Soapbox: Quality vs. Quantity

A case study on how Accretive Health adjusted its training approach for larger clients without sacrificing the quality of delivery.

By D’Anna Flowers, IT Training Manager, Accretive Health, Inc.

Today’s corporate training leaders often are faced with a common struggle: how to adequately scale their training operation to meet the needs or expectations of a growing number of employees or clients. Trainers are seeking new methods to meet the increasing demand for on-the-job, real-time training offerings. While employees are looking for new opportunities for their professional and personal growth, training departments face the challenge of a changing work environment and are forced to manage the imbalance of weighing quality vs. quantity. The following case study outlines how to revamp external training to effectively navigate an expanding client base while maintain high standards of quality application.

The Company: Accretive Health

Accretive Health was founded in 2003 with a singular focus: to help health-care clients strengthen their financial stability and deliver better care at a more affordable cost to the communities they serve. With respect for the challenges health-care providers face daily, the company developed three core solution sets that address health-care providers’ most pressing business needs. All three core solutions—Revenue Cycle Management, Quality and Care Coordination, and Physicians Advisory Services (PAS)—enable providers to lower costs while improving the quality of care and satisfaction of their patients, physicians, and staff through process excellence, best people, and proprietary leading technology.

Accretive Health’s information technology (IT) training team is charged with training and development related to the revenue cycle technology suite. The revenue cycle line of business comprises more than 900 Accretive Health employees, as well as the training of thousands of client end-users throughout the U.S.

The Challenge: A Training Program in Need of Change

In 2010, Accretive Health’s client base was expanding rapidly. The training model at the time required a “hands-on” IT training team that was on-site throughout the extended rollout. The methodology featured numerous group classroom training sessions, individual on-the-job coaching sessions, and limited access to Web-based training videos. No formal tracking was available, but trainers did host small meetings at the hospital to track and discuss metrics with end-users.

In response to the foreseeable needs of Accretive Health’s growing client base, the IT training team used metrics to identify areas of improvement. The 2010 training model dedicated 4.6 hours to training the average end-user on the technology. This translated to an average cost of $111 per end-user, when the trainer’s transportation, hotel, and per diem costs were included. It became clear that the 2010 training approach would not be sustainable when working with larger clients acquired in 2011 and 2012.

Developing a New Model

With these challenges and metrics defined, the team identified the goals for the upcoming year:

  • Develop a train-the-trainer methodology to replace the relationship between the Accretive Health trainer and the end-user in order to scale the training approach for larger clients
  • Provide Web-based training videos, delivery, and tracking for sites
  • Reduce the delivery time and cost required to train end-users while maintaining quality

Accretive Health developed a train-the-trainer model to scale the training approach for larger clients by empowering their own on-site operations team, as well as technologically savvy client leadership. The team followed the Bortz Learning Module, which heavily focused on knowledge and performance acquisition, review, practice, and assessments. Working with their client partners, the team identified “Super Users” to be trained in train-the-trainer classroom sessions. Once the “Super Users” were certified as trainers, they assisted with the remaining rollout through Web-based training and individual on-the-job coaching sessions.

The Accretive Health on-site operations team also led the long-term client usage and support through the completion of a tailored, online certification series. The program is dedicated to training Accretive operators on successfully driving and maintaining usage through technology best practices. Finally, daily training calls were held with the “Super Users” and operators during the rollout to discuss frequently asked questions and escalate training issues. The feedback received provided the Accretive Health IT training team with the information needed to develop additional reference guides or best practices that could be shared with the larger user population.

As the need for real-time references, Web-based training videos, delivery, and tracking increased, the team developed a series of online training videos for the Accretive Health technology suite. An extended enterprise learning management system (LMS) was implemented to track the learning plans and requirements for the numerous end-users.

Today, the Accretive Health course catalog for Web-based videos includes more than 75 custom courses over five lines of business. The catalog continues to grow as more requests are filtered to the team from across the company. Each course includes detailed interactions for the end-users, as well as testing and evaluation components to ensure the effective transfer of knowledge and maintenance of the training quality.

Paving the Way for Future Growth

These process improvements produced a significant reduction in dedicated training hours. The average 4.6 training hours per user was reduced to an average of .29 hours to effectively train on the technology. As a result, the cost of delivery decreased from $111 per end-user to an average of $14 per end-user.

Quality was maintained and tracked by utilizing the Kirkpatrick Evaluation Levels. IT training team members found their clients achieved more long-term success because the new approach created a sense of ownership in the technology. This success is attributed to the creation of online catalogs for their material; utilizing e-learning when possible; and continuously looking for smarter, more cost-effective ways to deploy the on-site delivery methods, including utilizing the train-the-trainer approach.

The mantra of Accretive Health’s executive team is “Speed to Value” for its clients and operations teams. Accretive Health has accomplished exactly that by significantly reducing its cost of training per user while dramatically increasing knowledge and subsequent use of the technology.

D’Anna Flowers is an IT Training manager at Accretive Health, Inc.; she spearheaded the effort to revamp the external training model. She was named a 2012 Top 10 Young Trainer by Trainingmagazine.

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