Describe an EPSS that you have used and its benefits to a training program.

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Chapter Five

 

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( Transfer of Training )

Objectives

After reading this chapter, you should be able to “V

1. Diagnose and solve a transfer of training problem.

2. Create a work environment that will facilitate transfer of training.

3. Explain to a manager how to ensure that transfer of training occurs.

4. Discuss the implications of identical elements, stimulus generalization.

and cognitive theories for transfer of training.

5. Develop a self-management module for a training program.

6. Discuss the technologies that can be used to support transfer of training.

7. Discuss the key features of the learning organization.

8. Provide recommendations for how to manage knowledge.

9.

 

Transfer of Training and Knowledge Sharing Are Important for Nonprofits

Nonprofit organizations such as the United Nations Children’s Fund (UNICEF) and government agencies such as the Peace Corps routinely send workers to some of the most dangerous, underdeveloped nations in the world. They rely upon temporary and short-term field workers and volunteers and have small training budgets compared to those of private, for-profit companies. Despite the difficulties they face, nonprofits still manage to train their workers successfully so they can be effective in their mission. It is especially important that what is emphasized in training is used on the job (transfer of training) and that the valuable knowledge that volunteers have gained about a location, its people, and the assistance needed is not lost when they leave the organization (i.e., knowledge sharing occurs).

For example, consider the online course used by Darkness to Light (D2L), an international child abuse prevention, education, and public awareness organization. “Stewards of Children Online” is designed to teach adults how to prevent and recognize signs of sexual abuse in children. The training was developed around “universal truths” to ensure that the basic principles emphasized in the course would be relevant for everyone, regardless of their culture, socioeconomic background, or location. For

 

 

 

185

 

example, one of the “universal truths” is that it is healthy and good for parents to talk to their children about their personal boundaries.

UNICEF, which provides humanitarian and development assistance to children and mothers in developing countries, uses a blended learning approach. The majority of e-learning programs offered by UNICEF include both CD-ROM and Internet formats, which allows trainees without dependable access to the Internet to train using personal computers available at their location. Course content is broken into modules so individual regions can easily customize content to local culture and situations.

At the Peace Corps, more than 90 percent of training is conducted by local staff in the field. The Peace Corps trains volunteers in the actual performance situations in which they will be working, based on the belief that skills taught in training better transfer to the work environment. For example, trainees in the Dominican Republic acquire many skills, including technical expertise, medical and security skills, and foreign language proficiency. Trainees are given real-world assignments—such as going into a community to purchase a loaf of bread—in order to use what they are learning.

Medecins Sans Frontieres (MSF), also known as Doctors Without Borders, is challenged by the need to manage knowledge gained by aid workers and logisticians who typically spend only six months to one year on a mission before leaving the organization. To help foster knowledge sharing, MSF requires volunteers who are completing an overseas mission to complete a “handover report” that documents their experiences and lessons learned in the field. Also, to ensure knowledge transfer, MSF rotates staff in and out of mission positions so that workers who are leaving can spend one to two weeks in the field training their replacements. In a mission of five or six persons, one person per month will rotate out over a period of six months. Similarly, to ensure the freshness of the staff, approximately 1,500 U.S. full-time staff members who are in charge of recruiting, training, program support, health assistance, and logistical coordination for the agency’s volunteers are required by law (an amendment to the Peace Corps Act) to leave the agency after five years of service. To ensure knowledge sharing for new volunteers, the Peace Corps training programs include well-documented learning objectives and competencies as well as content and lesson plans.

Source: Based on S. Boehle, “Going to Extremes,” Training (March/April 2008): 26-29.

 

INTRODUCTION

The training experiences of nonprofit organizations such as UNICEF, the Peace Corps, and MSF highlight the importance of ensuring that the design of training leads to learning as well as the use of training on the job. Also, these nonprofit organizations are taking steps to ensure that what trainees learn is shared with their peers. In many training programs, most of the attention (and money) is focused on developing the program, but just as important is the follow-up, which ensures that learning is put into practice.1 As you will see in this chapter, trainee motivation to learn as well as manager support for training are key issues for ensuring learning and the application of training to the job. .

Recall the Instructional System Design model presented in Chapter 1. After conducting a needs assessment, ensuring that employees are ready for training, and creating a learning

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

environment, the next step is to ensure that what is learned in training is applied on the job. Transfer of training refers to trainees’ effectively and continually applying what they learned in training (knowledge, skills, behaviors, cognitive strategies) to their jobs.2 As the nonprofit organizations in the opening vignette illustrate, the work environment and trainee characteristics play an important role in ensuring that transfer of training occurs. Transfer of training is also influenced by training design. Despite the importance of transfer of training and the emphasis that some companies are placing on it, research suggests that only 62 percent of employees transfer training immediately after completing training programs. This statistic decreases to 34 percent one year after training.3

Figure 5.1 presents a model of the transfer process. This model is useful for considering . what you can do to ensure that trainee characteristics, training design, and the work environment are conducive to transfer of training. The chapter is organized based on this model. As the model shows, transfer of training includes both the generalization of training to the job and the maintenance of learned material. Generalization refers to a trainee’s ability to apply learned capabilities (verbal knowledge, motor skills, etc.) to on-the-job work problems and situations that are similar but not identical to those problems and situations encountered in the learning environment. Maintenance refers to the process of continuing to use newly acquired capabilities over time.

For generalization and maintenance to occur, capabilities must be learned and retained. The model shows three factors that influence learning and transfer of training. Training design, trainee characteristics, and the work environment influence learning, retention, maintenance, and generalization. Training design refers to the characteristics of the learning environment. Chapter 4 covered important features of the learning environment— including meaningful material, opportunities to practice, feedback, learning objectives, program, organization and physical features of the training site. Another factor that influences learning and retention is trainee characteristics. Trainee characteristics include ability and motivation. The influence of trainee characteristics on learning was discussed in Chapters 3 and 4. If trainees lack the basic skills needed to master learned capabilities (e.g., cognitive ability, reading skills), are not motivated to leam, and do not believe that they can master the learned capabilities (low self-efficacy), it is doubtful that learning and

 

 

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FIGURE 5.1

A Model of the

Transfer

Process

Source: Adapted from T. T. Baldwin and J. K. Ford, “Transfer of Training: A Review and Directions for Future Research,” Personnel Psychology 41 (1988): 63-103.

Trainee Characteristics

· Motivation

· Ability

 

Training Design

· Create a Learning Environment

· Apply Theories of Transfer

· Use Self-Management Strategies

 

Work Environment

· Climate for Transfer

· Management and Peer Support

· Opportunity to Perform

· Technological Support

 

 

 

 

 

Learning Retention

 

 

 

 

 

Generalization Maintenance

 

transfer of training will occur. The third factor that influences learning, retention, and transfer is the work environment. The work environment includes factors on the job that influence transfer of training, such as managers’ support, peer support, technology support, the climate for transfer, and the opportunity to use newly acquired capabilities on the job.

Although transfer of training sounds like something to be considered after training occurs, it should be planned for before the training. Recall from Chapter 3 that assessment of trainee characteristics and the work environment is part of the needs assessment. Transfer of training does occur after the training occurs. However, the conditions that facilitate transfer need to be provided before the training actually occurs. For example, to motivate trainees to attend a training program, communications about the program need to emphasize the benefit of the training. Design of the learning process needs to include desirable features such as objectives, meaningful material, and opportunities to practice and receive feedback (recall the learning process from Chapter 4). Managers’ and peers’ attitudes toward training can influence trainees’ level of motivation to learn. This chapter focuses on identifying additional factors—besides the learning environment and trainee characteristics already discussed—that influence transfer of training. This chapter includes a detailed discussion of transfer of training theories and how the work environment influences transfer of training.

The chapter begins with a discussion of training design issues related to transfer of training, including (1) the application of theories of transfer of training to training design and (2) an emphasis on self-management as part of the training program. Next, the chapter addresses how the work environment influences the transfer of training process. Trainees’, managers’, and trainers’ roles in ensuring that transfer of training occurs are emphasized. Through discussions of learning organizations and knowledge management, you will gain a perspective on how the work climate can influence transfer of training. The chapter also points out that transfer of training can be enhanced by holding trainees accountable for using information learned in training and sharing that information with their colleagues. The chapter concludes with a discussion of learning organizations—a multifaceted approach for encouraging learning and transfer of training.

 

 

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TRAINING DESIGN

Training design refers to factors built into the training program to increase the chances that transfer of training will occur. Chapter 4 discussed the important factors needed for learning to occur (objectives, practice, feedback, meaningful material, etc.). For transfer of training to occur, managers need to apply transfer of training theories and encourage trainees to take responsibility for learning and to engage in self-management strategies.

Applications of Transfer of Training Theory

Three theories of transfer of training have implications for training design (the learning environment): the theory of identical elements, the stimulus generalization approach, and the cognitive theory of transfer.4 Table 5.1 shows each theory’s primary emphasis and the conditions under which it is most appropriate to consider.

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( * Appropriate Theory Emphasis Conditions Type of Transfer Identical Elements Training environment is identical to work environment. Work environment features are predictable and stable. Example: training to use equipment. Near Stimulus General principles Work environment Far Generalization are applicable to many different work situations. is unpredictable and highly variable. Example: training in interpersonal skills. Cognitive Theory Meaningful material and coding schemes enhance storage and recall of training content. All types of training and environments. Near and far TABLE 5.1 Transfer of Training Theories )

 

 

Theory of Identical Elements

The theory of identical elements proposes that transfer of training occurs when what is being learned in the training session is identical to what the trainee has to perform on the job.5 Transfer will be maximized to the degree that the tasks, materials, equipment, and other characteristics of the learning environment are similar to those encountered in the work environment.

The use of identical elements theory is shown in the hostage training simulation used by the Baltimore Police Department. The Baltimore Police Department needed to teach police sergeants the skills to handle hostage-barricade situations in which lives are at stake— skills such as negotiating with a troubled husband holding his wife and/or children hostage. The first hour of a hostage situation is critical. The sergeant must quickly organize resources to achieve a successful end to the situation with minimal or no injuries. A simulation was chosen because it provides a model of reality, a mock-up of a real situation without the danger. Multiple scenarios can be incorporated into the simulation, allowing the sergeants to practice the exact skills they will need when faced with a hostage crisis.

The simulation begins by having the trainees briefed on the hostage situation. Then they are directed to take charge of resolving the incident in the presence of an instructor who has personally been involved in similar real-life incidents. Each trainee supervises one difficult and one easy scenario. The simulation is designed to emphasize the importance of clear thinking and decision making in a situation in which time is critical. It is essential that the trainees take actions according to a set of priorities. These priorities place the greatest value on minimizing the risks to the hostages and isolating suspects before communicating with them. The simulation scenarios include elements of many actual hostage incidents such as forced entry, taking persons against their will, the presence of a weapon, and threats. As trainees work in the simulation, their actions are evaluated by the instructor. The instructor provides feedback to the trainees in writing after they complete the simulation or the instructor can correct mistakes as they happen.

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The training simulation mirrors the exact circumstances of actual hostage situations encountered by police officers. Also, the checklist of activities and behaviors that the sergeants are provided with in training is the exact checklist used in hostage situations that occur on the street. Evidence of generalization is provided by police sergeants who have successfully dealt with a bank-hostage situation by using the skills emphasized in the simulation. The Baltimore Police Department is also concerned with maintenance. At the conclusion of the simulation, officers may be able to demonstrate how to successfully free hostages. However, the incidence of hostage situations is fairly low compared to other tasks that police officers perform (e.g., issuing traffic citations, investigating burglaries). As a result, the police department is concerned that officers may forget what they learned in training and therefore have difficulties in hostage situations. To ensure that officers have opportunities to practice these infrequently used but important skills, the training department occasionally schedules mock hostage situations.6

Another application of the theory of identical elements is found in the use of simulators for training airline pilots. Pilots are trained in a simulator that looks exactly like the cockpit of a commercial aircraft. All aspects of the cockpit in the simulator (e.g., gauges, dials, lights) are the same as in a real aircraft. In psychological terms, the learning environment has complete fidelity with the work environment. Fidelity refers to the extent to which the training environment is similar to the work environment. If skills in flying, taking off, landing, and dealing with emergency situations are learned in the simulator, they will be transferred to the work setting (commercial aircraft).

The identical elements approach has also been used to develop instruments designed to measure the similarity of jobs.7 Job similarity can be used as one measure of the extent to which training in the knowledge and skills required for one job prepares an employee to perform a different job.

The theory of identical elements has been applied to many training programs, particularly those that deal with the use of equipment or that involve specific procedures that must be learned. Identical elements theory is particularly relevant in making sure that near transfer occurs. Near transfer refers to trainees’ ability to apply learned capabilities exactly to the work situation. Programs that emphasize near transfer should include the following training designs:8

· The program should teach specific concepts and procedures.

· Trainees should be given an explanation as to any differences between training tasks and work tasks.

· Trainees should be encouraged to focus only on important differences between training tasks and work tasks (e.g., speed of completion) rather than unimportant differences (e.g., equipment with the same features but a different model).

· Behaviors or skills that trainees learn in the program should contribute to effective performance.

For example, in police officer training, new hires (cadets) practice shooting targets. During practice sessions, cadets fire a round of shells, empty the cartridges into their hands, and dispose of the empty cartridges into the nearest garbage can. This process is repeated several times. After graduation from the police academy, one new officer was involved in a shooting. He fired his gun, emptied the cartridges into his hand, and proceeded to look for a garbage can for the empty cartridges. As a result, he was seen by the gunman, shot, and killed!

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Identical elements theory does not encourage transfer where the learning environment and the training environment are not necessarily identical. This situation arises particularly in interpersonal skills training. For example, a person’s behavior in a conflict situation is not easily predictable. Therefore, trainees must learn general principles of conflict resolution that they can apply to a wide variety of situations as the circumstances dictate (e.g., an irate customer versus a customer who lacks product knowledge).

Stimulus Generalization Approach

The stimulus generalization approach suggests that the way to understand the transfer of training issue is to construct training so that the most important features or general principles are emphasized. It is also important to identify the range of work situations in which these general principles can be applied. The stimulus generalization approach emphasizes far transfer. Far transfer refers to the trainee’s ability to apply learned capabilities to the work environment, even though the work environment (equipment, problems, tasks) is not identical to that of the training session. Programs that emphasize far transfer should include the following training designs:9

· The program should teach general concepts and broad principles.

· Trainees should be made aware of examples from their experiences that are similar to those emphasized in training so that connections can be made among strategies that have been effective in different situations.

· The program should emphasize that the general principles might be applied to a greater set of contexts than those presented in the training setting.

The stimulus generalization approach can be seen in the design of managerial skill training programs, known as behavior modeling training, which are based on social learning theory. Recall from the discussion of social learning theory in Chapter 4 that modeling, practice, feedback, and reinforcement play key roles in learning. One step in developing behavior modeling programs is to identify key behaviors that are needed to be successful in a situation. Key behaviors refer to a set of behaviors that can be used successfully in a wide variety of situations. The model demonstrates these key behaviors on a video, and trainees have opportunities to practice the behaviors. In behavior modeling training, the key behaviors are believed to be applicable to a wide variety of situations. In fact, the practice sessions in behavior modeling training require the trainee to use the behaviors in a variety of situations that are not identical.

Cognitive Theory of Transfer

The cognitive theory of transfer is based on the information processing theory of learning discussed in Chapter 4. Recall that the storage and retrieval of information are key aspects of this model of learning. According to the cognitive theory of transfer, the likelihood of transfer depends on the trainees’ ability to retrieve learned capabilities. This theory suggests that the likelihood of transfer is increased by providing trainees with meaningful material that enhances the chances that they will link what they encounter in the work environment to the learned capability. Also important is providing the trainee with cognitive strategies for coding the learned capabilities in memory so that they are easily retrievable. (These strategies were discussed in Chapter 4.)

The influence of cognitive theory is seen in training design that encourages trainees, as part of the program, to consider potential applications of the training content to their

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jobs. Many training programs include having trainees identify a work problem or situation and discuss the potential application of training content. Application assignments increase the likelihood that trainees will recall the training content and apply it to the work setting when they encounter the appropriate cues (problems, situations) in the environment. Application assignments are work problems or situations in which trainees are asked to apply training content to solve them. The use of application assignments in training helps the trainee understand the link between the learned capability and real-world application, which makes it easier to recall the capability when needed.

Encourage Trainee Responsibility and Self-Management

Trainees need to take responsibility for learning and transfer.10 This includes preparing for training, being involved and engaged during training, and using training content back on the job. Before training, trainees need to consider why they are attending training and set specific learning goals (either alone or, preferably, in a discussion with their manager) as part of completing an action plan (action plans are discussed in more detail later in the chapter). Also, trainees need to complete any assigned pre-training assignments. During training, trainees need to be involved. That is, they need to participate and share experiences in discussions, to practice, and to ask questions if they are Confused. After training, trainees need to review and work toward reaching the goals established in their action plan. They need to be willing to change (e.g., try new behaviors, apply new knowledge) and ask peers and managers for help if they need it.

Self-management refers to a person’s attempt to control certain aspects of decision making and behavior. Training programs should prepare employees to self-manage their use of new skills and behaviors on the job. Self-management involves:

1. Determining the degree of support and negative consequences in the work setting for using newly acquired capabilities.

2. Setting goals for using learned capabilities.

3. Applying learned capabilities to the job.

4. Monitoring use of learned capabilities on the job.

5. Engaging in self-reinforcement.11

Research suggests that trainees exposed to self-management strategies exhibit higher levels of transfer of behavior and skills than do trainees who are not provided with self-management strategies.12 Self-management is important because the trainee is likely to encounter several obstacles in the work environment that inhibit transfer of training. Table 5.2 shows these obstacles. They include (1) lack of support from peers and managers and (2) factors related to the work itself (e.g., time pressure). Given the restructuring, downsizing, and cost cutting occurring in many companies, these obstacles are often a reality for trainees.

For example, new technologies allow employees to gain access to resources and product demonstrations using the World Wide Web or personal computers equipped with CD-ROM drives. But while employees are being trained to use these resources with state-of-the-art technology, they often become frustrated because comparable technology is not available to them at their work site. Employees’ computers may lack sufficient memory or links to the World Wide Web for them to use what they have learned.

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( Obstacle Description of Influence Work Conditions Time pressures Trainee has difficulty using new knowledge. Inadequate equipment skills , or behavior. Few opportunities to use skills Inadequate budget Lack of Peer Support Peers: Discourage use of new knowledge and skills on the job Peers do not support use of new knowledge. Are unwilling to provide feedback skills , or behavior. See training as waste of time Lack of Management Support Management: Does not accept ideas or suggestions that are learned Managers do not reinforce training or provide in training opportunities to use new knowledge, skills, or Does not discuss training opportunities behavior . Opposes use of skills learned in training Communicates that training is a waste of time Is unwilling to provide reinforcement, feedback, and encouragement needed for trainees to use training content TABLE 5.2 Examples of Obstacles in the Work Environment That Inhibit Transfer of Training Source: Based on R. D. Marx, “Self-Managed Skill Retention,” Training and Development Journal (January 1986): 54-57. ):

 

 

 

 

 

These obstacles inhibit transfer because they cause lapses. Lapses take place when the trainee uses previously learned, less effective capabilities instead of trying to apply the capability emphasized in the training program. Lapses into old behavior and skill patterns are common. Trainees should try to avoid a consistent pattern of slipping back or using old, ineffective learned capabilities (e.g., knowledge, skills, behaviors, strategies). Also, trainees should understand that lapses are common and be prepared to cope with them. Trainees who are unprepared for lapses may give up trying to use new capabilities—especially trainees with low self-efficacy and self-confidence.

One way to prepare trainees to deal with these obstacles is to provide instruction in self-management techniques at the end of the training program. Table 5.3 shows an example of self-management instruction. The module begins with a discussion of lapses, emphasizing that lapses are not evidence of personal inadequacy; rather, they result from habits of usage of knowledge and skill that have developed over time. Lapses provide information necessary for improvement. They help identify the circumstances that will have the most negative influence on transfer of training. Next, a specific behavior, skill, or strategy is targeted for transfer. The skill should be measurable and countable. Then, obstacles that inhibit transfer of training are identified; these can include both work environment characteristics and personal characteristics (such as low self-efficacy). Trainees are then provided with an overview of coping skills or strategies that they can use to deal with these obstacles. These skills and strategies include time management,

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( 1. Discuss lapses. 5. Identify when lapses are likely. • Note evidence of inadequacy • Situations • Provide direction for improvement • Actions to deal with lapses 2. Identify skills targeted for transfer. 6. Discuss resources to ensure transfer of skills. • Specify the skills • Manager • Make them measurable and countable • Trainer 3. Identify personal or environment factors • Other trainees contributing to lapse. • Low self-efficacy • Time pressure • Lack of manager or peer support 4. Discuss coping skills and strategies. • Time management • Setting priorities • Self-monitoring • Self-rewards • Creating a personal support network TABLE 5.3 Sample Content of Self-Management Module Source: Adapted from R. D. Marx, “Improving Management Development through Relapse Prevention Strategies,’ “Journal of Management Development 5 (1986): 27-40; M. L. Broad and J. W. Newstrom , Transfer of Training ( Reading, MA: Addison-Wesley, 1992); R. D. Marx and L. A. Burke, “Transfer Is Personal,” in Improving Learning Transfer in Organizations, ed. E. Holton and T. Baldwin (San Francisco: Jossey -Bass, 2003): 227-42. )creating a personal support network (persons to talk with about how to transfer skills to the work setting), and self-monitoring to identify successes in transferring skills to the job. Next, to deal with lapses trainees are instructed to be aware of where the situations are most likely to occur. The final part of the module deals with the use of resources to aid transfer of training. These resources may include communications with the trainer or fellow trainees via e-mail as well as discussions with their boss.

For example, a manager may have attended a training program designed to increase her leadership skills. After a discussion of lapses, the manager identifies a target skill, say, participative decision making—that is, discussing problems and potential solutions with subordinates before making decisions that will affect the work group. The manager defines the skill and how to measure it: “Discussing problems and solutions with my subordinates at least two times each week.” Next, the manager identifies factors that may contribute to a lapse. One factor may be the manager’s lack of confidence in being able to deal with subordinates who disagree with her view. Potential coping strategies that the manager identifies may include (1) scheduling time on the calendar to meet with subordinates (time management), (2) communicating to the boss the transfer goal and asking for help (create a support group), and (3) taking an assertiveness training course. In what situation may the manager be especially likely to experience a lapse? The manager identifies that she may be most likely to lapse back into an autocratic style when faced with a short time frame for making a decision (time pressure being an obstacle). The manager recognizes that it may be inappropriate to try to gain consensus for a decision when time constraints are severe and subordinates lack expertise. In the last step of the module, the manager suggests that she will (1) meet with her mentor to review her progress, (2) talk with other managers about how they effectively use

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participative decision making, and (3) resolve to communicate with other managers who attended the training session with her. The manager also commits to monitoring her use of participative decision making, noting successes and failures in a diary.

 

WORK ENVIRONMENT CHARACTERISTICS THAT INFLUENCE TRANSFER

As Figure 5.1 showed, several work environment characteristics influence transfer of training, including the climate for transfer, managerial and peer support, opportunity to perform, and technological support.

Climate for Transfer

Climate for transfer refers to trainees’ perceptions about a wide variety of characteristics of the work environment that facilitate or inhibit use of trained skills or behavior. These characteristics include manager and peer support, opportunity to use skills, and the consequences for using learned capabilities.13 Table 5.4 shows characteristics of a positive climate for transfer of training. Research has shown that transfer of training climate is significantly related to positive changes in managers’ administrative and interpersonal behaviors following training. To support the transfer of financial training emphasizing Southwest Airlines’s key business metrics, cost checklists explaining how employees can contribute to the company’s bottom line are distributed companywide following training.14 Flip charts showing highlights from manager-employee question-and-answer sessions are posted in work areas. All managers receive large posters displaying the company’s four “magic numbers” (net income, unit cost measure, net margin, and invested capital). The posters include blank columns that managers are expected to complete and regularly update to show the past year’s performance, the current year’s goals, year-to-date numbers, and quarterly results.

Consider how Vanderbilt University Medical Center’s work environment supports transfer of training. VUMC’s team training program is designed to teach participants about patient safety mistakes and ways to avoid them, team building, cross-checking and communications, decision making, and performance feedback.15 Several steps are taken to ensure that transfer of training occurs. Before the training starts, VUMC leaders are prepared to help the training succeed. Senior administrators, medical directors, and nursing staff attend a boot camp that highlights the team training program. A safety climate survey is conducted to determine how each department perceives the VUMC attitudes toward safety practices and patient safety issues. Then, each department is reviewed to find built-in errors that are system problems and to evaluate how the team communicates and deals with conflict. After the training, medical supervisors provide observation, coaching, and feedback. Checklists are provided for certain procedures, such as patient handoffs, medication administration, and briefing and debriefing sessions. These checklists help participants use the strategies emphasized in training to improve patient safety and the quality of patient care. Patients also help ensure safety. VUMC has created a video that patients are asked to watch when they are admitted to the hospital. The video emphasizes the importance of asking questions about medications and medical procedures.