In an era when initiatives such as pay-for-performance and revenue cycle optimization take center stage, training may seem more like an item on a check list than an outstanding opportunity. When budgets, strategies and annual plans are solidified, training may not make leadership’s radar beyond a cursory review. Yet, it is important to realize the importance of training and how much it can benefit an organization. Developing a strong training program can fuel organization greatness. Today, for example, health care organizations are facing a shortage in both nurses1 and physical therapists2, and any organization that has a top training program—not just for compliance, but for leadership and personal development, too—has an edge. When combined with a proactive approach to human resources, a strategic training program can be used to identify and cultivate rising stars and help ensure that your best staff will want to stay with your company. All organizations face challenges when developing training programs. These can range from the internal—how to develop a solution that works efficiently across an entire organization—to the external, with today’s increasingly mobile society and evolving regulatory systems. To overcome these obstacles, businesses in the HME and home health care sectors can implement best practices to develop a capable solution to improve quality of care and accomplish their overarching goals.
Tackling the Four Cs
All organizations have a hefty set of challenges to address when developing a training program. The four Cs are especially important.
- Content
- Convenience
- Consistency
- Centralization
Content—The first C, content, is the foundation of any training program, and many factors influence its quality. Foremost, is the content comprehensive, and does it thoroughly address all aspects of the topic in an engaging way? Are the instructors accredited with experience? Do you (or the administrators of the course) monitor regulatory requirements and keep coursework updated accordingly? Is content customized to ensure success for varied employee populations? How is the content best delivered? In-person? On-line? Through a combination of the two? Convenience—Another challenge a good training program addresses is the mobility and learning style of today’s workforce. Health care workers—particularly those in fields such as home health and occupational or physical therapy—are often mobile, working at many locations in any given week. They’re likely accustomed to using their vehicle as a home base, taking a few moments to fill out paperwork, make phone calls or handle other tasks while sitting in parking lots or grabbing a coffee. In other words, they need convenience. Consistency and Centralization—The two remaining Cs—consistency and centralization—work together to ensure reporting is thorough, organized and can stand up to tough audit scrutiny. To better understand the impact of consistency and centralization, consider a home-health agency with 400 employees in Massachusetts, Connecticut and Rhode Island. If audited, one of the agency’s most important tasks is demonstrating that every employee received consistent training, regardless of where they live and work, or when they completed coursework and testing. Consistency isn’t just important in the case of an audit, however; it also is a clear indicator of quality. Showing that all employees received the same quality and in their training and consistency in test results can solidify the training program’s overall effectiveness and ongoing compliance. A program that addresses all federal compliance requirements, such as HIPAA and state-specific accreditations, doesn’t just prepare for an audit. It can also show auditors you have proactive, thorough and organized documentation to potentially prevent them from further scrutinizing your processes. Next, a surveyor wants to see a centralized, single source for training documentation, even if each of the agency’s three states has different accreditation requirements. For an agency serving several states, it can be a challenge to gather, organize and then constantly maintain this highly detailed information. A strong training program includes a component to track results across all locations. Ideally, organizations will use a centralized platform to monitor consistency and compliance, and maintain updated reporting across all locations.
New Opportunities and Scrutiny
In recent years, health care organizations have been inundated with regulatory requirements brought about by health reform. Requirements and opportunities brought about by the Affordable Care Act include everything from electronic health records (EHR) adoption for meaningful use to the Medicare Hospital Readmissions Reduction Program (HRRP). Many of these new requirements also bring new opportunities, and the Medicare Hospital Readmissions Reduction Program (HRRP) is a good example. As hospitals respond to HRRP, they are tasked with maintaining a closer patient relationship throughout the continuum of care. This relationship is particularly critical if a patient is flagged at risk for readmissions. As a result, many hospitals are forming relationships with post-acute care facilities and referring at-risk patients for readmissions. This scenario opens new doors for post-acute care providers to build relationships with hospitals—and new revenue streams as well. It sounds ideal, but preparing staff at the post-acute care facility to specifically address the hospital’s concerns—in this case, mitigating patient risk for readmissions—is vital to achieving a successful, win-win relationship. For example, a training program must address specialized patient care for the diagnoses most commonly readmitted within 30 days: acute myocardial infarction, heart failure and pneumonia. It needs to include interactive or practical training for complex cases, as readmitted patients frequently have multiple diagnoses, extensive follow-up instructions and numerous medications, which are factors that often lead to confusion and non-compliance. A training program that specifically addresses a clinical or regulatory issue such as preventable readmissions can serve multiple purposes. First, if an organization is trying to establish itself as a preferred provider for referrals, it can prove compliance, quality and preparedness. Second, as any organization forges new relationships and secures a new referral stream, these actions may lead to more scrutiny from payers or surveyors, which in turn may lead to an audit. A strong training program, especially one that includes consistent, centralized training documentation, will address and resolve any possible scrutiny.
Best Practice Training Program
You have a geographically and socially diverse workforce. It includes social media-savvy, app-downloading types alongside employees who speak English as a second language and are the first to admit that their kids are the technology experts in the family. You have employees who send emails at all hours, stop at Starbucks regularly to use Wi-Fi and probably have enough supplies to live out of their cars for a week. Meeting these diverse needs requires a multi-dimensional approach. Health care is one of the most stringent industries in terms of compliance training. Organizations must provide documentation that can stand up to state, federal or payer audits at any time. How, then, do you develop a best practice training program that is cost-effective and conducive to today’s workforce while standing up to any audit? Going one step further, how can you strategically leverage your training program to identify and nurture leadership, or attract and retain top talent? Having a best practice training program doesn’t require the highest cost resources. It doesn’t require a large-scale cookie-cutter program where you take one expert’s solution and apply it across your entire organization. It does, however, require a blend of process, strategy and technology. Go blended—A blended approach includes both classroom and online training. In many cases, live training is just too expensive. Consider the cost of redirecting 30 employees from their jobs, paying for travel and meal costs, and hiring a trainer. In some cases, live training is ideal, but organizations are able to make a strategic decision with the blended approach. Online—Staff can go at their own pace, at their convenience, in any location. With basic courses, such as one on HIPAA compliance delivered quickly and affordably, most employees will log on and knock them out when they have a few minutes of downtime. Classroom—Save maximum impact training for the classroom. For instance, assign an introductory course online to give your staff a baseline understanding. Then have a “lunch and learn” class, when the trainer leads a discussion about the practical application of what everyone learned in the class. That way, time spent out of the field is minimal, but valuable. Consider simple vs. complex—Separate training into simpler versus more complex tasks, and then set up courses accordingly. When determining methods (in-person or online) as well as activities such as simulations or scenarios, consider the complexity of the material and what is appropriate. The simplest content is ideal for straightforward reading and Q&A. More complex topics lend themselves to interpretations and simulations. Incorporate variety—Blame the apps, social media and array of technology we have at our disposal; we have short attention spans. Consequently, multiple teaching methods can help your workforce learn more and improve compliance. In addition to in-person and online teaching, consider using scenarios, online simulations and interactive formats. Leverage online tracking—Centralized online tracking is essential. It’s the simplest and most thorough way to not only prove compliance in the event of an audit, but also keep track of ever-changing training records within your organization. For online courses, you’ll already have a built-in system to show completion of courses and tests. Health care organizations can also input classroom coursework manually into this same online system to ensure that all records are centralized and consistent. Keep doing what you do best—If you’re known for diabetes care and want to use your own training, then use it. Or if you know your workforce and believe they need specialized training for certain topics, go with your internal knowledge. Just be sure to add these courses to your tracking system so you have one centralized source of data.
Be Prepared
Compliance requirements change frequently and the risks and liabilities for non-compliance grow greater all the time. The Hospice Item Set, which is new hospice quality reporting mandated by the ACA, took effect July 1, 2014. As a pay-for-reporting measure, failure to accurately report can equate to reduction in CMS payment. And, while compliance is the most obvious reason for having a strong training program, it’s followed closely by professional development, health care quality and reduced costs. As organizations strive for higher quality care and clinical outcomes, they are holding all personnel accountable for their actions. Organizations are under pressure to monitor and cut costs, even as they add training to meet state and federal requirements. As they face new levels of scrutiny, organizations can ease the audit process by relying on a centralized online system to track and report all testing. In health care’s increasingly complex landscape, having everything you need for an audit is a good thing. Preparing an entire health care organization to improve overall outcomes? That’s a great thing.
References
- 2014 Nursing Shortages Fact Sheet, American Association of Colleges of Nursing, http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
- Pignolet, Jennifer, “With Aging, Active Clientele, Physical Therapists IN Demand,” The Spokesman Review, Nov 2013, http://www.spokesman.com/stories/2013/feb/03/upward-mobility/
