Challenge: Turnover. Employee turnover increased to 28%, up from 18%. This churn created many problems including quality of care issues, decrease in billable hours and a major increase in overtime being used.
This increased the financial strain on this company.
Solution: 120 day Onboarding; Triage system
History: In the past 6 months, the manager that had been at this company the longest retired. During the managers tenure he had trained other managers who adopted his abrupt and militaristic style of communicating. During this time, reimbursement regulations changed and there was more emphasis on billable hours. Staff would put in for overtime when they could not complete their documentation when whey were with the patient.
Innovation Lab
Two of the highest performing therapists along with two underperformers and three others were selected to attend the Innovation Lab. They had therapists with 10+ years of experience down through, less than 2 years, along with generation X, Z, millennials and baby boomers represented in the group. Total in the group was 7. Ideal number for the Innovation Lab is 5 to 9. [You can learn more about ideal teams in the Work Smart Club.]
Through a process of discovery, the group found a pattern. Specific cases required much more time than others. The demands of this patient exceeded even the best therapists ability to complete the treatment plan along with the documentation in the time allotted.
Actions Taken
Because of the findings from the Innovation Lab, the team recognized there needed to be better monitoring of staff progress in the onboarding. They increased the onboarding time so new staff could gain more coaching from experienced staff.
Through a study of the patients, the innovation team identified those patients causing delays in documentation or treatment progression and set up training on protocols and charting to reinforce their comfort levels.
The team also recommended triaging the identified group that caused 95% of the roadblocks for a different level of care than a therapist. This required a new type of staff and when they compared the overtime used to the cost of the staff, they were able to more than justify the expense. The billable hours, overall, improved and overtime decreased and only was only used in emergencies or in case of staff call outs.
Final Outcome
Turnover decreased to 17%.
Billable hours increased 20%
Control Measures
The innovation team set up a monitoring process of the onboarding to see that it was working the way they intended it. Tracking and monitoring would be conducted by the preceptor and tracked monthly with their other metrics.
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