainee is finally beginning to “get the knack of” performing a complex task. At such point, persistence in practice is needed to set the execution securely in habit. Overlearning, the objective of practice during training, may be described as the stage of learning, brought about by repetition, at which the perceptual-motor pattern of task performance is so firmly set as to withstand interference from other activity and to ensure retention (Pearlson and Saunders 44). It will not be practical–or, indeed, necessary–to keep the trainee practicing a task under an instructor’s continuing guidance until the execution of the task has evolved into habitual performance at the trainee’s ultimate skill level. But it would be unwise to shortchange the trainee in terms of supervised practice. The instructor should provide enough attention in the early practice to be sure that the practice results in an irreversible movement toward high-level “automatic” performance (Pearlson and Saunders 87).

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Following other searchers (Pearlson and Saunders 54) success accompanying an nurses’ act or resulting from it can serve as a powerful reinforcer. Anticipation of success can also have a motivational value; the instructor may favorably influence performance by indicating to the trainee that performing the task in such and such a way will make the execution smoother or easier or faster or produce other evidence of success. But there are cautions to be observed in the use of anticipated success as an incentive. Unless the success anticipated actually ensues, frustration and decreased motivation will probably result. In addition, it is difficult to define success in the trainee’s process of mastering a job, particularly a job with complicated or precise tasks. Performance will progressively improve rather than become dramatically “successful.” Signs of improvement may be minimal in terms of objective outcomes or employee perception. This is particularly true in periods of plateaus in learning. The trainees may be beginning to zero in on feedback indications but reading the signs slowly. Or they may be moving to the use of a more efficient channel of feedback but may not be ready to cut loose from the earlier one and are relying on both (typically, continuing to use visual feedback as kinesthetic feedback begins to take hold), in which case the speed of execution is governed by the slower channel. In these instances, progress is occurring in skill development, but trainees are not likely to be aware of it or to experience feelings of “success” (indeed, may feel discouragement or frustration instead). The instructor’s indicated course is to be alert to those subtle aspects of employee performance representing “intangible” progress and to reinforce them by expressions of approval until the more perceptible signs of achievement evolve.

The weakness of the article is that it does not mention weaknesses and problems connected with information systems training initiatives. Following Pearlson and Saunders (2005, 76), problems can only be identified and proactively managed if they are anticipated by and considered within the mental models that organizational personnel hold about the future. These mental models are the recurrent images, depictions, and scenarios that we hold of our organizations and the action paths of these organizations. In many cases, training problems and conflicts have a great impact on results of the study and effectiveness of the proposed training initiative.

There is no information about nurses expectations and needs identified by them. It is known that employee expectations that are not attached to what an employer expects of the employee are a sure basis for disaffection and its unpleasant consequences. The experience of success has a potential for especially beneficial effect in the different case of young employees who are willing to exert themselves but have little reason to expect success. The building-up of efficacy expectations, through the kind of training that proceeds from success to success and ensures effective performance at each stage, is an important task of the instructor in the training of all learners. It is a crucial factor in the training of those learners whose history has been marked by failures and who lack confidence in their ability to master a new job. It is possibly part of the answer to the problem of dealing with young learners who are poorly prepared by educational achievement to enter the labor market.

It would be useful to describe and differentiate two generations of nurses: young adults and older adults. Many young adults (between 20-30 years old) have excellent computer skills and do not require information systems training. Thus, the older group of nurses needs additional training in computer literary skills. Of all the supposed characteristics of employees of the “new generation,” possibly the most troublesome to industrial management as a problem in productivity is the feeling among some that they can receive the organization’s rewards without a significant commitment to the means of earning them. If in the experience of these employees–work or nonwork, in school, home, factory, or wherever–rewards have not been contingent on performance, the difficulties associated with their acceptance of and adherence to performance standards on our jobs are likely to be compounded. It is in this context that “high expectations” have a disquieting connotation. A growing concern in the educational community regarding even high school graduates is the decline in academic achievement as measured by standard tests. This concern extends to industry since in many jobs the educational requirement–not in terms of grades completed but learning acquired–is relatively high; and in many other jobs, of lower skill level, a minimum academic achievement is properly presumed to be a requisite for job mastery. The consequence for industrial trainers of the trainee’s low academic achievement is that they must confront deficiencies in qualifications by enhancing the training so that all aspects of the job performance are brought up to scratch, which objective would require especially a heightened concentration on aspects for which background deficiencies must be rectified or offset. If there are deep deficiencies in job required academic skills, a company cannot be expected to provide the missing education. But restricted verbal or mathematical procedures not involving a wide academic discipline can be taught to apt employees successfully as a practical job-training endeavor. In addition, the use of performance aids such as tables, charts, displays, calculators, etc. may substantially reduce the reliance on academic skills and make job tasks performable by relatively poorly educated employees. (I am reminded of a simple table developed for determining the even distribution of warp ends over loom beams for the weaving of a variety of sheeting styles requiring different numbers of ends. Previously this operation, part of the “slashing” process, required calculations performable almost exclusively by the head slasher tender; with the aid of the table the entire crew of tenders and helpers, whatever their arithmetic skills, could readily make the determinations.

The article mentions organizational design but it does not mention possible changes in organizational structure and type of work. Most manipulative jobs are not as simple as laboratory exercises; they require manipulations not in the employee’s experience (though within his or her capability), and the motions that may be familiar must be combined in new ways for execution of the novel task. Moreover, the pattern of steps and motions must be strung along a chain of perceptual cues and feedback that, though useful for the trainee to know, cannot be incorporated in performance unless he or she performs. If refinement of the motion and feedback pattern is to be achieved, the performance must occur again and again and again (Schermerhorn and Hunt 21).


In spite of some weaknesses and limitations in research, the research study examines one of the most important problem in primary care settings. Without training and new programs for nurses, it would be impossible to introduce information systems in primary care setting. What a trainer can be sure of is that proficient performance in a manipulative job requires practice. Of course, it is necessary to demonstrate and explain the job task to the trainee; the value of modeling cannot be minimized. But learning cannot stop with a cognitive grasp of the steps in the task or the sequence of motions and an encoding arrangement to help fix them in memory. In very simple operations requiring manipulations already in the employee’s repertoire to large extent, modeling can claim credit for a good part of the learning. Advanced communication technology can generally be considered a subset of the general term ‘communication technology’. It is based on the use of sophisticated information management (generally telecommunication based) to enable multiparty participation in organizational. Electronic meeting systems are an example of advanced communication technology, which support groups by integrating the task focus of group support systems and the communication focus of computer-mediated communication systems. Changes in formal structure are one of the principal tools by which the organization’s executives can continue to keep their companies innovative but attuned to the current and anticipated future problems to face the company. Reorganizing the organization signals an adaptation to a changed environment and technical circumstances for which the current organization is no longer appropriate, rather than a mistake in the original organizational structure as outsiders who do not understand the dynamic nature of the business often assume. The main strength of the article is careful analysis and effective data collection techniques (a questionnaire method), sample size and evaluation techniques. Basically, rank-and-file training should not be program-oriented but geared to deal insightfully with the differences among learning stages and among trainees. The authors came to conclusion that such projects as PRACTIS should be introduced in primary care settings in order to improve medical care delivery systems and simplify nursing work.

Works Cited

Alpay, L. and Russell, A. Information technology training in primary care: The nurses’ voice. CIN: Computers, Informatics, Nursing, 20(4), 2002, 136-142.

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Pearlson, K. E., Saunders, C. S. Managing and Using Information Systems. Wiley; 3 edition, 2005.

Schermerhorn, J. R., Hunt, J.G. Organizational Behavior. Wiley; 9 edition, 2005.

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