Embed Size (px)
Citation preview
Hiring, Growing, & Retaining A Strong Primary Care
Workforce: Integrated Primary Care Teams At The Heart of
Transformation
Monday, August 25, 2014
8:00 – 9:30 AM
Coronado D
Learning Objectives:
Upon participation in this Educational Session, participants will be able to take the
necessary steps to:
1. Implement best practices for hiring, onboarding, and retaining primary care
teams.
2. Engage their staff in career ladders and training & mentorship programs.
3. Work toward the practical application of the physical characteristics of a health
center that supports team-based care.
Moderator: Darlene Nicgorski
Human Resource Consultant and Health Care Recruiter
Speakers:Robert Gray
President, Insightlink Communications
Stephanie GouldDirector, HR & Organizational Improvement, OneWorld Community Health
Centers
Rosa AgostoChief Talent and Learning Officer, Urban Health Plan, Inc.
Cindy Barr, RN, EDACOperations and Facilities Planner, Capital Link
Job Satisfaction in Health Centers
Source: StaffPulse Benchmark (A nationally representative, random sample of 11,200
employees in 65 health centers)
Health Center Employees By Tenure
Q: Overall, how would you rate your satisfaction with your job at this time?
Engaging & Growing a Front Line Workforce for Long Term Sustainability
Stephanie GouldDirector, HR & Organizational Improvement OneWorld Community Health Centers
About Us
Organizationally:
• In Omaha, NE; 9 Locations
• Unique Patients: 27,108 (↑15.9%)
• Visits: 116,047 Visits (↑ 9.9%)
• FTEs: 265 FTEs (309 People) (↑ 18%)
Operations Front Line:
• Front desk & appointment schedulers
• Medical records clerks
• Patient financial advocates
• Community outreach workers
• Patient support workers
• Marketplace enrollment specialists
Front-Line Workforce Challenges
• High demand for a very specific, limited labor pool - must be bilingual (Spanish) and culturally competent
• Lack of experience necessary for job success; – must have or able to learn medical vocabulary in two languages,
– communication skills, computer skills,
– customer service and basic office etiquette
• Current staff feedback expressed a desire for more opportunities to learn and grow
• Lack of direct career path options once through the Operations Department front door
Program Goals
1. Establish a New Hire Learning Academy
2. Implement a career ladder model
3. Train seasoned operations staff as mentors
To maximize departmental productivity and satisfaction, minimize turnover and grow future organizational leaders.
Academy Core Competencies
New Hire
• ACCOUNTABILITY
• ACHIEVEMENT ORIENTATION
• COMMUNICATION
• PROFESSIONALISM
• ORGANIZATIONAL AWARENESS
Mentor
• PEER SUPPORT
• IMPACT & INFLUENCE
• COMMUNICATION
• ORGANIZATIONAL AWARENESS
• EFFECTIVE MENTORING/COACHING
New Hire Learning AcademyCURRICULUM
Classroom Training Online Learning Job Shadow / Observation
OneWorld History, Mission, Vision,
and Values
Departmental Orientation
Electronic Health Record
Orientation
“Road map to Success at
OneWorld”
Employee Empowerment and
Personal Improvement
Customer Service &
Professionalism
Patient Rights & Responsibilities
Handling Patient Complaints
Emergency Codes
Cultural Diversity for Non-
Clinical Staff
Confidentiality & HIPAA
Competency exams for key
classroom courses
Customer Relations
Electronic Health Record
Practice
Medical Terminology,
Spanish/English Translation,
& Abbreviations
Job-Specific Task
Competency Assessments
Operations Staff: to
learn new hire role
among the team
Medical Providers: to
learn clinic operations
Mentors and trainers
observe new employee
on the job and provide
feedback.
MENTOR ACADEMY
CRITERIA
1. Meets or exceeds performance expectations on at least last two evaluations
2. Shows capacity to positively impact/influence peers
3. Demonstrates initiative
4. Exhibits passion and capacity for developing people
5. Desires professional growth
CURRICULUM
• Session 1: Mentor Kick Off –Understanding Roles and Expectations
• Session 2: Understanding Coaching & Mentoring Preferences
• Session 3: Providing Feedback
• Session 4: Understanding How People Learn
• Session 5: Assessing and Reporting Progress
CAREER LADDERTaught in the New Hire & Mentor Academies
Program EvaluationMethod Interval
Program Overall
Operations Employee Satisfaction
Operations Turnover Rate
Quarterly
MonthlyNew Hire Academy
Competency Self-Assessment
Training Course Exams
Job Competency Exams
Lessons Learned Feedback Sessions
Evaluation of Training Content/Effectiveness
Evaluation of Mentor Effectiveness
Mentee Progress Reports from Mentor
First Day of Training; 30 Days Post Training
Throughout Orientation
Day 7 and Day 10
Monthly
30 Days Post Hire
30, 90 and 180 Days Post Hire
10, 30, 90, 180 Days Post Hire
Mentor Academy
Satisfaction with Mentor Academy Content
Effectiveness of Mentor Academy Content
Lessons Learned Feedback Sessions
Mentor Effectiveness Self-Assessment
Upon completion of the Academy
Monthly
30 Days Post Mentee Assignment
Outcomes• Increased new hire job competency
• Improved productivity and impacted:– No Show Rates (2-4% lower for academy grads)
– Front Desk Denial Rates (~.1% lower for academy grads)
– Medicaid Approval Rates (~4% higher for academy grads)
• Employee Satisfaction Improved:– I know what is expected (increased 30%)
– Someone cares about me (increased 7%)
– Someone has talked to me about progress (increased 45%)
– I receive regular feedback (increased 4%)
Lessons Learned
• Program Delivery and Curriculum Design– Evaluate existing NEO
– Strategy for Internal Transfers
– Variable Class Size Strategy
– Build in Down Time
– Structure Job Specific Training Time
– Consider new hire mind set when evaluating progress
– Create re-training thresholds
• Relationships and Role Clarity
• Communication
• Contingency Planning
Urban Health Plan
Access
Equity
Excellence
To continuously improve the health of underserved communities
Rosa AgostoChief Talent and Learning Officer Urban Health Plan, Inc.
Our Community
60,000 Patients
300,000 Visits
770 Associates
URBAN HEALTH PLAN
Clinical Services
Social & Human Services
Education & Research
URBAN HEALTH PLAN
1988 Paloma Hernandez promoted toExecutive Director/1996 AppointedPresident & Chief Executive Officer
2001 Relocates to a new 40,000 sq. ft.site , El Nuevo, San Juan
Joint Commission accredited since 2003
2009 Nicholas E. Davies Award forExcellence from the Health InformationManagement Systems Society
Named one of the top 10 communityhealth centers in the country by HumanResources and Services Administration(HRSA)
Awarded Level 3 recognition as aPhysician Practice Connections—Patient-Centered Medical Home (PPC-PCMH) from the National Committeefor Quality Assurance (NCQA) in 2009and 2012
2013 Awarded NYC Business Innovation Challenge Grant for effecting incomemobility for our associates andcommunity
About Urban Health Plan
1974: Founded by Dr. Richard Izquierdo
Named one of the top 10 community health centers in the country by Human Resources and Services Administration (HRSA)
1988: Paloma Hernandez promoted to Executive Director / 1996: Appointed President & Chief Executive Officer
2009: Awarded Level 3 recognition as a Physician Practice Connections – Patient-Centered Medical Home (PPC_PCMH) from the National Committee for Quality Assurance (NCQA)
2001: Re-locates to a new 40,000 sq. ft. site, El Nuevo, San Juan
2013: Awarded NYC Business Innovation Challenge Grant for effecting income mobility for our associates and community
2003: Accredited by Joint Commission2013: Received Gold Award (Brandon Hall) for Excellence in OnBoarding (Talent)
2009: Nicholas E. Davies Award for Excellence from the Health Information Management Systems Society
2014: Opening of 50,000 sq. ft. Simpson Pavilion expansion site
On-Boarding
Culture
Engagement
Retention
URBAN HEALTH PLAN
• Determine critical and essential skills
• Use organizational culture
• Mission at the forefront
• Listen for Situation Action and Outcome
URBAN HEALTH PLAN
Interview and HireFor Fit & Culture
“Onboarding, also known as organizational
socialization, refers to the mechanism through which new employees acquire the necessary knowledge, skills, and behaviors to become effective organizational members and insiders.“*
Research has demonstrated that these socializationtechniques lead to higher job satisfaction, better performance, greater commitment, reduced stressand intent to quit.
*Source: Bauer, T. N., & Erdogan., B. (2011). Organizational socialization: The effective onboarding of new employees.
In S. Zedeck (Ed.), APA handbook of industrial and organizational psychology, Vol 3: Maintaining, expanding, and
contracting the organization, APA Handbooks in Psychology (pp. 51–
64). Washington, DC, US: American Psychological Association.
Now Move Forward
Tactics
Begins with a new associate orientation program emphasizing organizational culture and values; teaches essential skills plus regulatory/compliance areas
Individuated by title
On-line surveys plus face to face meetings
Follows the associate at key time frames during their first 6 months of employment, followed by opportunities forsocializing, recognition,team work, collaboration, learning &development, and culminating withAnnual Orientation and annual survey
URBAN HEALTH PLAN
Generations at UHP
13.70%
0.29%
46.24%
39.76%
Millennials (Y) X-ers Boomers Veterans
Millennials• Big and heterogeneous
• Giant of a generation
– 95 million strong (1/3 more than Boomers)
• America’s most ethnically and racially diverse
generation
– One in five has at least one immigrant parent
– One in ten has a non-citizen parent
– 35% are non-white or Latino (“minority”)
– One in ten does not speak English at home
Source: Millennials Rising URBAN HEALTH PLAN
Workforce
Young Little Experience Technologically Sophisticated Ambitious and Wants to Succeed From Our Local Communities Often Needs Essentials Skills / Critical Core
Competencies
URBAN HEALTH PLAN
Urban Health Plan’s Goals
• Elimination of barriers to acclimating to theorganization
• Acclimation
• Identification (and subsequent resolution) of issues
• High levels of satisfaction and engagement,
• Emotional attachment to the people in theorganization
• Maximizing resources
• Unwanted turnover
URBAN HEALTH PLAN
Very Satisfied/Satisfied Day 30Day 120
Day 180
A
Information Presented at NAO 99%
Training I received from my department 95%
Teamwork and cooperation in my department 98% 87% 90%
Level of communication in my department 93.5% 86% 88%
Level of communication - UHP 94% 93% 93%
Current Position 98% 93% 94%
Opportunities for professional growth at UHP 94% 91%
Addressing Concerns brought up at day 30/120 94% 91%
UHP is a good place to work 100% 98.9% 93%
URBAN HEALTH PLAN
Engagement
Retention
URBAN HEALTH PLAN
WellnessWorks @ UHP©
Free Fitness Classes (Zumba, Salsa, Tai Chi, Yoga and others)
Weight Watchers @ Work Program
Farm Share
Walk @ Work
Annual Wellness Works Expos
Marketing for Healthy Eating Options
M.A.M.A Classes
Tip of the Week
Lunch & Learn Wednesdays
Parenting – The Wonder Years
Employee Assistance Programs
URBAN HEALTH PLAN
Learning, Training, Development
English as a Second Language Management Program – UHP
Computer Literacy ICD 10
Public Engagement Presentation Skills Cultivating the Patient Experience
Medical Assistant Certification Program CUNY Assessment Test Prep
Financial Literacy College/Advisement Planning
Writing Tuition Assistance
E-Mail Etiquette Internships
Communication Shadowing
How to deal with “difficult for me” people Stretch Assignments
Motivational Interviewing – UHP Coaching at the time of need
Health Interpretation - UHP CMEs
URBAN HEALTH PLAN
• Urban Health Plan celebrates associates’ andrewards contributions to the advancement of themission of the organization, excellence in work andsuperior service.
• The program ranges from celebrating professions, bringing everyone together for an Annual HolidayGala and Annual Family Picnic, recognizingassociates for their length of service to honoringand rewarding associates who have demonstratedexcellence in their job performance, consistent with our core values and operating credo.
URBAN HEALTH PLAN
Recognition
Key Drivers
Engagement and Retention
Authentically Valuing Contributions Credible Leadership
Getting Recognized for Work Done Supportive Co-Workers
Recognition by Supervisor Job and Career Satisfaction
High Performing Organization
URBAN HEALTH PLAN
Associate Survey Scores vs.
National Benchmark ScoresUHP* National*
NAO 81.7 72.4
Career Advancement Opportunities 80.0 71.0
Process Org. 77.7 69.2
Would Recommend UHP to Work 87.0 78.9
Mission Important to me 93.8 86.2
Overall Satisfaction 84.9 78.2
Learning & Growing Opportunities 83.2 76.6
Recommend UHP for Healthcare 86.6 80.8
Reward & Recognition for Performance 73.4 68.2
Crossroads Group UHP Associate Satisfaction
Survey
Source: The Crossroads Group Employee
Satisfaction Survey
UHP* National*
Proud to be Associate of UHP 90.4 83.9
UHP to be Recognized as PCMH 87.4 78.9
Loyalty (Likely of working at UHP one year from now)
87.1
Retention at UHP Average for 2012/2013: 88%; 2014 YTD 92% vs.
The turnover rate of 20.4% for healthcare employees nationally according to the Human Resources Management Assocation.
Associate Survey Scores vs.
National Benchmark Scores
URBAN HEALTH PLAN
Health Center Recruiting Tips
Source: Expert Interviews for NACHC’s Recruitment, Onboarding & Retention Toolkit
Key Challenge – Candidates don’t know about health centers,
including yours
Promote awareness and understanding of health centers and get
the word out in all forums where candidates might be
Develop a clear and well-articulated mission that all staff members
know and that you “live” in all activities/interactions
Carefully assess and be realistic about your health center’s
strengths and weaknesses as a potential employer
Dedicate resources to becoming visible to provider candidates and
adopt “permanent recruitment” mode rather than waiting for an
opening to start searching
Health Center Recruiting Tips
Source: Expert Interviews for NACHC’s Recruitment, Onboarding & Retention Toolkit
Key Challenge – There aren’t enough good provider candidates
available
Get connected with and be visible to sources of future providers,
such as training/residency programs
Look for providers with backgrounds demonstrating they are
mission-driven and/or have experience with volunteer
organizations
Be open-minded and welcoming to providers of all types and
backgrounds (foreign origin, non-English first language, all
ethnicities, religious affiliations, all sexual preferences)
Consider “growing your own” sponsorships/scholarships to
develop providers from existing staff or from within the community
Health Center Recruiting Tips
Source: Expert Interviews for NACHC’s Recruitment, Onboarding & Retention Toolkit
Key Challenge – It’s hard to compete with other potential
employers
Search for candidates with an existing affiliation to your
community/ your type of community – relatives/roots in the area,
attracted to small towns, enjoys rural recreation, etc.
Address pay competition by being strong on total compensation –
good working hours, paid time off, help with loan repayment, good
health care benefits, strong CME support, chance to pursue a
particular professional interest, opportunities to “moonlight” at the
health center
Hire the whole family. Help the candidate’s spouse/partner with
local work opportunities and connect the candidate with community
resources, even during the interview phase
Health Center Retention Tips
Source: Expert Interviews for NACHC’s Recruitment, Onboarding & Retention Toolkit
Key Challenge – It’s hard to hold on to good people
Get off on the right foot – avoid off-putting contract language, make
the new hire welcome throughout the interviewing & hiring process
Have a strong on-boarding and acculturation program that goes
beyond just helping the new hire perform their job duties
Consider use of peer mentors and job-shadowing, as well as formal
training, to help new hires settle in and learn the culture of the
health center
Head off problems before they start through frequent “check-in”
conversations, well-developed team processes, formal surveys and
open communications, so job and work culture issues can be
identified and addressed before your key staff members go
“shopping” for another employer
Primary Care Teams
Source: Expert Interviews for NACHC’s Recruitment, Onboarding & Retention Toolkit
It matters where you are starting from:
Constraints such as current norms/behaviors and your health
center’s physical layout can limit how fast and how far a health
center can transform into fully integrated primary care teams
It matters where you are in the transformation process:
All transformation takes place while still serving patients so must
consider staffing and operations during a possibly lengthy transition
It matters where you intend to go:
Health centers are not identical in how they structure their primary
care teams nor how these teams operate so success in this
transformation requires being definite about what the goal is and
what it will mean to recruiting, staffing and day-to-day operations
Primary Care Teams
Source: Preliminary Results from NACHC’s 2014 Primary Care Team Assessment
Q: What percentage of your health center organization’s sites (i.e. locations, practice sites,
service locations) currently implement Primary Care Teams?
Implementation of Primary Care Teams
0 Percent
1 to 24 Percent
25 to 49 Percent
50 to 74 Percent
75 to 100Percent
9 %
13 %
56 %
13 %
9 %
Primary Care Teams
Among the health centers that are well along in transitioning to
primary care teams…
Team sizes are most likely to consist of 4-6 people
Most are led by a physician, include advanced practice providers,
medical assistants and nurses and report to the Chief Medical
Officer
Almost all empanel or assign patients to a specific team for both
routine and acute care, have established measurable goals and
engage in quality improvement and patient safety activities
How the team members’ roles and responsibilities are defined,
though, varies from health center to health center, while tending to
be more informal than formal
Source: Preliminary Results from NACHC’s 2014 Primary Care Team Assessment
“We’re all in our Places,
with bright shining faces…”
Cindy Barr RN, EDAC
Operations & Facilities Planner
Capital Link
In the Dance of Form and Function,
Form always Leads
All together in one place –
But what kind of place?
The Team Work Experience
To be effective, team work spaces must support:
Stress Reduction
Focused Work
Collaborative Work
Group Work
Strategically Use Natural Light
Petaluma Health Center - CA
Foster Balance
The All Together Challenge: Sound Attenuation
• Absorb Sound
– Incorporate carpet – ceiling tiles - buffer boards
• Mask Discrete Sounds
– Insert white, pink, brown noise appropriately
www.simplynoise.com
• Support Low Volume Conversation
– Create printer/scanner / copier alcoves
– Provide “talking rooms”
– Position workstations to enhance eye contact
Sound Attenuation
Sound Attenuation
Define Spaces for Group Work
• Interactive
• Inclusive
• Light-filled
• IT strong
• Right–sized
• Flexible
• Sustainable
Birch – ICHC - MI
Support Effective Engagement
Derek Parker FAIA, RIBA, FACHA
Co-Founder Center for Health Design
“The most influential tool you have to impact the health of your patients
is the environment in which you meet.”
Align Place and Therapeutic Model
Align Place and Process
• Zoned Exam Rooms • Jack and Jill Rooms
Accommodate the Need for Respite
Respite: A time away for renewal and refreshment
to support personal health and maximize effectiveness
• The Restorative Escape
– “I just need to clear my head …”
• The Reality Check
– “Can you believe…”
• The Personal Connection
– “How is your son doing in …”
The Restorative Escape Exercise
Your Patient Entry Experience
Your Goal: Continuously the Stress Response
– Communicate Welcoming Inclusion
– Address the Needs of Accompanying Persons
– Provide Relaxing Diversion
– Provide for Personal Needs
– Promote Safety, Privacy and Security
– Streamline Eligibility, Payment and Tracking Functions
The Staff Entry Experience
The Goal: Continuously The Stress Response
– Communicate Welcoming Inclusion
– Address the Needs of Team Members
– Provide Respite Times and Spaces
– Provide for Personal Needs
– Establish Priorities (80 – 20 Rule of Thumb)
– Streamline “Enrollment” Processes
Contact Information
Darlene Nicgorski [email protected]
Robert Gray [email protected]
Stephanie Gould [email protected]
Rosa Agosto [email protected]
Cindy Barr, RN, EDAC [email protected]
Additional Resources
NACHC Recruitment, Onboarding and Retention Toolkit for Health
Centers
NACHC StaffPulse and ExitPulse
www.nachcpulse.com
For more information, please contact Katja Laepke at [email protected]
or Beth Kujawski at [email protected].
