Improving Healthcare through Digitization: Assessing the Effectiveness of a Training Program for Employees at a Tertiary Care Hospital in South India

Improving Healthcare through Digitization: Assessing the Effectiveness of a Training Program for Employees at a Tertiary Care Hospital in South India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving Healthcare through Digitization: Assessing the Effectiveness of a Training Program for Employees at a Tertiary Care Hospital in South India Deekshitha Sanil, Harshavardhan Sai Sadineni, G. Somu, Roopa Priyanka D’Souza, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4160813/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The significance of information in the present era is unprecedented, and digitization has revolutionized industries and data storage methods. eLearning has emerged as a customised and cost-effective solution to address the limitations of traditional learning approaches. In a super-specialty tertiary care teaching hospital in South India, the need for effective and efficient training methods for nurses prompted the implementation of a newly developed digital learning tool. Methods This quasi-experimental pre-test post-test study involved 120 randomly selected nurses. A standardized questionnaire assessed the effectiveness and satisfaction levels of the newly implemented digital learning tool. Intervention: The hospital integrated the digital learning tool into the training program for nurses. Sensitized the participants through demonstrations, providing designated eLearning champions for support, and implementing a structured training process with pre-test, training material access, post-test, and feedback collection to assess effectiveness and satisfaction. Results The project yielded a net response rate of 83.3% among the recruited participants. Statistical analysis using Wilcoxon's Signed Rank test (p < 0.00001) and McNemar's test (p = 0.0077) demonstrated a significant increase in mean test scores and satisfaction rates after the implementation of the digital learning tool. Furthermore, a cost analysis revealed that the hospital saved a total value of Rs. 3,30,933.6/- through the newly implemented digitized training program. Conclusions This study highlights the importance and effectiveness of e-learning as a valuable learning tool for nurses, considering their work needs and conditions. Digitizing training processes enables hospitals to enhance training program coordination, monitor learner progress, and improve the learning experience. e-learning training nurses digitization cost analysis nursing education Figures Figure 1 INTRODUCTION Digitization involves converting non-digital records into digital formats, encompassing text, photos, maps, and more. [ 1 , 2 ] In healthcare, digitized training programs offer practical and accessible solutions to enhance performance and productivity. "eLearning" pertains to digital education, employing technology for remote learning. These methods include real-time and pause-resume techniques, including speech, video, networking, and computing. eLearning is further subdivided into Synchronous (learning that occurs in real time) and Asynchronous (learning that allows you to pause and resume at any time). [ 3 ] Numerous studies support eLearning's efficiency across sectors, with healthcare being no exception. Research shows significant improvements in knowledge, skills, attitudes, and notable cost savings. Implementing eLearning platforms in healthcare training has revolutionized traditional approaches, offering flexible learning while maintaining high-quality education standards. Initially, Burrhus laid the groundwork for modern e-learning in 1953 – 1956. The operant conditioning chamber devised by Skinner was known as the first teaching machine that elicited learners' responses by presenting problems and providing feedback for each answer. Later, he developed the first computer-based training (CBT) programs using "programmed instruction." [ 4 ] The rise of the internet in the mid - 1990s brought up new e-learning possibilities. WBT (web-based training) has become the most popular type of e-learning. Other factors that aided the spread of e-learning in the twenty-first century included the widespread availability of computers and portable devices and increased familiarity with information and communication technology. eLearning emerges as a pivotal tool empowering hospital staff to augment their learning without disrupting their demanding roles. The advantages are multifaceted, encompassing personalized training, cost-efficient solutions, and real-time feedback mechanisms. Given healthcare professionals' tightly packed schedules, flexible timelines and accelerated learning methods are essential, both facilitated by eLearning. A mere internet connection makes a wealth of knowledge accessible from anywhere, revolutionizing learning accessibility. Crucially, healthcare managers must oversee their workforce's learning progress. E-learning's data collection mechanism proves invaluable, not only in monitoring individual advancements but also in furnishing comprehensive statistical insights. The current study's objective encompassed transforming to a paperless training paradigm, spanning cost estimations, material digitization, assessments, and feedback collection. The study unveiled eLearning's value proposition in healthcare settings by dissecting expenditure categories. The effectiveness of eLearning is undeniable, as demonstrated by the improved learning outcomes and the satisfaction of all participants. It stands suitable for hospitals, indicating future program expansion viability. This study's significance is twofold: it addresses concerns prevalent in hospitals, particularly in India, regarding financial and technical barriers. It assuages apprehensions by demonstrating a guaranteed return on investment post-implementation. Enhanced learning experiences hold the potential to cultivate process efficiency as adept personnel seamlessly transfer newfound skills into practice, further elevating healthcare standards. METHODS This study adopted a quasi-experimental pre-test and post-test design to evaluate the effectiveness of digitization of training programs by assessing knowledge, perceptions, and experiences associated with it. The study targeted nurses of a 620 bedded, super-specialty tertiary care teaching hospital in Karnataka, India. A sample size of 30% of the study population was deemed adequate, enlisting 120 nurses using the random sampling approach. We achieved a net response rate of 83.3% and 100 complete responses used for the analysis, the study period lasting from January 2021 to April 2021, when the hospital was preparing to obtain its NABH accreditation. Observation of the existing training process adopted. The HR manager prepares an annual training schedule after consulting with the trainers and confirming the availability of the hall, scheduling at least 3 training programs every week. All departments received the circulated training schedules. NABH requires filing of all training records, so each training session prepared and printed pre-test, post-test, and feedback forms. The organization uses this to assess, analyse, and record each training activity. The employees were divided into batches based on availability, and a trainer was allotted to each set. A single trainer may have to train multiple batches on a single topic. After every training, the HR team manually evaluates and updates the scores of the staff and analyses the training feedback. The process's cost considerations were also explored by identifying contributing factors and calculating their net values. Developing the digitized training methods and tools. The training content was converted to video/pdf format and uploaded to one drive/ MS Teams. We assigned or hired instructors to present material for an online course. We provided the facilities for preparing, recording, and editing the material. We developed the pre-test, post-test, and feedback forms using MS forms. Implementation of the digitized learning tools. We sensitized the participants to the new training tool by demonstrating how to access the link and navigate the course. As most participants were over 35 and lacked digital literacy, each ward was assigned a designated eLearning champion to support and motivate staff to adopt eLearning. Whenever a problem arose, the champions would assist and guide the rest of their team members through the training phase. The HR team would share a training link with the employees, after which they logged in and completed the training within the specified time. The permission to access the link for the training is restricted within the organization and to specific employees, and authentication done by providing the participants with an official mail ID. The implementation process of the training links involved a sequence of steps. Upon clicking on the training link, participants were directed to the Microsoft login page to undergo authentication, requiring the use of valid credentials issued by the organization. Once authenticated, participants were guided to a pre-test form. After completing the pre-test, access was granted to the training material. This content was presented in various formats, such as video, PowerPoint, and PDF documents. Following the training phase, participants gained access to a post-test link, which they were required to complete within a specified time frame. Upon finishing the post-test, participants were provided with a feedback link, allowing them to share their insights and evaluations of the training experience. Assessing the effectiveness of the digitized training program The participants' satisfaction was assessed through their feedback via their responses in their questionnaires and during their interviews. During the eLearning demonstration class, participants were given the pre-assessment questionnaire. The assessment was conducted to evaluate the knowledge and perception of the participants towards implementing the new learning system. The first section of the questionnaire included demographic data such as age, qualification, designation, and work experience. The second section included questions to test respondents' perceptions of digitizing the training. Post-assessment was conducted after 4 weeks of digitization to study eLearning feedback among participants. The questionnaire assessed the effectiveness of training tools and preferred methods of learning. A Likert scale ranging from "Strongly agree "to "Strongly disagree" was used to capture the responses. The responses were entered and analysed using Microsoft Excel. McNemar's and Wilcoxon signed rank tests were then conducted using the EZR tool to analyse data and correlation. RESULTS 1. Estimating the expenditure in terms of cost of training activities. During the implementation of the project, cost contributors were identified, encompassing stationery consumables, electricity, and rental charges for the training hall. Stationary consumables accounted for expenses related to paper used for printing pre-test, post-test, feedback forms, and other learning materials. The estimation of building rental value per square foot was sourced from the administrative department. Additionally, electricity costs were calculated based on the total number of tube lights, fans, computers, microphones, projectors and their utilization hours. These components collectively formed the basis for assessing the project's expenditure. a) Cost of paper consumption in 2021 b) c) Month Total No of training sessions attended by the nurses Total no of paper utilized/month January 892 1784 February 1124 2248 March 854 1708 April 1280 2560 Table 1: Cost of paper consumption Number of papers required per person per training = 2 Average consumption of paper per month = 2075 Total number of paper consumption per year = 24900 Cost per paper = Rs.1/- ∴ Annual paper consumption cost = Rs.24900/- b) Cost estimation of electricity Area Electric device Capacity Watts Total numbers Usage HRs /month) Units consumed /month (watts) Training Hall Tube light 40 12 24 11,520 Ceiling fan 75 14 24 25,200 Mike 220 2 24 10,560 Computer 100 1 24 2,400 Projector 280 1 24 6,720 Total 56,400 Table 2: Electricity cost estimation At least three training programs, spanning two hours each, will be held in a week. Therefore, 12 training programs are conducted monthly and therefore the total training hours would be 24 hours a month. Energy consumption per month in units = 56,400/1000 = 56.4 KW Cost per unit=Rs.8.50 Cost of electricity utilized for training per month=56.4*8.5 = Rs.465.3 Cost of electricity utilized for training per year = 464.3*12 = Rs.5583.6 d) Training Hall rental value The rental value of the training hall is considered to be the opportunity cost. The approximate rental value and other details of the building was collected from the administrative office. Total area of the training hall = 800 ft 2 Rental Value per Square feet per month = Rs.30 Rent per month for training hall = 30 x 800 = Rs.24,000 Annual rental cost for the training hall = 24,000 X 12 = Rs. 2,88,000 Table 3: Training Hall rental value The annual training expenditure can be summarized as: Annual cost of paper Rs.37,350 Annual cost of electricity Rs.5583.6 Annual rental cost for the training hall Rs. 2,88,000 Total expense Rs. 3,30,933.6 Table 4: Annual training expenditure 2. Assessing the satisfaction of the digitized training program among the participants. Informal group interviews revealed that most nurses were excited and eager to adopt the new learning system because they could attend the training anywhere and at any time and learn at their own pace. They are not required to stay an extra hour to attend the training. Few nurses initially hesitated to change because they were concerned about the technology and worried that something would go wrong. It can sometimes be frustrating as technical glitches could prevent participants from completing the training. Participants were then given several demonstrations of online classes and opportunities for hands-on experience to help them overcome their fear and lack of digital literacy. Pre and Post-test questionnaires elicited responses from the participants on whether the current training system needs to be digitised before and after being introduced to a digitised training program. Initially, 10% of the 100 participants were unwilling to engage in digitized training programs, while 90% were willing to change and adopt a new learning system. However, after the training, 99% were willing to implement eLearning. All of the participants agreed that the course topics were presented and that it was beneficial to them because they could learn at their own pace and one’s leisure. 98% of the participants agreed that the online platform helped them better understand the subject and found the eLearning course more valuable and interesting when compared to traditional learning models previously practiced. Wilcoxon’s Signed Rank Test was used to test for significance difference in mean score of the pre-test and post-test after implementing the eLearning. Pre-test mean = 3.47 Post-test mean = 4.17 The Difference in mean of pre-test and post-test = 0.7 Hypothesis: H0: mean-pre = mean-post versus H1: mean-pre ≠ mean-post Wilcoxon’s Signed Rank test for significant difference in mean for paired samples resulted with a p value <0.00001 . Since the p value is less than 0.05, we reject the null hypothesis. Here the difference is statistically significant . This finding demonstrates that e-learning is an important and effective learning tool for nurses, considering their work needs and conditions. McNemar’s Test was used to test the significance of digitization of the training program. Post-test Total Yes No Pre-test Yes A (90) B (0) A+B = 90 No C (9) D (1) C+D = 10 Total A+C = 99 B+D = 1 N (100) Table 5: 2x2 Contingency table A - The number of participants who said yes in both Pre and post-test. B - The number of participants who said “yes” in Pre-test and said “No “in post- test. C - The number of participants who said “No” in Pre-test and said “Yes “in post- test. D - The number of participants who said “No” in both Pre-test and post-test. Here: A & D are Concordant pairs; B & C are Discordant pairs Hypothesis: H0: B – C = 0 versus H1: B – C ≠ 0 McNemar’s Test for significant difference in the discordant pairs resulted with a P value of 0.0077 , the difference was proved to be statistically significant. DISCUSSION As the study Hospital was pursuing a NABH accreditation, the need for and importance of employee training was emphasised during this time. The mandatory requirement to collect pre-tests, post-tests, and feedback for each training resulted in the use of a large amount of paper for printing materials and forms. Due to space constraints, storing these materials became a major issue for the organisation. Capturing attendance, manually assessing pre-test and post-test scores, and obtaining feedback added to the HR department's workload. Due to time constraints, health professionals frequently could not attend training, and additional time had to be set aside after working hours for training sessions. All of these factors favoured change and ensured a smooth transition into digitization. The findings of this study indicated that incorporating e-learning as part of the educational options available to nurses had a positive impact. Except for one participant who stated that it was more practical to take the traditional path for learning, 99 out of 100 respondents were willing to adopt a new learning system and agreed that digitization of current training mechanisms is necessary. This is in line with studies conducted by Dr. Wasmiy et al. [ 5 ] and Shashi Kant Dhir et al. [ 6 ], in Qatar and India, respectively, which found that e-learning courses have positively impacted participant satisfaction and were instrumental in transforming education at their institutions. Almost all of the nurses surveyed preferred online learning to traditional learning. The nurses were satisfied with the online format, which they described as convenient, flexible, and useful. These findings are consistent with literature that claim that nurses prefer a Web-based format because it provides convenience and flexibility. The efficiency of e-learning is attributed to learners gaining knowledge, skills, and attitudes more quickly than traditional instructor-led methods. [ 7 ] However, this is not the case everywhere, as other studies show that many nurses are dissatisfied with web-based formats, which can be changed by tackling barriers to proper implementation such as budget constraints; lack of institutional support, cooperation, and collaboration; insufficiently trained instructors; language barriers; an absence of e-learning policies; resistance to change; and accessibility issues. [ 8 , 9 ] Major factors that were initially thought to influence staff behaviour related to the adoption of e-learning included age and qualification, but there seemed to be little correlation between these variables in this particular study. A study conducted in Italy discovered that older people are less inclined to adjust themselves to technological changes [ 10 ], which will directly affect how older people would use e-learning modules. A study by Ahmed Maajoon in Saudi Arabia reported that people over 45 were less perceptive toward e-learning when compared to those under 44 years of age. [ 11 ] Thus, the overwhelming favourable responses obtained in our study could be attributed to the fact that 84% of our study participants fall below the age of 44 and were more inclined to adapt easily to change. Previous research has shown that persons with a significantly higher academic and professional education benefit the most from e-learning. And since all of our participants were working professionals with a diploma or bachelor's degree, their responses could not be compared to those who did not have such educational qualifications. It was also found that all of the study participants had previously been exposed to similar technology. This could have been a contributing factor influencing their decision to adopt eLearning. These results are supported by a study conducted in the UK which found that persons with better digital literacy have more positive attitudes and actions when it comes to adopting new technology. [ 12 ] Uniform metrics are required to track the links between learning and performance [ 13 ], and the success of a learning method is reflected in both the online course assessment and the participants' enthusiasm. [ 14 ] In order to explore the effectiveness of e-learning on the participants' knowledge, a Wilcoxon's signed rank test was conducted to check the significance of the difference found in mean scores of the pre-test (3.47) and of the post-test (4.17). The difference in pre-test and post-test mean scores was 0.7 (p < 0.00001), indicating that the difference is statistically significant. Studies suggest that eLearning can save 68% on annual training expenditures [ 15 ] and that web-based training can reduce up to 70% of an organization's training budgets by eliminating training materials and time/energy spent on unrelated tasks involved in training processes. [ 16 ] Savings associated with the realisation of learning opportunities, such as travel requirements and physical facilities, are also significant. [ 17 ] Similarly, in this study, the newly implemented digitizing training saved the organization a total value of Rs. 3,30,933.6/- and no additional costs were encountered during this initial implementation phase. The higher proportion of the expenditure was infrastructural costs, represented by the annual rental cost for the training hall of Rs. 2.88.000/-, followed by Stationary consumables valued as the annual cost of paper of Rs. 37,350 and the annual cost of electricity Rs. 5,583. The cost of electricity was calculated based on the number of hours the gadgets were utilized rather than the meter capture. In terms of cost reductions, blended eLearning training methods combining the best features of e-learning and traditional models have yielded similar outcomes. According to a study by Mysha Sissine et al. on the expenses of training community health workers (CHWs) in Sub-Saharan Africa, a blended strategy saves up to 67 percent over a traditional method. [ 18 ] CONCLUSION Hospitals maintain competitiveness and improve patient care through continuous and practical staff training. The staff of a hospital is its most valuable asset, and their performance has the most significant impact on the quality of patient care. As a result, it is vital to educate employees, support their professional growth, and ensure they are satisfied with their jobs. Hospitals can better coordinate training programs, monitor learner progress, and improve the learning experience by digitizing the training process, all while saving money. Digitization ensures a cost-effective, accessible, and flexible system that dramatically expands opportunities for lifelong learning. It could be one of the most effective staff education tools, particularly during challenging times like the Covid-19 pandemic. It also fosters a learner's proactive learning, resulting in an effective knowledge transfer, and is appropriate for practically every age group, meeting healthcare professionals' needs and working conditions. Promoting digital literacy is critical for a successful implementation, as is providing adequate training on using the technology. Digital literacy is no longer the domain of a select few professionals. Everyone in the health and social care industry requires strong digital capabilities and the knowledge, skills, and attitudes to do their jobs effectively. This study only covers the first phase of implementation; there is still much room for improvement in both the technology used and the development of training materials, providing additional benefits that will undoubtedly lead to even better results. Only immediate, short-term impacts were evaluated in pre and post-test assessments. Furthermore, the outcomes of this study cannot be generalized to other hospital settings due to variances in hospital infrastructure, staff perceptions of digitalization, and managerial support. More research is needed to determine the long-term impacts of online learning on nursing staff and their capacity to apply what they have learned in clinical and professional settings. Declarations STATEMENTS AND DECLARATIONS Acknowledgments The authors express their gratitude to the study hospital's nurses and staff, along with the eLearning champions, for their invaluable cooperation and support throughout the project. Competing Interests There are no competing interests in relation to the implementation and outcomes of this digitized training program. The project was undertaken solely to enhance training methods and improve learning experiences for the participants. All parties involved were dedicated to the successful execution of the project without any conflicts of interest. Ethics Approval Ethical considerations were an integral part of this project's implementation. The study followed the guidelines and approval of the relevant research ethics committee, ensuring that all aspects of the digitized training program adhered to ethical standards and considerations. Funding: No funding was received for this study hence Not Applicable References Information and documentation - Implementation guidelines for digitization of records. (2006). ISO.Org. https://www.iso.org/obp/ui/#iso:std:iso:tr:13028:ed-1:v1:en . Government Records Office, Manitoba Aof. May 2018. https://www.gov.mb.ca/chc/archives/gro/recordkeeping/docs/digitizing_records.pdf . What are Synchronous and Asynchronous eLearning. (2014). Commlabindia.Com. https://blog.commlabindia.com/elearningdesign/typesofelearning . Merzouk A, Kurosinski P. Konstantinos Kostikas. e-Learning for the medical team: the present and future of ERS Learning Resources, Vol 10, No 4, 2014. 10.1183/20734735.008814 . Dr WA, Dalhem, Noha Saleh. The impact of eLearning on nurses’ professional knowledge and practice in HMC. Can J Nurs Inf, 9, 3,4, 2014. Dhir SK, Verma D. Meenal Batta and Devendra Mishra. E- Learning in Medical Education in India, volume 54, October 15, 2017. Erica A, Nicholson. 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Allison Hodges. Corporate e-learning: how three healthcare companies implement and measure the effectiveness of e-learning, 2009. Reviriego E, Cidoncha MA, Asua J, Gagnon MP, Mateos M, Garate L. Elena de Lorenzo, and Rosa María González, Online training course on critical appraisal for nurses: adaptation and assessment. BMC Med Educ. 2014;14:136. Savvidis, The Benefits of an LMS for Hospitals. (2018), Webanywhere.Com. https://www.webanywhere.com/2018/06/18/the-benefits-of-an-lms- for-hospitals/ . Atreja A, Mehta NB, Jain AK, et al. Satisfaction with web-based training in an integrated healthcare delivery network: do age, education, computer skills and attitudes matter? BMC Med Educ. 2008;8:48. https://doi.org/10.1186/1472-6920-8-48 . Arkorful V, Abaidoo N. December. The role of e-learning, the advantages, and disadvantages of its adoption in Higher Education. Int J Educ Res, 2 12 2014. Mysha Sissine R, Segan M, Taylor B, Jefferson A, Borrelli M, Koehler. Meena Chelvayohan. Cost Comparison Model: Blended eLearning versus traditional training of community health workers. Online J Public Health Inf. 2014;6(3):e196. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Somu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYPACGyBmbGBgKADSB4jTkgbVYkC8lsNQmhgt8u3daRIMv85H889ubnvww4BBju9GAn4tBmfObpNg7LudO+POwXbDHgMGY0mCWiRygVp6buc23Ehsk+AxYEjcQEiL/AywlnO584FaJP8YMNQT1MJwA6iF4ceB3A1ALdJAWxIMiPDLZovEhuTcjTcS241lDCQMZ555QMBh7b0bb3z4Y5c770b6s4dvKmzk+Y4TchgIJLaBKTYgliBCORj8gWsZBaNgFIyCUYAJAPVUSphwgxDFAAAAAElFTkSuQmCC","orcid":"","institution":"Kasturba Medical College, Manipal academy of higher education","correspondingAuthor":true,"prefix":"","firstName":"G.","middleName":"","lastName":"Somu","suffix":""},{"id":283993282,"identity":"68a957b2-7918-4fe0-bee8-958104673fb2","order_by":3,"name":"Roopa Priyanka D’Souza","email":"","orcid":"","institution":"KMC hospital Attavar","correspondingAuthor":false,"prefix":"","firstName":"Roopa","middleName":"Priyanka","lastName":"D’Souza","suffix":""},{"id":283993284,"identity":"0528d364-b4ce-43b5-a0a0-cb30fee5539c","order_by":4,"name":"Rajesh Kamath","email":"","orcid":"","institution":"Manipal academy of higher education","correspondingAuthor":false,"prefix":"","firstName":"Rajesh","middleName":"","lastName":"Kamath","suffix":""}],"badges":[],"createdAt":"2024-03-25 05:17:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4160813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4160813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53774577,"identity":"85ae6d03-25d0-4854-a727-5a145bea8803","added_by":"auto","created_at":"2024-03-30 07:48:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143893,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExisting training mechanism\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-4160813/v1/b4dbc94b528e72764e6e737e.png"},{"id":53938045,"identity":"1ca66c0d-ce9f-4fb3-8dc8-3b5049723787","added_by":"auto","created_at":"2024-04-02 12:38:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":681104,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4160813/v1/d9954d35-ae2c-4bd1-a65c-3243a7160d47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Healthcare through Digitization: Assessing the Effectiveness of a Training Program for Employees at a Tertiary Care Hospital in South India","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDigitization involves converting non-digital records into digital formats, encompassing text, photos, maps, and more. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] In healthcare, digitized training programs offer practical and accessible solutions to enhance performance and productivity. \"eLearning\" pertains to digital education, employing technology for remote learning. These methods include real-time and pause-resume techniques, including speech, video, networking, and computing. eLearning is further subdivided into Synchronous (learning that occurs in real time) and Asynchronous (learning that allows you to pause and resume at any time). [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Numerous studies support eLearning's efficiency across sectors, with healthcare being no exception. Research shows significant improvements in knowledge, skills, attitudes, and notable cost savings. Implementing eLearning platforms in healthcare training has revolutionized traditional approaches, offering flexible learning while maintaining high-quality education standards.\u003c/p\u003e \u003cp\u003eInitially, Burrhus laid the groundwork for modern e-learning in 1953\u003cb\u003e\u0026ndash;\u003c/b\u003e1956. The operant conditioning chamber devised by Skinner was known as the first teaching machine that elicited learners' responses by presenting problems and providing feedback for each answer. Later, he developed the first computer-based training (CBT) programs using \"programmed instruction.\" [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The rise of the internet in the mid\u003cb\u003e-\u003c/b\u003e1990s brought up new e-learning possibilities. WBT (web-based training) has become the most popular type of e-learning. Other factors that aided the spread of e-learning in the twenty-first century included the widespread availability of computers and portable devices and increased familiarity with information and communication technology.\u003c/p\u003e \u003cp\u003eeLearning emerges as a pivotal tool empowering hospital staff to augment their learning without disrupting their demanding roles. The advantages are multifaceted, encompassing personalized training, cost-efficient solutions, and real-time feedback mechanisms. Given healthcare professionals' tightly packed schedules, flexible timelines and accelerated learning methods are essential, both facilitated by eLearning. A mere internet connection makes a wealth of knowledge accessible from anywhere, revolutionizing learning accessibility.\u003c/p\u003e \u003cp\u003eCrucially, healthcare managers must oversee their workforce's learning progress. E-learning's data collection mechanism proves invaluable, not only in monitoring individual advancements but also in furnishing comprehensive statistical insights. The current study's objective encompassed transforming to a paperless training paradigm, spanning cost estimations, material digitization, assessments, and feedback collection. The study unveiled eLearning's value proposition in healthcare settings by dissecting expenditure categories.\u003c/p\u003e \u003cp\u003eThe effectiveness of eLearning is undeniable, as demonstrated by the improved learning outcomes and the satisfaction of all participants. It stands suitable for hospitals, indicating future program expansion viability. This study's significance is twofold: it addresses concerns prevalent in hospitals, particularly in India, regarding financial and technical barriers. It assuages apprehensions by demonstrating a guaranteed return on investment post-implementation. Enhanced learning experiences hold the potential to cultivate process efficiency as adept personnel seamlessly transfer newfound skills into practice, further elevating healthcare standards.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study adopted a quasi-experimental pre-test and post-test design to evaluate the effectiveness of digitization of training programs by assessing knowledge, perceptions, and experiences associated with it. The study targeted nurses of a 620 bedded, super-specialty tertiary care teaching hospital in Karnataka, India. A sample size of 30% of the study population was deemed adequate, enlisting 120 nurses using the random sampling approach. We achieved a net response rate of 83.3% and 100 complete responses used for the analysis, the study period lasting from January 2021 to April 2021, when the hospital was preparing to obtain its NABH accreditation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObservation of the existing training process adopted.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe HR manager prepares an annual training schedule after consulting with the trainers and confirming the availability of the hall, scheduling at least 3 training programs every week. All departments received the circulated training schedules. NABH requires filing of all training records, so each training session prepared and printed pre-test, post-test, and feedback forms. The organization uses this to assess, analyse, and record each training activity. The employees were divided into batches based on availability, and a trainer was allotted to each set. A single trainer may have to train multiple batches on a single topic. After every training, the HR team manually evaluates and updates the scores of the staff and analyses the training feedback. The process's cost considerations were also explored by identifying contributing factors and calculating their net values.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eDeveloping the digitized training methods and tools.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe training content was converted to video/pdf format and uploaded to one drive/ MS Teams. We assigned or hired instructors to present material for an online course. We provided the facilities for preparing, recording, and editing the material. We developed the pre-test, post-test, and feedback forms using MS forms.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplementation of the digitized learning tools.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe sensitized the participants to the new training tool by demonstrating how to access the link and navigate the course. As most participants were over 35 and lacked digital literacy, each ward was assigned a designated eLearning champion to support and motivate staff to adopt eLearning. Whenever a problem arose, the champions would assist and guide the rest of their team members through the training phase.\u003c/p\u003e\u003cp\u003eThe HR team would share a training link with the employees, after which they logged in and completed the training within the specified time. The permission to access the link for the training is restricted within the organization and to specific employees, and authentication done by providing the participants with an official mail ID.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe implementation process of the training links involved a sequence of steps. Upon clicking on the training link, participants were directed to the Microsoft login page to undergo authentication, requiring the use of valid credentials issued by the organization. Once authenticated, participants were guided to a pre-test form. After completing the pre-test, access was granted to the training material. This content was presented in various formats, such as video, PowerPoint, and PDF documents. Following the training phase, participants gained access to a post-test link, which they were required to complete within a specified time frame. Upon finishing the post-test, participants were provided with a feedback link, allowing them to share their insights and evaluations of the training experience.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAssessing the effectiveness of the digitized training program\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e The participants' satisfaction was assessed through their feedback via their responses in their questionnaires and during their interviews.\u003c/p\u003e\u003cp\u003eDuring the eLearning demonstration class, participants were given the pre-assessment questionnaire. The assessment was conducted to evaluate the knowledge and perception of the participants towards implementing the new learning system. The first section of the questionnaire included demographic data such as age, qualification, designation, and work experience. The second section included questions to test respondents' perceptions of digitizing the training.\u003c/p\u003e\u003cp\u003ePost-assessment was conducted after 4 weeks of digitization to study eLearning feedback among participants. The questionnaire assessed the effectiveness of training tools and preferred methods of learning. A Likert scale ranging from \"Strongly agree \"to \"Strongly disagree\" was used to capture the responses. The responses were entered and analysed using Microsoft Excel. McNemar's and Wilcoxon signed rank tests were then conducted using the EZR tool to analyse data and correlation.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003e1. \u0026nbsp; Estimating the expenditure in terms of cost of training activities.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the implementation of the project, cost contributors were identified, encompassing stationery consumables, electricity, and rental charges for the training hall. Stationary consumables accounted for expenses related to paper used for printing pre-test, post-test, feedback forms, and other learning materials. The estimation of building rental value per square foot was sourced from the administrative department. Additionally, electricity costs were calculated based on the total number of tube lights, fans, computers, microphones, projectors and their utilization hours. These components collectively formed the basis for assessing the project\u0026apos;s expenditure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) \u0026nbsp; Cost of paper consumption in 2021\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64154786150713%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eb) \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ec) \u0026nbsp; Month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.67820773930754%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No of training sessions attended by\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ethe nurses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.680244399185337%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal no of paper\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eutilized/month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64154786150713%\" valign=\"top\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.67820773930754%\" valign=\"top\"\u003e\n \u003cp\u003e892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.680244399185337%\" valign=\"top\"\u003e\n \u003cp\u003e1784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64154786150713%\" valign=\"top\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.67820773930754%\" valign=\"top\"\u003e\n \u003cp\u003e1124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.680244399185337%\" valign=\"top\"\u003e\n \u003cp\u003e2248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64154786150713%\" valign=\"top\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.67820773930754%\" valign=\"top\"\u003e\n \u003cp\u003e854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.680244399185337%\" valign=\"top\"\u003e\n \u003cp\u003e1708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64154786150713%\" valign=\"top\"\u003e\n \u003cp\u003eApril\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.67820773930754%\" valign=\"top\"\u003e\n \u003cp\u003e1280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.680244399185337%\" valign=\"top\"\u003e\n \u003cp\u003e2560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Cost of paper consumption\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNumber of papers required per person per training = 2\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAverage consumption of paper per month = 2075\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTotal number of paper consumption per year = 24900\u003c/p\u003e\n\u003cp\u003eCost per paper = Rs.1/-\u003c/p\u003e\n\u003cp\u003e\u0026there4; Annual paper consumption cost = \u003cstrong\u003eRs.24900/-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Cost estimation of electricity\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eArea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eElectric device\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCapacity Watts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal numbers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUsage HRs /month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnits\u0026nbsp;consumed\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e/month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e(watts)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003eTraining Hall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003eTube light\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e11,520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003eCeiling fan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e25,200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003eMike\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e10,560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003eComputer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e2,400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003eProjector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e6,720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.160228898426324%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.602288984263232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.165951359084406%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.314735336194563%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e56,400\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Electricity cost estimation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt least three training programs, spanning two hours each, will be held in a week. Therefore, 12 training programs are conducted monthly and therefore the total training hours would be 24 hours a month.\u003c/p\u003e\n\u003cp\u003eEnergy consumption per month in units = 56,400/1000 = 56.4 KW\u003c/p\u003e\n\u003cp\u003eCost per unit=Rs.8.50\u003c/p\u003e\n\u003cp\u003eCost of electricity utilized for training per month=56.4*8.5 = Rs.465.3\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCost of electricity utilized for training per year = 464.3*12 = Rs.5583.6\u003c/p\u003e\n\u003cp\u003ed) \u0026nbsp; \u003cstrong\u003eTraining Hall rental value\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rental value of the training hall is considered to be the opportunity cost. The approximate rental value and other details of the building was collected from the administrative office.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"63.63636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal area of the training hall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e= 800 ft\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"63.63636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRental Value per Square feet per month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e= Rs.30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"63.63636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRent per month for training hall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e= 30 x 800\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e= \u003cstrong\u003eRs.24,000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"63.63636363636363%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual rental cost for the training hall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.36363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e= \u003cstrong\u003e24,000 X 12\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e= Rs. 2,88,000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Training Hall rental value\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe annual training expenditure can be summarized as:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.705882352941174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual cost of paper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRs.37,350\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.705882352941174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual cost of electricity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRs.5583.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.705882352941174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual rental cost for the training hall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRs. 2,88,000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.705882352941174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal expense\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"55.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRs. 3,30,933.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Annual training expenditure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. \u0026nbsp; Assessing the satisfaction of the digitized training program among the participants.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformal group interviews\u003c/strong\u003e revealed that most nurses were excited and eager to adopt the new learning system because they could attend the training anywhere and at any time and learn at their own pace. They are not required to stay an extra hour to attend the training. Few nurses initially hesitated to change because they were concerned about the technology and worried that something would go wrong. It can sometimes be frustrating as technical glitches could prevent participants from completing the training. Participants were then given several demonstrations of online classes and opportunities for hands-on experience to help them overcome their fear and lack of digital literacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePre and Post-test questionnaires\u0026nbsp;\u003c/strong\u003eelicited responses from the participants on whether the current training system needs to be digitised before and after being introduced to a digitised training program. Initially, 10% of the 100 participants were unwilling to engage in digitized training programs, while 90% were willing to change and adopt a new learning system. However, after the training, 99% were willing to implement eLearning. All of the participants agreed that the course topics were presented and that it was beneficial to them because they could learn at their own pace and one\u0026rsquo;s leisure. 98% of the participants agreed that the online platform helped them better understand the subject and found the eLearning course more valuable and interesting when compared to traditional learning models previously practiced.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWilcoxon\u0026rsquo;s Signed Rank\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Test\u003c/strong\u003e was used to test for significance difference in mean score of the pre-test and post-test after implementing the eLearning.\u003c/p\u003e\n\u003cp\u003ePre-test mean = 3.47\u003c/p\u003e\n\u003cp\u003ePost-test mean = 4.17\u003c/p\u003e\n\u003cp\u003eThe Difference in mean of pre-test and post-test = 0.7\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis:\u003c/strong\u003e H0: mean-pre = mean-post versus H1: mean-pre \u0026ne; mean-post\u003c/p\u003e\n\u003cp\u003eWilcoxon\u0026rsquo;s Signed\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eRank test for significant difference in mean for paired samples resulted with a p value \u003cstrong\u003e\u0026lt;0.00001\u003c/strong\u003e. Since the p value is less than 0.05, we reject the null hypothesis. Here the difference is \u003cstrong\u003estatistically significant\u003c/strong\u003e. This finding demonstrates that e-learning is an important and effective learning tool for nurses, considering their work needs and conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMcNemar\u0026rsquo;s Test\u003c/strong\u003e was used to test the significance of digitization of the training program.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.07421150278293%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.332096474953616%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59369202226345%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.037105751391465%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.037105751391465%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.666048237476808%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eA (90)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.666048237476808%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB (0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59369202226345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eA+B = 90\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.05800464037123%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.593967517401392%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eC (9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.593967517401392%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eD (1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.754060324825986%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eC+D = 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.05800464037123%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.593967517401392%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eA+C = 99\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.593967517401392%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eB+D = 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.754060324825986%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: 2x2 Contingency table\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA - The number of participants who said yes in both Pre and post-test.\u003c/p\u003e\n\u003cp\u003eB - The number of participants who said \u0026ldquo;yes\u0026rdquo; in Pre-test and said \u0026ldquo;No \u0026ldquo;in post- test.\u003c/p\u003e\n\u003cp\u003eC - The number of participants who said \u0026ldquo;No\u0026rdquo; in Pre-test and said \u0026ldquo;Yes \u0026ldquo;in post- test.\u003c/p\u003e\n\u003cp\u003eD - The number of participants who said \u0026ldquo;No\u0026rdquo; in both Pre-test and post-test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHere: A \u0026amp; D are Concordant pairs; B \u0026amp; C are Discordant pairs\u003c/p\u003e\n\u003cp\u003eHypothesis:\u0026nbsp;H0: B \u0026ndash; C = 0 versus H1: B \u0026ndash; C \u0026ne; 0\u003c/p\u003e\n\u003cp\u003eMcNemar\u0026rsquo;s Test for significant difference in the discordant pairs resulted with a P value of \u003cstrong\u003e0.0077\u003c/strong\u003e, the difference was proved to be \u003cstrong\u003estatistically significant.\u003c/strong\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAs the study Hospital was pursuing a NABH accreditation, the need for and importance of employee training was emphasised during this time. The mandatory requirement to collect pre-tests, post-tests, and feedback for each training resulted in the use of a large amount of paper for printing materials and forms. Due to space constraints, storing these materials became a major issue for the organisation. Capturing attendance, manually assessing pre-test and post-test scores, and obtaining feedback added to the HR department's workload. Due to time constraints, health professionals frequently could not attend training, and additional time had to be set aside after working hours for training sessions. All of these factors favoured change and ensured a smooth transition into digitization.\u003c/p\u003e \u003cp\u003eThe findings of this study indicated that incorporating e-learning as part of the educational options available to nurses had a positive impact. Except for one participant who stated that it was more practical to take the traditional path for learning, 99 out of 100 respondents were willing to adopt a new learning system and agreed that digitization of current training mechanisms is necessary. This is in line with studies conducted by Dr. Wasmiy et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and Shashi Kant Dhir et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], in Qatar and India, respectively, which found that e-learning courses have positively impacted participant satisfaction and were instrumental in transforming education at their institutions.\u003c/p\u003e \u003cp\u003eAlmost all of the nurses surveyed preferred online learning to traditional learning. The nurses were satisfied with the online format, which they described as convenient, flexible, and useful. These findings are consistent with literature that claim that nurses prefer a Web-based format because it provides convenience and flexibility. The efficiency of e-learning is attributed to learners gaining knowledge, skills, and attitudes more quickly than traditional instructor-led methods. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] However, this is not the case everywhere, as other studies show that many nurses are dissatisfied with web-based formats, which can be changed by tackling barriers to proper implementation such as budget constraints; lack of institutional support, cooperation, and collaboration; insufficiently trained instructors; language barriers; an absence of e-learning policies; resistance to change; and accessibility issues. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMajor factors that were initially thought to influence staff behaviour related to the adoption of e-learning included age and qualification, but there seemed to be little correlation between these variables in this particular study. A study conducted in Italy discovered that older people are less inclined to adjust themselves to technological changes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which will directly affect how older people would use e-learning modules. A study by Ahmed Maajoon in Saudi Arabia reported that people over 45 were less perceptive toward e-learning when compared to those under 44 years of age. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Thus, the overwhelming favourable responses obtained in our study could be attributed to the fact that 84% of our study participants fall below the age of 44 and were more inclined to adapt easily to change. Previous research has shown that persons with a significantly higher academic and professional education benefit the most from e-learning. And since all of our participants were working professionals with a diploma or bachelor's degree, their responses could not be compared to those who did not have such educational qualifications. It was also found that all of the study participants had previously been exposed to similar technology. This could have been a contributing factor influencing their decision to adopt eLearning. These results are supported by a study conducted in the UK which found that persons with better digital literacy have more positive attitudes and actions when it comes to adopting new technology. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eUniform metrics are required to track the links between learning and performance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and the success of a learning method is reflected in both the online course assessment and the participants' enthusiasm. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In order to explore the effectiveness of e-learning on the participants' knowledge, a Wilcoxon's signed rank test was conducted to check the significance of the difference found in mean scores of the pre-test (3.47) and of the post-test (4.17). The difference in pre-test and post-test mean scores was 0.7 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001), indicating that the difference is statistically significant.\u003c/p\u003e \u003cp\u003eStudies suggest that eLearning can save 68% on annual training expenditures [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and that web-based training can reduce up to 70% of an organization's training budgets by eliminating training materials and time/energy spent on unrelated tasks involved in training processes. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Savings associated with the realisation of learning opportunities, such as travel requirements and physical facilities, are also significant. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Similarly, in this study, the newly implemented digitizing training saved the organization a total value of Rs. 3,30,933.6/- and no additional costs were encountered during this initial implementation phase. The higher proportion of the expenditure was infrastructural costs, represented by the annual rental cost for the training hall of Rs. 2.88.000/-, followed by Stationary consumables valued as the annual cost of paper of Rs. 37,350 and the annual cost of electricity Rs. 5,583. The cost of electricity was calculated based on the number of hours the gadgets were utilized rather than the meter capture. In terms of cost reductions, blended eLearning training methods combining the best features of e-learning and traditional models have yielded similar outcomes. According to a study by Mysha Sissine et al. on the expenses of training community health workers (CHWs) in Sub-Saharan Africa, a blended strategy saves up to 67 percent over a traditional method. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eHospitals maintain competitiveness and improve patient care through continuous and practical staff training. The staff of a hospital is its most valuable asset, and their performance has the most significant impact on the quality of patient care. As a result, it is vital to educate employees, support their professional growth, and ensure they are satisfied with their jobs. Hospitals can better coordinate training programs, monitor learner progress, and improve the learning experience by digitizing the training process, all while saving money. Digitization ensures a cost-effective, accessible, and flexible system that dramatically expands opportunities for lifelong learning. It could be one of the most effective staff education tools, particularly during challenging times like the Covid-19 pandemic. It also fosters a learner's proactive learning, resulting in an effective knowledge transfer, and is appropriate for practically every age group, meeting healthcare professionals' needs and working conditions. Promoting digital literacy is critical for a successful implementation, as is providing adequate training on using the technology. Digital literacy is no longer the domain of a select few professionals. Everyone in the health and social care industry requires strong digital capabilities and the knowledge, skills, and attitudes to do their jobs effectively.\u003c/p\u003e \u003cp\u003eThis study only covers the first phase of implementation; there is still much room for improvement in both the technology used and the development of training materials, providing additional benefits that will undoubtedly lead to even better results. Only immediate, short-term impacts were evaluated in pre and post-test assessments. Furthermore, the outcomes of this study cannot be generalized to other hospital settings due to variances in hospital infrastructure, staff perceptions of digitalization, and managerial support. More research is needed to determine the long-term impacts of online learning on nursing staff and their capacity to apply what they have learned in clinical and professional settings.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSTATEMENTS AND DECLARATIONS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to the study hospital\u0026apos;s nurses and staff, along with the eLearning champions, for their invaluable cooperation and support throughout the project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests in relation to the implementation and outcomes of this digitized training program. The project was undertaken solely to enhance training methods and improve learning experiences for the participants. All parties involved were dedicated to the successful execution of the project without any conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical considerations were an integral part of this project\u0026apos;s implementation. The study followed the guidelines and approval of the relevant research ethics committee, ensuring that all aspects of the digitized training program adhered to ethical standards and considerations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study hence Not Applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInformation and documentation - Implementation guidelines for digitization of records. (2006). ISO.Org. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.iso.org/obp/ui/#iso:std:iso:tr:13028:ed-1:v1:en\u003c/span\u003e\u003cspan address=\"https://www.iso.org/obp/ui/#iso:std:iso:tr:13028:ed-1:v1:en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovernment Records Office, Manitoba Aof. May 2018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.mb.ca/chc/archives/gro/recordkeeping/docs/digitizing_records.pdf\u003c/span\u003e\u003cspan address=\"https://www.gov.mb.ca/chc/archives/gro/recordkeeping/docs/digitizing_records.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhat are Synchronous and Asynchronous eLearning. (2014). Commlabindia.Com. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blog.commlabindia.com/elearningdesign/typesofelearning\u003c/span\u003e\u003cspan address=\"https://blog.commlabindia.com/elearningdesign/typesofelearning\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMerzouk A, Kurosinski P. Konstantinos Kostikas. e-Learning for the medical team: the present and future of ERS Learning Resources, Vol 10, No 4, 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1183/20734735.008814\u003c/span\u003e\u003cspan address=\"10.1183/20734735.008814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDr WA, Dalhem, Noha Saleh. The impact of eLearning on nurses\u0026rsquo; professional knowledge and practice in HMC. Can J Nurs Inf, 9, 3,4, 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhir SK, Verma D. Meenal Batta and Devendra Mishra. E- Learning in Medical Education in India, volume 54, October 15, 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErica A, Nicholson. E-Learning in Nursing: The Effectiveness of Interactivity. Antonian Scholars Honors Program, 8, 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHend M, Al-Azazy SE, Sayed, Ahmed. The efficacy of two teaching methods on nurse\u0026rsquo;s knowledge regarding hepatic encephalopathy, 2014, 6:9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexis Harerimana NG, Mtshali H, Hewing F, Maniriho. Emmanuel Borauzima Kyamusoke3, Agn\u0026egrave;s Mukankaka, Emile Rukundo, Sylvestre Gasurira, Donatilla Mukamana, John Mugarura. E- Learning in Nursing Education in Rwanda: Benefits and Challenges. An Exploration of Participants\u0026rsquo; Perceptives, \u003cem\u003eVolume 5, Issue 2, PP 64\u0026ndash;92\u003c/em\u003e, 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValeria de Palo P, Limone L, Monacis F, Ceglie M, Sinatra. Enhancing e-learning in old age, Australian Journal of Adult Learning, 2018. Volume 58, Number 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed Maajoon, Alenezi MA. Faculty Members\u0026rsquo; Perception of E-learning in Higher Education in the Kingdom of Saudi Arabia. Texas Tech University; May 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCumming I, Davies J. Improving Digital Literacy, 2017, Health Education England, NHS, RCN publication code: 006129.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllison Hodges. Corporate e-learning: how three healthcare companies implement and measure the effectiveness of e-learning, 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReviriego E, Cidoncha MA, Asua J, Gagnon MP, Mateos M, Garate L. Elena de Lorenzo, and Rosa Mar\u0026iacute;a Gonz\u0026aacute;lez, Online training course on critical appraisal for nurses: adaptation and assessment. BMC Med Educ. 2014;14:136.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavvidis, The Benefits of an LMS for Hospitals. (2018), Webanywhere.Com. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.webanywhere.com/2018/06/18/the-benefits-of-an-lms- for-hospitals/\u003c/span\u003e\u003cspan address=\"https://www.webanywhere.com/2018/06/18/the-benefits-of-an-lms- for-hospitals/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtreja A, Mehta NB, Jain AK, et al. Satisfaction with web-based training in an integrated healthcare delivery network: do age, education, computer skills and attitudes matter? BMC Med Educ. 2008;8:48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1472-6920-8-48\u003c/span\u003e\u003cspan address=\"10.1186/1472-6920-8-48\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArkorful V, Abaidoo N. December. The role of e-learning, the advantages, and disadvantages of its adoption in Higher Education. Int J Educ Res, 2 12 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMysha Sissine R, Segan M, Taylor B, Jefferson A, Borrelli M, Koehler. Meena Chelvayohan. Cost Comparison Model: Blended eLearning versus traditional training of community health workers. Online J Public Health Inf. 2014;6(3):e196.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"e-learning, training, nurses, digitization, cost analysis, nursing education","lastPublishedDoi":"10.21203/rs.3.rs-4160813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4160813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe significance of information in the present era is unprecedented, and digitization has revolutionized industries and data storage methods. eLearning has emerged as a customised and cost-effective solution to address the limitations of traditional learning approaches. In a super-specialty tertiary care teaching hospital in South India, the need for effective and efficient training methods for nurses prompted the implementation of a newly developed digital learning tool.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis quasi-experimental pre-test post-test study involved 120 randomly selected nurses. A standardized questionnaire assessed the effectiveness and satisfaction levels of the newly implemented digital learning tool.\u003c/p\u003e\u003ch2\u003eIntervention:\u003c/h2\u003e \u003cp\u003eThe hospital integrated the digital learning tool into the training program for nurses. Sensitized the participants through demonstrations, providing designated eLearning champions for support, and implementing a structured training process with pre-test, training material access, post-test, and feedback collection to assess effectiveness and satisfaction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The project yielded a net response rate of 83.3% among the recruited participants. Statistical analysis using Wilcoxon's Signed Rank test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001) and McNemar's test (p\u0026thinsp;=\u0026thinsp;0.0077) demonstrated a significant increase in mean test scores and satisfaction rates after the implementation of the digital learning tool. Furthermore, a cost analysis revealed that the hospital saved a total value of Rs. 3,30,933.6/- through the newly implemented digitized training program.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study highlights the importance and effectiveness of e-learning as a valuable learning tool for nurses, considering their work needs and conditions. Digitizing training processes enables hospitals to enhance training program coordination, monitor learner progress, and improve the learning experience.\u003c/p\u003e","manuscriptTitle":"Improving Healthcare through Digitization: Assessing the Effectiveness of a Training Program for Employees at a Tertiary Care Hospital in South India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-30 07:48:05","doi":"10.21203/rs.3.rs-4160813/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"050f2207-6258-42dc-b4ac-3cba59615bbe","owner":[],"postedDate":"March 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-22T08:10:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-30 07:48:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4160813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4160813","identity":"rs-4160813","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}