Breaking the ice: Organizational culture alignment enhanced by a comprehensive new provider orientation

Editor’s note: This article was adapted from a paper submitted toward fulfillment of the requirements of Fellowship in the American College of Medical Practice Executives. Learn more about ACMPE certification: mgma.com/acmpe.

A large multispecialty group was created through multiple acquisitions in a short period of time in an environment where care delivery was transitioning to value-based reimbursement. These changes resulted in performance gaps in the onboarding process, during which poor communication created a lack of process alignment and inconsistent or incomplete information presented to new providers. The resulting dysfunction became apparent through a lack of unity in language, priorities, focus and goals, as well as general provider dissatisfaction.

As a result, it was determined that a new provider orientation was needed. A sub-committee of two management-level employees who had participated in the onboarding work group was tasked with creating a new orientation experience for new providers.

Goals

The development process began with review and consideration of goals, which included:

• The desire for informal sessions and dialogue
• Information that could apply to all providers at all education levels and all specialties
• Topics important to all new providers
• Information that reflects how the larger organization “thinks” about current and future issues and priorities that impact providers
• The opportunity for new providers to connect with other new providers, subject matter experts and decision-makers in the larger organization.

Topics

Topics should be considered “high impact” for providers and should yield knowledge and understanding of anything that affects compensation, incentives, career, personal well-being or personal risk. After a brief presentation on mission and values, additional topics included:

• Quality metrics and related income incentives
• Elements of the compensation formula
• Practical shortcuts and enhancements to the EHR
• Service excellence and related income incentives
• Monthly compensation statement including continuing medical education (CME) allowance and use
• Risk management, HIPAA and compliance
• Company employee assistance program (EAP)
• Introduction to the resources available in the health system
• Retirement benefit options
• Personnel policies for providers.

 
Once the topics were selected, subject matter experts were identified to present on as many topics as possible. Providers who functioned in leadership roles in the larger organization were approached first, with administrative personnel or executives filling in as presenters in the remaining topic categories.

Sessions

Location, capacity, duration and frequency of sessions were considered, along with the environment and messaging, including how the experience affected new providers and how first impressions could be the foundation of a successful long-term relationship. The overall message should be welcoming, recognizing that new providers are valued by the organization.

Given that 40 to 60 new providers typically entered the organization each year, a monthly session could accommodate the volume while also maintaining a level of intimacy in the conversations. Because a day-long education session felt excessive, time management became critical to keep the session to a half day.

Beginning with the session introduction, each host, attendee and presenter participated in an icebreaker that spoke to their role, education, where they lived and other personal facts. Participants were invited to ask questions and program breaks were incorporated to allow for short interactions. Non-alcoholic drinks, a continental breakfast and snacks were available throughout the session, and lunch was served at the end of the program. The top executives were invited to lunch with the new providers where they also participated in a town hall and open dialogue.

To reinforce the information presented and serve as a resource, each new provider received a personalized three-ring binder that included a welcome letter from the chief executive officer, the presentations, a list of phone numbers for organizational leaders, a list of committees and other opportunities to contribute to the decision-making process, and a sample newsletter and other sources of company information. In addition, new providers received small branded gifts of pens, cups, lunch bags and umbrellas, as tokens of their value to the organization.

Feedback

Anonymous feedback from attendees was requested so future sessions could be changed appropriately in terms of topics and presenters and if possible, provide a means of gathering data to help measure success. A common survey tool was used, limited to only a few questions — four to gather data and three to solicit comments. Attendees receive the survey immediately after the session.

Milestones

Finally, milestones for the development, initiation and execution of the project were created. It took six months from concept to first session. Given the size of the organization, the design, timeline and session structure needed to be clear before entering the approval process.  

Execution

Once the approval process was completed, topics and presenters were identified and their individual presentations secured. An agenda was established based on presenters’ availability and then subsequent presentations were added based on the previous topics provided. The agenda was also designed with some flexibility to allow for discussion. The takeaway materials included a general template for all providers but also options for individualizing non-presentation materials. Special invitations were sent to new providers who had joined the organization in the previous six months, including a copy to their site practice manager. The session hosts were briefed, reinforcing the casual nature of the event and desired outcomes. Lunch invitations were sent to the executives to ensure the event was on their calendar and to gather an accurate count for ordering food. The first session was ready to launch.

Results

For the first 11 sessions, 74 new providers attended, 39 (53%) of whom chose to respond to the post-session survey. All 39 (100%) affirmed that the content presented was helpful. On a scale of 1 to 5 with 1 being least favorable and 5 being most favorable, the average rating has been 4.67 with only one provider’s “overall” score less than 4. Comments have been very favorable with most along the lines of “very helpful” or “I wish I could have received this information sooner.” Feedback has been helpful in assessing demand and has resulted in the addition of topics on legal and risk management and expansion of presentation and conversation regarding EHR. Attendees and company executives have particularly appreciated the face-to-face interaction of the town hall format and have spoken to the benefits of creating these connections and conversations. Perhaps the most substantial outcome, which is not directly measurable, is the year-over-year positive change in provider engagement survey results. With 15% of the current providers having participated in new provider orientation, palpable improvement has been seen, as the health system has improved from a 75th percentile top-box overall ranking in an annual provider engagement survey to a 93rd top-box percentile ranking in a pulse survey less than one year later.

Related hospitals in the health system have also started an orientation for new providers who work, admit or see patients in their facilities. By all measurable data and participant comments, the program has been a great success.

Reflections, enhancements and lessons learned

The first new provider orientation session was not without issues, as presentation duration times were not well established and there was a lack of familiarity with available presentation technology. Subsequent sessions are continuing to improve as the hosts are learning to be flexible with their presentations. Through attendee feedback and other stakeholders, the structure of each session and the topics presented have continued to evolve and improve. Some of the observations and changes based on feedback included:

Importance of consistent hosts and presenters

Periodic host and presenter substitutions resulted in missed or altered information and timing challenges. Also, familiarity with the information and session flow allows hosts to better manage time and cover topics appropriately, while also encouraging conversation.

Importance of a standing routine

A month before their proposed orientation session, an email is sent to new providers’ site practice manager requesting that their calendar and patient schedule be blocked for the date of the session. Two weeks before the orientation session, an invitation is sent to new providers with a copy to the site practice manager including a confirmation request. Two days before the session, a confirmation email is sent to new providers and their site practice manager.

Once sessions are established, hosts and presenters are selected, and place and time are chosen — less time and energy is spent tracking down presenters who are “up next” on the agenda. Notices are also sent to presenters a couple weeks before a session as a reminder for changes to be made available to the organization/planning team at least a week before the next session.

A week before the next session, a lunch invitation is sent to all company executives requesting a quick confirmation turnaround to tally attendance, which is used to order food for the session.

Impact of thorough communication

Initially there was an assumption that new providers controlled their calendar and patient schedule, so site practice managers were not included in invitations and other communications. New provider attendance improved when the site practice team received the same and additional communication from the organizers of the orientation sessions.

Response to surveys 

Efforts to build relationships could be lost if there was no follow-up on questions that arose during the sessions or requests included on survey responses. As a result of feedback, new topics were added to the orientation session agenda and initiation of additional education was made more timely in the areas of billing and coding. A list of questions and requests that are not addressed in the session are kept by one of the hosts and individual follow-up is initiated less than 24 hours after the session.

Tightening the timing of presentations

Given the flexible nature of the sessions, time management is consistently a challenge. When a presenter constantly wanders from the topic or has prolonged explanations, a host will follow up after the session to offer ideas on how to shorten the presentation or address critical issues while staying focused. As a preferred alternative, after-session follow-up communication by the subject matter expert with the new provider is encouraged as a way to manage time while also encouraging relationship building.

New topics

Once it was discovered that there was a forum for new providers, the requests for participation increased. As participation requests come in, evaluation of session topics are scrutinized to determine if there are more relevant topics for providers. There continues to be resistance by the organizers to increase session duration as attendees seem to show signs of fatigue by the end of the half-day session. Periodically, presentations will be altered to allow for a very brief overview of a new topic, such as an introduction to the hospitals/health system.

Continuous improvement and ongoing feedback

The planners and organizers are always looking for better results, so a debrief with the hosts is held after each session to review what went right and where improvements can be made. In addition, there is a larger assumption that a dynamic organization needs a dynamic orientation session. Ongoing feedback is actively solicited from participants, executives and other key leaders in the organization to ensure topics are current and accurate.

Mandatory provider participation

Because the new provider orientation was a new concept, some of the site practice managers were initially reluctant to support or promote the sessions to providers. Also, some new providers were anxious to launch their practice and were resistant to taking a half day early in their employment to sit in a room for what they anticipated to be a monologue of philosophy, facts and figures. Within three months, the new provider orientation was shown to have substantial value to attendees and the larger organization so it became mandatory for all new providers in the first 90 days of employment.

Identifying ownership

The initial planners and organizers were passionate about the concept and success of the project. Broad creative freedom was given to this group for taking the project through to execution. Once operational, some questions arose regarding who owned the related and unbudgeted expenses. This led to broader conversations regarding ownership of content and future growth and development. Ultimately the new provider orientation fell under the department of human resources as an extension of the provider recruiting and onboarding process.

Key steps to building new provider orientation

• Review the practice’s areas of impact for existing providers. Anything related to provider compensation should be included, as well as how the provider is measured for quality of care and efficiency strategies related to the EHR. Presentations on impact areas should include a review of how to read related reports and ways to improve results through the use of available tools. Most of the practical application is picked up through periodic exposure and colleague conversations, but an introduction during orientation can give reassurance to new providers that there are support mechanisms to assist them in meeting their goals and achieving success.
• Organizational strategic initiatives should be discussed to ensure future alignment.
• Presentations by peer provider subject matter experts is critical for creating credibility with new providers for the organization and the topic. These individuals are typically the most passionate regarding their topic. Their enthusiasm frequently influences participants and keeps attendees engaged through the presentation.
• A dialogue vs. monologue format is essential for engagement.
• Direct interaction with executives or key leaders cannot be overstated as a way to connect with the organization’s leadership, goals and objectives.
• Any messaging to new providers that they are a valued member of the team is a strong connecting tool. Branded takeaways are recommended as a way for new providers to express pride in their role in their new organization.
• Gathering feedback is essential in assessing success and evaluating possible changes needed to topics, presenters or the session.
• Determine who owns the program from the beginning to ensure responsibility for staffing, expenses, resources, consistency of information, frequency of sessions and communication with those involved.