JOB AID MAKEOVER SPECTACULAROctober 17, 2009Ellen Reeder

Design Documentation – Path to Nursing CE Contact Hour Approval

1. Overview AORN, the association where I work, is accredited by the American Nurses Credentialing Center (ANCC) to approve nursing education. We receive between 600 and 700 applications per year. The ANCC criteria for approval are several pages long. To many first-time applicants who don’t have someone to mentor them through the process, applying for contact hours can be overwhelming. We provide lengthy and detailed instructions on our website, but most applicants don’t take the time to read it. Much of the time, our reviewers receive underdeveloped applications and hardly ever confirm approval the first time an application is submitted. It’s usually sent back for changes and then resubmitted by applicants for final approval, increasing everyone’s workload. To help applicants submit better applications, I created a PowerPoint presentation of 18 slides called “How to Simplify the Contact Hour Application Process.” Unfortunately, applicants didn’t read it either. Obviously, I needed to simplify my “How to simplify…” document.

The focus of my job aid is to provide a step-by-step guide/overview to help nurses and educators apply for nursing continuing education (CE) contact hours. Another important purpose of my job-aid redesign is to compel applicants to read the instructions.

2. AudienceApproval Unit applicants include educators from nursing chapters from our association, healthcare centers, nursing/medical colleges and universities, education entrepreneurs, and other nonprofit medical companies. The nurses who apply could most be described as ENFP (extravert, intuitive, feeling and perceptive). However, the educators/entrepreneurs who apply may also be Sensors as opposed to Intuitors, and so I also have the personality type ESFP, which require more details. Please see attached Appendix, Abela Worksheets A.1.a and A.1.b for more information.

3. Learning ObjectivesAfter viewing my job aid, my audience should think that they

a. better understand the CE approval application step-by-step process.b. are better prepared to submit an application. c. want additional more specific information regarding the application process.

My audience members should then take the following actions: Read through the 21-page Instructions document located on our website; write better, more informed objectives and content; and when they submit, the application contains more complete information. Please see Appendix, Abela Worksheet A.2.

4. Problem/SolutionMy learning audience doesn’t completely understand the nursing CE contact hour application process. My solution is to provide a job aid that presents a basic overview of the important criteria required for approval of contact hours in a sequential representation that should be more helpful to new and returning applicants.

5. EvidenceANCC requires certain criteria be met for education programs to be approved for nursing contact hours. The evidence I’ve listed is derived from the ANCC criteria for approval. Please see attached Appendix from the Abela Worksheets.

6 AnecdotesThis section isn’t relevant to my job aid since I chose the dense content display. In fact, the entire display is the story of the application process and highlights the most important aspects of applying for contact hours.

7. FormatI chose the dense content display format because of the nature of my audience, the objectives I developed (see completed forms attached), as well as the type of evidence presented. My audience members need a very direct and time-saving job aid to help with the application process. In addition, the nature of the evidence presented – education program application critera – didn’t seem to lend itself to the comic format.

8. SequencingThe job aid shows the path through the CE contact hour application process using ANCC criteria-based data. I decided to present the information in a simple and logical way: in the same order that it arises in the web-based application all applicants use. Even though Abela’s storytelling S.Co.R.E. method best relates to PowerPoint presentations, I believe it provides a valid guide for my sequencing, because once “tension is created or uncovered, the desire to resolve it can be so strong, we sometimes feel it as a physical need (Abela 2008, p. 77).” The applicants I work with have a strong need to resolve any issues that inhibit understanding the application process.

To provide clarity, I chose the sequencing that best helps lead applicants into the application process. It’s the most “direct, efficient route to communicating our simple plot (McCloud 2006, p. 12).”

By choosing sequencing that matches the application itself, the steps became more active for the reader, “anchored entirely in actions” (McCloud 2006, p. 14).” Each step provides an answer to, “What comes next?” and resolves the tension that may arise from applying for CE contact hour approval.

9. GraphicsMy first graphics decision was to use Jaegerman’s “Life Starts Here …” (www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0002w4&topic_id=1&topic) as inspiration because its chronological representation seemed very applicable to my project.

Next, I decided to limit the graphics to four elements that I repeated throughout the design: callouts, arrows, text boxes, and the stone-shaped path that guides the reader through the steps. “There’s one specific theme you need to keep at the forefront of your mind – consistency. Choose elemental style and stick with them (Duarte 2008, p. 115).”

I chose not to use any pictures or photographs. “Your audience has limited processing capacity; irrelevant information can overload this capacity and reduce the effectiveness of your

communication (Abela 20098, p. 98).” I wanted to keep the design as clear and easy-to-read as possible, with emphasis on the process.

At first, the callout “hints” were green and the text boxes for the numbered steps were white. I thought that keeping the most important text white would make it easier to read. I reversed my decision when I discovered that my eyes were first drawn to the green “hints” and not to the main steps. I also made the type smaller so that it’s clear that the “hint” callouts are not the main points to consider. Using contrast in the right way, I wanted to identify the main points quickly. “Viewers immediately perceive the difference between the attributes of two or more things, and this focuses their attention (Duarte 2008, p. 94).”

10. TextUsing Jaegerman’s “Life Starts Here …” (www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0002w4&topic_id=1&topic) and “The life cycle of a high-performance workforce” (Abela 2008, pp. 130-131) as examples of dense content display using lots of text too, I began to hone my content, based on the ANCC criteria for contact hour applications. My first decision had to be what to include and what to leave out. ‘Ask yourself, “What can I take away that won’t change the meaning?” (Duarte 2008, p. 106).’ I tried to include the right amount of detail by being specific: “Detail implies specifics: this is the role that detail plays in your presentation, bringing it down from the abstract into the concrete, to make it credible and useful to your audience (Abela 2008, p. 127).”

I chose Calibri font and used it consistently throughout not only because it’s easy to read, but also because it’s the designated font used in AORN emails and other written materials – it’s considered part of our brand. “Brand is what a company stands for in the hearts and minds of its customers; to be successful, the company must have an emotional connection with the consumer (Duarte 2008, p. 4).” “Choose a font that accurately reflects the personality of your brand (Duarte 2008, p. 142).”

Still trying to sharpen up the content, and not use any extraneous words, I decided to break up the text and create a hierarchy by labeling the secondary information as “Hints” and “Notes.” Hierarchy defines the structure formed when relationships are applied to a set of elements (Duarte 2008, p. 28).

11. LayoutOnce again using Jaegerman’s “Life Starts Here …” (www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0002w4&topic_id=1&topic) and “The life cycle of a high-performance workforce” (Abela 2008, pp. 130-131) as examples, I developed a “path” or “steps” layout that told the story of applying for contact hours in the same order as the application itself.

Duarte tells us to develop flow within the design intentionally (2008, p. 97). So, I grouped those elements together in the same way that they appear in the actual application: Planning Committee, Presenter, Commercial Support; Purpose/Goal, Objectives, Content, Teaching Strategies; Evaluation, Participation, and Marketing; and the final steps to approval – Review, Approval, Evaluation, Post Activity. “Their placement relative to each other tells a secondary story to the image itself (Duarte 2008 p. 104).” The path creates a unifying element that links related groups of items (Duarte 2008, p. 51). Since my dense content map doesn’t just flow from left to right, but from right to left, downward and upward, I decided to use two sets of numbering as well as arrows along the path to indicate proper direction. “Readers are conditioned to start at the top left and scan back and forth …. use a

symbol or arrow that clearly marks a starting point. The audience should be able to understand the intended order in which to process the information, without ever feeling lost or overwhelmed (Duarte 2008, p. 96).”

Finally, by spreading out my dense content display from one (I started with a complete display on one page) to four pages (it went through several versions), I was able to incorporate more whitespace, and get “visual breathing room (Duarte 2008, p. 106).”

12. MeasurementA question about instructional material will be added to the present evaluation of the approval process sent to applicants on a quarterly basis and answers calculated for a formal measurement (Likert scale). Informally, by observing the quality of applications after the job aid has been implemented.

13. Peer review resultsUsing Jennifer’s advice, I expanded to four pages and added more white space. I placed the “Notes” further away from the steps. I didn’t change any colors as she recommended, including the dark purple, because these colors are used by AORN and are part of our Brand.

On Ben’s advice, I changed the unique green color I had for “Submit” so that it matched all the other green text boxes. I also added color to my Correct/Incorrect objectives/content comparisons table to relate them more to the overall design. Ben suggested shortening my text, and I did a little. But after I expanded from two pages to four, I added more text needed to help meet my objectives.

Bibliography

Abela, A. (2008). Advanced presentations by design: Creating communication that drives action. San Francisco: Pfeiffer.

Duarte, N. (2008). Slide:ology: The art and science of creating great presentations. Sebastopol. CA: O’Reilly.

McCloud, S. (2006). Making Comics: Storytelling Secrets of Comics, Manga and Graphic Novels. New York: Harper.

Tufte, E. (2007). Megan Jaegerman's brilliant news graphics. Retrieved from www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0002w4&topic_id=1&topic

APPENDIX

Worksheet A.1a. Audience Personality Type

Audience Personality Type

Nurse educators from healthcare centers/universities ENFP

Education coordinator for AORN chapters and state councils ENFP

Entrepreneurs developing education for nurses ESTP

Worksheet A.1b. Audience Personality Implications

Presentation Implications

Provide all or part of presentation in advance Plan for lots of discussion and Q&A (via phone calls) Make sure to include all relevant facts and details in presentation or appendix Provide overview up-front Identify principles costs and benefits State implications for each person or group of stakeholders involved Present conclusions up front List all alternatives considered

Worksheet A.2. From-To Think-Do Matrix

From-To Think-Do Matrix

FROM TO

THIN

KApplying for nursing CE is easy and I don’t have to read any instructions or find out more about the process before I submit the application

This process is more complicated than I thought. I want to find out more.

THIN

K Applying for nursing CE contact hours is a lengthy and complicated process

With the right tools and instruction, I can approach the application process with confidence.

DO

Submitting applications that are incomplete, inaccurate, and missing vital information

Submitting more well-developed applications

Worksheet A.3. Audience Problem

The problem that my audience has is that they aren’t fully knowledgeable about how to

write applications that meet the criteria involved in obtaining contact hour approval for their nursing CE

program.

Worksheet A.4. Spectrum of Solution Contributions

Help recognize that Help define Help define the Solve part of the Solve the wholethere is a problem the problem solution space problem problem

This is where my presentation is on the spectrum.

Worksheet A.5 Solution Evaluation

Evaluation Criteria

Option 1

Produce Job Aid (Dense Content Map)

(Proposed Solution)

Option 2

Do nothing

(Alternative 1)

Option 3

Revise Original Power Point presentation that

graphic content map will replace

(Alternative 2)

Provide an overview of the nursing CE application process that helps to simplify

the process of applying for nursing CE contact hour approval and developing

education programs according to appropriate criteria.

A simple document that seems less intimidating

than the 20-page instruction manual

Status quo. More time spent working with

applicants on simple application problems that

could be solved with a job aid.

May not be read. Doesn’t meet individual needs. Still

10 pages long.

Improve submitted application content Inspire those reading the job aid to also read

the instructions.

Status quo Could be used in addition to the Job Aid.

Increase number of applications approved during first review

May improve understanding of how to

develop required application criteria. Time

saver

Status quo May not change anything. Status quo.

s

Worksheet A.6. List of Evidence

Evidence

1. American Nurses Credentialing Center (ANCC) criteria for approval of nursing continuing education (CE) contact hours.

a. Planning Committeei. Must have at least one member with a BSN

ii. Brief bio must contain information about experience planning CE for contact hours

b. Presenter/Authori. Presenter employed by industry can presenter certain

unrelated topics only.c. Planners and Presenters must indicate whether or not they

have a conflict of interest -- a financial or in-kind relationship with a commercial company that could influence the content of the nursing CE.

d. Purpose/Goal Statemente. Objectives

i. Describe expected learner outcomes in measurable terms

f. Content i. Must be directly related to the objective and written

as a topic outlineShow comparison/contrast of “correct” and “incorrect”

g. Teaching Strategiesh. Commercial Support

i. Keep education separate from promotional activities and disclose all commercial support of education activities

i. Marketing Materiali. ANCC accreditation statement

j. Review process i. Continuing Education Approval Committee reviews

applicationsii. 3-4 weeks for review

iii. Rush review processiv. Notification process

k. Program Approvali. 2-year approval

l. Certificate of Attendance and Evaluation formsi. Available for printing automatically after approval

m. Post Activity Reporti. Required 30 days after activity

2. ANCC does not recognize CEUs3. One contact hour = 60 minutes4. Activities that don’t support the definition of continuing nursing

education won’t be approved, including programs on financial planning and retirement

Job Aid Makeover SpectacularEllen Reeder

Worksheet A.7. Stakeholder Analysis

Whose help will we need for our recommendations to be implemented?

Director, Center for Perioperative EducationAORN

Continuing Education Approval ProcessReview Committee

What must each of them think or do for our recommendations to be successful?

Agree that there is a need for applicants for contact hour approval need more concise overview of the approval process

Agree that there is a need for applicants for contact hour approval need more concise overview of the approval process

Where do they stand on this?Would agree that many applicants need more mentoring of the application process.

Would agree that many applicants need more mentoring of the application process.

What do we need to do to close the gap? Providing a well-designed job aid Showing that the job aid helps

applicants write better applications.