By Margery Weinstein
With the health-care industry currently the largest employer in the United States and its labor market expected to achieve a 49 percent growth in the next five years, Miami Children’s Hospital (MCH) faced a steep challenge: a doubling of the demand for talented people in health care coupled with a labor supply that continues to dwindle. The hospital answered that challenge with initiatives that attract, train, and retain the kind of talented people the organization needs to lead it into the future.
MCH Turns the “People Dial”
Last year, MCH’s education team led a key strategic initiative under what it calls its People Dial, an organization-wide dial aimed at improving recruitment and retention, says Director of Staff and Community Education Loubna Noureddin. The goal was to reduce turnover among new employees by 50 percent. While MCH’s overall turnover rate of 7 percent is significantly lower than the health-care norm of 16.8 percent, turnover among MCH’s new hires, with one-year employment or less, was reported at 33 percent. To curtail new hire turnover, education leaders partnered with the organization’s executive leaders to create a best-in-class onboarding process.
This process begins with a special greeting by the entire senior leadership on the first day at MCH. “This special welcome is led by the CEO and is intended to bring value to new employees and emphasize the hospital’s strategic direction in a fun and creative way,” says Noureddin. Next, new employees tour the main campus as a group, where representatives from key hospital departments greet them. The tour ends with a “lunch with my manager” event where the employee’s leader escorts the new employee to their department. All managers, including those working off campus, participate in the event so no employee is left behind.
Nurturing positive relationships with managers is a priority at MCH. “The development of trusting relationships is a significant emotional compensation for employees in today’s marketplace,” says Noureddin. To that end, each new employee is assigned an MCH Buddy. Buddies participate in an eight-hour training session to learn about communication, coaching, learning, mentoring, and engagement strategies. Employees shadow their MCH Buddy for 40 hours, followed by weekly meetings. Buddies are compensated if the new hire rates his or her onboarding experience favorably. To date, 288 MCH buddies have been trained and assigned to a new hire. The MCH Buddy and manager also meet to plan the onboarding process and ensure that the employee receives the emotional, social, and environmental support needed to adjust to a new place and culture. Along with constant support from their MCH Buddy, new employees are supported by their departmental leader, who invites them to lunch at the 30- and 60-day milestones to discuss their onboarding experience and gather suggestions for improvement.
From there, an automated, employee-driven, Web-based onboarding solution guides the employee’s orientation. Employees rate their experience at 30, 60, and 90 days, and results are reviewed monthly by the onboarding coordinator and talent managers for further analysis and follow-up. New employees reunite at 90 days for a two-day culture-shaping retreat where they get to engage with their peers and experience the “MCH Way.” This includes a graduation celebration that is attended by senior leaders and managers.
“The results of this program have been outstanding,” says Manager of Organizational Development Rula Sater. The turnover rate among MCH new hires was reduced from 33 percent to 16 percent in the program’s first three months. New hire retention is still a fragile area, and a deeper dive into job fitness is underway to improve MCH’s overall selection and hiring processes.
MCH Change Management
Another major challenge for MCH last year was incorporating significant operational changes due to growth and digitization. The launch of an electronic medical record system across all areas of MCH, for example, meant process standardization and integration of hundreds of systems and disciplines across the entire health-care system.
To manage the transition to electronic medical records and other significant operational changes, MCH partnered with GE Consulting to manage the human side of business. The organization uses what it calls the Change Acceleration Process (CAP), an experiential learning process, to manage major operational shifts. “CAP provides MCH with a set of concepts, tools, and techniques to make rapid adjustments and adaptations,” says Sater. Participants come to CAP in teams of eight to 12 people with a problem to solve. The problems are related to organizational priorities. Each team works with a coach, a process expert knowledgeable about the problem, who guides them to a solution. The coaches are constantly present, working with the teams during training and after the CAP process is complete. The training alternates between learning the CAP framework—straightforward and easy-to-apply guidelines that divide the change process into seven steps: leading change, creating a shared need, shaping a vision, mobilizing commitment, making change last, monitoring progress, and changing systems and structures—and applying it to the current problem.
“The goal is to implement the principles of change management into all leadership training programs and to integrate change principles into all system-wide project plans,” says Chief Talent Officer and Vice President Michael Kushner. The process takes into account the role of super users and system champions, as well as powerful stakeholders who may not be adapting well to the system change.
Boosting Hand Hygiene via Technology
Hand washing long has been regarded as the most effective method to prevent health-care-associated infections. Guidelines from the Centers for Disease Control repeatedly have emphasized that hand washing is the single most important procedure for preventing infections, and that hospital-acquired infections are among the leading cause of complications in patient-care outcomes.
As such, MCH embarked on a two-year research program to identify a learning response system designed to provide a first line of defense in the control of health-care-associated infections. The system needed to be reliable and use subtle retention strategies to ensure proper hand washing 100 percent of the time when interacting with patients. MCH selected a learning response system known as Hygreen, and 1,482 physicians and clinical teams attended a 30-minute training session followed by a Web-based simulation of the process.
Hygreen identifies the badge of the Health Care Worker (HCW) and verifies that hand washing has occurred. A green LED is activated on the HCW badge when hand washing is done. When the HCW approaches the patient’s bed, a proximity-sensing bed monitor determines the status of the badge and creates a visible light around the bed for patients to acknowledge, “green light means I’m safe.” Patients and their families are trained daily to recognize the signs of good hand washing. They are empowered to ask the HCW to stop and wash their hands prior to touching them. They also are provided with stickers to recognize those who do it right. More importantly, the system documents the time and location of each incident through a wireless signal that enters the data into the central base. A daily report is generated and discussed at the daily huddle with staff.
As a result of the auto-response system, compliance with hand hygiene protocols increased to 94 percent. More importantly, hospital-acquired infections decreased by 89 percent. This initiative was led by the Infection Control and Prevention Team, which partnered with MCH customers and patient-care providers to get results.
“We know our staff wants to do the right thing. With this system in place, they are gently reminded to perform hand hygiene if they happen to forget. This creates instant feedback, followed by informal coaching and support, all helping to keep our patients safe at all times,” says Barbara J. Simmonds, director of Infection Prevention & Control. “It is nice to note that due to this program’s success, one of the families has donated monies to support the integration of Hygreen into all clinical practices at MCH.”
Shifting Culture to Shift Learning
To make organizational improvements, such as enhanced quality outcomes and lean methodology, that are needed to best serve its patients, MCH began its journey by reshaping its culture. To do that, the organization developed The MCH Way, a comprehensive and proven, two-day culture-shaping process that engages people and measurably affects their spirit and engagement in organizational values. “It allows employees to connect to the MCH values and guiding behaviors, determine habits that may slow progress, and minimize cultural barriers to change,” Noureddin explains.
MCH President and CEO Narendra Kini, MD, was a strong catalyst of transformational change, Noureddin emphasizes. “He understood that this foundational step was needed before embarking upon major strategic and business initiatives that would transform the way the administration; 650-affiliated physicians; and 2,750 clinical staff and front-line employees work together to deliver care and services to families,” she says.
An important business goal of transforming the culture, according to Kini, was to quickly engage people at all levels of MCH—starting with the senior leadership team—in The MCH Way to enable implementation of Lean Management processes and electronic medical records. Within 18 months, 70 percent of the hospital staff and leaders had participated in initial MCH Way culture-shaping sessions. And just as quickly, positive results were seen in a number of critical areas: The organization saw significant improvement in its medical staff satisfaction, from the fifth percentile, one of the lowest in the country, to 94 percent. MCH also experienced significant improvements in the patient experience and an increase in employee engagement in all off-site facilities.
Most importantly, MCH now has a “universal language” used in conversations, in meetings, and in documentation to ensure respectful, productive discourse, states Kini. Since the MCH Way is a mandatory part of new employee orientation, every employee gets the message from day one that the organization cares about the attitudes and behavior of its workforce.
The MCH Way is embedded into the organization’s annual performance management system. Fifty percent of employee performance evaluation is based on attitude and behavior.
The improvements and organizational shifts MCH’s learning professionals helped to power last year taught Noureddin key lessons she now is able to pass along to other learning and development executives. “Focus on the priorities of your organization. Have a clear understanding of your organizational strategy and link all training initiatives to your organization’s strategy goals,” she says. “Make sure you have a presence in organizational change and consistently communicate how your programs affect the bottom line. Develop your elevator speech so your impact on results is clear, focused, and undeniable.”