"Mrs. Fletcher," said Dr. Collins to the family planning clinic manager, "Could I speak with you for a moment?" Mrs. Fletcher invited him into her office and said, "How can I help you?"
"When will Miss Marlow be returning to her job as counselor?" asked Dr. Collins. "She's been gone almost two months now, hasn't she?"
"Her mother is still recuperating from the operation," said Mrs. Fletcher, "and when I spoke with her last week she still wasn't certain when she would be able to return to the island and come back to work. Why do you ask?"
"Well, I have seen a number of clients in the last two weeks who are recent new-comers to the family planning clinic and who have come to me with a number of questions about how their contraceptive method works and the side effects they are experiencing. I have asked them whether this was explained to them when they were counseled about family planning, and apparently they didn't get a good explanation during counseling. While looking at their records, I noticed that they were all counseled by Nurse Hamilton. If she is going to continue to fill in for Miss Marlow, I think you had better look into how good a job Nurse Hamilton is doing with counseling."
Mrs. Fletcher thanked Dr. Collins for this information and thought about the situation. Miss Marlow had had to leave the island very suddenly to take care of her mother, and since Miss Marlow hadn't known how long she would be gone, Mrs. Fletcher had asked Nurse Hamilton to counsel the new clients. Mrs Fletcher had briefly discussed with Nurse Hamilton how to counsel clients, but Nurse Hamilton had had no formal training in counseling. Mrs. Fletcher now asked her to come talk with her in her office.
"How do you feel your counseling is going?" Mrs. Fletcher asked Nurse Hamilton.
"I don't really know," responded Nurse Hamilton. "I've never had to do any counseling before, and even though you told me a bit about it, I'm not at all sure that I'm doing it right."
"I spoke with Dr. Collins this morning,"said Mrs. Fletcher, "and he told me he was concerned because a number of new clients have come to him with questions about their contraceptive methods and their side effects. He wondered how you were doing. Do you think you need some help with this?"
Nurse Hamilton replied,"I think that if I am going to continue to counsel, I need to know more about how to do it. I wouldn't want the clients to be dissatisfied."
"We really don't know when, or if, Miss Marlow will come back," said Mrs. Fletcher. "Would you be interested in continuing to counsel clients if you knew more about how to do it?" Nurse Hamilton said that she would. Mrs. Fletcher then had to decide what to do.
What is the performance problem?
Nurse Hamilton is not counseling clients properly. She is not giving the clients complete information on all the available methods and the possible side effects.Is it important?
Yes. Clients must receive complete information on all available methods in order to make a well-informed choice about the contraceptive method that is best for them. In addition, client satisfaction is essential to the success of the clinic.Does the individual have the skill to carry out the task?
No. Nurse Hamilton has never been properly trained in counseling. She doesn't know counseling techniques or all the information that should be covered in a counseling session.Has she done it in the past?
No. This is the first time she has had to do any family planning counseling.
Using the decision tree, Mrs. Fletcher saw that the next step would be to arrange for Nurse Hamilton to be trained in counseling. As is often the case, Mrs. Fletcher found that there were other factors to take into consideration. The clinic didn't have much money budgeted for training, and Miss Marlow was still expected to return at some point. But the family planning program was planning a major promotional campaign later in the year, and was expecting the number of new acceptors to increase. Even if Miss Marlow did return by then, Mrs. Fletcher though that it would be helpful to have Nurse Hamilton doing counseling as well. She saw this training as an opportunity for staff development and thought that the training would help Nurse Fletcher in her clinical duties as well.