Why not use Job Instruction to teach Job Instruction?
I discussed Job Instruction in a recent post. I mentioned that JI works best for jobs with few decision points and won’t work well for jobs with many decision points.
This means you can’t apply the detailed Job Instruction method to teaching Job Instruction! The Job Instruction job has too many decision nodes, each with multiple branches: A supervisor learning Job Instruction must decide which job to break down before demonstration. The supervisor also has many options in selecting and describing important steps and key points specific to the job itself. Every job will be different.
Nevertheless, our JI instructor successfully adapted the four general steps on the JI pocket card in teaching us:
1. Prepare the Worker: She asked each of us our background and reasons for taking the class, finding out what we knew about instructing, and provoked our interest in achieving better instruction.
2. Present the Operation: She showed us the detailed teaching technique (important steps, key points, reasons why) by sharing a video of a job instruction (the classic underwriters’ knot job)
3. Try out Performance: Each person in the class had to identify a job, create a job breakdown sheet, and teach the skill. Referring to the pocket card, the instructor and the class observed each person’s demonstration, offering feedback and encouragement. Over multiple demonstrations, we saw increased comfort and fidelity to the detailed teaching technique.
4. Follow-up: The instructor offered additional help after the class and encouraged us to practice regularly.
In our JI class, trying out performance meant that each participant taught another person a job. Each participant used the Job Instruction show-and-tell approach, with multiple passes through the job guided by the job breakdown sheet.
Adapting the workshop approach: Teaching PDSA
Over the past three years, the National Network for Oral Health Access (NNOHA) has engaged three cohorts of federally qualified health centers to integrate dental and medical care and improve the health of patients with diabetes. To achieve this integration, NNOHA has developed specific changes to the workflows of medical and dental visits.
NNOHA is working with seven federally qualified health centers to apply these changes this year.
Our project emphasizes learning by trying changes on a small scale. Initial experiences build confidence to spread the changes widely to providers and patients. We use Plan-Do-Study-Act (PDSA) testing as a core improvement method. My job is to teach and coach participants to learn and use PDSA.
Six months ago, I thought I could use Job Instruction to teach PDSA testing. I drafted a job breakdown sheet for a specific PDSA application (see the Appendix). The JI class showed me that a strict application of Job Instruction will fail because PDSA testing has too many decision points and branches.
Inspired by the teaching method used in the JI class to teach Job Instruction, I’m now testing a workshop approach.
Workshop Ingredients
Preparing for the PDSA test
A person from each of the seven health centers must present the story of a complete PDSA test to an audience of peers. I help the tester choose from the NNOHA outline of changes to the dental or medical workflows.
I coach the tester in the most difficult part of PDSA, the Plan step. I stress the core planning cascade based on the change that will be tested:
1. Identify the question(s) to be answered by the test.
2. For each question, state a predicted answer.
3. Describe how to get the test’s answer for each question. What is the plan to collect data to capture the test’s answer?
If the planning cascade is clearly stated, it is usually relatively easy to plan the logistics of the test. Furthermore, the Study step is structured perfectly: For each question, compare each predicted answer with the test’s answer. Reflect on the message in the comparison.
Presenting the PDSA test
The presenter uses PDSA logic to tell the audience the story of their change. Members of the audience have an evaluation sheet to take notes. After the story ends, one person from the audience gives feedback on it based on the evaluation sheet. I listen to ensure the essential steps and key points of PDSA testing are included in the story, offering one or two comments and questions to the presenter and audience.
We’ve run the workshop once virtually and once in person (four PDSA cycles presented so far).
The PDSA cycles' fidelity to the definition outlined by my API colleagues is much better than in previous years of our project.
Figure 1 PDSA Workshop Evaluation Sheet
Appendix: A Draft Job Breakdown Sheet for PDSA testing of a change to operations
I narrowed the application of PDSA to test a change to operations, aligned with Step III of the Job Methods pocket card:
Figure 2 Job Methods pocket card, public domain 1945
Application: Build evidence for a change so you can sell it to others. Use Steps I and II of TWI’s Job Methods to generate change ideas. Plan a test of your idea.
Focus on the Plan: The Plan step needs more attention than Do, Study, or Act because a good Plan requires careful thinking.
Figure 3 Job Breakdown Sheet, Plan Step Example