Retain your team through onboarding and training academies

The RWJBH Medical Group includes more than 1,750 unique physicians and more than 30 specialties, including primary care, in more than 250 locations throughout New Jersey. As the state’s largest academic healthcare network, RWJBH provides care to more than 1.8 million patients resulting in more than 2.1 million visits per year. 

The strategic goals for the medical group include expanded access, improved integration, becoming a center of excellence and enhanced recruitment/retention. RWJBH had average performance in these areas but wanted to improve the productivity of providers and staff, excel at customer service and reduce vacancy rate and staff turnover while improving employee retention. RWJBH Medical Group leadership assigned a team to meet these strategic goals. The team implemented a plan to retain staff through onboarding and training academies.  

1. Review job descriptions and competency evaluation 

As RWJBH Medical Group underwent a transformation, implementing Epic as their EHR platform, it became crucial to determine if the staff roles had changed due to this implementation. We reviewed our job descriptions for certified medical assistant (CMA), licensed practical nurse (LPN), registered nurse (RN) and our front desk patient service representative (PSR). We found that the job descriptions aligned with the actual work being performed.  

Upon reviewing the competencies, we discovered the absence of both a unified task list for onboarding and an annual competency checklist for new or existing employees, leading to a process that failed to meet employee needs. Staff felt overwhelmed after attending new hire orientation and EHR training when arriving at the practice.  

2. Conduct focus groups 

The team created three focus groups to better understand staff feedback. Our “best in class” were invited to attend one of three focus groups to share their candid thoughts. The groups included a mix of roles and geographic locations, were new to the role and organization and had experience in and outside of the network. We spent several hours listening to their feedback and suggestions to improve our processes.  

3. Analyze the results 

We compiled the feedback from our meetings: 

Practice managers 

Many of the practice managers (PMs) spoke positively about the PM playbook and resource guide developed for the Epic implementation, which detail how to effectively use the Epic system for department management. Some examples in the guide include how to access charity care, connect with customer service to review a bill, make a payment online and add users to common websites needed to perform their jobs. 

Opportunities for improvement included communicating how, when and which reports should be run. In the new system, PMs can access hundreds of report templates for operational assessment, an upgrade from receiving reports via email in prior systems.   

The PMs requested additional support for guiding staff through the probationary period (the first 90 days of employment), emphasizing the need for a single onboarding checklist and enhanced “cross-training.” While clinical staff are expected to complete training in specific tasks like scanning, creating telephone encounters and appointment scheduling, they are not fully trained to cover all front-end tasks.  

Clinical staff (CMA/LPN/RN) 

The majority of clinical staff were frustrated that practice workflows were not uniform across practices. In addition, more training was needed to understand the nuances of administering medications and vaccines, documenting point-of-care testing, performing EKGs and completing Medicare wellness exams. 

Patient service representatives 

The PSRs advocated for better scripting to boost their collection efforts, including copayments, previous balances and estimates for non-covered services. They also mentioned the lack of standardized provider schedules, recommended smaller practice settings for new hires and expressed preference for a scaled-down resource guide. 

Create a training academy to support teams 

Our analysis concluded that new hires require more time to learn and more personalized one-on-one support before they step into their new roles. So, we created the training academy to:    

• Improve and standardize the onboarding process for PSRs and CMA/LPN/RNs 
• Create standardized training that determines readiness for newly hired staff to report to their practices 
• Provide an opportunity for current employee career growth to become future trainers and potential supervisors/managers 
• Enable new trainees, after completing the training academy, to have a “warm hand-off” to their new practice (home base).  

4. Create onboarding checklists and training tools 

We compiled operational leadership’s checklists into two comprehensive ones — one for clinical staff and one for PSRs — covering all training topics to ensure consistency across training academies, including standard items like time and attendance, payroll and email etiquette. We then mapped all essential workflows for each role to corresponding competencies. 

Together, the team created a series of virtual training modules for the trainers, with the remaining modules delivered in-person at their practices, covering HIPAA/privacy, policies and procedures, human resources (HR) support, review of the training checklists, customer and patient experience training and incident reporting. Binders were created for the trainers to hold important information, training materials, completed checklists and other relevant documents at each site. 

5. Recruit and retain trainers 

The team identified a list of ideal practice locations and potential employees to become trainers. Some of the requirements for the potential practices and trainers included:   

• Geographically desirable, ease of access off major highways and centrally located in regions 
• Productivity of providers to allow for a true experience 
• Space within the practice needed to accommodate additional trainees 
• Possess a strong, competencies-based skill set; considered “best in class” employees 
• Demonstrate strong communication skills 
• Show potential to train others. 

Presentations to operational leadership aimed to introduce the program, explain its mechanics, obtain feedback and secure their buy-in, while also assuring them it would not result in increased PM workload due to a team dedicated to managing the training academies.  

The numbers have grown from eight locations and 20 trainers to 16 locations and 40 trainers since introducing the training academies. We initiated the program in primary care offices and expanded it to other specialties such as OB/GYN, pulmonary, pediatrics and sports medicine, with further expansion of additional training academies planned for 2024. 

6. Reward and recognize team 

HR developed a pay scale for trainers, starting with an initial $2.00 per hour increase to their base pay during their training period and the first 90 days. Upon a positive 90-day evaluation by the training academy team, and if both parties agree to continue, this increase becomes $2.50 per hour. After one year, the pay further rises to $3.00 per hour. To simplify, this “premium pay” would apply to all hours worked, eliminating the need for PMs to track time spent with trainees.  

7. Train the trainer 

Upon selecting trainers, the first wave of training began. To avoid patient care disruptions when allowing trainers to attend sessions, training was delivered virtually or onsite by the training team. Trainers completed modules in HR support, fall prevention, recognition, HIPAA/privacy, patient experience, policies and procedures, email etiquette and Press Ganey surveying.  Each module was scheduled for 30 minutes, and the same session was offered at three different times on different days to accommodate the trainers’ schedules. Trainers were only expected to attend one session for each topic but could attend more.  

Leadership development 

The medical groups viewed the trainer role as a career advancement opportunity with increased compensation. The training and skill-building were positively received by both the trainers and medical group leadership, and three trainers have since been promoted to office supervisor roles.   

Measurements of success 

RWJBH continuously measures successes, including patient, employee and provider satisfaction.  

Our training toolkit 

We have comprehensive tools to ensure the successes of new hires and current employees, leveraging existing solutions within the RWJBH network.  

• Clinical workflows: Staff receive detailed training on clinical workflows, covering each step and requiring documentation. For example, when giving a vaccine, the trainee must document the lot, NDC number, dose and administration site/date.  
• Technology: In October 2023, RWJBH reached a milestone by launching a new, integrated EHR platform across the entire medical group, marking a significant investment in its implementation.  
• Front desk processes: PSRs receive extensive training to support their role performance, including classroom sessions with a live trainer, web-based modules and a specialized revenue cycle training.  This training ensures they fully understand copay collection, patient estimates, registration, prior authorization, end-of-day cash reconciliation procedures and work queue training. 
• Step-by-step tutorials: We provide live, web-based and written tip sheets developed by subject matter experts and tested by our training team.  
• Training/HR: Trainers received training from HR leadership on how to handle challenging situations and personnel. 
• Real-life experiences: Training academies provide new hires the opportunity to practice workflows with a trainer’s guidance, helping build confidence and allowing observation of their skills and performance in direct patient care. The trainer offers real-time, constructive feedback and support, ensuring new hires are comfortable with their skills before transitioning to their permanent practice. 
• Patient and staff/provider satisfaction: RWJBH Medical Group’s success is measured primarily through our patient and employee experience scores, with the likelihood of recommending the practice and the providers assessed by third-party vendor Press Ganey. Our scores have consistently risen above the national average.  

Training academy feedback 

We surveyed staff who went through the training academy, allowing them to either identify themselves or submit feedback anonymously. Based on 150 completed surveys:  

• 100% of the trainers felt prepared to fulfill their trainer responsibilities  
• 96% of PMs noticed a positive difference in employees who attended the training academy versus our previous process  
• 92% of trainees believe the trainer spent adequate time with them each day  
• 98% of the trainees felt the trainer covered the appropriate material during their new hire training period. 

Positive comments from staff: 

• “I enjoyed the hands-on training I received.” 
• “I have never been with a job that trained BEFORE starting the position.” 
• “My two trainers were very detailed and patient when going over the most important topics.” 

Positive comments from the PMs: 

• “Employee arrived equipped with the skills to hit the ground running.” 
• “They come fully prepared. Epic oriented. This is definitely a plus for me.” 
• “It gives the new employee an opportunity to get familiar with Epic and demonstrate their basic competencies.” 

Negative feedback: 

• “Training Academy was too far from my home.” 
• “I was hired for an OB/GYN practice, and the training academy was an internal medicine practice. Although a great experience, I think training in OB-GYN practice would be better.” 
• “We learned too much.” 

Lessons learned 

The team has learned several lessons since the start of the training academy implementation.   

• Improved communication is important, and we need to communicate fully with operational leadership. We provided frequent communications during the development but need to continue these conversations to ensure ongoing support. 
• Improvement of technology was also seen as an opportunity. One frequent issue was that staff would complete the classroom training but not have access to the Epic system upon arrival in the training academy. This was frequently due to missed web-based training or IT security not setting up the correct role.  

Our trainers want to learn more to increase their competency. Because of this, they became “mentors,” stayed in touch with the trainees and answered questions via email or phone after the trainee left the training academy. Trainers are eager to receive feedback to improve their performance. 

Next steps and summary 

We plan to expand the number of training academies across New Jersey, enabling trainees to receive training closer to home and within their specialty, thereby meeting the medical group’s needs.  

Based on requests, the training academy team is working on creating specialized training academies for providers and practice managers. Recognizing that both roles can be overwhelming, the academies aim to educate participants about the organization, EHR system, the culture and policies and procedures of the medical group.  

The newly established training academy has proven successful, evidenced by increased patient and staff satisfaction. Patients have benefited from a well-trained care team, and this training model has elevated job satisfaction among new hires, current employees, trainers, PMs and leadership, while also offering promotional opportunities for trainers. The training academy program stands as a highly recommended strategy for any healthcare organization aiming to improve both patient and staff satisfaction and retention.