The Myth of the Tip Sheet and More

Hey, I wanted to revisit a post from February in which I asked, "What is a Tip Sheet?"

https://www.dhirubhai.net/feed/update/urn:li:activity:6498296458716999680/

The correct answer should be, "A Tip Sheet a reminder of something a user should know how to do already available in training documentation." In other words, a Tip Sheet is fleshing out something already touched on and the 'tip' of the Tip Sheet is giving some advanced guidance on how to better utilize, customize or personalize something in Epic.

Why is this even a question?

Too often the concept of a Tip Sheet becomes a catch-all for everything and everyone under the Epic sun. This is a mistake that even Epic themselves have fallen prey to - Epic includes 'tip sheets' with Release Notes for Upgrades in Galaxy (misspelling Tip Sheets, too!!!). 

Why is that a problem?

These are not 'tips'. Release Notes are actual changes to the system - in some cases changes to workflows. If you label most all communication and documentation as a Tip Sheet you will find your Epic End Users will not respond the way you hope. End Users will succumb to, 'Tip Sheet Fatigue'. If you flash a dozen or more Tip Sheets at an End User and several of the documents have no bearing or relation to that End User's role they are going to tune out any other Tip Sheets you try to stick under their nose.

We all know there are more than three ways to skin a cat in Epic. If End Users are not coached up and monitored on a regular basis they may incorporate their own 'shortcuts' and makeshift workflows to make things easier for themselves i.e., bad habits. When administration, leadership, management, analysts or whomever says, "we need a Tip Sheet" they are trying to cover their, ahem...they are passing the buck and not confronting the problem and ignoring the root cause.

If an End User is doing something incorrectly it's not necessarily a 'Training Issue'. It's a management issue. The End User went to training and passed an assessment. When they are out on the floor or in the clinic and pick up bad habits it's not due to a lack of diligence on the Training Team! If management would like the Training Team to help coach up some End Users that have developed bad habits, G-R-E-A-T! I don't know any Training Team that would not jump at the chance at that opportunity. To suggest what the End User needs is to have a Tip Sheet waived at them to solve the problem is wasted time and effort.

If there are issues on the floor or in the clinic that End Users are not following a workflow you should be able to point them to the User Guide for their role and other training documentation that spells out the correct workflow. Not a suggestion. Not a 'tip'. Exactly as they are required to follow the workflow. If you can attach any specific Hospital policy to that documentation, so much the better.

So, how are you supposed to tell End Users about stuff and things and stuff having to do with the things?

Your organization should develop a communication and documentation hierarchy. Different topics deserve different types of communication; FYI, Tip Sheets, Workflow Bulletin/Alert, et al.

You can even create a decision tree to make things easier.

What needs to be communicated - X.

Is X a new concept or something already in the system - X is a new section to an existing report.

Does X change or alter an existing workflow - No.

Then create an FYI and communicate the change through the Learning Home Dashboard and make sure it is part of any daily or weekly huddles or meetings.

Okay, but what if End Users were having issues finding reports and customizing them and you wanted to include that in the Tip Sheet?

Then you are failing at communication before you even begin! If End Users cannot find reports - why even bother telling them there is a new section to a specific report? If End Users do not know how to customize their reports - why are you adding new sections? The communication (remember X?) is about a new section to a specific report. That's what is needed. Now, you can reference other documentation in the Training Documentation and Quick Start Guides about reports and customizing reports.

Creating a document that includes documentation already found elsewhere creates multiple versions and often different instructions on how to complete tasks in Epic. How many Tip Sheets are floating around your organization right now regarding Patient Lists or Multi-Provider Schedules across how many versions of Epic and how many contradict the others?

The best case situation is that your training documentation is robust, sound, up to date and all Workflow Diagrams are represented for each application and their user roles. That documentation should be readily available on an intranet site and the Learning Home Dashboard.

Ha! The last time the Workflow Diagrams were updated was years ago during implementation - nobody has time to go check that stuff!

Then, let me ask; what is the correct workflow for anything in your organization?

If you cannot find the document that clearly states what the correct workflow is in 45 seconds - how does anybody know?

Does it exist as 'shared knowledge' in the ethosphere amongst the Project Team?

What happens when there is turnover on the Project Team?

How are analysts supposed to continue to build if nobody on the Project Team can pinpoint the correct workflow?

How is the Training Team supposed to create documentation and train End Users when the answer to 'what is the correct workflow' varies from analyst to analyst?

When administration and management are in an uproar because they were way off their goals for CMS Meaningful Use/Interoperability and have no idea why - who do you think they are going to come after (hint: it's not the analysts)?

How are End Users supposed to know how to do their job?

Okay, but that sounds like a lot of work and my organization doesn't have the resources investing in a Training Team to do what you describe.

Really...you don't say?

There is a direct correlation to Patient Satisfaction, Employee Satisfaction, revenue and a well allocated Training Team. Training and communication folks need to have the time and resources to do their job effectively. Asking a Trainer to compact 16 hours of content into 4 hours because Dr. Zorderz doesn't think they need to be in class that long leads to angry physicians complaining about the "stupid computer system". Not having End Users complete a 'Refresher' class every 12-18 month because, "employees in a classroom means money lost on the floor" leads to staff skipping documentation an doing the bare minimum so they don't get yelled at by management.

Let me leave you with a few thoughts; do you want the doctor, nurse and staff that see you in the clinic and or the hospital to have the bare minimum of knowledge on how to use the system before you go in for your next Encounter? When they have a question or don't know how to do something in the system do you think they should be able to quickly check the Learning Home Dashboard or ask a Super User? Do you want them to just keep blindly clicking until they get to the next screen? When your bill comes in the mail a few months from now and you were billed for anesthesia when you got a Flu shot are you going to wonder? When a bill comes with the charge for the anesthesia and now the Flu shot, too, plus you apparently had your appendix removed (a second time) while you were in the hospital after slipping and falling at a friend's house are you going to question the lack of training? What about a few days later when you send a message via MyChart and the physician has not responded to you after 36 hours and the medication you need still has not been ordered or refilled?