Training and Management Through Three Basic Instructional Objectives

Long before I ever heard of a “medical practice executive,” I spent some time teaching college. It started while I was still in graduate school, when I accepted a teaching assistant (TA) position as a classroom instructor in the college language program. The supervising professor created the syllabus and course requirements, of course, but he allowed us a certain latitude in planning our lessons and running our classrooms. He wanted us to learn how to be good teachers as much as he wanted the students in our charge to become proficient in the language we taught.

Our weekly TA meetings, then, amounted to an additional course of study for us—except we got paid to take this class! What I learned as a TA has turned out to be some of the best, most useful stuff I learned in my entire academic career.

We spent a great deal of time in our meetings discussing instructional objectives—every lesson plan we prepared required us to come up with three kinds of objectives, based on the way humans acquire knowledge.

The classic domains of educational objectives take into consideration the student’s “whole being” by including:

• Cognitive Goals. The instructor decides what the student should know at the conclusion of the lesson or course of study. Cognitive learning encompasses the facts and theories, the resources available, and how things work.

• Affective Goals. The instructor decides what the student should feel at the conclusion of the lesson or course of study. Affective learning covers appreciation for the mission, motivation to make the effort, and value in the job and its contribution to the company’s purposes.

• Conative Goals. The instructor decides what the student should be able to do at the conclusion of the lesson or course of study. Conative (or psychomotor) learning is all about the skills the student will acquire and refine.

Failure to address any of these categories results in a weaker lesson plan, because it reduces the chances for the student to grasp and retain the new information presented. The human mind is naturally receptive to a combination of knowledge, skills, and motivation.

Employee Training Programs

Physicians and practice managers should see an immediate application for these principles. Training programs throughout your practice will become more effective if you deliberately formulate—and pursue—all three types of instructional objectives as you plan and deliver lessons for receptionists, billers, telephone operators, clinical staff, computer users at all levels—everyone!

We often do training “on the fly”—pairing a new employee with a veteran who can show him or her the ropes. That’s important, because it creates relationships and focuses the new worker on practical, day-to-day procedures. It uses real-life situations to help a new recruit understand what’s important and how to get it done in real-time.

But often—when the “buddy system” summarizes a practice’s entire training program—there’s a disconnect for the staff employees. I’ve seen some version of this famous quote pinned to the wall of medical practice employees’ work areas for years:

“We, the unwilling, led by the unknowing, are doing the impossible for the ungrateful.”

Office workers laugh and say, “Ain’t it the truth!” because they often don’t fully understand why they must do all the tasks their jobs require. And whose fault is that, if not ours? Sometimes we get so caught up in teaching the mechanics of the job, we fail to clarify how each job fits into the big picture. In other words, we’ve neglected to address affective goals for our staff.

If we ignore the emotional nature of humans, we will find it nearly impossible to motivate them—especially when we need them to make that extra effort required for keeping patients and referring physicians happy. Some practice managers and the physicians they serve will respond to these observations with, “Don’t bother me with all that touchy-feely stuff! I need practical advice for running my practice.” They don’t feel any obligation to “hold staffers’ hands.” They believe that reasonable adults don’t need it.

And they are wrong.

Whether you’re a fan of Abraham Maslow or not, most of the behavioral science world recognizes his hierarchy of human need as a practical model of human motivation. The “practical stuff” about job function and daily operations reflects the lowest two strata of Maslow’s famous pyramid (Figure 1).

Figure 1. Maslow’s hierarchy of human need.

Employees who turn in excellent performance consistently are best motivated by the upper-level needs. After their basic security concerns are covered, they respond best to affective rewards having to do with belonging to the team, being an admirable worker, and achieving their personal best.

The more thoroughly your staff members learn the material presented in your training programs, the better they will follow the procedures you have designed. When you train staff on a new computer system, introduce privacy rules and procedures, or teach telephone skills, design training activities with all three types of instructional objectives in mind.

Beyond Training Programs

By applying the principles of instructional objectives, you can do even more for your practice than build more powerful training programs. You could actually revolutionize your effectiveness as a leader. It begins by understanding how leadership—the power to influence people—closely parallels teaching.

Different roles, different situations, and different styles will dictate various leaders’ actions and decisions, but one thing remains the same: The leader is trying to influence at least one other person’s knowledge, attitudes, and abilities. Whether the practice administrator is counseling a file clerk about coming in late or presenting her recommendation to the physicians about which electronic medical record (EMR) system to choose, she’s trying to influence behavior.

The administrator wants the file clerk to show up on time every day—hopefully after a single conversation. To achieve that goal, the administrator will increase her chances for success by planning her talk around the threefold objectives used in education:

• Cognitive. What do you want the clerk to know (e.g., practice policy, reasons for demanding punctuality)?

• Affective. How do you want the clerk to feel (e.g., appreciate promptness as a value, develop a sense of commitment to fellow employees)?

• Conative. What do you want the clerk to be able to do (better) (e.g., how to get to work on time consistently)?

In the file clerk’s case, the goals focus more on attitudes than on skills, but a positive conversation may very well include offering some tips on how to manage his or her time in the mornings. As a bonus, offering some personal advice can also strengthen the administrator’s relationship with the clerk, thus building loyalty and a desire to perform well.

Using the same model, the administrator plans her EMR presentation for the physicians by asking the same questions: What does she want them to know or understand? What does she want them to feel about it? What skills can she teach them? Here are some possible goals:

• Cognitive. The physicians will know and understand the differences and similarities among systems under consideration.

• Affective. The physicians will feel satisfied that the administrator and her committee have done a thorough job of investigating and comparing EMR systems.

• Conative. The physicians will be able to make a reasonable choice among the alternative systems under consideration.

I’ve over-simplified a very complicated process for illustrative purposes. The list of objectives for an actual EMR presentation would more than fill the space for this article. But you get the idea.

Influencing people (leadership) amounts to the same thing as teaching people. To influence others (without simply trying to manipulate them), you need to help them understand your point of view, appreciate its value, and be able to accept and follow your plan. Thinking like a teacher will help you focus your strategies and make your communications more effective. And that gets results.