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The influence of transfer system factors and training elapsed time on transfer in a healthcare organization

Dissertation
Author: Beverly J. Mihalko
Abstract:
Organizations and other sponsors of training face increasing pressure to demonstrate the value or impact of their training programs on individual and organizational performance. A critical element in the validation of training effectiveness is the permanent transfer of learned knowledge, skills, and behaviors to the workplace. The generalization of learned material to the job and maintenance of trained skills, are greatly influenced by training design, trainee characteristics, and work environmental factors. Using a multidimensional approach to identify all factors that promote or inhibit transfer could provide performance technologists and instructional designers with the insight necessary to design and develop strategic interventions that may enhance transfer and sustained workplace performance. Much of the empiric research has examined evidence of transfer soon after training while studies assessing the generalization or maintenance of skills and knowledge are few; yet, the majority of training transfer models specify a change in performance or behavior at the individual or organizational level following training as the primary measure of transfer. The purpose of this study was to examine trainee perceptions of transfer system factors that influence the transfer process as a continuum in a multi-center healthcare organization 9 to 24 months following a management training program using the validated Learning Transfer System Inventory (LTSI) survey instrument. In addition, the study examined the influence of time elapsed since completion of training on stage of transfer achieved. Results showed that trainees who perceived a more supportive work environment had a greater likelihood of progressing to maintenance of the skills and knowledge learned in training. Individuals who achieved the maintenance stage of transfer specifically, perceived motivation to transfer learning, performance self-efficacy, and transfer design as strong catalysts for transfer in this study while mean scores for trainees who achieved only partial transfer or no transfer of skills indicated a perception of a weak transfer climate overall. Time since completion of training was not found to be a significant influence on the stage of transfer achieved. Previous studies have suggested that the transfer climate in organizations is complex and unique to specific types of organizations and training programs. These study results support previous findings and contribute to the understanding of transfer as a process. These and other findings are discussed as well as implications for instructional designers, performance technologists, and the business of healthcare. Limitations related to the study and recommendations for future research are also presented.

TABLE OF CONTENTS

Dedication …...…………………………………………………………………………………... ii

Acknowledgements……………………………………………………………………………... iii

List of Tables ………………………….………………………………………………………..viii

List of Figures …………………………………………………………………………………...xi

Chapter 1- Introduction……….......................................................................................................1

Background of the Study.....................................................................................................3

Training in Healthcare Organizations .....................................................................3

Performance Improvement in Healthcare Organizations ........................................4

The Learning Transfer System Inventory (LTSI) ...................................................5

Purpose of the Study ...........................................................................................................8

Research Questions ...........................................................................................................11

Definition of Terms ...........................................................................................................13

Significance of the Study ..................................................................................................15

Summary ...........................................................................................................................16

Chapter 2- Review of the Literature ………………….................................................................17

Introduction .......................................................................................................................17

Training Effectiveness ......................................................................................................18

The Nature of Transfer ......................................................................................................20

Factors That Affect Transfer .............................................................................................21

Motivational Influences on Transfer .................................................................................24

Expectancy Theory ...............................................................................................25

Equity Theory .......................................................................................................27

v

Goal-setting Theory ..............................................................................................27

Transfer Climate ...............................................................................................................29

Holton’s HRD Evaluation Model .....................................................................................34

The Stages of Transfer ......................................................................................................36

Transfer Intention .................................................................................................39

Transfer Initiation .................................................................................................40

Partial Transfer .....................................................................................................40

Transfer Maintenance ...........................................................................................41

Summary ...........................................................................................................................42

Chapter 3- Research Methods ………….......................................................................................43

Sampling Frame ................................................................................................................43

Research Design ................................................................................................................44

Instrumentation .................................................................................................................44

Data Collection Procedures ...............................................................................................47

Data Analysis ....................................................................................................................48

Summary ...........................................................................................................................52

Chapter 4 – Results ……...............................................................................................................53

Description of Study Participants .....................................................................................54

Participant Demographic Data ..........................................................................................55

Training Session Attended and Elapsed Time ......................................................55

Years Worked in Healthcare .................................................................................56

Education ..............................................................................................................57

Work Location ......................................................................................................57

vi

Current Position in Healthcare ..............................................................................59

Time in Current Position .......................................................................................59

Gender and Age of Participants ............................................................................60

Descriptive Statistics of Research Variables ....................................................................60

Stage of Transfer ...................................................................................................60

Transfer System Scales .........................................................................................61

Specific Training Program Scales .............................................................64

General Training Scales ............................................................................64

Analysis of Research Questions ............................................................................65

Research Question 1 .................................................................................65

Research Question 2 .................................................................................66

Research Question 3 .................................................................................69

Research Question 4 .................................................................................71

Research Question 5 .................................................................................74

Research Question 6 .................................................................................77

Research Question 7 .................................................................................82

Summary............................................................................................................................97

Chapter 5 – Discussion …….........................................................................................................99

Introduction ……………………………………………………………………………..99

Analysis of Research Findings .........................................................................................99

Research Question 1 .............................................................................................99

Research Question 2 ...........................................................................................101

Research Question 3 ...........................................................................................103

vii

Research Question 4 ...........................................................................................105

Research Question 5 ...........................................................................................107

Research Question 6 ...........................................................................................109

Research Question 7 ...........................................................................................109

Summary of Research Findings ......................................................................................111

Implications for Practice …….............................................................…........................116

Implications for Instructional Design ………………………………………… 117

Implications for Performance Improvement…………………………………...117

Implications for Healthcare ................................................................................120

Limitations of the Study .................................................................................................121

Future Research Opportunities and Challenges...............................................................123

Conclusions..……………………………………………………………………………125

Appendix A – Contents of Greenbelt Lean Six Sigma Training Program .....................126

Appendix B – Research Approval Letters ......................................................................128

Appendix C- Learning Transfer System Inventory (LTSI) Agreement …….................130

Appendix D-Definition of LTSI Scales...........................................................................132

Appendix E - Research Questionnaire ………………………………………………....134

Appendix F-Participant Contact Notices ........................................................................141

Appendix G-Research Information Sheet .......................................................................144

Appendix H-LTSI Scale Codes ......................................................................................146

References …...............................................................................................................................147

Abstract ……...............................................................................................................................161

Autobiographical Statement ……………...................................................................................163

viii

LIST OF TABLES

Table 1: LTSI Items not Included in Analysis of Transfer Factors ..............................................49 Table 2: Data Analysis of Research Variables .............................................................................50 Table 3: Frequency Greenbelt Training Program Attended .........................................................55 Table 4: Time Between Completion of Training and Transfer Study Questionnaire ...................56 Table 5: Years Worked in Healthcare ...........................................................................................57 Table 6: Highest Level of Education Completed ..........................................................................57 Table 7: Work Location ................................................................................................................58 Table 8: Current Position ..............................................................................................................59 Table 9: Years in Current Position ...............................................................................................60 Table 10: Participant Age .............................................................................................................60 Table 11: Perceived Stage of Transfer .........................................................................................61 Table 12: Descriptive Statistics of Transfer System Scales and Subscales .................................63 Table 13: Relationship Between Training Elapsed Time and Stage of Transfer .........................66 Table 14: Means and Standard Deviations for Motivation Scales by Stage of Transfer ..............67 Table 15: Multivariate and Univariate Test Scores for Motivation Scales Across Stages of Transfer .........................................................................................................................68

Table 16: Mean Scores on Two Measures of the Transfer Motivation Scale as a Function of Stage of Transfer ...........................................................................................................68

Table 17: Means and Standard Deviations for Trainee Characteristic Scales by Stage of Transfer .........................................................................................................................69

Table 18: Multivariate and Univariate Test Scores for Trainee Characteristic Scales Across Stage of Transfer ...........................................................................................................70

Table 19: Mean Scores on Two Measures of the Trainee Characteristic Scale as a Function of Stage of Transfer ...........................................................................................................71

ix

Table 20: Means and Standard Deviations for Work Environment Scales by Stage of Transfer..........................................................................................................................73

Table 21: Multivariate and Univariate Test Scores for Work Environment Scales Across Stages of Transfer .....................................................................................................................73

Table 22: Mean Scores on Two Measures of the Work Environment Scale as a Function of Stage of Transfer ....................................................................................................................74

Table 23: Means and Standard Deviations for Ability Scales by Stage of Transfer.....................75

Table 24: Multivariate and Univariate Test Scores for Ability Scales Across Stages of Transfer .........................................................................................................................76

Table 25: Mean Scores on Two Measures of the Ability Scale as a Function of Stage of Transfer .........................................................................................................................76

Table 26: Education Level by Stage of Transfer ………………………………………………..78

Table 27: Current Position by Stage of Transfer ………………………………………………..79

Table 28: Work Location by Stage of Transfer …………………………………………………79

Table 29: Years in Healthcare by Stage of Transfer …………………………………………….80

Table 30: Current Position by Stage of Transfer ………………………………………………..80

Table 31: Age by Stage of Transfer ……………………………………………………………..81

Table 32: Gender by Stage of Transfer ………………………………………………………….82

Table 33: Means and Standard Deviations for Transfer System Factors by Education Level ….83

Table 34: Multivariate and Univariate Test Scores for Transfer System Factors Across Education Level ............................................................................................................84

Table 35: Means and Standard Deviations for Transfer System Factors by Current Position......85

Table 36: Multivariate and Univariate Test Scores for Transfer System Factors Across Current Position .........................................................................................................................86

Table 37: Mean Score of One Transfer System Factor as a Function of Current Position...........87

Table 38: Means and Standard Deviations for Transfer System Factors by Work Location .......87

x

Table 39: Multivariate and Univariate Test Scores for Transfer System Factors Across Work Location ........................................................................................................................88

Table 40: Mean Score of One Transfer System Factor as a Function of Work Location ............89

Table 41: Means and Standard Deviations for Transfer System Factors by Years Worked in Healthcare .....................................................................................................................89

Table 42: Multivariate and Univariate Test Scores for Transfer System Factors Across Years Worked in Healthcare ...................................................................................................90

Table 43: Mean Score of Two Transfer System Factors as a Function of Years Worked in Healthcare .....................................................................................................................91

Table 44: Means and Standard Deviations for Transfer System Factors by Years Worked in Current Position ............................................................................................................92

Table 45: Multivariate and Univariate Test Scores for Transfer System Factors Across Years Worked in Current Position ..........................................................................................93

Table 46: Means and Standard Deviations for Transfer System Factors by Age .........................94

Table 47: Multivariate and Univariate Test Scores for Transfer System Factors Across Age .....95

Table 48: Mean Score of Three Transfer System Factors as a Function of Age ..........................96

Table 49: Means and Standard Deviations for Transfer System Factors by Gender ....................96

Table 50: Multivariate and Univariate Test Scores for Transfer System Factors Across Gender ...........................................................................................................................97

xi

LIST OF FIGURES

Figure 1: LTSI Version 2: Conceptual Model of Constructs .........................................................7

Figure 2: Model of the Research Variables ....................................................................................9

Figure 3: Stages of the Transfer Process .......................................................................................11

Figure 4: Organizational Climate and Trainee Performance ........................................................32

Figure 5: Holton’s Conceptual Evaluation Model ........................................................................36

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CHAPTER 1 Introduction Organizations and other sponsors of training face increasing pressure to demonstrate the value or impact of their training programs on individual and organizational performance (Friedman, Hatch, & Walker, 1998). A critical element in the validation of training effectiveness is the permanent transfer of learned knowledge, skills, and behaviors to the workplace. The generalization of learned material to the job and maintenance of trained skills, are greatly influenced by training design, trainee characteristics, and work environmental factors (Baldwin & Ford, 1988; Burke & Hutchins, 2007; Ford & Weissbein, 1997). Billions of dollars in direct costs are spent annually on training programs in the United States (ASTD State of the Industry, 2008); yet, evidence of changed behaviors in the workplace following training is scarce (Baldwin & Ford, 1988; Gist, Bavetta & Stevens, 1990; Georgenson, 1982; Saks, 2002). A recent survey of chief executive officers found that 64% wanted data from organizational training evaluation measures that demonstrate application of learning such as change in behavior or use of skills or technology following training inititatives (Phillips & Phillips, 2010). Employers seek to improve the methods used to evaluate training effectiveness and improve training outcomes, given the increasing evidence of the intervention design and delivery (Broad & Newstrom, 1992; Burke & Hutchins, 2007; Foxon, 1994) and work climate elements (Cromwell & Kolb, 2004; Foxon, 1997; Rouiller & Goldstein, 1993; Russ-Eft, 2002) that influence transfer. Using a multidimensional approach to identify all factors that promote or inhibit transfer could provide trainers and training planners with the insight necessary to design and develop strategic interventions that may enhance transfer and sustained workplace performance (Burke & Hutchins, 2007).

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Much of the empiric transfer research has examined individual factor scales or constructs that influence transfer, while other studies have examined factor scales customized to the specific study (Holton, Bates, Seyler, & Carvalho, 1997). Holton, Bates, and Ruona, (2000) and others (Cromwell & Kolb, 2004; Kontoghiorghes, 2001; Kozlowski & Salas, 1997; Tracey & Tews, 2005;) propose a view of transfer from a systemic, multi-level perspective, fully integrating the examination of multiple work climate factors and secondary influences on transfer. Using Holton’s (1996) HRD Research and Evaluation Model as a theoretical framework, the Learning Transfer System Inventory (LTSI) (Holton, et al., 1997; Holton, Bates, & Ruona, 2000), was developed to serve as a generalized instrument for training evaluation. This instrument has been administered to numerous training participants representing a range of organizational settings and training programs in business and industry in the U.S. and internationally (Bates & Holton, 2004; Bates & Khasawneh, 2005; Chen, 2003; Chen, Holton, & Bates, 2005; Holton, Chen, & Naquin, 2003; Kirwan & Birchall, 2006; Weldy, 2007; Yamnill & McLean, 2005) and subject to exploratory and confirmatory factor analysis confirming its validity, reliability, and strong psychometric properties (Chen, Holton, & Bates, 2005; Holton, 2005; Holton, Bates, Bookter & Yamkovenko, 2007; Holton, Bates, & Ruona, 2000; Holton, et al., 1997; Khasawneh, Bates, & Holton, 2006; Yaghi, Goodman, Holton, & Bates, 2008; Yamnill & McLean, 2001). Studies examining transfer system factors that influence transfer using the LTSI instrument in human service agencies broadly (Clarke, 2002), and healthcare organizations specifically, however, are clearly lacking in the literature. The prospect of a valid, reliable instrument to assess organizational transfer systems, would greatly benefit the planning, design, delivery, and economic utility of effective training programs in all organizational settings (Donovan, Hannigan, & Crowe, 2001).

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The purpose of this study is to examine trainee perceptions of transfer system factors that influence the transfer process following a management training program in a multi-center healthcare organization using the LTSI survey instrument. If this instrument can improve the identification of factors in the individual, training design, and work environment that influence transfer, consideration should be given to furthering the use of such instruments to improve training outcomes in the healthcare setting. . Background of the Study Training in Healthcare Organizations Healthcare organizations are highly complex work environments with unique training challenges for trainers and managers. Employed in one of the most highly regulated industries in the United States (U.S.), healthcare staffs are subject to multiple training programs at the individual, departmental, and organizational level in order to keep pace with the accreditation, regulatory, technological, clinical knowledge, financial, social, and organizational changes that routinely impact both operational and clinical practice (Fallon & McConnell, 2007). New hires must undergo orientation to both organization and department or program-specific policies and practices, often requiring direct supervision and mentoring to ensure mastery and competency related to clinical skills practices. Many healthcare personnel must also meet strict requirements for continuing education to ensure that they maintain professional competency and licensure or certification, as appropriate. Human resources and management personnel must ensure staff completion and documentation of training mandated by healthcare accrediting as well as state and federal safety and public health agencies (Shi, 2007). Additionally, patient care personnel are subject to training on equipment and new devices or products, new or revised procedures,

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computer software, and related administrative processes each time a change, revision, or upgrade is introduced. Despite the complexity, scope, and importance of training in healthcare organizations, assessment of the effectiveness of training in this work setting has been largely overlooked in the transfer literature. Performance Improvement in Healthcare Organizations Since the publication of the Institute of Medicine Report in 2000 (Kohn, Corrigan, & Donaldson, 2000), the U.S. healthcare industry faces increasing economic and public pressure to reduce costs, improve quality and efficiency, and reduce medical errors. Recent legislative policy proposed by the Centers for Medicare and Medicaid Services (Public Law 109, 2006) imposed value-based purchasing of healthcare services by holding healthcare organizations accountable for improving their performance outcomes. Effective October, 2008, the inpatient prospective payment system no longer reimburses healthcare providers for the care and services rendered to patients resulting from medical mistakes. Subsequently, administrators continue to seek ways to better identify and improve processes and practices that improve quality and patient safety, and decrease the resultant costs. Recognized throughout the business community as an effective methodology to analyze and reduce error and waste, Lean Six Sigma methods are being introduced in healthcare organizations to provide staff with the skills and tools in management and clinical processes that support organizational strategic initiatives (Kontoghiorghes, 2001; Lazarus & Neely, 2003; Trusko, Pexton, Harrington, & Gupta, 2007). Between October, 2006 and April, 2008, 378 management and front line staff at a large multi-center healthcare system in southeast Michigan participated in Lean Six Sigma Green Belt training. The healthcare system is comprised of 7 hospitals and over 125 medical facilities. Each training program consisted of eight days of instruction conducted over a three month period.

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Participation in the program was considered mandatory for all managers and senior administrators but was also open to anyone else in the organization who wished to participate. Participants were full-time employees of the St. John Healthcare System who attended and completed an instructor-lead, classroom-based management training program. Enrollment in each of the eight-day training sessions was strictly limited to 50 participants. Under the supervision of a lead Master Black Belt training coordinator, Certified Black Belt instructors conducted the training sessions using lecture and team activities to present and exercise Lean Six Sigma concepts and techniques. Topics presented in the training sessions included value stream analysis, change acceleration process, team facilitation, control concepts, rapid improvement event (RIE) methods, and other Lean Six Sigma processes. A complete listing of the training program topics is presented in Appendix A. Study questionnaires were submitted by 153 training participants, with 135 evaluable questionnaires included in the final analysis. Considered to be more than just another management training program, a change in culture was introduced through a shared vision of operational excellence using Lean Six Sigma methods and strategies to drive the quality initiatives set forth by organizational leaders. The Learning Transfer System Inventory

Both learning and transfer are critical outcomes for training professionals in all businesses and industries. It is evident from the study of transfer over the past two decades that it is complex and encompasses multiple factors in the person, training, and work climate that influence transfer in work settings (Holton, Bates, & Ruona, 2000). Organizations hoping to improve learning and performance as a direct result of training programs must be fully aware of the factors that influence or mediate transfer of learning and seek ways to diagnose those factors that may reduce or inhibit transfer in the work environment. Recognizing the need to develop

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consistent measures of transfer variables using acceptable methods of scale construct validation, the Learning Transfer System Inventory (LTSI) (Holton, Bates, & Ruona, 2000) was developed to address these perceived shortcomings in the existing transfer research. The LTSI is a theoretically-based, psychometrically-sound instrument comprised of four scales, and 16 transfer system factors with potential applicability across organization types and training programs. Both training-specific and general training transfer factors are included in the 89-question survey instrument. Version 1 of the instrument evolved from the addition and deletion of constructs from the eight-factor structure proposed earlier by Rouiller & Goldstein (1993) that resulted in a set of scales consistent with transfer of learning in work settings. Using factor analysis, Holton et al. (1997) analyzed an expanded instrument that included a total of nine constructs affecting the transfer of training: supervisor support, opportunity to use, transfer design, peer support, supervisor sanction, personal outcomes-positive, personal outcomes-negative, change resistance, and content validity. Bates, Holton, Seyler, & Carvalho (2000) were able to demonstrate initial evidence of construct, content, and criterion validity of a nine-factor transfer climate instrument suggesting organizational referents, rather than situational and consequence cues (Rouiller & Goldstein, 1993), are key to trainee perceptions of transfer climate. These findings suggested further studies were needed to validate the psychometric integrity of the proposed as well as additional transfer scales, and a need to perform construct validation analysis across work groups and work settings. In Version 2 of the LTSI, seven additional constructs were added to the survey instrument and subjected to both exploratory and confirmatory factor analysis. The resulting instrument included the original nine constructs and seven additional constructs that address

7

motivation to transfer (Noe, 1986), transfer effort-performance, performance-outcomes, ability (Baldwin & Ford, 1988; Colquitt, LePine, & Noe, 2000; Hunter, 1986), learner readiness, performance self-efficacy (Chiaburu & Marinova, 2005; Gist, 1987; Mathieu, Tannenbaum, & Salas, 1992), and personal capacity for transfer (Ford, Quinones, Sego, & Sorra, 1992). These 16 constructs complete the theoretical framework proposed by Holton, Bates, and Ruona (2000). This conceptual model is presented in Figure 1. The 16 constructs included in Version 2 of the LTSI are further grouped into four scales: trainee characteristics, motivation, work environment,

Figure 1. LTSI Version 2: Conceptual Model of Constructs

Secondary

Performance self-efficacy

Influences

Learner readiness

Motivation

Motivation to transfer Transfer effort

Performance Performance

Outcomes

Feedback

Peer support Personal outcomes-positive Environment

Supervisor support Personal outcomes-negative Openness to change

Supervisor sanctions

Outcomes

Ability

Content validity Transfer design Personal capacity for transfer Opportunity to use

(Holton, Bates, & Ruona, 2000)

and ability (Holton, Bates, & Ruona, 2000) which correlate directly with factors identified in the transfer literature as influencing transfer outcomes. Learner readiness and performance self- Learning Individual Performance Organizational Performance

8

efficacy factors comprise the trainee characteristic scale. The motivation scale includes motivation to transfer, transfer effort-performance expectations, and performance-outcomes expectations. The work environment scale includes feedback/performance coaching, peer support, supervisor/manager support, resistance/openness to change, personal outcomes positive, personal outcomes negative and supervisor/manager sanctions. The ability scale includes perceived content validity, transfer design, personal capacity for transfer, and opportunity to use learning. The four transfer system scales described here were included as independent variables in this study of a heterogeneous trainee group in a multi-center healthcare organization using the Version 2 LTSI questionnaire.

Purpose of the Study The purpose of this study is to examine the relationship between trainee perceived transfer system factors and training elapsed time on progressive stages of transfer in a healthcare organization at time intervals of 9 to 24 months following completion of an eight-day management training program. The Learning Transfer System Inventory (LTSI), a validated survey instrument developed by Holton, Bates, and Ruona (2000), was used in the participating organization to determine trainee perceptions of the motivation, work environment, trainee characteristics, and ability factors that promote or inhibit transfer of knowledge, skills, and attitudes from the training environment to the work environment. The study also investigated the relationship between trainee demographic characteristics, including age, gender, education, tenure, position, and work location, and perceived transfer system factors. These study variables and the respective research questions (RQ1-RQ7) included in this study are presented in Figure 2.

9

Figure 2. Model of the Research Variables

RQ 7 RQ 6 RQ 1

RQ 2, 3, 4, 5

Note: RQ = Research Questions Trainee Demographics •

Age •

Gender •

Education •

Tenure •

Position •

Work location Transfer System Factors

Trainee Characteristics •

Learner readiness •

Performance self-efficacy Motivation •

Motivation to transfer learning •

Transfer effort- performance expectations •

Performance-outcomes expectations Work Environment •

Feedback/performance coaching •

Supervisor/manager support •

Supervisor/manager sanctions •

Peer support •

Resistance/Openness to change •

Personal outcomes-positive •

Personal outcomes- negative Ability •

Personal capacity for transfer •

Perceived content validity •

Opportunity to use learning •

Transfer design

Training Elapsed Time Transfer Intention

Transfer Initiation

Partial Transfer

Maintenance

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Although much is written about the potential influences on transfer, the nature of transfer itself remains rife with questions and often open to interpretation. Much of the empiric research has examined evidence of transfer soon after training while studies assessing the generalization or maintenance of skills and knowledge are few; yet, the majority of training transfer models specify a change in performance or behavior at the individual or organizational level following training as the primary measure of transfer. Without clear definitions of transfer, however, identifying specifically when transfer has occurred is difficult, at best, especially when studying transfer in the context of cognitive, problem solving, or management development training programs (Foxon, 1993). Questioning the assumption of transfer as a product of training, Foxon (1993) proposed the conceptualization of transfer as a process composed of multiple stages with each of the stages being prerequisite to each subsequent phase. The four transfer phases described in this transfer process include: 1.

Transfer intention: the motivation of the learner to apply learning in the work environment following training; 2.

Transfer initiation: the attempt to apply some aspect of the learning in the work environment; 3.

Partial transfer: the transfer of some of the learned skills or use of skills from time to time; and, 4.

Transfer maintenance (two stages): conscious maintenance where learners use new skills on a conscious basis when the opportunity presents itself and unconscious maintenance where the new skill or knowledge is fully incorporated into the work routine and may be generalized to other aspect of work practice.

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This model of transfer process, presented in Figure 3, conceptualizes the way learners commit to try, practice, discontinue, abandon altogether, or ultimately imbed in their work function the knowledge and skills learned in training on a continuum. Foxon’s (1993) proposed stages of transfer support the theoretical framework of the dependent variable in this study.

Figure 3. Stages of the Transfer Process

(Foxon, 1993)

Research Questions Transfer system constructs identified in Holton’s (1996) HRD Evaluation Research and Measurement Model, including motivation, trainee characteristics, ability, and work environment, and Foxon’s (1993) model of the stages of the transfer process provide the conceptual framework for this study. The following research questions guided this study. Research Question 1 Is there a positive relationship between time since completion of training and the stages of transfer?

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Research Question 2 What factors in the Learning Transfer System Inventory motivation scale (motivation to transfer learning, transfer effort-performance expectations, performance-outcomes expectations) influence the transfer process in healthcare employees? Research Question 3 What factors in the Learning Transfer System Inventory trainee characteristics scale (learner readiness, performance self-efficacy) influence the transfer process in healthcare employees?

Research

Question 4 What factors in the Learning Transfer System Inventory work environment scale (feedback/performance coaching, supervisor/manager support, supervisor/manager sanctions, peer support, resistance/openness to change, personal outcomes-positive, personal outcomes- negative) influence the transfer process in healthcare employees? Research Question 5

What factors in the Learning Transfer System Inventory ability scale (personal capacity for transfer, perceived content validity, opportunity to use learning) influence the transfer process in healthcare employees? Research Question 6

Are there differences in stage of transfer achieved across selected demographic characteristics, including education, position, work location, years in healthcare, years in current position, age, and gender?

13

Research Question 7 Are there differences in perceived transfer system factors across selected demographic characteristics, including education, job type, work location, years in healthcare, years in current position, age, and gender?

Definition of Terms The following definitions are provided to lend clarity of the terms used in this study. Black Belt Experienced professionals with significant training and skill in problem solving and the application of statistical methods needed to execute Six Sigma systems. Typically a full time position, Six Sigma Black Belts support Green Belts as trainers and/or leaders of problem-solving teams (Trusko, et al., 2007). Construct Validation

The collection, documentation and evaluation of a unified body of evidence to see how well a scale measures, operationalizes, or correlates with the theoretical psychological construct it claims to measure (Campbell, 1959). Green Belt

Individuals who have completed training in Six Sigma processes used to analyze, design, measure, and improve processes. Green Belts generally serve as members of problem- solving teams on an as needed basis (Trusko, et al., 2007).

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Learning Transfer System Inventory (LTSI ) An evaluation instrument composed of 16 factors with 89 items that assess trainee perceptions about all factors in the person, training, and organization that influence transfer of training (Holton, Bates, & Ruona, 2000). Six Sigma A process that uses statistical methods, problem solving, and quality principles to measure, analyze, and reengineer processes to achieve an error rate below 3.44 per million events (Trusko, et al., 2007). Training Elapsed Time The time difference between completion of training and another specified point in time (Baldwin & Ford, 1988). Training The planned learning experience designed to promote a permanent change in the knowledge, attitudes, or skills of individuals. (Campbell, Dunnette, Lawler, & Weick, 1970, as cited in Noe, 1986). Transfer of Training The effective generalization and maintenance of skills and knowledge gained in a training program (Baldwin & Ford, 1988). Transfer Climate

A wide variety of organizational and perceptual variables which limit or support the

application of knowledge, skills, behaviors, and attitudes learned in training (Mathieu,

Tannenbaum, & Salas, 1992)

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Transfer Process

The stages of learner efforts to try, practice, maintain, discontinue, or fail to use new

skills on a time continuum, with each stage being a prerequisite to the

next (Foxon, 1993).

Transfer System

All factors in the person, training design, and work environment that influence the

transfer of learning to the job (Holton, 1996).

Significance of the Study Findings from this study will contribute to the understanding of training transfer in the following ways:

This information will provide an understanding of the perceptions of transfer system factors in a complex, multi-center healthcare organization.

Information obtained from this study will be used by healthcare organizations to address perceived deficiencies as well as leverage points predictive of transfer in the planning, design, and/or delivery of management training programs.

This study will inform the question of the relationship between training elapsed time and the stages of transfer in a healthcare organization.

This study will inform the question of the influence of trainee perceptions of transfer system factors on the stage of transfer continuum in a healthcare organization.

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Data obtained from the LTSI instrument will contribute to the further development and refinement of this tool for research and practical purposes by HRD professionals and trainers in organizations.

This study will contribute to the understanding of the potential generalization of the LTSI instrument as a diagnostic tool for improvement of training effectiveness in organizations.

Summary This chapter discussed the system of factors that affect the effectiveness of organizational training as a means of improving individual and organizational performance. The research suggested that traditional approaches to training evaluation are generally inadequate in their assessment of training effectiveness. Rather, a more holistic approach, as suggested by Holton’s (1996) conceptual model can help identify work climate factors that inhibit or support transfer in all work settings to improve training programs and maximize the transfer of new knowledge and skills back to the job. The LTSI was introduced as a validated, psychometrically sound instrument that can be used to estimate and target areas in need of improvement to maximize a return on training investments. Research questions were described and specific terms used for this study were defined accordingly. Finally, the significance and potential limitations of the study were also described. In the next chapter, a review of the relevant literature on the nature of transfer, factors believed to influence transfer of training, the HRD Model of Training Evaluation, and stages of transfer will be presented and discussed.

Full document contains 176 pages
Abstract: Organizations and other sponsors of training face increasing pressure to demonstrate the value or impact of their training programs on individual and organizational performance. A critical element in the validation of training effectiveness is the permanent transfer of learned knowledge, skills, and behaviors to the workplace. The generalization of learned material to the job and maintenance of trained skills, are greatly influenced by training design, trainee characteristics, and work environmental factors. Using a multidimensional approach to identify all factors that promote or inhibit transfer could provide performance technologists and instructional designers with the insight necessary to design and develop strategic interventions that may enhance transfer and sustained workplace performance. Much of the empiric research has examined evidence of transfer soon after training while studies assessing the generalization or maintenance of skills and knowledge are few; yet, the majority of training transfer models specify a change in performance or behavior at the individual or organizational level following training as the primary measure of transfer. The purpose of this study was to examine trainee perceptions of transfer system factors that influence the transfer process as a continuum in a multi-center healthcare organization 9 to 24 months following a management training program using the validated Learning Transfer System Inventory (LTSI) survey instrument. In addition, the study examined the influence of time elapsed since completion of training on stage of transfer achieved. Results showed that trainees who perceived a more supportive work environment had a greater likelihood of progressing to maintenance of the skills and knowledge learned in training. Individuals who achieved the maintenance stage of transfer specifically, perceived motivation to transfer learning, performance self-efficacy, and transfer design as strong catalysts for transfer in this study while mean scores for trainees who achieved only partial transfer or no transfer of skills indicated a perception of a weak transfer climate overall. Time since completion of training was not found to be a significant influence on the stage of transfer achieved. Previous studies have suggested that the transfer climate in organizations is complex and unique to specific types of organizations and training programs. These study results support previous findings and contribute to the understanding of transfer as a process. These and other findings are discussed as well as implications for instructional designers, performance technologists, and the business of healthcare. Limitations related to the study and recommendations for future research are also presented.