Blended-Learning at the 'Zorgboog'

2012 – De ‘Zorgboog’ (care arch) is an organization that delivers housing, welfare and health care to all generations. In the region of Helmond, the Netherlands over 2600 employees are working in nursing, care, home care, child health care and maternity care.

The Zorgboog has developed a digital learning environment, named the ‘Leerboog’ (learning arch). In an interview Hub Simons, manager HRM, Gaby Paulen, training consultant and Kirsten Godding, HRD consultant, tell about the drivers, the approach and results of a new way of educating.

Changing funding streams within the healthcare require increasing employees’ productivity. Furthermore more often quality agencies demand that quality is secured through training, increasing the demand for education. However the interest in traditional schooling is diminishing. Participants will receive a multitude of theoretical information to which they need to listen, while parts of this are irrelevant or already known. “The impact of traditional forms of  training is often small" says Kirsten Godding who has implemented and developed the new way of educating, together with others in the role of project leader.
Such developments require smart solutions and a different arrangement of the way of training of staff. For the transfer of theoretical knowledge, the Zorgboog finally opted for e-learning. This idea originated in June 2008. The Zorgboog had visited other organizations to get inspiration. In one of these hospitals they already made use of e -learning. Through this visit, the idea got more body and shape. In 2012 the entire organization is using the digital learning environment.

The following objectives underlie this project at the Zorgboog:
– Managing education and training efficiently (in terms of costs and time), while maintaining quality.
– Increasing the results of education and training.
– Get the message across that ‘learning is fun’. Employees have more control over their own development, and feel responsible for it.
– A uniform approach in training management and uniformity in registration.
The final mentioned objective was included because the Zorgboog is the result of a merger and therefore some things were organized inefficiently. For example, there was a lot of diversity between locations in the area of training and also a central up-to-date registration lacked. One of the aims of this project was to improve this.

The idea of e-learning was first tested with a number of nurses and managers within the organization. They responded very enthusiastically. Subsequently, the department Training has developed a business case and presented it to the Board. When the Board was enthusiastic as well and gave agreement a pilot project was launched. During a nine-month pilot the Zorgboog has offered the course ‘Business Assistance Grant’ and the course ‘Reserved & Risky Treatments’ using blended learning. Blended learning is a combination of e-learning and training on the job. It was chosen for these specific courses because with these you involve employees throughout the organization. So there was an organization-wide pilot. It was about 400 employees and more than 50 executives.
All participants have received an introduction digitally as well as a paper copy. Furthermore, there were walk-in clinics to take away the so called ‘cold feet’ feelings. About 25 percent of the participants in the pilot has visited these clinics. The secretariat of the department Training was fulfilling a help desk function for the employees. They can take over an account remotely to resolve a problem. Furthermore, at the start of the pilot there were created three flexible workplaces for employees who did not have a computer at home. However hardly anyone used it.
The objectives and results of the pilot have been evaluated and found to be a success in all aspects. Since September 2010, all 2,600 employees of the Zorgboog are learning through the digital learning system (named ‘Leerboog’, learning arch).

How does it work?
The Zorgboog facilitates its employees to keep their professional knowledge up to date,  in an attractive and efficient way. For example, the training for ‘Reserved & Risky treatment’ is offered through the learning arch. At a time that suits them, employees can learn and improve their professional skills online. The theoretical knowledge participants acquire through e -learning. In e-learning modules, the participant chooses learning activities that suit him or her.
Tim Lansink, graduate from the study Training and HRD, has developed a teaching model: the e-learning triangle, which serves as a starting point. The participant chooses a quiz, an exercise, a case study or learns the theory from a manual. This manual is suitable for various skill levels. Difficult words are defined using a mouse-over. Some pupils need this definition and call it; others know the word and therefore require no explanation. For those who wish for more depth, additional information is available. After completion of the theoretical final test, the participant follows the practical training, where skills are practiced. The skills are certified and the participant is qualified and competent. The figure below gives an idea of how the learning system works.
It was decided to ‘blended learning’, a combination of online and offline learning. The theory is presented in the digital learning environment in an attractive manner and supported with visual material. When employees have successfully finished  the theoretical test, they follow the practical training. In this way, employees start to work in practice well prepared, and there are fewer teaching hours needed, because the theory is not reviewed plenary. The trainer follows the progressions of participants on the basis of completed results in a particular case or practice test. Further, interaction among the participants is possible; participants can ask each other questions and provide feedback. The personal portfolio of the employee is automatically updated with his or her results. Both employee and supervisor see the results.
To a great extend the Training department itself develops training materials for the digital learning environment. Gaby Paulen illustrates the process thus: “First, learning objectives are established. Some learning objectives are at the level of knowledge and others refer to skills. The learning activity is chosen on the basis of the learning objectives: what is an appropriate learning activity. The next step is to develop the material or the training in practice.” At this time, the Zorgboog sees a shift in this area. There is an increasing exchange of material within the health care sector. This is done through a so-called online marketplace ‘Care Success’ and various networks. The Zorgboog puts certain demands of quality and the form that is used. It is their intention to work together with other organizations and trainers in the care sector in an even smarter way, in the future.


E-learning realizes customized training. Previously there was a two days training for everyone. Now every two years the employee studies only those parts of the theory that are relevant to him or her. They learn much more focused and fill only the gaps in their knowledge. They have self-control and responsibility for their learning. Hub Simons says the following: “The degree of flexibility for employees has increased. They can decide for themselves when they do what. So to speak, 24 hours a day." The motivation of employees to develop increases by this. A survey has shown that employees are generally enthusiastic about e -learning. Employees like the fact that they themselves have control. Some people report that they sometimes miss the book, but nevertheless they think that the organization does have to go on with it.
A positive trend is also seen at the level of the individual performance of the staff. The average grade in the digital testing is currently almost 9. Very high scores are achieved. In addition, employees show well prepared at the practical tests. Eventually  it should appear from quality research whether the quality of care has actually increased. It is certain that more time for caring rests by this new way of educating.
The new way of training is also easier to estimate in terms of budgets and to justify. There are fewer out-of-pocket costs, making budgeting easier. However, it does require an investment in programs. Within three years, the investment returned for the Zorgboog. Costs are saved because employees need fewer hours for the transfer of knowledge, thus less delay hours. On average, there has been a decrease of 50 percent of the lost time hours compared to the traditional way of training. As a result, the costs for the use of teachers decreased by half on average. Furthermore through the central registration, the Zorgboog can register the progress and performance better and can easily report them towards the inspection. The learning management system contains all relevant management information and there is an up-to-date overview available.

Next steps

At this time, the Zorgboog is thinking of offering by e-learning (in the Leerboog) the introduction program for new employees and parts of the course for supervisors. In addition, the Zorgboog wants to further improve the management information in the field of training. It is important to check whether the information generated matches the target critically.
The Zorgboog also would like to collaborate more with other organizations in the care-sector. “Our advantage should not be inhibitory; we would like to share with others" said Hub Simons. Currently the Regional Centre for education (ROC) uses  some modules. They also see that this has chances in the future and are working on a module together with the Zorgboog.
Finally, it should all be a bit flashier and more interactive. “We want to move with the times by working more with interactive images and videos and integrating social media. Variation in learning activities offers the pupil a learning opportunity that meets individual needs and preferences. We have to take into account limitations imposed by the current ICT-systems and the available time and budget" said Kirsten Godding.

The interviewees have some tips for other organizations that want to start such a program:
– Provide for a project manager and a steering committee who are responsible for results and progress. This gives ‘body’ to the project.
– During the orientation process, visit other organizations to gain inspiration. You do not have to reinvent the wheel yourself.
– Put it on the agenda of the Board of Directors and the Management Team because it is an organization-wide project.
– The role of the Training Department will change from consultant to (co)developer. Take this into account.
– Employee development is often imposed from above, now. It is difficult to change that. Understanding is necessary to put the responsibility actually among employees and let them have the control.
– Prepare the steps well. Take time at the beginning of the project to create support and make the right choices. Let people participate in the change process. A broad support is necessary for the success of the project!
– Good communication is very important. Involve the works council, the executives and employees from the beginning of the process.
– Start by identifying what you want reach and then decide which system fits. The purpose determines which system you choose. Make sure that you invent the IT side well in advance and that the system is connected to the personnel administration.
– Some of the employees will fear ‘cold feet’ at their first time to learn from the computer. This must be facilitated. In addition, a small group of employees will require extra attention because they cannot or don’t want to learn with the computer.
– The IT network must meet the requirements to host a digital learning environment. The bandwidth determines the speed of the internet. But the network should also be suitable for flash, movies and the computer need to have microphones.
– Make sure you ‘re the leader! You can distinguish as organization and employees show that you to inspire and tie them.

An information poster on the learning program is attached. More information can be found on the organizations website: