Education Alone Is Ineffective at Improving Provider Skills

Education and staff training provide practitioners with the knowledge required to develop the skills to do their job well. However, education alone is one of the least effective interventions in the Institute for Safe Medication Practices’ hierarchy of effectiveness of risk-reduction strategies because it targets human reliability, and humans are inherently fallible.

Figure 1: ISMP’s hierarchy of effectiveness of risk reduction strategies.

Education does not guarantee that the new information has been learned, will be correctly applied in the right circumstances, and will lead to the desired skills. Additionally, knowledge and skills may erode over time, especially if they are not often required or not reinforced through routine activities. Education alone is a weak strategy for the following reasons:

• Education relies heavily on human memory and vigilance, and individuals may forget new information or fail to apply new knowledge correctly.
• Education does not solve memory slips or lapses (including forgetting and being preoccupied or distracted).
• Education does not easily change habits or at-risk behaviors. Most at-risk behaviors are caused by system failures, leading individuals to work around them. They are rarely associated with a lack of knowledge, but rather a lack of awareness of the risk associated with the task or with not following the approved process.
• Education does little to change system reliability; instead, it targets human reliability, and humans are inherently fallible.
• Education requires frequent repetition to reinforce learning, since its usefulness relies heavily on memory and vigilance.

Instead of using education as the only strategy to reduce the risk of errors, it should be layered with higher leverage strategies that improve system reliability.

ISMP’s hierarchy of effectiveness of risk-reduction strategies describes high-, medium-, and low-leverage strategies that may be considered (Figure 1). High-leverage strategies are most effective because they can eliminate the risk of errors and associated harm by ‘designing out’ hazards; however, they often require complex implementation plans. Medium-leverage strategies, which are easier to implement, reduce the likelihood of errors or minimize harm; however, they may need periodic updating and reinforcement. Low-leverage strategies, which aim to improve human performance, are easy and quick to implement; however, they are the least effective strategies for error prevention even though they are frequently relied upon.

For more information, please refer to the full article: https://www.ismp.org/resources/education-predictably-disappointing-and-should-never-be-relied-upon-alone-improve-safety

Reference:
ISMP. Education is “predictably disappointing” and should never be relied upon alone to improve safety. ISMP Community/Ambulatory Care Medication Safety Alert! https://www.ismp.org/resources/education-predictably-disappointing-and-should-never-be-relied-upon-alone-improve-safety. 2020; 25(11):1-4.