I have been in the automation field since 1986, and have spent a good amount of the time in that field working in customer support in one fashion or another. Over that time, I have had a lot of opportunity to look at technology adoption issues over some duration of time.
One of the things I have noticed is that, as new generations of users are trained in the use of a particular technology, much gets lost in translation. It's like the old party game of telephone. You know the game; a person in a circle of people whispers a message in the ear of the person next to them and that person whispers the message to the next person, and so on, around the circle until the message is returned to the originator. That originator then repeats aloud the original message and the message as it was returned to them. It is very rare that the message returns intact.
My observation of technology training in pharmacies (and other organizations!) is that it is very similar. Even if the vendor trains the first generation of users well, and leaves excellent training materials behind, training of new generations of users proceeds on an apprentice-like model that is essentially "let me show you how I use this". In the process, both information on HOW the technology is to be used, and WHY it is to be used that way gets lost, as succeeding generations of trainers whittle away at the fund of information to be passed on, each removing information they don't consider important. In my experience, about two to three generations in, users have only a rote notion of the steps needed to get through normal processes, and have little information about why they take those steps, or what to do if the technology requires intervention.
An example of this is in the use of bar code scanning to verify activities in the use of a technology. It is not uncommon, in my experience, for users to quickly lose track of why they are scanning, or what the value of that scanning might be in their protection. As a result, they develop shortcuts around the scanning process that essentially devalue the step. Koppel, for example, describes situations in a BCMA system where nurses tape wristbands on the door jamb of a room so they don't have to scan the patient. I have also seen pharmacy technicians pre-print ingredient labels used to verify setup of a TPN compounder on a sheet of paper and scan that paper rather than the containers they are actually hanging on the compounder. The scan, because the technology demands that they scan, but their scanning does not result in the safety it is intended to provide because the codes they are scanning are not attached to the patients, or containers or apparatus that the codes are intended to represent.
For this to be avoided, training needs to be consistently delivered by a program founded on some clearly articulated outcomes using standardized materials that ensure that certain messages are consistently delivered. The most important messages, in my experience, have less to do with HOW the technology is to be used (although I don't want to make that unimportant) than they do with WHY the technology is to be used in certain ways, and NOT in others.
In my somewhat-less-than-humble opinion, this means that relying on human diligence and an apprentice-style of teaching is a bankrupt strategy, and automation of the training itself become essential. This automation must include end-of-training assessment that forces the trainee to demonstrate that they have, or have not, learned key concepts important to the proper use of the technology.
What do you think?