For the 12th episode of our Monday Morning Healthcare IT Podcast Series, Tom is joined by Shantra Moore, Jason Huckabay and Stephen Tokarz, HCIs Director of Training and Activation, and Senior Vice Presidents of Operational Delivery, respectively. They discuss two of the newer, more unconventional methods of ongoing new hire EHR Training: on-the-floor training and eLearning. In addition, they cover cost considerations for both, why outside resources are so beneficial to their success, and advice for organizations who are preparing to conduct ongoing new hire training.
For our listeners, keep in mind that an EPR, or Electronic Patient Record, is simply the term used in the United Kingdom to loosely refer to what we, here in the US, would call an EMR or EHR.
In case you missed it, make sure to check out our last episode, where Dave Lang goes over what organizations must consider when determining if they are ready to implement an EPR (Electronic Patient Record).
Tom: Hello and welcome to the 12th episode of our Monday Morning Healthcare IT Podcast Series. My name is Tom Letro of the HCI Group, and for everyone here at HCI, I hope that you all had a safe and happy holiday season.
Today I will be joined by Shantra Moore, our Director of Training and Activation, as well as our Senior Vice Presidents of Operational Delivery, Jason Huckabay and Stephen Tokarz.
In today’s episode, we will go over two of the best unconventional methods for ongoing new hire training: On-The-Floor Training and eLearning. In addition, we will cover some cost considerations for both, why outside resources can be so beneficial to their success, and some advice for any organizations preparing for a new EHR Training project.
Thanks for joining me today, everyone.
On-The-Floor EHR Training
All: Thanks Thomas.
Tom: Thank you for being here everyone, I love the enthusiasm. Now let’s get started with on-the-floor training. What are some planning considerations that must be looked at when it comes to on-the-floor training?
Jason: Well, I think that before you can consider an on-the-floor training, or an on-the-job type training program, you have to understand how strong your super user program is, because it all starts with who is going to do that on-site training. Typically, it is the super user, which means you need to have a really strong operational readiness program, which is going to start way before traditional training for the go-live even begins, when you start identifying who those super users are, what their skill set is, and what that plan looks like to get them ready, so that they are not just trained ahead of time, which is often the case with super users, but that they are actually a super user on the system, and they have the skill set to train on-site for new hires.
Tom: Right, and, for our listeners, when you say on the floor training, you basically mean that you just show up and are plugged in right away, right?
Jason: Right, you are going to show up and shadow someone else on the floor that has the exact same role that you have, that is going to do the exact same functions you do within a given day, typically they are going to have some sort of a guide that they follow, and they are going to have like a checklist. They need to make sure that you can do x, y, z, before you are done with your on the floor training, and you are able to do it on your own.
Tom: And what would be some benefits to doing on the floor training versus other methods of ongoing new hire training?
Stephen: So, definitely scheduling. Because when someone reports to their first shift they can then begin with the learning process as opposed to having them go to another facility or block out time outside of work to do the learning. One thing that is of note, we see a lot of success with on-the-job training for roles that do somewhat limited documentation in the system, so some of the therapies and other roles, roles like nursing and physicians, typically they do benefit from some protected time to learn the system and practice, but as Jason was saying, some of those roles that have more limited documentation tasks, putting together a strong checklist and on the job program has been really successful.
Tom: But I feel like if you were to just plug somebody in that the downside might be that there might be some more errors maybe because they haven’t had a chance to learn anything ahead of time, they are just brought in and told here you go, good luck. Is that the case?
Jason: You know, I don’t know that it actually works that way, because even though they have the nurses or physicians have protected time to learn the system, true adoption doesn’t occur until they hit the floor. So the adoption time is probably going to be close to the same. Even if I take you through training, you are going to need a day or two of working with the system in a live environment around your peers before you are really going to feel comfortable within the system. So basically, by skipping that protected time, you lengthen the adoption time, but I think that is more valuable because it is time in the system around your peers, in front of the patients, seeing how it works.
Tom: Ok, well what’s the drawback then if that is the case?
Jason: Oftentimes it is staffing. The unit or the floor doesn’t have a resource that can conduct the on-site training, so they don’t have the resources capable of delivering it, and then the other drawback would be that they don’t actually have a user in that area that is truly skilled and that can deliver it, you know. There is a lot of people that can do a good job at their job but can’t necessarily train someone else. And what you need is a super user on the floor that is not only good at what they do, but that has the skills and that has the training to bring someone else up to speed.
Stephen: Yeah, and piggybacking off the staffing piece, a lot of times, hospitals in clinics are strapped for staff to begin with, so being able to have a set of nurses, or having folks do a part-time load is something that is difficult to plan for. So…lost my train of thought there. I feel like I’m on the news. But it is difficult to plan for because the demands of patient care and taking care of the customers can sometimes be so great, but really to have a true, effective, on the job training, you need to be able to lessen the load for the instructor as well as the person that is learning, so they can progress through at a more manageable pace versus a full capacity load.
Jason: And another benefit of having that program in place though, is that trainer is always on the unit. So even if you have existing employees, who aren’t new hires, who are struggling in a particular area of the system, they have a go-to resource close by that can provide them the information they need to be more efficient in the system. So having that skill set embedded within the unit gives more benefits than just the new hire program.
Shantra: Well, and they’re experts in their field too, so they are really equipped to be able to answer specific workflow questions, which sometimes when there’s, I guess, classroom training, you could have a trainer who really knows the system well, but might have some areas with question marks when it comes to workflow. So that is another benefit.
Stephen: I mean training really doesn’t end or should not end, there are constantly going to be updates to the system, people will be discovering new and more efficient ways to utilize the system, and it is important to have an avenue to disseminate that information out to the entire staff and their peers. So having that embedded, almost super user instructor role that lives on helps people use the system even better every day.
Tom: Ok, and now that we have gone over some of the basics for on-the-floor training, I feel like we can move on to eLearning. So, as opposed to on-the-floor training, what goes into planning for, or preparing for eLearning?
Stephen: So, many vendors provide standard out of the box e-Learnings, which are useful to familiarize yourself with the core functionality, but we recommend at least doing some customization or tailoring of the e-Learning so that it is more relevant, and so people will pay more attention and feel more engaged, so we like to do some of our e-Learnings in a day-in-the-life fashion. So actually leveraging someone who is using the system currently, and having them help put together the e-Learning script so that it shows what their day in the life basically looks like, interacting with the system. Doing it in this way is just, like we said, a lot more relevant, and it sticks more with the end users. So some of that up-front planning is important. You also have to be cognizant, though, when you create custom e-Learning that there is a custom update process that has to be gone through, so we don’t recommend customizing all eLearning, but having some core eLearning that takes people through the 80% of what they do in their day is of value.
Tom: And what are some downsides vendor-based eLearning versus maybe a more tailored approach?
Jason: The vendor ones are strictly functionality based, so they will show you which buttons to push, but they won’t give you the why as to why you are pushing that button at that particular time for that particular client.
Tom: Ok, so basically if you are looking for a more streamlined approach that doesn’t go too far in depth, you go with the vendor-based approach.
Shantra: Sometimes though, the screens can look a bit different because different hospitals can customize the way that their screen looks, so if an end user views one of the e-Learnings and sees “wow, this screen is drastically different,” it can cause a little bit of anxiety or confusion because they are looking at the screen going “ah, this isn’t what my organization does!”
Tom: Right, and I would assume that even small changes can probably throw people off.
Jason: Well, and the system does change. Any time there is an upgrade, or possibly if there is an internet update, so an eLearning that you create today may not be relevant in 6 months. It may have several screens that are different, and therefore requires constant updating. And if you don’t have the staff to perform new-hire, chances are that you don’t have the staff to perform eLearning updates.
Shantra: One of the benefits is that the message is consistent, so all of the end users are receiving the exact same message, it is not dependent on who the trainer is, so that is why a lot of clients do like to use eLearning, but there are definitely some challenges with that too .
Tom: But there will be challenges with anything you do, right? So basically the main takeaway from e-learning is that everyone views the system the same way, there is no “well I learned it this way, or well I learned it this way,” so basically it can be tailored as tightly to your organization as you want it to be.
Shantra: As long as you have the staff to do that.
Tom: Of course, but more staff probably leads to more costs. And speaking of costs, I feel like when it comes to on-the-floor training, it would be fairly cost-effective because you don’t have to spend any time in the classroom with the trainers, everything is done on the floor. Am I right to assume that?
Stephen: Yeah, that is a good way to look at it, the cost is more up front when you are doing a classroom training outside of the persons place of work, because you are paying not only for a instructors time, you’re potentially leasing space, and you are also paying time of the person that is there to learn. So it’s worth doing the due diligence to add up all those costs, and then see if you can justify some of these other methods.
Tom: Right, and I feel like with classroom training you might have someone who doesn’t necessarily learn the same way as someone else, but when it is on the floor, it isn’t really a question of how you learn, it’s a matter of this is how you are going to learn because this is how it’s going to be. But how does the cost of eLearning compare to the cost of on-the-floor training?
Jason: Delivery of eLearning is the absolute cheapest, because it is just a streamed bit of content from the internet or from your LMS or learning management system. So the actual delivery of it is very cost-effective. Maintenance is where the expense comes from. Making sure that the modules are current, making sure that they have been updated after each upgrade that the client site goes through, or any, just, changes to the system. You would be surprised at how much the system can change in the first 6 months after go-live, just because the departments start using the system, they see something in the workflow that they don’t care for, they don’t feel like it is the most efficient way to do something so they make a change. Well that change has to be captured and then integrated into the e-Learning.
Importance of Utilizing Outside Resources
Tom: Ok, and how often would you say healthcare organizations should consider bringing in outside resources for assistance in their training projects? Is there ever a time where an organization wouldn’t consider engaging outside resources?
Jason: I think you can make a case that it is as effective or more cost-effective to bring in the right outside partner to provide some of this training versus carrying staff at a full-time rate throughout the entire year.
Stephen: And also recognizing that, healthcare IT jobs, there is a larger than normal turnover rate, so that’s something that you have to constantly deal with when you have your full-time staff in place, and you may need to bring someone in from the outside anyways to bridge that gap, so forming that relationship early with a trusted partner is something that you can leverage for the life cycle of the project.
Shantra: It is always nice to bring in experts, especially [because] by the time a lot of people go “oh wow we are really lacking in this area, what should we do?” By then there is a lot of time that has been lost, so it is great to be able to partner with somebody on the outside who already has experts who can already come in and hit the ground running. They already have the knowledge base, so that’s a huge one there.
Advice for Organizations Preparing for Ongoing New Hire Training
Tom: That makes sense to me, the more help that you bring in, the more effective your project can be. And last question here everyone, but is there any advice you would give to healthcare facilities who are trying to figure out what they are going to do, or how they are going to handle ongoing new hire training for an EHR Training project?
Stephen: Maybe one thing is a lot of times the training program is a first impression for new physicians or nurses, so in a marketplace, especially with physicians, it is more and more competitive to get them to join your medical group or health system. Having a world class onboarding, training, and support process in place can really be a differentiator and help you to attract top talent to your organization. So this is something that not only the training department should be looking at, but also the CFO, CEO, COO, in regards to just building the business with more talent through a good program.
Jason: I would also dovetail onto that that you can’t emphasize the importance of the new hire and training program period. Because in order to get maximize ROI from the system - I mean these are very expensive electronic medical record systems that our clients are installing. In order to get maximum utilization out of that system, it is going to come from having employees that know how to get maximum utilization from the software. And without that, there is no way for the executives to see the return that they are looking for.
Stephen: It’s like putting me behind the wheel of a Ferrari when I can’t drive a stick shift.
Jason: Absolutely, there’s a reason that racecar drivers drive racecars, because they know how to get the absolute maximum performance out of the vehicle.
Tom: Ok so basically if you’re looking for effective training, sounds like what you’re going to need is a bunch of people who know how to drive the metaphorical Ferrari, like you three of course. And thank you everyone, we appreciate you stopping by here today, but that is all the time that we have today.
To any of our listeners who are looking for more information on EHR Training, or on what goes into ongoing new hire training, make sure to subscribe to our blog and our podcast, as well as to follow us on social media.
Also, make sure to comment below with any questions, concerns, things we may have missed, or even topics you would like us to cover, so that we can keep the conversation going.
For Shantra Moore, Jason Huckabay, and Stephen Tokarz, this has been Tom Letro of The HCI Group. The HCI Group, offering a smarter approach to healthcare IT.