Interview with LCDR Kathleen Charters
Kenko Shimbun, April 1985, pp. 8-9.
As far as education and training goes, what’s in it for the average corpsman?
We see ourselves as a department, a team of people here, to provide the staff with skills so that they can go up in rate, to provide them with training, so that they can perform to the level that’s expected of them.
One of the big things that we want to work on more this year, one of our up-and-coming goals, is to spend more time teaching people how to handle the unexpected, to put more emphasis on training that’s geared towards a disaster or an unexpected event that will give people the skills both at the management level and at the provider “hands on” next-to-the-victim level.
Can we expect more drills then?
Well I don’t directly control drills but you can certainly expect more training to help you do better in drills.
Where we are now, as far as the department goes, is that we have in place all the programs that are required. Mr. Wentland did that and I’m very grateful he’s left big footsteps to follow in. He’s done a tremendous amount for this command and we’ve achieved a steady state where we are doing all the things that JCAH and IG require, and also what society at large expects us to provide m the way of support to the community, and support to the fleet. So that’s all in place.
What we’re trying to do now is go a step beyond and enhance and improve the level of care and level of skills by doing not just what you have to do but also what you’d like to do. For instance, the Registered Nurses and physicians at the hospital are concerned about getting Continuing Education Units (CEU’s) or Continuing Medical Education (CME).
They want to keep up their license or they want to keep up their skill. One of the things we would like to expand upon is to come up with an even better program for CEU’s and CME.
Most people come here wanting to contribute, wanting to do well, and some place along the line, sometimes they get so frustrated at not being able to get the support, the backing, the training, whatever it is, to do a good job they stop caring. And when you don’t care then you can’t do a good job. You’ve got to care. I think that if we could show them we care and we’re going to get them the training and the education they need to do a good job – and we’ll support them in any way we can in achieving that – then they’ve got the energy to go for it and do a good job. That’s what our department is all about – setting people up to do it right and do it well.
What are some of your long-term goals?
We have several long-term goals: One of them is the issue of accountability. Who is accountable for going to these mandatory classes? There’s a lot of griping and unhappiness about “every time I turn around there’s another class to go to, there’s another thing I have to do.”
Is our department supposed to be a babysitting service and hand out warning tickets – you’re overdue on this, you’re overdue on that – or is our department there to say “these are the things required of you, this is what you’ve accomplished. This is what you need to accomplish. These are the times at which it is available. If the format we offer is not helpful, let us know so that we can re-do the format.”
We would like to shift accountability back to the individual – you are responsible for getting yourself to the classes that are required, and we will do everything we can to help you. Along those lines, we had an eight-hour class that combined CEW (Cultural Expressions Workshop) and MRR (Military Rights and Responsibilities). There are about 88 people at the command who need to take it, but they were having a great deal of difficulty getting away for an eight-hour day. We’re completely re-doing the program, and we’re going to be, starting in May, putting it in a different format, giving the class in four-hour modules instead of a whole eight-hour day. So people can get away for just a part of a day instead of having to be gone a whole day. It makes it easier on their work areas.
The other thing is that we’re also trying to make people aware of why we’re teaching this. It’s one of those items on your fitness report or your evaluation where they ask “have they done anything for affirmative action?” and you sit there and scratch your head and think “well, who do I do something positive for affirmative action? What control do I have over that?” This class is part of the affirmative action plan.
Any other long-term goals?
Our education and training department ·with five people in it truly cannot go out and teach all the classes. It’s just not physically possible. We’ve been very fortunate that throughout the hospital – all levels of the enlisted, Nurse Corps Officers, Medical Corps Officers, MSC’s – we have really good support in helping us to teach these classes. We set up what’s required and then contact people we think would be interested in teaching these things and ask them “would you provide some time to teach this material? We will give you the outline of what needs to be taught. We will tell you what the objectives are or you can do your own objectives for it. But this is what we need to cover and this is the time span in which we have to cover it.”
We have had a tremendous response. For example, LT Slater poured hours of work into developing our blood administration certification program. People were very pleased, they said they learned things they didn’t know, that the time was well spent, and they were also able to pick up two hours of continuing education unit credit towards relicensure.
One of our long-term goals is to encourage and develop the instructor pool. We couldn’t survive without it, and we’d like to give people positive recognition for it.
Do you think that the Navy in general has gone overboard on the issues of credentialing and quality assurance? Some doctors seem to think so.
In terms of credentialing, the intent behind what we are trying to do is good – the intent is to ensure people have the educational background, the training they need to be safe in their practice, and I have no qualms about that.
What we’re floundering so badly in is we don’t know how to document that. We really don’t know “what does it take? What are the minimum standards required to ensure somebody’s practice is safe and sound?”
And the big scare about it is, who’s to judge that? This, more than anything else, is the question people ask: “Who are you to sit and look over my file and tell me I’m not safe in my practice? On what grounds are you making that determination?” The problem is, we don’t have any solid grounds to make that determination.
You can look at things statistically and say “okay, statistically, he’s got more patients with complication than this guy over here.” However, you go back and look at it – well, he takes on higher risk patients than this guy who says “No, I don’t want to handle somebody because that may have a bad outcome.” And he says, “Well, whether this patient has a bad outcome or not, he needs help.” That’s what makes people nervous. “Where’s the criteria?” and that’s what we’re developing right now.
We’re very much in the infancy of this and as we get more sophisticated, as we learn what are distinguishing factors, then we will do much better with credentialing.
All the hoopla in the news media about military medicine and military medical care – what’s your opinion on some of these reports?
As a health care provider, I find it depressing. It’s demoralizing to say the least. In many ways we’re lucky, people are concerned about quality of health care. That’s a good sign. The problem is, how do you put it into perspective?
I’ve worked both in the civilian sector and in the military sector. Military health care, in my point of view, is excellent health care. If we fall down anywhere, it’s in our inter-personal relationships with our patients and it’s with a system that is set up where our primary purpose for being is something that hasn’t happened yet, dealing with a war-time situation.
Our secondary mission is to meet peacetime needs. So, you’re being pushed and pulled in two directions. You’ve got to train for something that might happen but hasn’t happened yet. You’ve got to spend the time to do that, but in the meantime, you have a job to do.
If you could say something to patients, what would you say?
I would say to them – it is their life, it is their health. And they have something very much at stake in maintaining and preserving their life and their body’s functions so that they can do the things they want to do in life. As an Education and Training department, we try on two levels to fulfill those needs.
The second thing we try and so is see that if there is a specific educational need of the health care consumer that we can meet either through setting up programs here at the hospital, through holding things like the health fair, or through giving out education and training pamphlets.
Let your needs be known and we will try and make the health care provider sensitive to listen for what those needs are and aware of where they can send the consumer to get those needs met.
If you had one thing you’d like to say to staff members about their education, about what you would like to encourage them to do, what would it be?
Education is a very personal and very individual thing and in order for them to get anything out of it at all, they have to be self-motivated.
You can teach all day and if the person you’re teaching isn’t interested and doesn’t care, nothing is going to get through. You can give a 15-minute quick-and-dirty to somebody who is really interested, and they will soak up every word you say and take your references and hand-outs and go back to read, and look, and dig, and get a tremendous amount out of it.
So, what I would like to say to staff is: Think about what you want to accomplish. Think about what your goals are and how you’re going to achieve them and if we don’t offer an education and training program that helps you further that, come and talk to us about it, because we certainly can develop one to meet your needs or there may be something there that does and you just don’t recognize it.
Are you glad to be in this position?
Very much so. Not because of the hours or the days, but because of the challenge. I don’t see too many positions that affect as many people as this one does, at all levels throughout the hospital. Ultimately, the real challenge it if we do our job right, people are going to get ‘good health care.