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Carilion Clinic: Training 9,000 Employees on Epic
Based in Roanoke, Virginia, Carilion Clinic is a not-for-profit healthcare organization that serves more than a million people.
Like any healthcare organization today, Carilion faces new challenges. Frequent Epic Systems upgrades mean thousands of employees must be continually trained on how to use the latest version. Fierce competition for talent is also a concern, especially for a not-for-profit clinic that can’t always compete on salary. This, coupled with increased demands for healthcare, due to both changes in policy and an aging population, requires doing more with fewer resources— especially when it comes to ensuring quality patient care.
A key component in the ability to deliver that care is a highly engaged, passionate workforce. Yet Carilion’s people management systems, in contrast to their patient management systems, were highly siloed. According to Robert James, HR technology manager, “There was no visibility. There was no global approach to data around learning, performance, succession or competencies.”
Originally, Carilion implemented Cornerstone Learning to manage training in advance of the rollout of Epic. “Knowing we’d have to train thousands of staff with role-specific education on how to do electronic charting was daunting,” said Robert James, hr technology manager for Carilion Clinic. “We knew we couldn’t manage that level of complexity with our existing system.”
But James and his team saw that addressing other challenges would require more than a new Learning Management System (LMS). Carilion implemented Cornerstone Performance to both streamline reviews and correlate performance and learning data. The clinic also began using Cornerstone’s Observation Checklists, a tool that enables real-time, on-the-job performance tracking and testing for basic competencies.
Today, James and his team use Cornerstone to help them build a true organization-wide culture, not just of engagement, but of values. “We use Cornerstone to reinforce our core values, our Five Cs, and that affects employee engagement,” said James. “People are impressed after coming to Carilion from other organizations and seeing how we make sure employees are prepared to deliver quality healthcare.”
Evaluated competencies. Carilion relies on Observation Checklists to validate employee skill proficiency. “Observation Checklists is used by 70 percent of our staff,” said James. “It’s particularly helpful in ensuring clinicians participating in high risk or low frequency activities can renew their validations. And we can be more certain of ongoing competency.”
Streamlined audits. The team also uses Observation Checklists to streamline audits. “Audits are whirlwinds, and it’s not just Joint Commission. We’re routinely asked to show documentation, and with Observation Checklists, we can get information out to folks in a minute to show the validation history of a clinician.”
Delivered targeted Epic training. Via Cornerstone Learning, employees can stay current with Epic upgrades. “Because we can build curriculum in Cornerstone around a position that correlates to an Epic role, it’s extremely easy to get the right education to the right people,” said James. “We couldn’t accomplish Epic training without Cornerstone. We’re training 8,000-9,000 people every few years with only Cornerstone and 20-30 trainers.”
Increased engagement. Within Cornerstone, James and his team can link learning to performance and vice versa. “Cornerstone helps us show employees how to use learning to improve performance. Employees realize we’re invested in them. And that helps us create a more engaged workforce.”
Developed new leaders. Cornerstone is also instrumental in onboarding newly promoted leaders. “Right away, they’re in Cornerstone taking classes. Some courses are practical, like how to use the HR system. Others are philosophical, such as how to have difficult conversations with employees.”
Gained visibility into organizational trends. Carilion relies on Cornerstone Performance to identify performance and compensation trends. “With Cornerstone, we were able to identify issues with our pay practices, namely a disconnect between ratings and merit increases,” said James. “We wouldn’t have known that if we weren’t using Cornerstone to centrally manage performance reviews for 11,000 employees.”
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Wanted: Healthcare Leaders Comfortable with Ambiguity
Jack be nimble! I find myself thinking about the nursery rhyme phrase lately when I'm explaining the demands facing today's healthcare leaders. The current challenges facing the industry — increased pressure on margin, the need to rebuild infrastructure and the need to adapt to a changing marketplace — make for a formidable set of candlesticks. Simply put, leaders can no longer force-fit the realities of today’s healthcare environment into yesterday’s mold. Like most nursery rhymes, "Jack be Nimble" has ancient origins, originating in a pagan tradition wherein a person's ability to jump over a burning candle without extinguishing the flame was a harbinger of good luck. So how can today’s healthcare leaders clear the flames of today’s unfamiliar obstacles? The answer is agility. Agile leaders adapt quickly to changing circumstances. Today’s successful healthcare leaders are able to maintain margins and not compromise quality patient care. They collaborate to form relationships and partnerships as they create care paths. They get results with and through every caregiver and stakeholder in a way that values each idea and contribution. Based on the work of Lombardo and Eichinger [i], the secret is "knowing what to do when you don’t know what to do." The management performance experts call it "learning agility." For most people, developing this skill requires focused and intentional practice of the ability to lead in ambiguous situations. For learning leaders, then, the challenge is even bigger: How do you intentionally design a learning experience that builds agility, which by necessity can't rely on standardized flow and predictability? These four tips can help healthcare organizations create a more methodical and repeatable, yet agility-focused, learning process: 1. Place leaders in experiences that are unfamiliar and outside their normal areas of expertise. For example, assign clinical caregivers to lead non-clinical strategic projects. A senior nursing director could take the lead on a process improvement project to decrease wait times in the Emergency Department. 2. Provide resources for leaders to keep a lookout for what they are noticing about the situation. Help them understand context, who the stakeholders are and what deliverables are expected. These are basic project management concepts that many leaders have not formally used. Offer these resources to help them avoid making assumptions or overlooking critical information. 3. Build in time for leaders to pause to think and reflect about what they are learning. This could take the form of a mid-project status review to surface what is and isn’t working, or regular journaling. A good coach or mentor is also particularly helpful here to help employees process what is happening. 4. Make sure they master the learning. Repetition is key to fostering the ability to be more agile in unfamiliar situations. Identify ways for leaders to keep practicing their new insights to use in other situations. Stop for a minute and think about what your company's specific new candlesticks might be. What can you do to help your leaders hurdle them smoothly and gracefully? With repeated practice, good luck is sure to ensue! [i] Eichinger, R. W., Lombardo, M. M., & Capretta, C. C. (2010). FYITM for learning agility. Minneapolis, MN: Lominger International: A Korn/Ferry Company. Photo: Shutterstock
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