LA VALUTAZIONE NEL SISTEMA FORMATIVO IN AMBITO SANITARIO: APPRENDIMENTO, TRANSFER E CAMBIAMENTO NELLA PRATICA QUALI RISULTATI DELLA FORMAZIONE

The evaluation of the training system in hospital setting: learning, transfer and change in the professional practice as a result of the training This Ph.D thesis reports the results of a survey carried out in a Regional Hospital in the North of Italy aiming at assessing the outcomes of a training course about the “Manual handling of patients: methods, techniques and postures for the prevention of risks” (MMPz) and dedicated to the hospital staff (mainly nurses and support operators). As for the possible training outcomes in particular, the survey has been focused on the concept of transfer and the factors that have positively and negatively affected on it. These factors can be referred to the singular person, the training program and the entire organization, according to the Integrate Model of Training Evaluation and Effectiveness by Alvarez, Sala and Garofano. The term transfer refers to “the extent to which a person who has attended a training activity effectively applies new knowledge, abilities and competences at work” (Baldwin e Ford, 1988). Training is a consolidated and widespread reality which can be found in different organizational contexts, deals with several social processes and tends to meet different demands about knowledge acquisition and skill development. In hospital setting, it can be seen as a strategic lever thanks to which the hospital organization aims at ensuring quality in performance. In Italy, since the first of January 2002, a system called Educazione Continua in Medicina (ECM – Long Life Learning in Medicine) has been activated. It has involved all the hospital operators, staff or free lance. Question is: is the acquisition of training credits a synonym of improvement, efficacy and efficiency? The survey has involved 1095 participants to the training course and 46 coordinators. Given the sample size and the presence in the sample of different Complex Operating Units, the methodological choice has been made of constructing a structured questionnaire for the self-administration. It was built on the basis of the information collected by carrying out 6 focus groups with the participants to the training course and 10 interviews to coordinators (as privileged witnesses of the practices daily used at work). The questionnaire includes items asking personal details and item asking to assess training activities, with a four-point rating scale: 1 = definitely no, 2 = no more than yes, 3 = yes more than no, 4 = definitely yes. Data analysis (666 participants, equal to 60% of the sample and 41 coordinators, equal to 89,1% of the sample) has been carried out by using a statistical software that has estimated such central tendency indexes as mode, median, mean, such validity indexes as explained variance and standard deviation and Cronbach’s alpha as a reliability index. Results show a positive reality, as the staff declares to transfer what they have learned during the course in terms of theoretical knowledge and practical skills in their work activities. Besides they seem to share what they have learned with people who did not attend the course. When this does not happen, causes can be found in factors related to the training course (time, duration and place of the course), the organization (training does not have a dedicated time and happen during the rest days), and singular people (in some cases resistance to change and little collaboration emerged). The role of the coordinator is resulted to be active and fundamental both in the management of the training activity and in the evaluation and monitoring of the transfer. The evaluation discriminates between the two groups of “participants” and “coordinators”, as the latest declare the do it (by direct observations and individual or group interviews) but the former seem not to realize it. The evaluation represents an opportunity for change and development that should be activated at a peripheral level (each coordinator in their own operating unit) and continually: in this way training could be considered not only as an expenditure, but also as e real investment for human resources management.