In one of the courses for my degree in Instructional Design, Development & Evaluation, our Professor, Phil Doughty, wouldn’t let us use the word “need.” And he was serious. We got called out, all semester, for using that word. We were forced to restate our point without using the word “need.” It was a moderately unpopular teaching technique amongst my classmates, and, while I felt like I understood it at the time, like any good life lesson, it means more and more to me as I go.
The teaching point was that until you do a valid needs assessment and a thoughtful analysis of what the barrier is to the desired performance, you have no business presuming the existence of a need. Many instructional interventions presume a “need” that may or may not actually exist – amongst academics it’s almost a reflex.
There are many things that get in the way of performance: lack of motivation, presence of barriers, organizational difficulties, lack of training/knowledge. In the arenas of medical education, clinical practice transformation, and quality improvement, we seem to forget that idea, and quickly presume an educational need. But more often, doctors, nurses and other members of the healthcare team know what should be done, but are constrained in their performance by other issues. Problem analysis should be the first step in problem solving: What could be impairing performance? What evidence do we have about each of these potential barriers. Once we identify these problems, we should be able to make better decisions about the appropriate interventions.