.. . . . “.7. .u. .‘ , “ 4 ' x V ' t . ‘ ‘ - - ~.:.¢: ': ‘ _ . W , '. i' '.'. ‘ H in u ‘ ' - ‘.' .‘ ‘ , - "‘ *' ' '. . . . V . ' .' . . .. ‘ m , ...,..,9.fi “‘ ‘iV‘v IIIIIIILW w LIBRARY T Michigan State l University This is to certify that the dissertation entitled THE PERCEPTIONS OF THE KEY POSITION MANAGERS AT THE ARMED FORCES HOSPITALS IN SAUDI ARABIA ON PROPOSED GUIDELINES FOR STAFF DEVELOPMENT PROGRAMS presented by Said Jubran Al-Qahtani has been accepted towards fulfillment of the requirements for Ph.D (19ng Educational Administration a/M Major professor Date February 8, 1989 MS U ii an Afl'irnmtive Action/Equal Opportunity Institution O~ 12771 PLACE |N RETURN BOX to remove this checkout from your record. T0 AVOI FINES return on or before dd. duo. DATE DUE DATE DUE DATE DUE MSU It An Nfirmdlvo Action/Equal Opportunity Inflation ammo-m THE PERCEPTIONS OF THE KEY POSITION MANAGERS AT THE ARMED FORCES HOSPITALS IN SAUDI ARABIA ON PROPOSED GUIDELINES FOR STAFF DEVELOPMENT PROGRAMS BY Said J. Al-Qahtani A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Educational Administration 5&7‘33‘“ ABSTRACT THE PERCEPTIONS OF THE KEY POSITION MANAGERS AT THE ARMED FORCES HOSPITALS IN SAUDI ARABIA ON PROPOSED GUIDELINES FOR STAFF DEVELOPMENT BY Said Jubran Al-Qahtani This study involved the development of proposed guidelines for staff development programs at the Armed Forces Hospitals in Saudi Arabia. After those guidelines were developed it was the purpose of this study 1) to explore, investigate and compare the perceptions of the Armed Forces Hospitals' key position managers on the proposed guidelines and 2) to make recommendations to the trainers, educators, and the administrators of the Armed Forces Hospitals as well as the top authorities of the Armed Forces medical services directories based on the study findings. The population of this study was comprised of the hospital adminisitrator, the assistant hospital administrator, the chief of professional staff, the nursing director, the personnel director and training director in seven Armed Forces Hospitals located in six major cities. A questionnaire and interview techniques were used to gather the data for this study. The data generated were presented in a way to show how all respondents collectively and by sub-groups responded to the questionnaire items. The A jug—— SAID AL-QAHTANI statistical techniques used for data analysis were frequency distribution, percentage, means and standard deviations. It appeared from the study findings that first, there are no significant differences in the perceptions of key position managers (sub-groups) on the proposed guidelines. Second, the respondents favor a comprehensive staff development model which consists of three elements: 1) orientation for all employee categories (local, international, Saudi, non—Saudi), 2) in-service training and 3) continuing educational programs for all employees. Third, the respondents favor a centralization of command philosophy and decentralization through execution by the subdivided units. Finally, it was recommended that the medical services directorate should take a leading role in the training and educational activities at the local Armed Forces Hospitals. TABLE OF CONTENTS List Of Tables loot-0......onoo-ooooooooooooooonooooooo List Of Figures anoonInooooooooonooooo-oooooooooooooooo CHAPTER I NATURE OF THE STUDY eloooooooooooucacao-000.00.... Introduction ..................................... The Historical Background of the Armed Forces' Medical Services Directorate (MSD) in Saudi Arabia ............................ MSD Responsibilities ............................. Internal Organization of MSD Hospitals ........... Staff of AFHs .................................... Statement of the Problem ......................... Purpose of the Study ............................. Importance of the Study .......................... Limitation and Generalization of the Study ....... Research Questions ............................... The Organization of the Research Report .......... Definition and Abbreviations ..................... CHAPTER II REVIEW OF THE LITERATURE IUIOOOIOIIIOIOIOOOIOOOOOO History of Staff Development ..................... ' Identifying Learning Needs in the Health ‘ Care Institutions O...00.0.0...OOVOCCIOIOOIIOOOOO k iv Page ix xi 10 11 12 12 13 14 15 17 17 20 Methods of Needs Assessment ...................... Questionnaires ............................. Interviews ................................. Observation Techniques ..................... Records Analysis ........................... Planning for Staff Development Programs .......... Learning Techniques .............................. Adult Education Principles ....................... Strategies for Teaching .......................... Lecture .................................... Discussion Methods ......................... Individualized Instruction ................. Simulation Techniques ...................... Laboratory Methods ......................... Field Experience ........................... Evaluation ....................................... Evaluation Process ......................... Sumary OOOODOIIICIOOI.0......IIOOOOOOOIOOOIOIOIC. CHAPTER III METHODS AND PROCEDURES ........................... Introduction ..................................... Population ....................................... Hospital Administrator ........................... Assistant Hospital Administrator ................. Chief of Professional Services ................... Page 23 23 24 24 25 26 3O 3O 32 33 34 36 37 38 39 41 43 47 48 48 48 49 51 51 A Personnel Director .IOOOCOOIIODOCIOOOOIIUOOOUI. Director of Nursing ............................ Training Director ............................. Instrumentation ............................... Data Collection .........-............... Questionnaire Survey and Interview ...... Existing (Official) Records ............. Data Analysis ................................. Summary loco-oo-onone.on.cocoa-ooon-oooonoooooo CHAPTER IV PRESENTATION AND ANALYSIS OF DATA ............. Demographic Data .............................. Nationality ................................... Locations ..................................... Occupation .................................... Educational Level ............................. Sex ........................................... Experience in the Saudi Armed Forces Hospitals Hospital Experience in General ................ Section 1 ..................................... Mission Statement, Philosophy, Goals and Objectives and the Implementation of the Staff Development Program ............... Section 2 ..................................... Determining Educational Needs ........... The Effective Instructional Methods ..... Section 3 ..................................... vi Page 53 54 55 58 59 6O 61 62 62 63 64 64 67 67 67 69 69 72 72 72 79 79 82 89 Page 89 The Orientation of Overseas Employees . Content OOIQCIOIOIOIOIOOOI.00.000.000.000... 93 Hospital—Wide Orientation Program .......... 96 Content of Hospital-Wide Orientation Program COCOOOOOOIIIIOOIDIOOOOIIOOIIIIOIOOCO 99 Department Orientation Program ............. 104 Content of the Department Orientation Program 0.0.0....U0.0IOOOOOIOOOCOOC'IOIOOOOI 105 MSD Orientation Program .................... 108 Content of MSD Orientation Program ......... 112 Section 4 ........................................ 116 Section 5 ........................................ 118 Summary .......................................... 121 CHAPTER V SUMMARY, CONCLUSIONS, DISCUSSION AND RECOMD‘ENDATIONS . C D O O I I U 0 I O O I O 0 C O I O D C C O I O I O C C O I C I 122 Section 1 CI........ I.IIOCIIODOIOCIOOIOOOIIOI D... 122 Summary of Purpose and Procedures of Study I.0.0.0.0000...OIIOOOOOIIUIIOOOOOI 122 Research Questions ........................ 123 SectionzIOOOIOOOOIIOOOCIOOOIDOOOOOIIIICIOIOO... 124 Findings from the Demographic and Personal Data IOIOCDCIOOOOOIIOODODIOCOIOIOO 124 Conclusions I0.......OCOOCCOOIOOOOIIOUII... 124 Findings Drawn from the Responses of the Respondents on Questionnaire .............. 12S conClUSionS 00000.0.ooooooooooooooooooooolt 130 Discussion noooonolooooooo-oononoooonoooooooooooo 132 Page Recommendations ................................. 139 Recommendation for Further Research ............. 141 Summary ................................... ..... 142 APPENDIX A ........................................... 144 APPENDIX B ....... ...... .............................. 163 APPENDIX C ........................................... 171 APPENDIX D ........................ ...... ............. 177 REFERENCES ooooooooaooonooooooooooooooooo-oooooaoooool 181 viii LIST OF TABLES Page Budget Appropriation for the Ministry of Health ... 2 Hospitals, Beds and Primary Health Centers Under Ministry of Health .......................... 4 The Progress Made on the Total Number of The Armed Forces Hospitals' Beds from 1981 - 1988 ..... 7 The Distribution of the Respondents in Relation on their Nationality, Educational Degree, Sex, and Their Work Experiences ................... 65 Respondents Perceptions by Frequency and Percentage on Items Related to the Appropriate Needs Assessment Method ........................... 75 The Respondents Perceptions by Frequency and Percentage on the Proposed Needs Assessment Methods ......‘OCOOC......OIIIOOOOOIIOOI‘IOUIIIIOOI 80 Respondents Perceptions by Frequency and Percentage on Items Related to the Appropriate Instructional Methods ......OOIOOOIOOOICIOIODOIIOO. 83 Respondents Perceptions by Frequency and Percentage of Items Related to the Proposed Orientation of Overseas Employees .............. 91-92 Respondents Perceptions by Frequency and Percentage on Items Related to the Proposed Hospital-Wide Orientation Program 0 o I o o o o I o o o I o 0 97-98 Respondents Perceptions by Frequency and Percentage on Items Related to the Proposed Departmental Orientation Program .................. 106 Respondents Perceptions by Frequency and Perception on Items Related to the Proposed MSD orientation ProgramOClOlIOIIIOCOOOOIOIIIOOO 110-111 Table Page 4.9 Respondents Perceptions by Frequency and Percentage on Proposed Models for Training and Continuing Educational Programs .............. 117 4.10 Respondents Perception by Frequency and Percentage on a Set of Recommendations to the Trainers and Educators ....................... 119 FM Fig Fig Fig Fig FIGURE 2-1 4-1 4-2 4-3 4-4 4-5 LIST OF FIGURES Page The Adaptation of Knowles Model to the Needs Analysis in the Staff Development O.II00............OOIOIOIIIOOO. 21 The Percentages of the Respondents in Relation on Their Nationality ............ 66 The Percentages of the Respondents in Relation to Their Educational Degree ..... 68 The Percentages of the Respondents in Relation to Their Sex .................... 70 The Percentages of the Respondents in Relation to Their Experiences in Saudi AFH 0‘.........IOOII.....IOOOIIIIIOOOI...O 71 The Percentages of the Respondents in Relation to Their Experiences in Hospitals IOOIIOOOOIOICOIOOII‘OI00.0000... 73 xi CHAPTER I Nature of the Study Introduction One of the most important elements in Saudi Arabia's development over the last quarter century has been the establishment of a modern nationwide system of health care services. Due to the improvement of economic conditions and the tremendous progress made by the Kingdom, the health services have greatly expanded and improved since the establishment of the Ministry of Health in 1953. The Ministry of Health has primary responsibility for the Kindom's health care program. During the 1980-85 development plan it spent nearly $10 billion on new construction, the establishment of projects to improve health services and the creation of a Health Services Council to develop and coordinate health policy. (Ministry of Information) (See Table 1-1) Currently a number of ministries and government agencies provide medical services. These include the Ministry of Interior, the National Guard, the Ministry' of Defense and Aviation, and other agencies which manage highly equipped hospitals and health centers of their own. For example, the Ministry of Defense and Aviation manages several hospitals, one medical center and a medical academy. ooo.oow.00v.w mmm.~>o.h ooo.cvm.v~m.m occ.oom.mvhio~ ooo.oon.mom.w 44808 omh.mmvtfi oooiomptmo~.~ ooo.ooo.mmfi.v oootcoo.nvw.~ coo.oon.ahw.m muoonoum unwEQoHo>oo Av omo.vm~.~ ooo.om>.mo~.a ooorooo.o~H.~ ooo.oom.omp Ia manhooum mocmcmucumz can cowumummo Am ppm.omm ooo.ooo.mmn.~ ooo.oom.womia ooo.ooo.mm>.~ ooo.>hm.omm mwusuavcomxm . ucwuuauwm AN omh.mnm.m ooo.ooo.own.m ooo.ooo.~mm.m coo.ooc.m-.m ooo.ooo.~mv.m mofiumHmm Ag guano: no xuumficfiz nmma mama mm¢~ «mam nmmm uOuuwm hmmq I mama EOHm =844m= m0 fiMHmHsz mzfi “Om 20H6u:-.-niou :55 52%.: Etta—5:3 use ;=-¢-J ...-.3235:- ..aU 2:350 NOanWAi at: up... 0. .2 9:50: ...-E39..— 3...}... 05.15.00 9.5-. .900 .0331 5:: 9:560. $.53 ...-[:23 .0. .3025.— twin 213550: .‘lLlIIII 7:59:65 :Dv .56.: 5 i g 5 O U “WWI” 05:5: .0 Evita-:0 >u¢to< .2... 22 setting helps to determine the "real" learning needs versus the "nice to know" needs. Organizational needs that can generally be met by a learning experience are those identified as being necessary to function competently in that particular setting. Individual learning needs will vary based on educational preparation, experience, licensure requirements, career-oriented goals, and most importantly, individual abilities. The personal goals and needs of the individuals must be considered along with the goals and needs of the organization if the ultimate outcomes, as identified on the model, are to be attained. Disregard for the needs of the employees as individuals can serve as a deterrant in their motivation for continued learning. At Rhode Island Hospital, a needs survey was conducted using the same questions for supervisory and nonsupervisory staff. In addition to completing the questionnaire regarding their own personal education needs, supervisors were asked to indicate what courses their employees needed. A comparison of the completed supervisory and nonsupervisory forms produced remarkably different results. For example, the supervisors expressed a need for courses related to improving employee attitude. The nonsupervisors were interested in courses related to career development, such as management skills for nonsupervisory persons. In planning programming both of these needs must be addressed. In some cases these needs will be overlapping. Conducting a needs 5. . 14. 23 study will help to determine the kinds of programming that will be most useful to the organization and its employees (Parker, 1986). Grubb and Mueller stated that the person or persons selected to gather the data should have a knowledge of the hospital and good rapport with those from whom the information is to be gathered. A record of past educational activities in all areas of the hospital and outlines of presently planned learning activities will be valuable to the data gatherer (1975). In fact, the needs assessment can be conducted through a variety of methods. Those methods can be: Questionnaires The questionnaire method is considered to be one of the most common techniques in needs assessments for staff development programs. Puetz (1987) stated that although there are many effective ways of assessing learning needs the one most often chosen by continuing or staff development educators is the questionnaire. In her book on evaluation in nursing staff development (1985) she listed general guidelines related to the design or format of the questionnaaire. Those guidelines are: 1) The form should be attractive. Use a substan- tial weight of paper, colored paper and/or colored inks. 2) A graphic design can be used to attract the respondent's attention to the form. 3) The questionnaire should be short. If possible, tell the respondent approximately how long it will take to complete the questionnaire. 24 4) Instructions should be clear and concise. Print instructions in bold type. 5) The questionnaire layout should be organized in a logical sequence. Put easily answered questions first, then proceed to more difficult items. 6) All pages of the questionnaires should be numbered as should all items included in the questionnaire. 7) Include an example before any item that may be difficult to understand. Interviews Another common technique is the interview to collect data for staff development programs. In a structured interview, the same questions are asked of all those being interviewed in the same way. In unstructured interviews, the interviewee is asked to direct reactions or comments to one topic, event, or experience and can speak as freely as desired. Babbie (1973) stated that if the respondent clearly misunderstands the intent of a question or indicates that he or she does not understand, the interviewer can clarify matters, thereby obtaining relevant responses. One of the advantages of the interview method is that the interviewer can observe the respondent for reaction while posing the questions. gppervation Techniques Observation techniques involve watching employees perform in their work environment. Observation is particularly useful in assessing psychomotor skills and affective components of employee activities that are not 25 easily assessed using written questionnaires. O'Connor (1986) stated that observations may be systematic or random and they may be conducted by the educator, trained raters, supervisors, peers, advisory committee members, or the learner. When needs assessment depends heavily on observation of performance, it is vital for the educator to conduct at least some of the assessments directly. O'Connor added that observation techniques require several elements for success. Careful planning to determine what will be observed and how observations will be rated is essential. Well-defined criteria and objectives are necessary to focus the observation on essentials. Raters must be trained in use of the rating instrument, and periodic checks on rater reliability must be made to ensure objectivity in reporting. Samples of both positive and negative behaviors must be recorded and observation should take place over time. Puetz (1987) stated that if the purpose of the observation is to assess learning needs, it will be necessary to schedule observations over a period of time; perhaps several months or even a year to be certain an adequate representative sample of behaviors has been seen 0 Records Analysis As a source of collecting data for staff development programs, the educator may consider analyzing the existing organization-based records such as statistical reports, incident or accident reports, maintenance records, personnel A ‘- 26 related data as turnover and absentee records as well as patient records. O'Connor (1986) stated that records analysis can be a first step in needs assessment by revealing areas needing more focused exploration with questionnaires or observation. Such an analysis can aid in the interpretation and prioritization of learning needs by tying learners' expressed needs to those of the organization and larger society. Because organizational records are compiled for reasons unrelated to learning needs assessment, analysis and interpretation can be highly subjective. Therefore any identification of learning needs based on such records should be confirmed using other techniques. In addition to questionnaires, interviews, observation and records analysis, there are many other needs assessment methods that exist which can be used alone or in combination with others. Planning for Staff Develgpmgnt Programs The completed assessment will provide a mass of data, and in order to utilize it and analyze it, a great deal of planning, preparation and promotion is required. To fulfill such tremendous responsibilities, it is imperative that orientation and continuing education educators and trainers be thoroughly trained for their jobs. The basic knowledge required of those individuals must include the following: How to set goals, write objectives, put a program together, sell programs, utilize resource persons/materials, communicate, provide professional enrichment, evaluate 27 programs and how to ascertain whether the program has produced positive results resulting in more knowledgeable, and meaningful patient care (Rowe, 1985). Therefore the education and training department or the department in charge of orientation and the continuing educational programs must have a number of goals if it is to be effective. Mager stated that "an objective is a description of a performance you want learners to be able to exhibit before you consider them competent." In the process of developing program objectives, the statement of objectives should express the performance expected of the trainees upon completion of the program. The end-of—course objectives are stated in terms of observ- able behavior or performance, and do not simply describe what the trainees have learned as stated by (Ribler, 1983). Mager and Beach (1983) state that objectives represent a clear statement of instructional intent and are written in any form necessary to clarify that intent. They added that in practice you will have at least twice as many statements as you have taken on your list. They developed a list of the characteristics of the objectives statement which can be summarized as the following: 1) An objective says something about the trainee. It does not describe the textbook, the instructor or the kinds of classroom experiences to which the trainee will be exposed. 2) An objective talks about the behavior or performance of trainee. It does not describe the performance of the teacher. A 28 3) An objective is about ends rather than means. It describes a product rather than a process. 4) An objective describes the conditions under which the trainee will be performing his terminal behavior. 5) An instructional objective also includes information about the level of performance that will be considered acceptable. Writing good objectives is not easy. A good objective is one that motivates the educators to take action and provides direction for that action. There are several criteria that can be used for writing good objectives. These criteria will help the educators to improve their efforts to develop objectives that work for them. The American Hospital Association have listed the following criteria: 1 - Objectives should be written. Many people think that writing objectives is unnecessary. They feel that as long as they think about them it doesn't matter if the objectives are written down or not. This is a dangerous assumption. The purpose of writing objectives is to clarify them. Once an objective is written down, the investment in it increases. As the investment increases, the personal commitment increases. Written objectives have other advantages as well; they are less likely to be forgotten or lost in the midst of daily pressures and it is easier to integrate several objectives at once and to identify and resolve conflicts among them. 2 - Objectives should be realistic and attainable. If an objective is unrealistic, it is not an objective at all. , 29 It must be attainable. This doesn't mean that one should set low objectives. Objectives should be challenging, they should make one stretch and grow, but they must also be set at a reasonable level —- one toward which a person can be both able and willing to work. Although motivation increases as objectives are set higher, if one sets an objective so high that one does not believe it can be accomplished, one will probably never try. Attainability is difficult to define. Ultimately, each person or organi- zation must judge what is truly attainable. History is full of examples of people achieving unattainable objectives. If an objective feels right, and if it makes sense, it probably can be reached. 3 - Objectives should be specific and measurable. When objectives are stated in vague terms, they provide very little direction. It is difficult to know exactly where to start and in what direction to proceed. 4 - Objectives should have time schedules. Assigning target dates for accomplishing objectives increases motiva- tion, commitment, and action. Each step along the way should be assigned a realistic target date that can and should be adjusted if conditions change. As each target date is reached, a person will experience the pride of accomplishment and greater confidence in the ability to achieve still higher objectives. A 30 5 - Objectives should be compatible. Objectives should be compatible with one another. Otherwise, accomplishing one may prevent you from accomplishing another. Learning Techniques This section will cover the strategies to facilitate learning and how to apply the principles of adult education to the learning process. Adult Education Principles Human behavior is 23 very complex and individualized phenomenon. Since the task of staff development programs is to change the attitude and the behavior, it is imperative that individualism be examined and considered by the planner, the trainers and the educators in the process of designing their programs. A view of learning and behaviorial change which holds strong implications for adult education is the perceptual theory of psychology (ASCD, 1959, Combs & Snugg, 1959). This theory suggests that how an individual perceives people, objects, and events in his or her environment will greatly influence how he or she behaves. Because of the significance of people's perceptions as pertaining to behavior, attitude, and learning, it is most important for educators to give a great deal of consideration to things that determine or affect human perception. A din 31 Verduin, Miller, and Greer have listed a several per- ceptual determinants: Beliefs - what adults believe to be true affects their behavior, whether these take the form of faith, knowledge, assumption or superstition. Beliefs are reality to individuals and their behavior is rooted in this reality. Values - People's feelings about what is important to them which can be related to ideas, a way of life, material things or people. EEEQE - what individuals require to maintain or enhance themselves. Attitudes - An emotionalized belief about the worth (or lack of worth) of someone or something. Self-experience (Self concept) - How individuals think others presently see them: how they feel about this, their concept of the roles they play, and how they feel about these, and their ideal role concepts. In Appendix C fourteen principles of adult education which were developed by Mary Petersen appear as stated in her article, "Adult Educator Competencies". Those principles of adult education provide the conceptual framework for performance competency to guide instructors in the inservice department. From those principles the following criteria can be generated: The adult will respond positively to learning if the answer of the following questions is "yes". 32 1. Does the information have some personal meaning for the participants? 2. Can they relate what they are learning to their goals? 3. Are they active participants in the learning process? 4. Are they exploring new ' information and experiences? 5. Are the learning sessions uninterrupted and extended over a substantial span of time? 6. Can they consolidate what they have learned before going on to new information or skills? 7. Can they learn in an unpressured environment? This understanding of the adult participant requires close personal interaction between the participant and the instructor or the educator. Strategies for Teachigg There are a variety of teaching and instructional techniques or learning styles which can be used for adult programs. These techniques can be used to impart knowledge, to teach a skill, to change attitudes, or to encourage creativity. Rezler and Rezmovic, (1981) defined learning style as "the manner in which an individual perceives and processes information in learning situations." In one of their series guides for the improvement of instruction Alexander and Davis, (1977) developed a list of the most common instructional methods, and the advantages and the limitations of each method. Those methods are presented in the following discussion. 33 w Opinions differ widely regarding the effectiveness of lecturing as an instructional method and much research has been directed at comparing the effectiveness of the lecture with other instructional methods. The results of these studies indicate that the effectiveness of the lecture method depends on the nature of subject and on the skill of the teacher who uses it. Users of the lecture method must consider how to overcome its limitations and use its strengths to best advantage. These advantages and limitations are listed below. Advantages 1. It allows the teacher to cover a large amount of material. 2. It permits the teachers to use their experi- ence and knowledge in an organized and systematic presentation. 3. It can be used with large groups of students. 4. It provides opportunity for students to develop the ability of listening accurately and critically. 5. It doesn't require special instructional equipment or materials. Limitations 1. The lecture method makes it difficult for the teacher to accommodate students' individual differences. 2. It places heavy reliance on students' listening, memory, and note-taking skills. 3. It demands sustained student concentration. —__——— 34 4. It doesn't provide an opportunity for judging audience understanding or reaction accurately. 5. It is not adequate for developing high-level intellectual skills, e.g., problem solving. Many of the above limitations may be overcome by skillful preparation and presentation and/or by combining the lecture with other methods. Discussion Methods The discussion is generally regarded as one of the most effective methods of instruction for small classe groups. Research studies support this view and s and indicate that the discussion method is particularly effective for learning complex skills such as critical thinking and problem solving. The discussion method is a generic label that encompasses a variety of techniques. These techniques have been developed as a means of focusing on instructional objectives. different The primary value of all discussion techniques is that they provide an opportunity for students to gain experience through participation and interaction. When groups are encouraged to present and build upon their own id show (1) higher-than-average achievement on information, (2) positive attitudes toward school, they tests of the teacher, and the subject matter, (3) lower levels of anxiety, and (4) more positive self—concepts. As the teacher increasingly structures the discussion so as to influence student ideas, the less students learn in higher kip 35 cognitive processes such as the ability to think critically. It is the active exchange of ideas, facts, and opinions that constitutes the learning dynamic in the various discussion methods. Some instructors hesitate to use the discussion mode because of its apparent inefficiency. The inefficiency of the discussion mode -- i.e., number of objectives achieved per amount of time spent, or number of students achieving objectives per time spent -- rides critically upon two factors; (1) the participants being adequately prepared for the discussion, and (2) the participants, and especially the leader, being adequately skilled in discussion techniques. Advantages 1. The discussion permits the members of the group to become directly and actively involved in the learning process. 2. It maintains student interest. 3. It provides opportunity to share information and experiences. 4. It provides opportunity to practice and learn such intellectual skills as organizing facts, discerning questions, presenting a coherent argument, and thinking reflectively on one's own ideas and those of others. 5. It provides opportunity to practice and learn interpersonal communication. 6. It provides feedback to the teacher on student progress. Limitations l. The discussion method does not function well unless participants have a common background of knowledge and level of maturity. "1IIlIIlIII-'-IIIII-I--IIIIIII-IIIIIIIIIIIIIIIIIIIIIIIIIII-----------I-. 36 . 2. It is time consuming. 3. It depends upon the learner's capacity and mood for participating, and the teacher's willingness to prepare for the discussion in advance. 4. It depends upon all participants having previously learned the discussion skills required to enhance effective participation. Individualized Instruction Individualized instruction refers to a wide variety of instructional techniques in which students proceed at their own pace to reach an educational goal. Such techniques are designed to accommodate individual differences among students in learning styles, motivation, personality, knowledge, and skills. Individualized instructional techniques differ in the degree to which students and teachers share the responsibility for setting the instruc- tional goals, structuring the learning process, and evaluating the knowledge and acquired skills. The computer-assisted instruction and the audio-tutorial instruction are good examples of the individualized instruction. Advantages l. Individualized instruction accommodates individual differences among students. Students may learn at their own rate and review materials as frequently as necessary. It is particularly effective for slow learners and results in a high rate of retention. 2. Lessons are planned and designed to achieve predetermined outcomes. 3. Students are challenged and motivated because they are responsible for and can control their own learning progress. l 1 37 4. Students' and instructor's time is used efficiently. 5. Content and procedures are standardized and reproducible. 6. The teacher can continuously monitor the progress of each student. Limitations 1. Individualized instruction requires extensive time to prepare and validate packages. 2. It permits ‘little social interaction or summary integration of material unless specifically planned for through discussions, debriefings, or peer-assisted learning sessions. 3. It requires supervision and counseling for students who are not familiar with the method. 4. It requires management procedures and data collection. Simulation Techniques Simulation techniques present students with a task that can only be completed successfully by learning and applying a particular body of facts, concepts, principles, or strategies. Simulation tasks provide students the oppor- tunity to experience situations that would not likely be encountered in real life and to interact and learn from them without fear of serious consequences. Three most frequently used simulation techniques are games, simulated systems, and role playing. Advantages 1. Because simulation activities are fun and are perceived as having relevance to real-life situations, students are usually motivated to participate. 38 2. They provide students with the opportunity to become directly involved in learning activi- ties. 3. Many simulation activities promote and reward critical thinking because they involve analyzing possible Options and the probable consequences of choosing them. 4. Students of all ability levels can benefit from simulation activities. Students with greater ability are more likely to derive inferences from the experience and generalize or transfer them to real life. Students with lesser ability benefit since highly abstract concepts and principles may be simplified and translated into concrete behavior. Limitations 1. Simulation techniques can be expensive. Commercial materials are costly; those produced by the teacher may require extensive expenditure of development and testing time. 2. Students may learn to respond incorrectly or inadequately if simulation does not include all important elements of the phenomenon represented. 3. Simulation techniques usually require a great deal of time. The amount of time required is directly related to the level of learning involved. Laboratory Methods Laboratory methods can be employed in any academic discipline where practical experience is to be related to theoretical formulations. They need not be confined to "the laboratory," but can include field trips, interviews, and visits to real-life institutions or situations. Whatever laboratory methods are employed, they should be combined with other instructional methods. Students should be prepared with the prerequisite knowledge they will need for the laboratory experience, either by lecture, text assignment, or individualized instruction. 39 Advantages l. The laboratory method allows students to discover things for themselves through controlling conditions, observing relation- ships, making measurements, interpreting data, and drawing conclusions. 2. The method allows for active involvement of the learner because it emphasizes direct experience with manipulating objects and materials pertinent to the tOpic being studied. 3. It enhances student motivation since it provides the opportunity to develop under- standing and skills that can be used outside the school setting. 4. It permits development of such attributes as carefulness, precision, and tolerance for ambiguity. Limitations 1. In comparison to other instructional methods, it is relatively inefficient for obtaining information. 2. It can be expensive, requiring equipment, materials, and space. Field Experience A field experience is usually conducted as a planned study in which the teacher and students mutually agree on specified goals to be achieved. Arrangements are made for the field placement, and the course of events and progress of the study are usually the responsibility of the student thereafter. Field experiences provide a wide range of learning opportunities including: living and working in another culture and environment, and/or gaining practical work experience 1J1 industry, a commercial establishment or government agency, working under the supervision of a 40 skilled practicing professional, and/or participating in field research programs. Advantages 1. Field experience accommodates individual differences among students in learning style and aptitude. 2. It provides the Opportunity to increase knowledge and skills in realistic situations. 3. It enhances students' motivation by permitting them to become involved in controlling the learning process. 4. It provides the opportunity to integrate. Limitations 1. The effectiveness of the field experience depends to a large extent upon cooperation of people in the field who are not under the instructor's control. 2. Its effectiveness depends upon the student having developed interpersonal skills and habits of self-control. ' 3. It requires planning, counseling, and supervision by the instructor. 4. The instructor may be uncomfortable in a situation that requires close relationship with the student. The key to selecting any teaching method is to target the objectives. In order to present information effec- tively, instructors must choose strategies based on the objectives they wish to achieve (Haggard, 1984). Linton and Truelove list other factors besides achievement of objectives that should be considered when choosing a teaching technique. 1 - Trainee's previous education, experience, interest and motivation; 41 2 - Degree of content difficulty and complexity; 3 - Class size; 4 - Availability and cost of facilities and equipment; 5 - Training time - ‘most efficient and effective method for allocated. Also the instructor is responsible for maintaining a learning environment such as the classroom set up. In Appendix I).a set of tables are included which contain recommended Instructional Techniques with the appropriate room arrangement in regard to imparting knowledge, teaching a skill, change of attitude, and encouraging creativity. Those tables are adapted from Russell Robinson's book: An Introduction to Helping Adults Learn and Change (1983). Evaluation Tobin, Wise and Hull (1979) defined the evaluation as the process of ascertaining or appraising the value of something and as such requires that a judgment be made. In staff development evaluation is aimed at determining the value of specific learning offerings, and the effectiveness of the overall effort. Presently, the evaluation has become a concern of hospital professionals in all areas of practice. The practitioners at the bedside, in the lecture room and in the community no longer can provide services without concern about demonstrating that the services indeed are beneficial to their clients. The recent emergence of continuing education and staff development programs as *— . n. 42 important components of staff education has led to a need to evaluate the effectiveness of those educational programs as well. Purposes of Evaluation vThe purpose of evaluation can be: (1) to assist the educator in defending various programs by knowing the accomplishments and contributions of activities to the hospitals' goals. (2) To provide the administration, the educational department and staff with a means of determining the efficiency and effectiveness of both management and operation. Only by appraisal is it possible to ensure that programs are suited to the trainees or the participants for which they are designed and that they effect the behavioral changes required for improved products or services. (3) To encourage the trainer or the educator and the staff to upgrade their professional skills, look for better facilities, and provide better instructional materials so that measurable improvement will result. Types of Evaluation There are varying opinions about the most appropriate type of evaluation. The most common ones are formative and summative. As i1: conceived fur Scriuen (1967), formative evaluation is utilized to determine if the program is operating as originally planned or if improvements are necessary before the program is implemented. The major concern of summative evaluation is the evaluation of the 43 final product with the major emphasis being program appraisal. Evaluation Process In order to have a successful evaluation certain steps need to take place in the process of evaluating any program. Seven steps were developed by Sara Steel and Robert Brack which can be summarized and listed as the following: 1) Understanding First, it is necessary to understand the purpose of evaluation. Once the purpose is established, other decisions can be made: the level of quality, who will use the results, what information is to be collected, and when it is needed. A major reason for evaluating the attainment of objectives is to help the adult learn confidence and motivation to participate in more continuing education opportunities. To achieve this purpose, the data must be collected in a non-threatening manner and in such a way that the learner will accept and use the information. To accomplish this purpose the student should be told the results of the evaluation. 2) Specifying If the particular behaviors that indicate achievement of the objective are not stated in the objective itself, list the examinable outcomes that indicate goal attainment. Also, if one objective is more important than another, use an ordering system to show the relative importance of each. 44 When doing these tasks, keep in mind the adult education principle that states that adults are task oriented and want to see meaning to their learning. To specify behaviors either an inductive or deductive method can be used. Induction is accomplished by grouping a number of small related tasks together and transforming their behavior into a meaningful behavior for the adult; deduction starts with the larger behavior and lists the observable measures it comprises. 3) Describigg The person who conducts the evaluation should decide on the quality of acceptable evidence. Generally, the more precise the data the more time it takes to obtain them, and this is especially worrisome in adult education because learning time is usually limited. Adults often become disgusted if time is used for evaluation that they think would be more profitably used in learning. How accurate must the information be? Is it important that the results be replicated, or is it sufficient to obtain a self-assessment from the learner? Much faith has been put in the experimental approach to evaluation, but this level of data is not needed in all instances. In addition, some data obtained with this method are poor and of little use. The cost/benefit ratio needs to be considered. Also, it is possible that data from several less rigorous means will be as accurate as that from the experimental approach. 45 4,5) Comparing_and Judging These two steps are usually done together. While different tasks are required to accomplish these steps, some similarities exist between them. The tasks are to compare the results at the end of the course with the objectives set, to compare the results with the original need for the offering, and to compare these results with other means of meeting the objectives. Judging entails deciding whether the results meet the standards used to evaluate, whether any negative impact outweighs positive results, and whether the objectives and standards were obtainable and realistic. 6) Valuing Whereas judging determines whether the objectives were met, the valuing process assigns worth to the achievement of the objectives. If the objectives were met, was the effort worth the cost? The answers to questions such as these are more significant than whether the objectives were met. An offering may have achieved the objectives but be of little worth. On the other hand all the objectives may not have been met, but the program may have been of great value to the learners. 7) Influencing The valuing process has a direct bearing on the influence exerted. It is evident that the evaluation process is time consuming and costly, therefore the information gained should be used to improve programming. 46 Sometimes the information gained is for the programmer to use directly, but sometimes it must be referred to another person for action. This requires a plan to carry out this role. The value of the evaluation depends upon its subsequent use to expand effective programming. To have a successful evaluation it is also important to require a careful management to assure that the evaluation activities proceed as planned. According to Kosecoff and Fink authors of Evaluation Basics, the three most important functions in managing an evaluation are scheduling, staffing and budgeting. The director or the coordinator of training and educational department needs to be familiar with the details of the evaluation process to know what is to be accomplished by what time. He or she also is responsible for assigning department staff members or people involved in evaluation activities to the evaluation study and monitoring their activities. In discussing the evaluation of an evaluation, Stufflebeam lists several standards for [good evaluation. These are summarized below: 1) An evaluation must be technically adequate that is it should provide an accurate assessment of all pertinent areas under investigation. 2) An evaluation should be useable. It should be oriented to the informational needs of the users and should provide the needed information in a form that can be used. 3) An evaluation design should be practical. It should be workable in the situation where it is to be carried out. 4) 5) 6) 7) 8) Chapter II has presented a selected review of literature pertinent to this investigation about staff development 47 The evaluation results should be reported. The report should be sufficiently clear to leave 1K) doubt as tx> the conclusions and recommendations. The evaluation should be complete. The total range of findings should be reported. The evaluation should be objective. Those conducting the evaluation should be sufficiently independent so that the results are not distorted by personal feelings or prejudices. The evaluation should provide applicable information. The information provided should allow those reading it to act on the conclusions and recommendations. The evaluation should be balanced. Both strengths and weaknesses should be considered and reported. Summary activities. The review provided a foundation for a comprehensive conception of the staff development programs by including its history, its importance in the health care field and the process of staff development. CHAPTER I I I Methods and Procedures Introduction There were two purposes for conducting the study: 1) to explore, investigate and compare the perceptions of the key position managers at the Armed Forces Hospitals on proposed guidelines for staff development programs. These perceptions were determined by use of an instrument which was generated from a review of literature, standards of the Joint Commission on Accreditation of Healthcare Organization and the publications of the American Hospital Association. 2) To make recommendations to the trainers, educators, and the administrators of the Armed Forces Hospitals as well as the decision makers at MSD headquarters based on the study findings. This chapter is devoted to a discussion of the methods and procedures used in conducting the study and is divided into four sections including description of the a) population, b) development of the instruments used in the study c) data collection procedures, and d) statistical methods used in analyzing the data. Population The population of this study comprised the key position 48 49 managers at the main Armed Forces Hospitals in Saudi Arabia. Detailed information on the population will be given in the first part of this section. In the second part detailed information will be given also on the places where the studies were conducted. For the purpose of this study, the organizational chart of the Armed Forces Hospitals at King Abdul Aziz Air Base (AFHKAAB) was taken as a model to identify the key position managers (see Figure 3-1). The duties and responsibilities of those key officers will be presented here as they were described in the manual book printed by (AFHKAAB). Hospital Administrator His obligations, functions and ethical conduct are as follows: 1) Organize the administrative functions of the hospital, delegate duties, and establish formal means of accountability for subor- dinates. 2) Establish those hospital departments needed to assure the efficient management of the hospital, provide for interdepartmental meetings as necessary, and attend or be represented at such meetings. 3) Facilitate effective communication between the medical staff and departments of the hospital. 4) Take all reasonable steps to assure that the hospital complies with applicable laws and regulations. 5) Establish an organizational structure to carry out the programs of the hospital and to meet the needs of the patients. 6) Implement the Program Director's and MSD's policies on the financial management of the h05pital. 50 MI E .5 _§ % 1: SE 5 i E E]: ‘ n —’ Figure 3—1 El .— ——J - .6625 8892.. bacon .6525 E292; 7) 8) 51 Take all reasonable steps to maintain and safeguard appropriate physical resources and to assure their proper and efficient uses. Coordinate and contribute to the effective planning and evaluation of hospital programs. Assistant Hospital Administrator The Assistant Administrator reports 'directly to the Hospital Administrator and is responsible for the following medical ancillary and support services: Respiratory Therapy Physical Therapy Housing Medical Records Transportation Dietary Communications Administration Office Education Personnel Preventive Medicine He is responsible for the following primary duties: 1) 2) 3) 4) 5) 6) Assumes full administrative responsibility for the above departments including guidance of planning, policies, budgeting and space utilization. Complete special reports and studies as directed by the Hospital Administrator. Recommends policy and procedure changes as necessary or prudent. Acts on a number of Hospital Committees as appointed by the Administrator. Reviews and evaluates performance of depart- ment heads. Assumes all duties of the Hospital Adminis- trator in his absence. Chief of Professional Services Professional Services immediate circle surrounding the patient, and concentration of the professional and scientific Housekeeping/Laundry-Linen in the Imospital constitute the the mobilization ...... - 52 resources dedicated to his restoration to health. Professional services include Medical, Surgical, Obstetrical, Pediatric, Pathology, Laboratory, Radiological, Pharmaceutical, Dental, Medical Records, Dietary, Outpatient, and Nursing Services. It is the responsibility of the Chief of Professional Services as well as the Administrator to help bring all factors pertaining to hospital operation into a coordinated teamwork to make possible the proper attention to patients by the physicians. Specific responsibilities and functions of the Chief of Professional Services are: 1) He functions as an advisor to the Program Director, in determining the hospital mission and goals and the medical staffing necessary to achieve these goals. 2) He is responsible for the quality of medical care rendered by all of the practitioners in the hospital and its associated clinics. 3) He is responsible for the overall direction of both medical and patient education. 4) Being the Chairman of the Medical Advisory Committee and member of the Advisory Council Board, responsible for maintaining a sense of direction :hi committee disputes, decisions, and policies. 5) He is responsible to oversee the medical staff's Quality Assurance Program and to review, analyze the monthly Quality Assurance activity. *6) He is responsible for providing residency training programs in the following specialties and subspecialties, according to the Availability of spaces: -1, Internal Medicine and Subspecialties Dermatology Gastroenterology Pediatrics Anesthesiology General Surgery OB/GYN Orthopedic Surgery Otolaryngology Urology Pathology Dental Pharmacy Ophthalmology Pulmonary Disease Radiology Infectious Diseases * (Now it is done in coordination with the Training Department) Personnel Director The Personnel Director reports directly to the Hospital Administrator and is responsible for the following areas or functions: Government Relations Recruiting Policy Development Benefit Administration Manpower Planning Orientation Travel Recreation The duties of this department include: 1) Initiates and coordinates the development of personnel policies, ures. directives, and proced- 2) Directs and administers classification and compensation studies and programs. 3) Oversees the development, maintenance and update of manpower procedures. planning systems and 4) Directs the process to obtain work, visitor and dependent visas, drivers' licenses, residency permits, and sponsorship changes. 5) Informs worldwide recruiting offices of manpower needs and directs the hiring process and orientation of new employees. 6) Establishes and conducts Saudi training programs with all hospital departments where Saudi Trainees are assigned. (Now it is the responsibility of the Training Director) " '1 54 7) Represents hospital in Labor court cases against the hospital after conferring with legal counsel. 8) Counsels employees on disciplinary matters, resolves personnel and contract questions, and interprets Employment Policy. Director of Nursing The Director of Nursing reports directly to the Hospital Administrator and is responsible for the nursing divisions and its various sub-divisions. The following report to the Director: Assistant Directors of Nursing OB/GYN Nursing Nursing Supervisors OR/RR CSSD Supervisor ICU Social Services Medical Nursing Surgical Nursing The responsibilities of this position include the following: 1) Organizes the department of Nursing consistent with the scope of patient services offered and the established Standards of Nursing Practice. 2) Establishes and implements Standards for Nursing Practice and Nursing Systems to provide the optimal achievable quality of nursing care. 3) Reviews and recommends policies and procedures that relate to qualifications and employment of personnel in Nursing Service. 4) Provides and assigns staff in adequate numbers and qualifications to administer individual- ized goal-directed nursing care. 5) Maintains regular review and evaluation of quality and appropriateness of nursing practice and function. 6) Prepares budget for the Nursing Department and maintains effective controls for budget administration and allocations. 55 7) Reviews and evaluates job performance of assigned personnel promotes professional and personal growth utilizing available resources. 8) Liases with hospital departments and medical staff to promote harmonious and cooperative relationships to effect improved patient care and efficient implementation of services. 9) Represents the Nursing Department in institutional planning which includes need for nursing services. Training‘Director The duties and the responsibilities of the Training Directors were not specified in the manual because the training and education activities were a part of the personnel department functions and medical education was the responsibility of the Chief of Professional Services. The assumption is that the Training Director is responsible of all facets of training and educational activities in coordination with the Medical Director for the medical education, with the Nursing Director for the in-service education of the nursing staff and with the administrator, personnel director and the head of departments for the hospital-wide training and education activities. The distribution of the target population and the number of responses by hospital and occupation are shown in Table 4-1. Six persons responded from the Armed Forces Hospital in Riyadh: one Administrator, one Nursing Director, one Personnel Director, one Training Director and one Chief of Professional Services, and his assistant who was treated as a Chief of Professional Services. 56 In Al-Hada Hospital all the occupations were represented except the Chief of the Professional Services and the training director. But the Director of the English Language Center and a Senior supervisor on the Training and Education department were treated as a training director, at the same time it should be noted that the researcher held a lengthy interview with the Training Director who was not able to fill out any of the questionnaires. Tabouk Hospital was represented with one respondent under each occupation. The same case was for the Armed Forces Hospital at King Abdulaziz Air Base in Emahran and Dhahran Medical Center, but it should be noted also that the person who was treated as a training director othahran Medical Center is the administrator of Dhahran Medical Academy and the reason for treating him as training director because 1) both the Dhahran Medical Center and Dhahran Medical Academy are under one director; 2) both of them are located in one campus; and 3) the academy is used as a training facility for Dhahran Medical Center and other Armed Forces hospitals. In Jeddah all tflua occupations were represented except the Chief of the Professional Services. In Khamees Mushait the Personnel Director chose not to participate in filling out the questionnaires nor to set a time for an interview. The hospital was represented with one Hospital Administrator, and his assistant, the Chief of Professional Services, Nursing Director, Personnel Director and two Training Directors. One was the Director of the 57 Training Center, the other one was a physician who acts as a medical educator and was treated as a training director. Finally, it should be noted that some of the respon- dents under the occupation categories in those hospitals had different titles other than the ones that were established for the study. For example, the Hospital Administrator was given the title of the Executive Officer in some of the hospitals and the Chief of the Professional Services is called the Director of Medical Administration or the Medical Director. In some cases, the researcher made an effort to make sure that they have the same duties and responsibilities of the key position managers as were described earlier. The study was conducted at seven hospitals located in six cities or five regions. Eastern Region The study was conducted at: l) Dhahran Medical Center - Dhahran 2) The Armed Forces Hospital at King Abdul Aziz Airbase - Dhahran Central Region The study was conducted at: 1) The Armed Forces Hospital in Riyadh Western Region The study was conducted at: l) The Armed Forces Hospital in Al-Hada 2) The Armed Forces Hospital in Jeddah 58 Southern Rggion The study was conducted at: l) The Armed Forces Hospital in Khamees Mushait Northern Region The study was conducted at: 1) The Armed Forces Hospital in Tabouk Instrumentation A questionnaire was used as the basis to gather the data needed to answer the research questions posed in this study. The researcher developed the questionnaire in three stages. An initial draft of the instrument was based on information obtained from the review of literature, the standards of the Joint Commission and the publication of the American Hospital Association. Next, that draft was submitted to a research expert (the instructor of CEP 907A -- Advanced Methods of Research as an assignment for the class and to one of the teaching assistants) to ascertain whether the questionnaire met the general standards for questionnaire construction, such as clarity, design and length and whether it was consistent with the purpose of the study and the research questions. The researcher then gave the questionnaire to ten Arab students who were pursuing their higher education at Michigan State University in related fields to obtain their comments, evaluation and suggestions. The final revised questionnaire was comprised of two parts. The first part of the instrument contained questions 59 designed to elicit personal and demographic information about the respondents, including nationality, occupation, degree, years of experience and location of work. The second part of the questionnaire contained five sections. The first has items related to the development of the mission statement, goals, and objectives of the staff development program, the second has items related to needs assessment method and the recommended instructional techniques. The third has items related to the determina- tion of time, eligibility, location and content of the proposed orientation programs, fourth has items related to the proposed models for training and continuing eduction programs, and fifth has items related to a set of recommendations to the trainers and the educators of the staff development programs. Data Collection Two types of data were gathered by employing two different methods of data collection: a) a questionnaire survey and interview, b) existing (official) records, governmental documents and reports, both published and unpublished, books and periodicals, resource centers, institutions and persons in the field of health care education and administration, previous research studies, and personal experience (the researcher has worked for the Armed Forces Hospital in Dhahran for more than six years as Assistant Director of Human Resources Department and then as Assistant Hospital Administrator). 60 Questionnaire Survey and Interview Since the primary objective of the study was to identify and compare the perceptions of the key position managers at the Armed Forces Hospitals on appropriate guidelines for staff development programs the relevant data had to be obtained necessarily through a survey. Accordingly the researcher visited each hospital included in the study to distribute the questionnaire and to conduct the interview with the key position managers at those hospitals. To facilitate his mission and to obtain the needed assistance in administering the questionnaire and conducting the interviews, a letter was obtained from the chairman of the researcher's doctoral committee addressed to his sponsor in Saudi Arabia explaining the researcher's need to go back to Saudi Arabia to conduct the study. Upon arrival there the researcher requested a letter from the Director of MSD to each hospital director asking for help and cooperation with the study. In collecting the data, the researcher spent about six weeks visiting seven hospitals in six cities. The following procedures were followed in distributing the research instrument and collecting the data needed for the study in each hospital. 1) A memorandum from the Program Director in each hospital was obtained to the listed key position managers to get their cooperation. 2) The key position managers were identified as the following: hospital administrator, assistant hospital administrator, the chief of professional staff, nursing director, personnel director and training director. 61 3) The researcher was introduced to the participants by either the Office of the Program Director or the Training Director. 4) The researcher spent 15-20 minutes with each participant to give him or her an overview of the study and to hand out the questionnaire. 5) At a scheduled time the researcher collected the questionnaire and at the same time conducted an interview with the participant to seek feedback on the contents of the questionnaire or any related matters. 6) A lengthy meeting took place with every training director in each hospital to talk about the training and educational activities in his or her hospital and to obtain more information on matters related to the research. Existing (Official) Records A selective review of the literature on orientation, in-service training and continuing education was undertaken. Library research was conducted at the main library and the library of the College of Business at Michigan State University. In addition to the above resources, the researcher made a trip to Chicago, Illinois in March, 1988 to visit the main office of the Joint Commission on Accreditation of Health Care Organization, Hospital Research and Educational Trust, and the Resource Center of the American Hospital Associations. The researcher also had an opportunity to attend and observe some (M5 the orientation and continuing educational programs at several of the American hospitals. During his visit to Saudi Arabia in summer of 1988, the researcher made a trip to the capital city to visit the headquarters of the National Guard Medical Services, and Ministry of Finance and 62 National Economy (Central Department of Statistics), for the purpose of collecting some statistical reports as secondary data for the study. Data Analysis The data analysis was comprised of two parts; one was an analysis (M5 the characteristics of respondents such as nationality, position, experience, place of work and other relevant variables. These data were used to compare and contrast differences ix) the perceptions of managers having differing backgrounds. The second part was an analysis of items related to the following: 1) mission statement, goals and objectives of staff development programs, 2) methods of needs assessment and instructional techniques, 3) proposed orientation programs, 4) proposed models for training and continuing educational programs, 5) a set of recommendations to the educators of staff development programs. In all parts of the analysis, frequency, mean and percentage distribution were used to summarize the characteristics of respondents and responses to the questionnaire items. Summary This chapter on the Design of the Study focused on the source of data, population, data collection, instruments and procedures followed. 'The presentation and the analysis of the data form the basis for the next chapter. CHAPTER IV Presentation and Analysis of Data This chapter contains the research findings and the analysis of the data obtained in this study. The data presented are based on responses given by 43 key position managers at the main Armed Forces Hospitals in Saudi Arabia. First the demographic data are described. Then the data regarding each of the eight research questions are analyzed and presented in the following order: Section 1. Information related to ndssion statement, goals, objectives, and the implementation of staff development program. Section 2. Information related to the appropriate method(s) of determining educational needs and the recommended instructional techniques for the various staff development programs. Section 3. Information related to time, place and contents of a proposed orientation program. Section 4. Information related to a prOposed model for training and continuing education programs for hospital staff. Section 5. Information related to a set of recom- mendations for staff development educators. 63 64 Demggraphic Data Seven questions were used iml the questionnaire instrument to furnish the characteristics of the target population which comprised the hospital administrators, assistant hospital administrators, the chiefs of profes- sional staff, nursing directors, personnel directors and training directors in the Main Armed Forces hospitals in Saudi Arabia. The number of respondents for this study was 43. Those questions cover the following: 1) nationality of the respondents; 2) name of their hospital; 3) their occu- pation; 4) their educational level; 5) their sex; 6) years of their experience in the Saudi Armed Forces Hospitals and 7) years of experience in hospitals in general. This information is reported by frequency and percentages and is displayed in Table 4-1. Nationality Table 4-1 and Figure 1 present the distribution of the respondents by nationality. As the table shows, 44.2% or nineteen of them were Saudis. Eighteen respondents, or 41.9%, were from Europe and North America. The Middleasterners were 5 or 11.6% and one respondent from the Far East. 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E022 any—2.5222 szzmmmmm< mnumz making—Omaha. 2.2.2. 92. 022.5522“ 0222.: 2° flu02 DOME..— >22 0222292220122.— mhszZOA—mmz «-22 02.2.2.2. 76 Table 4-2 indicates that the total group is fully in agreement with item 2 which states that setting goals and objectives is important in the process of developing any training or education program. They also believe that those goals and objectives need to be in writing. Item #3. STATING THE GOALS AND OBJECTIVES OF THE LOCAL INDIVIDUAL PROGRAMS AT EACH HOSPITAL ARE THE RESPONSIBILITY OF TRAINING AND EDUCATION DEPARTMENT WITH THE PARTICIPATION OF THE DEPARTMENT HEADS UNDER THE DIRECTION OF THE TOP MANAGEMENT. Eighty one percent of the total respondents believe that stating the goals and objectives of local individual programs at each hospital are the responsibility of the Training and Educational Department with the participation of the department heads under the direction of the top management. The rest, 19%, disagree. Table 4-2 indicates that the nursing directors were in lease agreement with item 3 and both the Chief of Professional Services and the Personnel Director are in full agreement with it. Item #4. PEANNING FOR PROGRAMS IS THE RESPONSIBILITY OF THE TRAINING AND EDUCATION DEPARTMENT. Table 4-2 indicates that 71.4% of the total respondents were in support for the idea of giving the Training and Education Department the responsibility of planning the educational activities. (M1 the other hand, 28.6% took the position of disagreement. Among those disagreeing were two administrators, one assistant administrator, two chiefs of 77 professional services, three nursing directors, one personnel director and three training directors. Item #5. IDENTIFYING TRAINING NEEDS IS THE RESPONSI- BILITY OF THE TRAINING AND EDUCATION DEPARTMENT WITH THE PARTICIPATION OF (1) DEPARTMENT HEADS AND (2) PARTICIPANTS (EMPLOYEES). Table 4-2 indicates that more than four-fifths of the total respondents (88.4%) believed that identifying the training needs should be the responsibility of the Training and Education Department with the participation of both the department heads. and the [participants (employees), while 11.6% of the total respondents disagree with item 5. Among those who agree with item 5 were all the administrators, all the chiefs of professional services, all the personnel directors, 88.9% of the training directors, 75% of the assistant administrators and 71.4% of the nursing directors. Item #6. PREPARING THE PROGRAM MATERIALS IS THE RESPONSIBILITY OF THE STAFF OF THE TRAINING AND EDUCATION DEPARTMENT. Approximately one-fifth of the total group disagrees with giving the staff of the Training and Education department the responsibility of preparing the program materials. Another 4.8% were undecided but more than two-thirds of the total respondents (73.8%) were in agreement. Table 4-2 indicates that the chiefs of the professional services were divided into two groups. Fifty percent of them agree with it and 50% disagree. 78 Item #7. NOMINATING THE PARTICIPANTS FOR THE TRAINING AND EDUCATION PROGRAMS IS THE RESPONSIBILITY OF THE DEPARTMENT HEADS. Approximately 70% of the total respondent group, as indicated in Table 4-2, judged that nominating the participants for the training and education programs should be the responsibility of the department heads. Among the total respondents, 9.3% were undecided, 20.9% disagree. Among those who disagree with item 7 were two assistant administrators, two personnel directors, and five training directors. Four persons were undecided; those are one administrator, one chief of professional services, and one training director. The rest of the sub-groups agree with item 7. Item #8. EVALUATING THE PROGRAM IS THE RESPONSIBILITY OF TRAINING AND EDUCATION DEPARTMENT, DEPARTMENT HEADS, PARTICIPANTS, TOP MANAGEMENT AND SOMETIMES A CONSULTANT. As indicated in Table 4-2, 92.9% of the total population believe that evaluating the program is the responsibility’ of the “Training and Education Department, department heads, participants, top management and sometimes a consultant. The same table indicates that one Chief of Professional Services and one Training Director disagree and one of the personnel directors was undecided. Item #9. THE EVALUATION PROCESS SHOULD BE DURING AND AFTER THE PROGRAM. 79 As indicated in Table 4-2, almost everyone agrees that the evaluation process should be during and after the educational and training programs (95.3%), except one of the personnel directors disagreed and one of the administrators was undecided. Item #10. THE EVALUATION SHOULD INCLUDE EVALUATING THE INSTRUCTOR(S), THE PARTICIPANTS, THE CONTENT, THE INSTRUC- TION METHOD(S) AND THE PROGRAM ENVIRONMENT. Every person who participated in this survey believed that the evaluation should include evaluating the instructor(s), the participants, the content, the instruc- tion method(s), and the program environment as indicated in Table 4-2. Section 2 The perceptions of the total respondents on the best method(s) of determining educational and training needs and the most effective instructional method(s) for the various educational activities are presented in this section. DeterminingyEducational Needs (Items 11-14) Items (ll-14) contain items with respect to methods for determining educational and training needs. In the following, the suggested methods will be listed with perceptions of the respondents. Item #11. USING THE QUESTIONNAIRE METHOD. 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N - . . . . . . . . . 222.2 2 . . . . 8.: 2 5 82d 8N 862 2 222.22 2 222.82 2 8.! 2 8.8 N . . . 8.8 N 922 2.2.2. 2.28.283 9.. 8.5 . 22 8.. 02m 53.2 .22 2 .22 2 x 2 22 2 x 2 8 2 8 2 2202. 220220 05:22.2. 320220 20222232022 2020220 052:2 22230822 29 202220 222.23 c2Eu< 22022222233 222-22 0220:sz szzmmmmm< mam—m2 Gmmcmomm M222. ZO m0UZWDOH~E >22 ZOELHQmm—m FEM—020.59“ ”222:. 0.2. 0322.2. 81 determine educational needs, 4.7% are undecided and 16.3% disagree. Among the sub-groups, one administrator and one chief of professional services were undecided. Among those who disagree with item 11 were two administrators, two chiefs of professional services, one nursing director, one personnel director, and one training director. The rest of the sub-group were in agreement with item 11. Item #12. USING THE INTERVIEW METHOD. Table 4-3 indicates that 86% of the total respondents agree with using the interview method as a technique for needs assessment, while 7% disagree and 7% were undecided. Two administrators and one chief of professional services disagree with item 12, while one administrator, one personnel director, and one training director were undecided. The rest of the sub-group were in agreement with item 12. Item #13. USING THE OBSERVATION METHOD. Table 4-3 indicates that 81.4% of the total respondents agree with using the observation method as a technique for a needs assessment, one administrator, one chief of pmofes- sional service and one training director disagree with item 3 while one administrator, two assistant administrators, one personnel director, and one training director were undecided. Item #14. USING THE DOCUMENT FILES (INCIDENT REPORTS, FOR EXAMPLE). 82 Table 4-3 indicates that 86% of the respondents agree with using the document files as a technique to gather data needed for the process of identifying training and educational needs; 2.3% were undecided and 11.6% disagree. Among the sub-groups, two assistant administrators, and three training directors disagree with item 14 while one chief of professional services was undecided. The Effective Instructional Methods The proposed instructional method for the various staff development programs and the perceptions of the respondents toward each method are presented below. Item #15. THE LECTURE METHOD: THE TRAINER WILL BE SPEAKING TO A TRAINING GROUP USUALLY FROM PREPARED NOTES. THE TRAINER STANDS IN FRONT OF THE GROUP AND GIVES INFORMATION ON SPECIFIC TOPICS. Table 4-4 indicates that 69% of the total respondents agree with using the lecture method for orientation programs. Among them are six administrators, five assistant administrators, five chiefs of professional services, two personnel directors, and six training directors. The table indicates also that 59.5% of the total respondents favor using the lecture method for continuing education programs. 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INDIVIDUAL STUDY: THE TRAINEE ENROLLS IN HOME-STUDY COURSES OR READS INDEPENDENTLY. Table 4-4 indicates that two assistant administrators amd one nursing director favor using the individual study method as an instructional technique for orientation programs while 90.5% of the total respondents think it should be used for the continuing educational programs. Among them, all the administrators, all the personnel directors, all training directors, six of the assistant administrators and five of the chiefs of professional services and the nursing directors. The table indicates also that 33.3% of the total respondents favor the individual study for in-service training programs, among them, two administrators, five assistant administrators, two chiefs of professional services, three nursing directors, and training directors. Item #17. COACHING: INDIVIDUAL ON-THE-JOB TRAINING. THE SUPERVISOR WORKS CLOSELY WITH THE TRAINEE ON SPECIFIC JOB TASKS. Table 4-4 indicates that 90.7% of the total respondents would favor using the coaching method for in-service 85 training programs. Among them are all the chiefs of professional services and all the nursing directors. The table indicates also that 25.6% of the total respondents favor using the coaching method for orientation programs. Among them are one administrator, two chiefs of professional services, three assistant administrators, three nursing directors, one personnel director, and one training director. Among the total respondents, 18.6% think that the coaching method can be used for continuing educational programs. Item #18. ROTATION: INDIVIDUAL ON-THE-JOB EXPERIENCE IN DIFFERENT JOB TYPES, LOCATIONS, DEPARTMENTS, ETC. Table 4-4 indicates that 65.9% of the total respondents favor using the rotation method for in-service training programs. Among them are seven training directors, six assistant administrators, five personnel directors, four chiefs of professional services, four nursing directors and one administrator. The table indicates also that 89% of the total respondents favor using the rotation method for orientation programs, too. Among them are five adminis- trators, four nursimg directors, three assistant adminis- trators, two chiefs of professional services, one personnel director, and one training director. Almost 37% of the total respondents favor using the rotation method for continuing education programs. Among them are six training directors, four nursing directors, two chiefs of professional services, two assistant adminis- trators, and one administrator. 86 Item #19. MEETING TO SOLVE PROBLEMS THROUGH GROUP DISCUSSION. THE TRAINOR OR CHAIRMAN CONDUCTS DISCUSSION AND INVOLVES TRAINEES IN ATTEMPTS TO SOLVE PROBLEMS AND REACH DECISIONS. Table 4-4 indicates that 70.7% of the total respondents favor using the workshop method for continuing education programs. Among them are six training directors, six assistant administrators, five chiefs of professional services, five nursing directors, four administrators, and three personnel directors. The table indicates also that 56.1% of the total respondents favor using the workshop method for in-service training programs too, among them, six nursing directors, five administrators, five training directors, four assistant administrators, two chiefs of professional services, and one personnel director. Only twelve percent of the total respondents favor using the workshop method for orientation programs. Among them are two personnel directors, two training directors, and one nursing director. Item #20. SIMULATION: INDIVIDUALS RECEIVE HANDS-ON EXPERIENCE THROUGH SIMULATION OF THE WORK ENVIRONMENT AND ON-THE-JOB SITUATIONS. Table 4—4 indicates that 87.8% of the total respondents favor using the simulation method for in-service training programs. Among them are all the training directors, six administrators, six assistant administrators, six nursing directors, five chiefs of professional services, and four 87 personnel directors. The table indicates also that 43.9% of the total respondents favor using simulation methods for continuing education programs. Among them are five assistant administrators, five nursing directors, four training directors, two administrators and two chiefs of professional services. Only 22% of the total respondents favor using the simulation method for orientation programs. Those are four nursing directors, one administrator, one assistant administrator, one chief of professional services, one personnel director, and one training director. Item #21. ROLE PLAYING: A SIMULATED SITUATION IN WHICH TRAINEES ACT OUT THE THOUGHTS AND BEHAVIORS OF PERSONS IN PARTICULAR ROLES IN THE ORGANIZATION. TRAINEES ACT OUT THE SITUATION AND THEN DISCUSS WHAT HAPPENED AND WHY. Table 4-4 indicates that 65.9% of the total respondents favor using the role playing method for continuing education programs. Among them are all the nursing directors, six training directors, five administrators, four assistant administrators, three chiefs of professional services, and three personnel directors. The table indicates also that 61% of the total respondents favor using the role playing method for in-service training programs. Among them are all nursing directors, seven assistant administrators, four chiefs of professional services and four training directors, three administrators, and one personnel director. 88 Only 22% of the total respondents favor using the role playing method for orientation programs. Those are four nursing directors, two assistant administrators, two training directors, and one personnel director. Item #22. CASE METHODS: STUDY OF A SITUATION WHICH INVOLVES A SPECIFIC INCIDENT OR ORGANIZATIONAL PROBLEM. THE CASE IS PRESENTED ORALLY, IN WRITING, OR BY FILM. CONFEREES ANALYZE AND DISCUSS IT, DETERMINE THE ISSUES, AND PROPOSE SOLUTIONS. Table 4-4 indicates that 76.2% of the total respondents favor using the case method for the continuing education programs. Among them are all the administrators, all the nursing directors, six training directors, five assistant administrators, five chiefs of professional services, and three personnel directors. ‘The table indicates also that 54.8% of the total respondents favor using the case method for in-service training programs. Those are seven training directors, six assistant administrators, three nursing directors, three personnel directors, two administrators, and two chiefs of professional services. Only seven percent of the total respondents favor using the case method for the orientation programs. Among them are two nursing directors and one training director. Item #23. BRAINSTORMING: A METHOD OF INCITING A GROUP TO "THINK-UP" ORIGINAL AND CREATIVE IDEAS. THE GROUP LISTS ALL IDEAS AND SUSPENDS JUDGEMENTS; FREEWHEELING THINKING AND HITCHHIKING ON OTHERS' IDEAS ARE ENCOURAGED. 89 Table 4-4 indicates that 85.7% of the total respondents favor using the brainstorming method for continuing education programs. Among them are all the chiefs of professional services, all the nursing directors, seven training directors, six administrators, six assistant administrators, and five personnel directors. The table indicates also that 42.9% of the total respondents favor using the twainstorming method for the in-service training programs. Those are four nursing directors, four training directors, three administrators, three assistant administrators, three chiefs of professional services, and one personnel director. Almost 9.5% of the total respondents favor using the brainstorming method for orientation programs. Among them are one assistant administrator, one nursing director, and two training directors. Section Three Information related to the perceptions of the respondents (mm the proposed orientation programs are presented in this section. The Orientation of Overseas Employees Item #24. TIME AND PLACE OF THE ORIENTATION OF THE OVERSEAS EMPLOYEES. IN ORDER TO MEET THE GOALS AND THE OBJECTIVES OF THIS PROGRAM, IT SHOULD BE CONDUCTED AT: A) THE COUNTRIES OF THEIR POINTS OF HIRE, B) MSD HEADQUARTERS BEFORE THEIR ARRIVAL TO THE LOCAL HOSPITALS, AND C) LOCAL HOSPITALS, AFTER THEIR ARRIVAL. 90 Table 4-5 presents data related to the perceptions of the respondents on the suggested place and time for conducting the orientation of the overseas employees. The table indicates that 76.9% favor conducting the program at the local hospitals while 61.5% favor conducting the program at the countries of the employee's point of hire. Only 2.6% favor conducting the program at the MSD headquarters. Among those who prefer training conducted at the local hospitals are all the chiefs of professional services, six training directors, five administrators, five assistant adminis- trators, five nursing directors and three personnel directors. Those who prefer training to be conducted at the countries of the employees' point of hire are five assistant administrators, five chiefs of professional services, five training directors, four nursing directors, three personnel directors, and two administrators. The only person who prefers training to be conducted at the MSD headquarters is one of the assistant administrators. Item #25. THE DESIGN OF THE PROGRAM. THE DESIGNING OF THE ORIENTATION PROGRAM OF OVERSEAS EMPLOYEES IS THE RESPONSIBILITY OF: A) THE RECRUITING COMPANIES, B) THE MSD HEADQUARTERS, C) LOCAL HOSPITALS AND D) ALL THE ABOVE. Table 4-5 indicates that 64.3% of the total respondents favor giving the responsibility of designing the orientation of the overseas employees to the following: 1) the recruiting companies, 2) the MSD headquarters and 3) the local hospitals. 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The table indicates also that 35.7% of the total respondents favor giving the responsibility of designing the orientation of overseas to the local hospitals. Those are four training directors, three personnel directors, two administrators, two assistant administrators, two chiefs of professional services and two nursing directors. Out of the total respondents, 9.5% who favor giving the responsibility to the recruiting companies, and 2.4% to the MSD headquarters. Content The proposed content for the orientation of overseas employees and the perceptions of the respondents toward each element of the content are presented below. Item #26a. THE HISTORICAL BACKGROUND OF THE KINGDOM. Table 4-5 indicates that 90.2% of the total respondents favor giving the program participant a brief on the histori- cal background of the Kingdom as a part of the program's content. Among those who agree are all the administrators, all the assistant administrators, all the nursing directors. 83.3% of the personnel directors. 80% of the chiefs of professional services, and 75% CHE the training directors. The table also indicates that 4.9% of the total respondents were opposed and 4.9% were undecided. 94 Item #26b. THE LOCATION OF THE KINGDOM. Table 4-5 indicates that 92.2% of the total respondents favor giving the participant of the program some information about the Kingdom's location as a part of the program's content. Among those who agree are all the administrators, all the assistant administrators, all the nursing directors, all the personnel directors, 80% of the chiefs of pmofes- sional services and 75% of the training directors. The table indicates also that one chief of professional services and two training directors disagree with item 26b. Item #26C. KINGDOM'S POPULATION. Table 4-5 indicates that 95.1% of the total respondents agree to give the participants of the program some information about the Kingdom's population, 9.8% were opposed and 9.8% were undecided. Among those who were in favor are all the assistant administrators, all the nursing directors, 85.7% of the administrators, 83.3% of the personnel directors, and 62.5% of the training directors. Item #26d. KINGDOM'S CLIMATE. Table 4-5 indicates that all the respondents favor giving the participants some information about the Kingdom's climate except one assistant administrator who was opposed and one administrator who was undecided. Item #26e. KINGDOM'S NATURAL RESOURCES. Table 4-5 indicates that 75.6% of the total respondents favor giving the participants of the program some informa- tion about the Kingdom's natural resources, 14.6% were 95 undecided and 9.8% were opposed. Among those who were in favor are all the personnel directors, 87.5% of the training directors, 85.7% of the nursing directors, 75% of the assistant administrators, 57.1% CH? the administrators, and 40% of the chiefs of professional services. Item #26f. THE RELIGION OF THE KINGDOM. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the religion of the kingdom. Item #269. KINGDOM'S RULES AND REGULATIONS. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the Kingdom's rules and regulations. Item #27a. LIFESTYLE OF SAUDI PEOPLE. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the lifestyle of Saudi people except one chief of professional services and one training director were opposed to item #27a. Item #27b. CUSTOMS OF SAUDI PEOPLE. Table 4~5 indicates that all the respondents favor giving the participants of the program information about the customs of Saudi peOple. Item #270. TRADITIONS OF SAUDI PEOPLE. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the traditions of Saudi people. 96 Item #27d. HABITS OF SAUDI PEOPLE. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the habits of Saudi people except one personnel director who was undecided. Item #28. THE DEVELOPMENT OF HEALTH CARE INSTITUTIONS. Table 4-5 indicates that 90.2% of the respondents favor giving the participant of the program information about the develOpment of health care institutions in the Kingdom, 4.9% disagree and 4.9% were undecided. Among those who were in favor are all the administrators, all the assistant administrators, all the nursing directors, 88.9% of the training directors, 80% of personnel directors, and 60% of the chiefs of professional services. Item #29. TRAVEL ARRANGEMENTS. Table 4-5 indicates that all the respondents favor giving the participants of the program information about the travel arrangements, except one assistant administrator who was opposed and one chief of professional services and one training director who were undecided. Hospital-Wide Orientation Program Item #30. TIMING. WHAT WOULD BE THE BEST TIME TO CONDUCT THE HOSPITAL-WIDE ORIENTATION PROGRAM: A) BEFORE THE NEW EMPLOYEE STARTS THE WORK, B) THE FIRST DAY HE/SHE STARTS THE WORK, C) AFTER HE/SHE STARTS THE WORK. Table 4-6 indicates that 76.2% of the total respondents favor conducting the program before the new employee starts 97 3 8.82 22 8.82 o 8.82 2 222.8 3 8.82 o 8.82 2 92 2 . . . . . . . . . . . . 222.222 2 . . . . . . . . 5 use: 22:222.; 2 . . . . . . . . . . . . 222.2: 2 . . . . . . . . Q'2 2.22292 222223: . v22 22222 N. 8.82 .2 8.82 22 8.82 2 8.82 22 8.222 2 8.82 2 92 82222222832 2.22- 2 .. .. .. .. .. .. .. .. 8.2 2 .. .. 5 aeéooeNE-NEENNNE: 22.20223: 62.292002 N. 8.82 o 8.82 22 8.82 2 8 E 22 8.252 22 8.82 2 92 222282.22 . < 8 222.22 8 8.222 2 8.82 22 8.82 2 8.82 a 8.2» 2 3.22 m 92 2 . . . . . . . . . . . . . . . . . . . . 8.3 2 2... 2:22.23: 22 8N2 2 . . . . . . . . . . . . 8.2 2 8.: 2 9'2 2.. .232 . 22222232 . o 8 .2222 N. 8.82 22 8.82 22 8.82 2 8.82 a 8.82 o 8.5 2 92 82232522228 222222288 . m 8 2822 N. 8.8 22 8.82 22 8.82 2 8.82 o 8.82 a 8.82 2 92 2 222.22 2 . . . . . . . . . . . . . . . . . . . . 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Twenty one percent favor conducting the program the first day the new employee starts work and 2.4% agree to conduct the program after the new employee starts work. Among those who favor conducting the program before the new employee starts work are all the administrators, eight of the training directors, five of the nursing directors, four of the chiefs of professional services, five of the assistant administrators, and three of personnel directors. Content of Hospital-Wide Orientation Program The prOposed content for the hospital-wide orientation program and the perceptions of the respondents toward each element of the content are presented below. Item #313. HOSPITAL HISTORY Table 4-6 indicates that 85.7% of the total respondents favor giving the participant of the program a brief on the hospital's history, 9.5% disagree and 4.8% were undecided. Among those who were in favor are all the nursing directors, all the personnel directors, six administrators, six training directors, and five chiefs of pmofessional services. Item #3lb. HOSPITAL'S GOALS Table 4-6 indicates that all the respondents favor giving the participants of the program a brief on the hospital's goals as a part of the program's content. Item #31C. HOSPITAL'S PHILOSOPHY Table 4-6 indicates that 92.9% of the total respondents favor giving the participants of the program a brief on the 100 hospital's philosophy. Among those vdua were le favor are all the administrators, all the chiefs of professional services, all the nursing directors, all the personnel directors, seven of the training directors, and six of the assistant administrators. The table also indicates that 2.4% of the total respondents were Opposed and 4.8% were undecided. Item #328. THE HOSPITAL ORGANIZATIONAL CHART Table 4-6 indicates that all the respondents except one training director favor providing the participants of the program with information related to the hospital's organizational chart. Item #32b. HOSPITAL DEPARTMENTAL COMMUNICATION Table 4-6 indicates that all the respondents favor briefing the participants of the program on information related to the hospital department communication. Item #32C. FACILITY - MAP OF HOSPITAL Table 4-6 indicates that 90.5% of the total respondents favor talking to the participants of the program about the facility and the map of the hospital. Those who were in favor are all the chiefs of professional services, all the nursing directors, all the personnel directors, seven of the assistant hospital administrators, seven of the training directors, and five hospital administrators. The table indicates also that 7.1% of the total respondents were opposed to item 32c and 2.4% were undecided. 101 Item #33a. PERSONNEL .RELATED INFORMATION (PAYROLL, BENEFITS, VACATION) Table 4-6 indicates that all the respondents favor the idea of giving the participants detailed information about the personnel functions which may include payroll, benefits, vacation, promotions, absences and illness. Item #33b. POLICIES AND PROCEDURES OF PERSONNEL DEPARTMENT Table 4-6 indicates that all the respondents except one assistant administrator favor the idea of explaining the policies and procedures of the personnel department to the participants of the program. Item #343. HOSPITAL POLICIES ON VISITING HOURS Table 4-6 indicates that 95.2% of the total respondents favor giving the participants information about the hospital policies on visiting hours. The table indicates also just one chief of professional services opposed with item 34a and another one who was undecided. Item #34b. HOSPITAL POLICIES ON TIME CLOCKS Table 4-6 indicates that 90.2% of the total respondents favor giving the program's participants information related to the hospital policies on time clocks. Those who were in favor are all administrators, all the assistant hospital administration, all nursing directors, all personnel directors, five chiefs of professional services and five training directors. The table indicates also that 2.4% of the total respondents disagree and 7.3% were undecided. 102 Item #34C. HOSPITAL POLICIES ON THE CAFETERIA Table 4-6 indicates that all the respondents favor providing the participants of the program with information related tx> the hospital policies concerning the cafeteria, except one training director who was opposed and one chief of professional services who was undecided. Item #34d. HOSPITAL POLICIES ON DRESS CODE Table 4-6 indicates that all the respondents favor providing the participants of the program with information related to the hospital policies on dress code, except one training director who was opposed and one chief of professional services who was undecided. Item #34e. HOSPITAL POLICIES ON PARKING Table 4-6 indicates that 92.9% of the total respondents favor giving the program's participants information related to the hospital policies on parking. Among those who were in favor are all the administrators, all the assistant administrators, all the nursing directors, seven training directors, five chiefs of pmofessional services, and five personnel directors. The table indicates also that there is one personnel director who was opposed and one chief of professional services and one training director who were undecided. Item #35. EMPLOYEE HEALTH POLICY AND PROCEDURE Table 4-6 indicates that all the respondents favor giving the participants information on the policy and procedure of employee health except two training directors; one was opposed and one was undecided. 103 Item #36. SAFETY PROGRAMS (FIRE PREVENTION AND DISASTER PLAN) Table 4-6 indicates that all the respondents favor giving the participants information about the safety programs except one training director who was undecided. Item #37a. INFORMATION RESOURCES - POLICY MANUALS Table 4-6 indicates that 88.4% of the total respondents favor providing the participants with information related to policy manuals as an information resource for the employees. Among those who were in favor are all the administrators, all the assistant administrators, all the nursing directors, all the personnel directors, five chiefs of professional services, and five training directors. The table also indicates that 4.7% of the total respondents were opposed and 7.0% were undecided. Item #37b. INFORMATION RESOURCES - LIBRARY Table 4-6 indicates that all the respondents favor providing the participants with information about the library except one chief of pmofessional services who was opposed to item 37b. Item #38a. EMPLOYEE RESPONSIBILITIES - INCIDENT REPORTS Table 4-6 indicates that all the respondents favor providing the participants with information about the employee responsibilities on incident reports. 104 Item #38b. EMPLOYEE RESPONSIBILITIES - PATIENT CARE Table 4-6 indicates that all the respondents favor providing the program participants with information related to employee responsibilities on patient care, except one training director who opposed item 38b. Item #38c. EMPLOYEE RESPONSIBILITIES - PROFESSIONAL LIABILITY Table 4-6 indicates that all the respondents favor providing the program participants with information on the employee's professional liability, except one training director who was opposed to item 38c. Item #39. TOUR OF THE HOSPITAL Table 4-6 indicates that all the respondents favor taking the new employees on a tour to Show them the hospital facilities, except one training director who was opposed to item 39. Department Orientation Program Item #40. ACCORDING TO JCAH STANDARDS, EVERY NEW EMPLOYEE IS SUPPOSED TO BE INTRODUCED TO THE RULES AND REGULATIONS OF THE DEPARTMENT AND PROVIDED WITH THE NEEDED TRAINING SKILLS. IN ORDER TO INTRODUCE THE NEW EMPLOYEE TO THE DEPARTMENT, THE BEST TIME TO CONDUCT SUCH A PROGRAM IS: A) RIGHT AFTER THE HOSPITAL-WIDE ORIENTATION PROGRAM, WHEN THE EMPLOYEE STARTS HIS/HER WORK FOR THE DEPARTMENT, B) ANY TIME DURING THE PROBATION PERIOD (3 MONTHS), C) AFTER THE PROBATION PERIOD. 105 Table 4-7 indicates that 85.7% of the respondents favor conductimg the department orientation program right after the hospital-wide orientation program. Among those who were in favor are all the administrators, all the chiefs of professional services, seven training directors, six assistant administrators, six nursing directors, four personnel directors. The table indicates also that 14.3% of the total respondents favor conducting the program during the probation period. Content of the Department Orientation Program The proposed content for the department orientation program and the perception of the respondents toward each element of the content are presented below. Item #41. DEPARTMENT ORGANIZATIONAL CHART Table 4-7 indicates that all of the respondents favor briefing the program participants on the department organizational chart, except one chief of professional services who was undecided. Item #42. NATURE OF DUTIES AND JOB DESCRIPTION Table 4-7 indicates that all the respondents favor giving the new employee his or her job description and to explain the nature of his or her duties during the program. Item #43. THE ROLE OR THE FUNCTION OF THE DEPARTMENT Table 4-7 indicates that all of the respondents favor talking to the new employee about the role or the function of the department except one chief of professional services who was opposed to item 43. 106 2 . 2222.3 8 8.8 o 2222.22222 2 2222.222 22 2222.22222 8 2222.82 2 9.2 N 222.22 2 22262 2 . . . . . . . . . . . . . . . . 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DEPARTMENTAL POLICIES AND RULES Table 4-7 indicates that all the respondents favor talking ix) the new employee about the department policies and rules. Item #45. DEPARTMENT COLLEAGUES AND THEIR FUNCTION Table 4-7 indicates that all the respondents favor talking 1x) the new employee about their department colleagues and their function except one personnel director who was opposed to item 45. Item #46. WORK AREA - EQUIPMENT AND SUPPLIES Table 4-7 indicates that 93% of the total respondents favor providing the new employee with information related to the work area, the equipment and the department's supplies. Among those who were in favor are all the administrators, all the assistant administrators, all the nursing directors, all the personnel directors, seven training directors, and five chiefs of professional services. The table also indicates that 7% of the total respondents were undecided. Item #47. OPPORTUNITIES FOR DEVELOPMENT OF JOB SKILLS Table 4-7 indicates that 95.3% of the total respondents favor that the new employee should be informed of the opportunities for development of job skills. Among those who were in favor are all the administrators, all the assistant administrators, all the nursing directors, all the personnel directors, eight training directors and five chiefs of professional services. The table indicates also that one chief of professional services and one training director were undecided. 108 Item #48. PERFORMANCE EXPECTATIONS Table 4-7 indicates that all the respondents are in favor that the new employee should be aware of the performance expectations. Item #49. CAREER ADVANCEMENT Table 4-7 indicates that 90.7% of the total respondents favor giving a brief on career advancement to the new employee. Those who favor include all the administrators, all the chiefs of professional services, eight training directors, seven assistant administrators, six nursing directors, and five personnel directors. The table also indicates that 9.3% of the total respondents were undecided. Item #50. AVAILABLE EDUCATION PROGRAMS Table 4-7 indicates that all the respondents favor providing the participant of the program with information related to the available education programs, except one personnel director and one training director who were undecided. MSD Orientation Program Item #51. ELIGIBILITY: WHO SHOULD BE ELIGIBLE FOR THIS PROGRAM? A) THE MSD SAUDI COLLEGE GRADUATE ONLY; B) THE MSD SAUDI NON-COLLEGE GRADUATE BUT OCCUPYING OR PROMOTED TO SUPERVISORY POSITION; C) THE SAUDI LOCAL HIRE OCCUPYING OR PROMOTED TO A SUPERVISORY POSITION; OR D) ALL OF THEM. Table 8 indicates that 83.3% of the total respondents favor the idea that all the Saudis should be eligible for this program. Among those who were in favor are all the 109 assistant administrators, all the nursing directors, all the personnel directors, seven training directors, four administrators, and four chiefs of professional services. The table indicates also that 11.9% of the total respondents believe that the MSD college graduate should only be eligible for the program and 4.8% only believe that MSD - non college graduate only should be eligible for the program. Item #52. LOCATION: THIS PROGRAM SHOULD BE HELD AT: A) MSD HEADQUARTERS; B) DHAHRAN MEDICAL ACADEMY; C) IN A ROTATING BASE (EVERY TIME IN ONE OF THE LOCAL HOSPITALS). Table 4-8 indicates that 54.8% of the total respondents favor holding the program in a rotating base, those who were in favor are seven training directors, Six assistant administrators, four personnel directors, three nursing directors, two administrators, and one chief of professional services. 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E02. 8.8 on 8.82 . 8.22222 22 222.2222 22 8.82 22.222 22 222.8 a 9.2 2222.. N . . . . . . - 2222.2 2 . . 222...N2 2 . . . 25 N2..22 SN 8.. N . . . . . . . . . . . . 00.N2 2 2222.2 2 92 222222222222 . o 22m. 2222. 92m 22822 x 2 22. 2 x 2 i 2 x 2 3 2 x 2 ...OP 3.00:0 GSc—flzv 20802.0 .86030m 5902.6 “5232 Sauna.“ 3 3.50 ~c.ou( SEO< 6039-0009 8.0—— E<¢UO~= ZO—hfier—S—O Gm: GHMOLOF— NIH. Oh. naught—mm min: 20 HOS—.Zmnvzm: GZ< >QZmDOm—mh >m ZOnEM—Ummm wPZHGZOmmm—m .2228 22-. 22222222. 112 those are all tflue nursing directors, five administrators, five training directors, four assistant administrators, five training directors, four assistant administrators, three chiefs of professional services, and three personnel directors. The table indicates also that 14.3% of the total respondents believe that the program should be held twice a year, 11.9% every two to three months and 9.5% once a year. Content of the MSD Orientation Program The prOposed content for time MSD orientation program and the perception of the respondents toward each element of the content are presented below. Item #S4a. HISTORICAL BACKGROUND - MINISTRY OF HEALTH Table 4-8 indicates that 83.3% of the total respondents favor giving the participants a brief on the historical background of the health ministry. Those who were in favor are seven training directors, seven assistant adminis- trators, six administrators, six nursing directors, five personnel directors, four chief of professional services. The table indicates also that 11.9% were undecided and 4.8% opposed with item 54. Item #54b. HISTORICAL BACKGROUND - OTHER HEALTH SERVICES PROVIDERS Table 4-8 indicates that 78% of the total respondents favor giving the participants a brief on the historical background of other health services providers. Those who were in favor are seven assistant administrators, six nursing directors, five administrators, five personnel ll3 directors, five training directors, and four chiefs of professional services. The table indicates also that 7.3% of the total respondents disagree and 14.6% were undecided. Item #54C. HISTORICAL BACKGROUND OF MSD Table 4-8 indicates that 92.9% of the total respondents favor giving the participants a brief on the MSD historical backgorumd. Those who were in favor are all the adminis- trators, all the chiefs of professional services, all the personnel directors, all the training directors, six nursing directors, and five administrators. The table indicates also that two administrators oppose and one nursing director was undecided. Item #556. MSD ORGANIZATIONAL CHART Table 4-8 indicates that 78.6% of the total respondents favor talking ix) the participants of the program about the MSD organizational chart. Those who were in favor are all the training directors, six administrators, six assistant administrators, six nursing directors, five personnel directors, and three chiefs of professional services. The table indicates also that 7.1% disagree and 14.6 were undecided. Item #55b. MSD PHILOSOPHY Table 4-8 indicates that 88.1% of the total respondents believe that the participants should be told about the MSD philosophy. Those respondents are all the administrators, all the chiefs of professional services, all the training directors, six assistant administrators, six nursing 114 directors, and four personnel directors. The table also indicates that 11.9% of the total respondents were undecided. Item #SSC. MSD PURPOSE AND GOALS Table 4-8 indicates that 90.7% of the total respondents believe that the participants should be told about the MSD purpose and goals. Those respondents are all the adminis- trators, all the chiefs of professional services, all the training directors, six assistant administrators, six nursing directors, and five personnel directors. Item #S6a. THE LOCATION OF MSD FACILITIES Table 4-8 indicates that 78.6% of the total respondents believe that the participants should be told about the locathmu of MSD facilities, those respondents are all the personnel directors, seven training directors, six assistant administrators, six nursing directors and five adminis- trators. The table indicates also that 11.9% of the total respondents disapprove and 9.5% were undecided. Item #56b. THE CAPACITY OF MSD FACILITIES Table 4-8 indicates that 81% of the total respondents believe that the participants of the program should be told about the capacity of MSD facilities. Those respondents are all the personnel directors, seven training directors, six assistant administrators, six nursing directors, five administrators, auui four chiefs <3f professional services. The table also indicates that 11.9% of the total respondents disapproved and 7.1% were undecided. 115 Item #56C. RELATIONSHIP BETWEEN MSD HOSPITALS Table 4-8 indicates that 90.5% of the total respondents believe that the participants of the program should know how the MSD hospitals communicate with each other. Those respondents are all the chiefs of professional services, all the personnel directors, all the training directors, six administrators, six assistant administrators, and six nursing directors. The table also indicates that 4.8% of the total respondents disapprove and 4.8% were undecided. Item #57. MSD PERSONNEL FUNCTION (PAYROLL, VACATION, ETC.) Table 4-8 indicates that 93% of the total respondents favor providing the participants of the program with information related to the MSD personnel function (payroll, vacation, etc.). Those are all the administrators, all the assistant administrators, all the chiefs of professional services, all the personnel directors, seven training directors, and six nursing directors. The table indicates also that one training director disapproves, and one nursing and one training director were undecided. Item #58a. THE AVAILABLE TRAINING PROGRAM IN-COUNTRY Table 4-8 indicates that all the respondents favor providing the participants of the program with information about the available training programs out-country, except one chief of professional services and one training director who disapproved with item 58b. 116 Section 4 The proposed model for the training and continuing education programs and the perception of the respondents are presented in this section. Item #59. FIRST MODEL: INDIVIDUALIZED TRAINING AND CONTINUING EDUCATION PROGRAMS TO MEET THE NEEDS OF A PARTICULAR EMPLOYEE WITHIN THE DEPARTMENT. Table 4-9 indicates that 83.7% of the total respondents favor the proposed individualized training and continuing education programs model. Those are all the administrators, all the chiefs of professional services, all the nursing directors, seven training directors, five assistant administrators, anui four' personnel directors. The table indicates also that 7% of the total respondents disfavor and 9.3% were undecided. Item #60. SECOND MODEL: DEPARTMENTAL TRAINING AND CONTINUING EDUCATION PROGRAMS THE NEEDS OF A PARTICULAR DEPARTMENT AND ITS EMPLOYEES. Table 4-9 indicates that 93% of the total respondents favor the proposed departmental training and continuing education model. Those are all the administrators, all the nursing directors, all the training directors, seven assistant administrators, five chiefs of professional services, and five personnel directors. The table indicates also that 7% of the total respondents were undecided. Item #61. THIRD MODEL: A HOSPITAL-WIDE TRAINING AND CONTINUING EDUCATION PROGRAMS (PARTICIPANTS ARE FROM MANY DEPARTMENTS) 117 222.222 N. 2222.82 22 2222.82 o 222.22 2222.82 o 8.82 o 8.82 2 92 2.228. 2222522222 .8 .2822 822.22 EN EN 2 . . . . 2222.2 . . . . . . . . . 222 2252 2222252222 222.222.... - No 2222.22 2222.22 2222.22 2222.82 22. 8.22222 22 2222.82 0 2222.82 2222.82 22 8.22222 22 8.22222 2 8 22.222222. 2222222222222 2222 .280 2252 222.222.2222 823-22.22.22: - 2m 22222.. 8.2222 22. 2222.82 22 222.2222 2 22.82 2222.2 2 2222.222 2 8.22222 2 8 omNd 2222.N 2222.2 22 . . . 222.222 2 . 222.22 2 2222.222 2 . . . 25 222222222. 2222222222222 .8 .2228 2252 0222222222... 22220252228 - 8 2222. 222.8 2222 8.22 2 222.2222 . 2222.82 8.82 o 8.2 2 2222.82 2 92 2222.22 . . . . . 222.222 2 . . . . . 2222.222 22 . . . 2,: 2222.22 o2.N 2222.2 22 8.9.. N 222.222 2 . . . . . . . . . . . . 92 22.222222. 8.822922 3 2802252 22222522 22.222.22.222. . 2222 2222.2. o5 2.822 I 2 i 2 i 2 2. 2 22. 2 2r 2 I 2 .l—OP 3.00:0 GSEQPP 208025 .268201 2202.0 @5332 5030.5 3 .030 ac.ou< SED< Egon-500.0 EC: m2<-00~§ AUZHDOM—m2— >9 ZOELm—UKM: mhzmnzcmmmm a-.. 039—. 118 Table 4-9 indicates that all the respondents favor the proposed hospital-wide training and continuing education model. Item #62. FOURTH MODEL: A TRAINING AND CONTINUING EDUCATION PROGRAM SHARED BY THE ARMED FORCES HOSPITALS. Table 4-9 indictes that all participants favor the proposed training and continuing education programs shared by the Armed Forces hospitals except one nursing director who disfavor item 62. Section 5 The perception of the respondents on a proposed recommendation to the staff development educators are presented below. Item #63. THE TRAINING AND CONTINUING EDUCATION PROGRAMS SHOULD BE PLANNED AHEAD AND PUBLICALLY ANNOUNCED AMONG THE HOSPITAL EMPLOYEES. Table 4-10 indicates that all the respondents favor the training and continuing education programs be planned ahead and publically announced among the hospital employees, except one personnel director who disapproved and one administrator who was undecided. Item #64. THE TRAINING AND EDUCATION DEPARTMENT SHOULD HAVE CONTROL OVER TRAINING AND EDUCATION ACTIVITIES INCLUDING MEDICAL EDUCATION. Table 4-10 indicates that 62.8% CH? the total respondents favor the training and education department having control over all training and education activities 119 coca —v coco, c cc.ccp o 8.03 s. cndo o cc.cc. 0 02.2.3 0 a! uo__.>=o< 222N.22 NNN 22.. 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Those who favor i1: include eight training directors, seven. assistant. administrators, four ;personnel directors, three administrators, three» nursing the efforts of the training directors. In this regard, Al-Nifay (1981) stated that the determination of training needs was based on feelings and guess work because this was the easiest way to do it. He added that the people inside the hospital were too busy with day-to-day problems and had little time to spare for the study of training needs. Also, most of the training staff are non-Saudi Arabians hired txa define expected 'training needs based on their personal experience. The proposed staff development programs don't exist in any of the Armed Forces Hospitals. Even the orientation programs which are the ultimate need of the new employees are not offered in some the hospitals, except for the international employees -- and sometimes even then it is limited to the nursing staff only. This situation led one of the physicians at one of the Armed Forces Hospitals to say the proposed comprehensive staff develOpment model isn't just worth trying, it must be implemented successfully. Recommendations The following recommendations based on the findings, conclusions, and discussions of this study are offered to 140 the MSD headquarters authorities and the top management at the Armed Forces Hospitals in Saudi Arabia. 1) The MSD should take a leading role in the training and educational activities, and the MSD is expected to define and develop the mission statement, the philOSOphy, and the broad goals and objectives of the training and educational activities at the’ Armed Forces Hospitals. Although, the MSD is expected to leave the door open for the local hospitals to initiate their individual programs to meet their local needs. 2) Supervisors, managers, and department heads, as well as the staff of the hospital, should: A -- contribute in the development of the goals and objectives of the local training educational programs. B -- participate in the process of identifying the ‘training ‘needs .and evaluating the training and educational programs. 3) The staff development programs should be comprehensive and consist of three elements: A -- orientation for all employee categories. B -- inservice training C -- continuing educational programs for all employees. 4) The content of any orientation program should include information related to the following three basic subjects: A -- the organization or the unit as a whole B -- the ground rules for working in the unit or organization. C -- the advantages of working for the unit or the organization. 5) The Training and Education Department at the local hospital should have control over, or coordinate all the training and education activities. V 141 6) The Training and Education Department at the local hospitals should have a complete record of all the training and education activities. 7) Among the staff of the Training and Education Department there should be: A --.A qualified physician with some experi- ence in medical education activities to coordinate all the medical education programs. B m-Ik well qualified registered nurse with some experience in inservice education to coordinate all the nursing training and education activities. C --A well qualified person with some experience in the Allied Health Professionals education activities to coordinate all the technicians training and education programs. Recommendation for Further Research This study involved a comprehensive look at a description of the proposed guideline for the staff development programs based on Opinions of the key position managers at the Armed Forces Hospitals in Saudi Arabia. The results from similar studies in other organizations or agencies (such as the National Guards, Ministry of Interior or Ministry of Health, etc.) might or might not be the same to test its generalizability. This study may be replicated at those organizations to find whether the Opinions of the key position managers vary according to the nature and the structure of the organization, or other characteristics of settings in which they practice. The roles of the hospital health care professionals in the implementation of the staff development programs should be further investigated for both 142 theoretical and pmactical application. Examples of questions that need to be answered are: 1) Is it feasible in terms of present resources to have the staff development programs be a part of the role of existing hospital professional staff at the Armed Forces Hospitals? 2) Do the low ranks of employees of the Armed Forces Hospitals have the same perceptions as the key position managers in regard to apprOpriate guidelines for staff development programs? 3) What should be the specific roles of the private companies who operate the Armed Forces Hospitals in planning and conducting the staff development programs? 4) What is the role of the international employees in performing educational and training activities at the Armed Forces Hospitals? And what is the expected one? 5) How can the Armed Forces Hospitals best organize and coordinate the delivery of training and educational activities for the residency students? 6) What specific factors, e.g., staff to coordinate, funding, resource materials are most closely associated with success in hospital staff development programs? Summary This final chapter has presented the summary of purpose and procedure, research questions, review of major findings, conclusions, discussion, and recommendations for both practical and further research. The review of major findings and conclusions which were drawn from the data displayed in Chapter IV, answered the general questions posed in Chapter I. The discussion was offered in an effort to present implied results (M3 the researcher's visit, and his 143 interviews with time key position managers at their sites, which were not included in the findings. In view of the fact that not all the questions can be answered by any one study, the recommendations were suggested as practical approaches to increase the body of knowledge pertaining to the staff development activities as 23 basis for human resources development. APPENDICES APPENDIX A 1) THE COVER LETTER 2) THE QUESTIONNAIRE 144 IN THE NAME OF GOD THE MOST MERCIFUL AND THE MOST BENEFICIAL Dear : The Professionals in the hospitals are considered to be one of the most important elements in the health care institutions and therefore their quality and effectiveness has an effect on the improvement of the quality of health care services. For this reason, in the health care institutions around the world, effort is being made to provide possible ways to develop the quality of the hospital staff. The health care institutions in Saudi Arabia are concerned about the importance and the necessity of providing the means to achieve such goals. As Professionals in the health field, you are the first one who should be considered for identifying these means because you are the person most directly involved in the process of health services. Therefore, the purpose of the present study is to ask your opinions on the appropriate guidelines for the staff develOpment programs for the employees of the Armed Forces hospitals in Saudi Arabia based on this instrument which was generated from review of the literature, standards of the Joint Commission, and the publication of the American Hospital Association. Your opinions will be confidential and no one will be able to recognize that these are your opinions. The result will be reported in aggregate form and the individual identity and responses will be kept confidential. Your participation in this survey is voluntary. You may, without penalty, elect not to participate at all, or not to answer certain questions. You may indicate your willingness to participate by completing this survey. The importance of this study is to provide some information which might help the researcher to make recommendations to educators, trainers, and the top authorities at the Armed Forces Hospitals in the process of developing an effective staff development program. This questionnaire consists of three parts. The first part is designed to elicit personal and demographic information about the respondents, the second part is related to the development of mission statements, goals, objectives, needs assessment and instructional methods. Part three is related to the determinatiqn of time, eligibility, location and content of the proposed staff development programs. It may take an hour to conduct the interview and to go over this questionnaire. Please read the questionnaire carefully, forward any additional explanatory comments and feel free to include any additional information. Sincerely, Said Al-Qahtani ”Researcher" Ph.D. Candidate College of Education Michigan State University 145 INTERVIEW QUESTIONNAIRE TEE PERCEPTIONS OF THE KEY POSITION MANAGERS AT THE ARMED FORCES HOSPITALS I] SAUDI ARABIA OH PROPOSED GUIDELINE FOR STAFF DEVELOPMENTS PROGRAMS I)? SAID AL-QAHT AN I 146 To gain a more complete and clear concept. of the staff development programs and the proposed models(s), the researcher recommends that. you read the questionnaire in its entirety before responding. 147 PART ONE Personal Data Please put a B beside the appropriate response in the space provided. I. Nationality: Please indicate your nationality. E) Saudi C) Europe or North America 1:) Middle East or Arab countries. [I Far East 11. The name or your hospital: III. Occupation: What is your present position? [1 Administrator. E) Assistant Administrator. D Chic: 0: Professional Stair. E) Nursing Director. U Personnel Director. El Training and Ed. Director. E) Head of a Dept. IV. Degree: What is your highest degree? DDoctorate DMaster DBachelor UOther 148 V. Sex: [Male DFemale VI. Years of experience in the Saudi Armed Forces hospitals: C) 1-2 years I324 years De-b years Dmore than 6 years Years oi experience in hospitals: Eli-5 years DS-io years 1310-15 years Elmore than 15 years 1:49 PART TWO This part deals with mission statement philosophy, goals and objectives of Training and Ed. activities for ms. 1. In order to set the mission statement the philosophy, the broad goals and objectives of the training and educational activities, there are two choices. Please circle the appropriate one as you see it A- The door should be open for each hospital to state their philosophy, to meet the local needs. B- It should be the responsibility of the MSD to set the mission statement the philmophy, the broad goals and objectives oi the h‘aining and educational activities but at the same time to leave the door open for local hospitals to initiate their individual programs Which meet their needs. Those local programs should match the philosophy of MSD. Comments: 150 Questions 2 through 10 deal with development and the implementation of the staff development program. Please indicate your perception and mark the apprOpriate blank to the right of the following statement according to the following scale: 1- Strongly Disagree. 2- Disagree. 3- Undecided. 4- Agree. 5- Strongly Agree. 2. Setting goals and objectives is important in the process of developing any training or 1 education program. I] D N a.» Dc» [:1 DUI 3. Stating the goals and objectives of the local individual programs at each hospital are the responsibility of Training and Ed. Dept with the participation of the department heads under the direction of the topmanagement C) D U U E) 4. Planning for programs is the responsibility of the Training andEd.Dept U D E] U C) 5. Identifying training needs is the responsibility of the training and Ed. Dept with the pardcipation of (l) department heads and (2) participants (employees). I] I] E) D U 6. Preparing the program materials is the responsibility of the staff of the Training and Ed. Dept D U U U D 10. ll. 13. 14. 151 nominating the participants for the l 2 3 4 5 training and education programs is the responsibility of the department heads. DECIDE) Evaluating the program is the responsibility of Training and Ed. Dept, department heads, participants, top management and sometimesaconsultant. D D I] C) D The evaluation process should be during, and after the program. 1:) D C) D E) The evaluation should include evaluating the instructor(s), the participants, the content, the instruction method (3) and the program environment E) E) D D C) The most effective method of determining educational needs is through the process of data gathering and that can be considered through a variety of methods which are mentioned below. For questions ll through 14 marl: the appropriate blank to the right of the statement according to the following scale: l- Strongly not recommended. 2- Not recommended. 3- Undecided. 4— Recommended. 5- Strongly recommended. 1 2 4 Using the questionnaire method. U D E] I] I5] Using the interview method. [I D D U C) Using the observation method. I] U D D U Using the document files (incident reports, for example). 1:) E) D D U 152 For each of the instructional methods mentioned below, please 15 l6 17 18 19 20. determine your perceptions on the appropriate method in relation to each program by marking the blanks to the right of the statement For questions 15 through 23, you may recommend one method for more than one program. maxim Continuing In Service ionization Iminins W The trainer will be speaking to training group usually from prepared notes. The trainer sands in front the group and gives information or specific topics. 1:) D D MZW- The trainee enrolls in home-study courses or reads independently. U U D W Individual on-me-job training. The supervisor works closely with the trainee on specific job tasks. I] U U Rotation. Individual on-the-job experience in different job types, locations, departments, etc. Cl C) U Wop, Meeting to solve problems through group discussion. The trainer or chairman conducts discussion and involves trainees in attempting to solve problems and reach decisions. [1 E) U Simulation, Individuals receive on-hands experience through simulation of the work environment and on-the-job situations. Cl C) U 21 22 23 153 W Continuing Maxine A simulated situation in which trainees act out the thoughts and behavior of persons in particular roles in the organization. Trainees act out the situation and then discuss what happened and why. [1 U W. Shidy of a simationin which involves a specific incident or organization problem. The case is presented orally, in writing, or by film. Conferees analyze and discuss it determine the issues, and propose solutions. 1:) D W. A method of getting a group to come up with original, creative ideas. The group lists all ideas, suspends judgement encourage freewheeling thinking and hitchhiking on others' ideas. 1:) D In Service APPENDIX 8 OFFICIAL LETTERS 2’: 25 154 PART THREE The Orientation program of Overseas Employees In order to meet the goals and the objectives of this program, it should be conducted at- A- The countries of their points of hire. B- MSD headquarters before their arrival to the local hospitals. C- Local hospitals after their arrival. The designing of the Orientation Program of the Overseas Employees is the responsibilities of: A- The recruiting companies. B- The MSD headquarters. C- Local hospitals. D- All of the above. WI. For each of the subject areas mentioned below, please mark in the blank to the right of the statement which indicate your agreement or disagreement to the following scale: 1- Strongly not. recommended. 2 - not Recommended. 3- Undecided. 4- recommended. 5— Strongly recommended. 155 This program can provide new employees with information about the following subjects: 26 The Kingdom as a whole. 1 2 3 4 5 a. historical background. U D D U D b. location. U U U D U c. population. [J U U U D d. climate. D U U U D 0. natural resources. D D D D D 1. religion. [I U U U D g. rules and regulations. D U D D D 27 People of Saudi Arabia. a. lifestyle U D D U D b. customs. D U U U U c. traditions. D D D U U d. habits. D D U U U 26 The development of health care instiuitions D U U U D 29 Travel arrangements in case it is going to be conducted atthecountryofpointofhire. D D D U U 30 31 32 156 Hospital-Wide orientation Program. Iiming- ' What would you think is the best time to conduct this program? In the following there are three choices, which one would you prefer? A- before the new employee starts the work 8- the first day lie/she starts the work. C- alter he/she starts the work. Cement For each of the following subject areas mentioned below, please mark in the blank to the right of the statement which indicates your agreement or disagreement according to the following scale: l- Strongly not recommended. 2 - not recommended. 3- Undecided. 4- Recommended. 5- Strongly recommended. The hospital's a. history U D E] D D b. goals. [1 U E] E] Cl C. philosophy U U U U U Hospital organization a. organizational chart D D U U U h. department communication D U D U U c. facility--map of hospital. D D D D U 33 34 35 36 37 38. 39. 157 Personnel a. payroll, benefits, vacation, promotions, absences and illness. b. policies and procedures. Hospitals Policies a. visiting hours b. time clocks c. cafeteria d. uniforms, name tags, etc e . parking Employee Health b. policy procedure Safety Program a. fire prevention b. disaster plan Resources a. policy manuals b. library. Employee Responsibilities to Hospital a. incident reports b. patient care c. professional liability Tour of the Hospital. 1 C] D U D U E] El D [3 DEC] 2 CID DECIDE] DEC] 3 DC] DDCJDCJ EDD 4 DC] DECIDE] [IL—JED CID DECIDE] [DE-JD 40. 41 42. 43. 44. 158 Department Orientation Program 11mins According to JCAH Standards, every new employee is supposed to be introduce to the rules and regulations of the department and provided with the needed training skills. In order to introduce the new employee to the department, the best time to conduct such a program is: A- right after the hospital-wide organization program, where the employee starts his/her work for the department B- Anytime during me probation period (3 months). c- After the probation period. ' 952nm For each of the subject areas mentioned below, please mark in the blank to the right of the statement which indicates your agreement or disagreement according to the following scale: l- Strongly not recommended. 2 - not recommended. 3- Undecided. 4- Recommended. 5- Shongly recommended. 1 2 3 e 5 Department organization chart. [I D [I E] U Nature of duties--job description. [1 U U U U The role or inaction of department [I U U D D Department policies-rules and procedures [1 U U U U 45. 46 47. 46. 49 50. 51 52. 53. 159 N Department colleagues and their 1 functions D E] Di.» [:1 DUI Work area-equipment and supplies. [I U C] U [:1 Opportunities for development of job skills CI U C] U Conduct/performance expectations D D U 1:] Career advancement and mobility opportunities. [I D D U U Available education programs [1 D U U HS!) Orientation Program. This program is eligible for: A- the MSD Saudi college graduate only. B- the MSD Saudi non-college graduate, but occupying or promoted to supervisory position. C- the Saudi local hire occupying, or promoted to a supervisory position D- all of them. This program should be held at; A— MSD Headquarters. B- Medical Academy c- In a rotating base (every time in one of the local hospital). This program should be offered: A- every two or three months. B- twice a year. C- once a year. D- as needed. 54. 55- 56. 57. 56. 160 Genres; For each of the subject areas mentioned below, please mark in the blank to the right of the statement which indicates your agreement or disagreement according to the following scale: 1- Strongly not recommended. 2- notrecommended. 3- Undecided. i— Recommended. 5- Strongly recommended. Historical background l- Ministry oi Health (brief) D [1 E] U U 2 - other ministries and agencies providing health care services (National Guard, Red Crescent.) (brief) E] Cl C] D D 3- MSD (detailed) D D [1 Cl 1 2 3 4 5 MSD Organization l-organizatlonal charts U U C] U U 2- philosophy I] U U D U 3- purpose/goals D U D D U MSD Hospitals, Training Schools and Field Hospitals l- locations [3 D D U D 2 - capacity U E] D U D 3- relationship [I U E] U [1 Personnel: payroll, absences, illness, vacations, promotions, retirement [1 D D D U Education and Training Training programs available: I- in-country D D D U U z-out-country U U U D U 59. 60. 61. 62. 161 Training and Continuing Education Programs The life long learning is a fact of life for health professionals. Please indicate your perceptions and recommendation for the following four proposed models for training and continuing education programs: 1- Strongly not recommended. 2 - not recommended. 3- Undecided. 4- Recommended. 5- Strongly recommended. Individualized training and continuing education programs to meet the needs of a particular 1 2 3 employee within the department U U D U e5 DU Departmental training and continuing education programs to meet the needs of the department employees. U U U D D A hospital-wide training and continuing education programs (participants are from many departments). D D U D D A training and continuing education programs shared by the Armed Forces' Hospitals. D D U C) D 63. 64. 65. 66 67. 162 For questions 63 through 67, please indicate your perception on me following statements, and mark the appropriate blnk according to the following scale: 1- Strongly disagree. 2- Disagree. 3- Undecided. 4- Agree. 5- Strongly Agree. The trainig and continuing education programs should be planned ahead and publically announced among the hospital 1 5 employees. [1 D D U U The Training and Ed. Dept should have a control over all training and education activities, including medical education. I] U D D E] N t.» .5 Participating in Training and Ed. programs is condition for promrtion or merit increse. (As trainer or educator if applicable) [:1 U E] U U Participating in Training and Ed. programs should be a condition for promotion or merit increase. (Asaparticlpant). D U D D D Support and commitment of the top management is important for the training and education activities. D U D C] U 163 MICHIGAN STATE UNIVERSITY W comm-rm ON manor MOLV'ING IAI‘I’ W6 0 W 0 «cream m SUIIECTS locum ‘ m HALL a") ”5473. June 30,1988 Said J. Al-Qahtam' 920 S. Harrison EaSt Lansing, MI 48823 Dear Mr. Al-Qahtani: Subject: THE CASE OF THE ARMED FORCES HOSPITALS “IN SAUDI ARABIA “ " ' The above project is exempt from full UCRlI-IS review. I have reviewed the proposed research proracol and find that the rights and welfare of human subjects appear to be pretected. You have approval to conduct the research. You are reminded that UCRHiS approval is valid for one calendar year. Ifyou plan to continue this project beyond one year, please make provisions for obtaining apprbprt'ate LCRIHS approval Any changes in procedures involving human subjects must be reviewed by the UCRIHS prior to ' initiation of the change. UCRIHS musr also be nou'fied promptly of any problems (unexpected side effects, complaints, etc.) involving human subjects during the course of the work. Thank you for bringing this project to our attention. If we can be of any future help. please do net hesitate to let us know. Sincerely, JKH/sar cc: E. Nonnamaker MSU u ‘- Alfie-news Aer-enamel apprise-0y Immu- 164 MICHIGAN STATE UNIVERSITY comm: or mucmou usr mm . macaw - «814-1054 harm or mucmowu. ADDGNB'IINIION muaseuluui J June 21, 1988 Jeneral Ahmed Al-Sharbini Program Director Dhahran Medical Cancer, Dhahran Medical Academy and the Armed Forces HOSpical at King Abdulaziz Air Base Dhahran, SAUDI ARABIA ‘ Dear Jeneral Al-Sharbini: This latter is to report on the progress of Mr. Said Al- Qahtani. Said has passed his comprehensive examinations and is now in the process of deve10ping his dissertation. For his dissertation he is planning to study the perceptions of key managers at the Armed Forces Hospitals in Saudi Arabia on appropriate guidelines for staff development programs. He has develOped an extensive questionnaire which he plans to administer to chase managers. To complete his dissertation he will need to visit each hospital to administer the inscrumenc and to interview the administrator, assistant adminiscracor, chief of the professional staff, nursing director, personnel director, and the training director. He is in the process of making arrange- ments to adminiscer the questionnaire and conduct the interviews this Summer, and any assiscance you may give him will be deeply appreciated. After Said has collected his data he will need to return to Michigan State University to do a computer analysis of his data and complete his dissertation so that he may present it to his doctoral guidance committee for his final oral examination. ’ o Sincerel ’urs, ‘/L ‘7’» fly: r 54/ Eldon R. Nonnamaker Professor ERR/DH MSU it an Allin-noun Action/Equal Opportunity Inuit-mew 165 III’ , o r; B ' \ \£ VL 3 at) I U. u) o . UL‘J. | QUJV‘ g. .. Q. Li.) 1.1.4: @1531: 131.11 shim 2..le um :cépg5n 1——_—.US_-JI Mend! hauler—.34.. 5...};de WI©|WIv1£hJ a Cgfl‘, LL“ is,” fig-III (Sn—h “WWI;V:LLAJJI alxhu/J’HI “(4.3.1 #1.,le EH", out)?” 9)....” JLAAVJ “”354." 1’44 H IJLQQQJNSMIJ a I‘M! mgr—1...." ”DEF-ll . an.) at”?! fist)! £32.! pL—J‘ll ”Ja- mildew: H030! ”I, “.5;wa cut—..., WWJ—lt ,. ...—5an man 3)::- -L_'.:.l gas—J: WL: ... ...... ' h a \c\\‘" tea-m: U/)/// HIJ‘JI He WI“ i._...1....n any than cal—.45.." ..u J...» 166 : 'l‘ ”“1"“ 5“,"? 2) Mel/La ' 13;; ab )Mfln LALa—J‘ iji‘ 1.2.; Lat—w) : @511 1.4.4: .3511! 19.11 suns am: :31 m (MAJ-“WI a C6”: LJJI Ls” All rS—JI elk—5.x." bJJVIIJJAI-JWI.'VQMI an)... *h-ldefia—JI v.3 pas; e93“! ”it’d ”a“: ”#21,...le rt”, 4:411, leg.“ 4L9. VJ ,L____m n44. MEL-legal}... Us)“, ”54.41., . Wu . e._._'.JL.J JLaaUJ #IJI (Sh-1., #91:?)thle “‘55wa out...) 2......pr 9‘14.) mun 3);.) oust dos—J! es» «s—Ju \t \ \‘N ”AI/":4 0/ I / J r V-LIJAJI 4.». W!“ Lad—a." my 1.5.3.1! cuss." ,u J14: 167 : .3433) P v W's/M . on?) J .‘l ULA—M 0“)“ LI... LU) , guy: Lain .5511! as." shall! 3..qu 3,1»: Lou—an .sL,LM “AELu).£;LuUI‘FAJI EQUJ'.HJ* Lua- QIJ‘JJL.’ 11”." MI“ e‘J—IAJI 34.0qu 0 L36)..." ‘4.“ b” '51—}! ‘03-." 0L*r_;SJJI thragrhiJJanJehairafl ‘;Lha1JI‘fi.He sea-IVJJJAM tJJ '41: earn—1.4: v31” ,4..." 9.4.2!qu tn,” one)!” 5.95.1: Jw w’ ,L__...m u)... Laudewnéa, IJLQvIePJJ' ”5.3.4:, . WI . bub) JLgqufileI (sh-.3 Qp—gueuvléot IJIJ 4‘3;wa can...” 2.....wa . p.944 a...” 1,9va nos—n on. M fx-"J w'°"a‘)b / am~.‘§,uzjsfi,¢huhum - r 33‘: \ n4_i_s.5.:_h .s-e-i/"JJ '12 <\ )//f lJJ‘ my“ 1r—"‘"' I a...- a-gAJN-r‘ Q} ‘ . .1 "I 2......4...” eu-LU lea-L“ ska-354' r“ as“ U W L/ , J U APPENDIX C PRINCIPLES OF ADULT EDUCATION 168 Ht” OUJVI 2.... LL33 WI cabal! in“! cabin! LlaJI 3414‘! Q ~ i t" r. g ' ~53 { H - A JMIH/Ifll i3: )MJLJ 3M MIQI’J—‘wa‘vm—efiéa o ‘5de u.“ by M {Sun-’1 QMIglfiArh/dlylh'dpm f—gJ-DI-JIJHJHI "'3', JUJ’IJ 9*.“ JLM V" sly—$4.." 1a).) 4.4L.) Jo. VJ ”3.14! ash-...! r'---”‘ 01.).» Laud eLrLL-aJI v-——-'05-' Isl, “$.34va cash-..., ~as...»4,..,_..:..|...J e r—S'JJ C—eUI 3);) 'L—J—IJ AJcr'h-JI agat— <, ‘ 951-“ ail-“J ' \<|\°'~ . m.» ”TD )/ V—JSIJLH. use 4.3.9.1149 1.4...." sum timer.“ ,u ...... 169 ~ ”w' W' ‘8‘“ Memorandum WWIMI . ob—d—lb To. Robert S. Crowder DAT! 21.09.1988 Hospital Administrator Haj. Dr. Hoh'd FROM apt. mh'd n-HCICfi RECE'VED sniufiweeeee Assistant Administrator/Program SUBJECT QUESTIONNAIREeeeeeeeeeeeeeeeee 2' SE? 388 !'“:4:""‘UIOOO In reference to the Heme. from Sajor General Dr. Abdul-Hamid Al-Praidi. the Director of 11.3.0. dated 29.01.1409H.. concerning the above subject. attached please find a questionnaire provided by Said Al-Qahtani who is currently studying in Hichigan State University. Please. also note that this questionnaire has been approved for distribution by the Actg. Program Director Hajor Dr. Hoh'd Sulaifieh. Please make arrangement for him to meet with you and different personnel listed below on 24th and 25th of Sept.. 1988 for 15-20 minutes each. hey are: 2. Hoh'd Thubaity. Patients 8. Administrator 3. Nigel Devereux. Support 5. Administrator 5. Iris Nelson. Nursing Director 6. Hanson:- Al—Hansour. , Personnel Director Upon completion. please return this questionnaire to my office for collection by Mr. Al-Qahtani. Thank you very much for your co-operation in this matter. W’ in. CIPC. HOh'd M-MIIn Assistant Adsinistretor/Program 170 ~ :2. ' .. . - ‘ All}? 3". $399)!) " :4.th bum Li’s 1.1.3, an...“ .31 ,m an." slain in.» z ,1 m (M 31-” ~.—-‘-‘-') 9,5.» yuan: We, 1.4.4:»;ny sens... ”a. c £363., IJJI is...” r51.” fS—JI ,1...)qu ”may: 01,... lib/43,4! us (ii: p._...1..:..n.,wa:.n rtflJ'stSU rep: 5’wa uqu I”; ,jn—a, zJHJV’H—‘JI ”SUD, s 21):..." 9%.)! ”##I . at.” thu v’ H“)! asks-3 putt ”as. macaw! “...—405.! 1.31., “.qu?) cast—..., WMJDT . ...—5,4.) $013,13wa uwtwb r‘v‘“ ell-“J fl ”pi/",4 .///// HI)“ Lassa WI“ MI @I)“ WI cpl-04"." (U fie“ 1. 171 ADULT EDUCATOR COMPETENCIES Accept the learner as a person with feelings and ideas to create an environment conducive to learning.* first level: A. Demonstrate verbal and nonverbal acknowledgement of learner's desire to learn his/her new job. 8. Demonstrate a support attitude as a co- learner. second level: Encourage learner to relate past experiences to new material. third level: Support learner's suggestions for appropriate change. Establish and maintain communication with learners regarding job responsibilities to promote a relationship of trust confidentiality, and support.* first level: A. Provide clear and realistic job responsibilities. B. Introduce hospital jargon gradually. second level: A. Provide specific times and places when you will be available to learners for questions. B. Follow up on requests and report back. C. Acknowledge difference of opinions. third level: Obtain feedback from learners to check uniform application of policies and procedures. Develop educational offerings with realistic behavioral objectives to meet the needs of the learner, to be consistent with hospital goals, and to reflect current nursing and health care practice. first level: A. Obtain input from learners, supervi- sory personnel, and other appropriate hospital staff regarding job-related needs of orientation and continuing education.* 8. Determine priorities of above job- related needs. C. Translate job-related needs in behavioral objectives for learner. D. Develop objectives which 1. indicate current hospital practice, policy, and/or procedure 2. build on the learner's previous job-related knowledge 3. depict observable behavior 4. 172 4. correlate with the learner's level of comprehension and function 5. fit within a realistic time frame - 6. progress from simple to complex 7. reflect current concepts and research in the health care field second level: Increase competency and efficiency in the above. third level: Assist others to accomplish the above (eg. peers, resource persons). Utilize a variety of learning opportunities for individ- uals and groups to promote active participation by the learners. first level: A. Utilize two to three teaching methods appropriate to the material and the learners (eg. lecture, discussion, demonstration) B. Utilize group dynamics principles. 1. produce physical climate of warmth and informality 2. produce emotional climate of understanding and trust 3. practice task functions (eg. initiating, setting goals, informing, seeking information, coordinating, evaluating, elaborating, summarizing, etc.) 4. practice maintenance functions (eg. standard-setting, tension~ reduction, supporting and encour- aging, gatekeeping, harmonizing, expressing feelings, compromis- ing, energizing, etc.) 5. encourage individuals in group to become model members. second level: A. Adapt teaching methods based on the learner's response. B. Utilize new teaching methods. third level: Share expertise in teaching methods with other instructors. Utilize apprOpriate hospital and community resources to provide educational offerings reflective of current nursing and health care practice. first level: A. Keep up-to-date on current concepts at hospitals and in the health care field. 173 second level: B. third level: A. Keep up-to-date on resources available within the hospital and community. Contact persons at hospitals and in community agencies as guest speakers and/or resource persons. Assist hospital personnel to develop themselves as resource persons. Assist guest speakers in evaluating their presentation. Assist community healthcare agencies as requested. Continuously evaluate the learners' progress and the effectiveness of the facilitator to determine if the learners' objectives are achieved. first level: A. second level: A. third level: Evaluate the learner's performance in the classroom and on the unit, utilizing two to three evaluation methods (eg . feedback from learners , supervisors, orientors, and other appropriate personnel: skills inventory, self-evaluation tools; tests: return demonstrations; observations: audit, etc.)* Evaluate the instructor's teaching performance in the classroom and on the unit by obtaining written and verbal feedback from the learners, supervisors, orientors, and other appropriate personnel.* Revise objectives, content, teaching methods, etc. based cu] above evalua- tions. Same as first level, A, above, except applied to continuing education offerings. Same as first level, B, above, except applied to continuing education offerings. Same as first level, C, above, except applied to continuing education offerings. Provide learners with self-evaluation tools and appropriate recommendations for their areas of growth. Establish appropriate physical conditions to promote an environment conducive to learning. first level: A. B. Provide adequate physical conditions (eg. writing space, lighting, seating, temperature) Assemble appropriate equipment prior to class. 10. 174 D. second level: Provide adequate time for breaks. Arrange audiovisual aid for good visibility by all. Make apprOpriate recommendations to improve physical conditions and/or equipment, within budgetary limits. Maintain current knowledge, skills, and attitudes in nursing and education to ensure relevancy in classroom and clinical instruction. first level: A. second level third level: Establish a systematic approach in keeping self current about job knowledge (eg. regular time set aside for book and journal review, confer- ences with resource persons or peers, rounds, etc.) Participate actively on nursing unit. Ensure professional growth by partici- pation at internal and external educa- tional opportunities, self-directed learning, and/or membership in professional organizations. Assist peers in maintaining and evlauating their nursing and education expertise. Foster communication within the department to promote coordination of services and sharing of resources. first level: A. B. second level: A. B. third level: Identify role of other departmental personnel. Identify role of support services (eg. secretaries, printing services, library). Utilize other instructors as resource persons (eg. content of classes, teaching methods, teaching materials). Infomn other departmental members of your activities. Inform other departmental members of changes that may affect their roles. Establish and maintain an effective working relationship with orientors to provide more effective orientation and continuing education programs.* first level: A. B. Establish list of orientors and chief orientor if appropriate. Review orientor's role and instruc- tor's role with learners and orientors. ll. 12. 13. 175 C. second level: third level: Provide orientors with list of compe- tencies to use in assisting the learners. Utilize orientors for two-way communicathmu on their units (is, planning, publicizing and evaluating orientation and continuing education offerings). Assist orientors in applying adult education principles (eg, orientors' workshop, orientor's manual, one-to-one support). Keep informed of changes in hospital policies and pro- cedures to provide current orientation and continuing education offerings. first level: A. B. second level: A. 8. third level:* Determine formal and informal channels of communication. Regularly review apprOpriate policy and procedure books and meeting minutes. Route requests for changes to approp- riate person(s). Devise written and/or verbal methods to inform learners of changes in policies and procedures that affect their role in hospital (eg. classes, newsletter, flyer, memos, informal group meetings, communication through supervisory personnel, etc.)* Become a member of appropriate committees. Problem-solving: recommend changes in policies or procedures to reflect current, safe practice. Assist the learner to identify the effects of stress on his/her job performance to support their mental health.* first level: A. B. C. second level: third level: Assist learner to identify his/her feelings. Ensure confidentiality of all information. Encourage learner to use appropriate channels of communication for constructive criticism. Refer learner to other appropriate supportive services. Assist learner to clarify his/her problems and to assess possible solutions. Serve as consultants to supervisory staff to assist them in evaluating their employees. 176 first level: second level: third level: Provide supervisors with summary evaluations at end of learner's orientation (ie, strengths and areas of growth).* Upon request, assist supervisors in evaluation of learner's performance. Upon request from supervisor and/or learner, recommend alternative employment options (eg, transfer to another unit or area, termination, promotion, change in hours or shift, or further schooling). l4. Serve as consultants to hospital personnel regarding educational resources to facilitate self-directed learning. first level: second level: third level: Promote use of educational calendar and audiovisual listings.* Recommend apprOpriate books, journals, audiovisual aids, resource persons, and community resources.* Assist hospital personnel in develop- ing their own continuing education programs or in individualizing continuing education programs to their needs. * Guidelines to the instructor regarding feedback to obtain or information to relay on rounds. APPENDIX D INSTRUCTIONAL TECHNIQUES AND ROOM ARRANGEMENT 177 Instructional Techniques to Impart Knowledge _ Techniques appropriate for ONE RESOURCE PERSON PRESEN- TATIONS to inform, give information, disseminate knowledge, de- velop understanding: Technique Description Room Arrangement . 0 Committee Questto’ ning of a resource person 0 0 Hearing by a panel of interviewers for \ (_. ' externporaneous responses. 0 O O O O 0 film One-way organized presentation I O O O O I I 0 Interview Questioning of a resource person 0‘ O. by an individual on behalf of *" audience. e . e e e e . 0 Lecture. One-way organmed formal Speech presentation of infonnatton or Q point of View by resource person . . . . . . Lecture with Several group representatives 0 ’ . Group Response interrupt resource person at O . Team (Audience appropriate times for immediate \ <- Reaction Team) clarification of issues 0 O O O O O O Screened Sub-groups develop questions 3 ' g Speech they wish resource person to o e O O Q Q 0 O I O O O 0 address extemporaneousty 178 Techniques appropriate for SEVERAL RESOURCE PERSON PRE- SENTA'I‘IONS to inform, give information, disseminate knowledge. develop understanding: Technique Description Floom Arrangement Colloquy Panels of 3 or 4 resource persons .. .. and 3 or 4~representat~es of the CO 0 audience discussing issue. 9 (— O O O O O 0 Debate Conflicting views stated by each . . resource person and clanfied turther ON {0 by argument between them. . . . . . . O O Dialog Informal. conversational discourse between 2 resource persons. 0 Cl 0 O O O Dramatic Prepared play or skit to lnlonn. §$f Presentation . O 0 e. O Interrogator 2 to 4 resource persons questioned .0 0 Panel by 2 to 4 interrogators. $ 4" Panel Discussion Panel of 4 to 7 resource persons . . . carry on a discussion of an issue m belore an audience (inlormal dis. cussion “overheard" by audience). . . . e o e O . 0 Symposium 3 to 6 speeches or lectures presented 0 . in turn by resource persons on ; various phases of a single subject or problem. e e e e e e 179 Techniques appropriate as FOLLOW-UPS to presentations of one or more resource persons to invoive the audience: Techniques Description Room Arrangement 0 Buzz Groups Sub-groups ol 4 to 6. with 4 to 6 E minutes to discuss particular issue or question raised by resource person. ' ' z z ' ° 0 Chain Reaction Sub-groups discuss presentation :3 Forum and formulate questions to be . f f R asked resource person. 0 o . . .' . ' o o o 0 Forum Free and ooen question/discussion [:3 period immediately following a lecture, of o of. o 5 . O . O . Group Sub-groups of 10—20 discuss prob- . O . Discussion Iems or issues raised. for 15-30 . o 0 . minutes. . . o o . . O Huddle Pairs or triads (2-3 persons/groups) E Groups discuss specific issue for 2 to 3 ‘ 0 minutes. 0. . . . . . 0 Listening 3—4 members in audience are I" Team designated to listen and raise . .f . . .V questions after presentation. . . . . . . F Question Opportunity tor any in audience to :1 Period directly question speaker. .I .1 .1 E \. \. . I. Reaction Panel of 3 or 4 react to presenta- 0 6. Panel tion by panel discussion. " O O O O O O . . . . 0 Reaction 3 or 4 persons in turn give their 0 0 Symposium reaction to presentation. . . . . . . .0 Screening 3 or 4 persons screen questions .0 ‘ i Q. Panel raised by audience (on cards) beiore presenting questions to resource person. . . . . . . € 180 Room Arrangements 1. Theater Style [:3 2. Herringbone Style .0 [:3 . P. . C .;Q. 433.; 3. U-sliape Style [I] 4. Diamond Style pr Hexagon Style 0 O 6. Conference Style ll i .. C O. 7. Chairs in Circle 8. ClassroomStyle ,° ' °, :::3 ' ' L.:' E. .1 [ii—.1 i. .J i. .1 2:.) 9. Chairs in Small Semicircles 10. Banquet Style :3 . :3 . -. .° °. .° °. .° Q. IQ“. .Q. REFERENCES REFERENCES Alexander, IL. and Davis, R. Choosing Instructional Techniques. East Lansing, Michigan: Michigan State University, 1977. Al-Nifay, A. An assessment to redesign in-service trainimg programs for gparaprofessionals employed ih’ military hospitals under the jurisdiction of the Saudi Arabian Ministery of Defense. Unpublished doctoral dissertation. University of Pittsburgh, 1981. Armstrong, M.L. ”Bridging the gap between graduation and employment.” The Journal of Nursing_ Administration/November-December 1974. Babbie, E.R. Survey Reseagch Methods. Belmont, California, Wadsworth Publishing Company, Inc., 1973. Baird, L. and Schneier, C. and Laird, D. The Trainingand Development Sourcebook. Amherst, Massachusetts. Beach, Dale. The Management of People at Work. MacMillan, 1970. 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