In this episode, you’ll hear how digitized assessments drive caregiver confidence and competence.
Welcome to competency corner, a podcast to equipping HR and learning and development professionals with industry tools and news, to prepare your workforce for the future, unlock the power of your teams to reach your full potential with our competency experts.
Jai Shah: 0:15
Welcome to Competency Corner. My name is Jai Shah and I’m the CEO and Co-founder of Kahuna Workforce Solutions. Bringing about lasting change and leaving an impact on an organization is not easy. It often takes a clear vision, courage to pursue that vision, and the persistence to get through many roadblocks in order to bring about lasting change. Today, I’m lucky enough to talk to someone who has all of those characteristics. Tammy Richards of Intermountain Healthcare has spent her career redefining education for caregivers at Intermountain. I hope you find her passion for this subject as inspiring as I do.
Jai Shah: 0:51
I am pleased to be talking to Tammy Richards today, AVP of Professional Practice at Intermountain Healthcare, and we are going to be discussing her legacy of developing an innovative competency framework that’s being used across the Intermountain system, and now is available to other healthcare systems through a partnership that we are lucky and fortunate to have with Intermountain Healthcare. So, Tammy, can you give us a little bit of background about yourself and your history with Intermountain Healthcare?
Tammy Richards: 1:21
Absolutely. Thank you. Well, one of the most meaningful periods in my career was the 20 years that I actually spent on the front line working as a nurse and many ICUs and I am truly an Intermountain advocate. I’ve always worked at Intermountain Healthcare. I’ve learned from others who have left Intermountain and come back to Intermountain and I have always chosen to just stay. I love Intermountain Healthcare. I think they are always striving to do the right thing for patients and that matters to me. But I remember when I was moving from ICU to ICU, I was so frustrated with some of the orientation that I would receive. It was so different and I think that was my first experience with the frustration of poorly curated, poorly organized, poorly executed education. But I also had an opportunity of becoming a writer for Intermountain Healthcare and I think my background as a nurse helped me develop policy and procedures and guidelines for Intermountain Healthcare.
Tammy Richards: 2:40
I was able to work from home during that period of time. But then I was tapped on the shoulder by the current senior vice president of clinical operations. And she asked me to coordinate extraordinary care for Intermountain Healthcare, which we had rebranded and it was a new vision and strategy for us providing extraordinary care and all its dimensions to our caregivers, to our patients and communities. After a few years of coordinating that initiative, I moved into managing director and then ultimately assistant vice president of patient engagement. Patient engagement was also incorporated within my portfolio of education. We had historically always had education managed through our human resource department. At the time the senior vice president had asked, should we have a clinical education department because 80 – 90% of the education that we provided at Intermountain Healthcare is clinical. It is having to do with our clinical employees so I worked very closely with her vice president human resources at that time and stood up a clinical education department.
Tammy Richards: 4:03
The rest is history. I have just been engaged and involved in leveraging best practice, evidence-based practice, education, clinical education, leveraging simulation and I helped leaders start the very first simulation center and labs here at Intermountain as well. All of it comes together to provide that best practice and education experience that I felt I was missing when I had been a frontline nurse.
Jai Shah: 4:36
Yeah and so in that journey, you know, a couple of things really strike me. Number one, Intermountain, in our experience has always been a leader and that’s been validated as we’ve gone to market and we talked to other healthcare organizations as well as some influential strategy consulting organizations within the healthcare industry. Intermountain always comes to the forefront at the top of the list of innovators. So despite that, were there some challenges in trying to get buy-in and trying to get a new way of doing education off the ground?
Jai Shah: 5:24
The reason I ask is that as we interact with a lot across a lot of different verticals, the people that actually are able to get these programs off the ground, competency-based initiatives, to me are the true innovators. They’re the ones who have to really fight what is normally a pretty traditional way of doing education and that’s not an easy thing to affect change within the organization. So I’m curious about what your experience was at Intermountain in terms of challenges and roadblocks.
Tammy Richards: 6:00
Great question and I think, you know, at the time we stood up the clinical education department, we also had a CEO, Bill Nelson, who was saying you know, we need to act like a system. We have 20 plus hospitals, 180 clinics. We have home care sites. We have so much that we’re offering in our communities, but we don’t necessarily work as a system.
Tammy Richards:: 6:22
We, we work in silos and he had said that multiple times and a lot of our leadership meetings and it was just, it was perfect because it allowed us to say, you know, it doesn’t make sense if we have our clinical programs, which Intermountain is known for our clinical programs and the great work that comes out of our clinical programs. If we have these teams who are identifying what a best practice is at Intermountain and let’s pick intensive medicine, intensive medicine, we have you know, 25 directors of intensive care units in a room with the system leader, deciding that a new practice should be adopted. And at that time, everybody is in agreement. They have consensus, they all know that they’ve got some different processes going on and they’re going to go and change practice to all do it the same.
Tammy Richards:: 7:18
And act like a system. And that’s great. And as we heard back, you know, months later that some of the metrics didn’t change. So even though we had this vision and this leadership support for acting as a system, what was the problem here? Why were we not seeing consistent outcomes or improved outcomes based on these changes? And we found that there were 25 different ways of educating that best practice. And a lot of redundancy was happening around the, around the system. And we knew right then there was a lot of opportunity. Opportunity for us to improve the consistency of the content to improve and reduce redundancies the development. And then also to find efficiencies, how can we do this and not have 25 different people spending time creating content. Let’s have two or three create content and everybody implements, and then we can measure and we can improve based on the outcomes. And so from an education perspective, that was our strategy. And from a leadership perspective, they were bought in. They saw the, they saw the gaps in the work that we were doing currently. They saw that and they were hearing it from our CEO that we wanted to act like a system. So any healthcare system that wants to find those efficiencies by acting as a system and being a system, this is a strategy and the work that has to be done. It is not easy.
Jai Shah: 9:06
And part of that work that we see the result of is something we refer to as curation. And I know that either curation, one of the difficult things about curating content is to get on the operational level, get the right team together and get agreement on consistency and harmonizing one way of doing things based on the clinical practice and standards. So did you assemble a team? You mentioned, you know, maybe reducing the number of voices in the room to really come up with a way to build consensus. Did you go about recruiting a team of maybe learning curation type people? And what was that process like recruiting people into this journey with you?
Tammy Richards: 9:58
That well, what you just described was the hardest part of all of this work and it lasted about two years and it did, it took a vision. We had the vision people, uh, our leaders, our frontline could subscribe to the vision. They understood why we would want to do this. And then you have to gather data. What we were using at the time, we were using a visual of a faucet that was just on full blast and people were having to drink out of this faucet that’s on full blast and people were not able to do it. They were not able to be competent because the flow was so heavy. We were developing so much information. We were doing nothing really in, cause it with one another. We were just creating content and having it be assigned to multiple people. And when we started to slow the flow and slow that faucet to the point where we had identified some consistency, some areas for opportunity, it made a difference. And then we were able to gather even more people on board with that vision. So the vision is so important in my mind and then the data. Then you gather experts. And so what we did at the time, we had eight clinical programs, women and newborns, pediatrics, oncology, cardiovascular, surgical services, and others. And we gathered experts in each of those areas. And, um, we literally had a meeting where our organization has been together. I mean, we had been a system for years and years and some of the educators or the managers in life departments had never met one another. We were sitting in those rooms and then say, oh, you’re the manager of the bone marrow transplant. And there were only two in the whole system and they’d never met face to face.
Tammy Richards: 11:59
And so we were bringing people who understood the content. We brought leadership, we brought a lot of our educators, together in a room and they laid out what they were doing. And it was at that point, we saw the variation. We saw that an or nurse and one hospital was getting 2000 hours of orientation and another or nurse in another facility where they were taking care of the exact same patients were getting a thousand hours of orientation. And we knew we needed to identify what best practice was based on evidence. What has been a part of our orientations for so many years, and people just didn’t want to let go of but there was no evidence to support it. We had to let go of that. And that was not an easy process.
Tammy Richards: 12:57
Did we end meetings early because the temperature in the room got so heightened, many times? Did we have to bring in others that we’re not as emotional about the content, absolutely? But we went, we continued and we pressed on and we saw so much success as we moved forward that we just couldn’t let it go. And the more we went forward, the more we had. And Brie Dance was amazing. She had the group that was doing our electronic curriculum support system at the time, working together to capture this electronically. So we didn’t have to go through that again, it was so important.
Jai Shah: 13:45
Yeah and you mentioned, you know, technology and the road to digitization, I would imagine that at some point the scale of what you’re trying to do really doesn’t happen unless there’s technology behind it. And that’s obviously a crux of our partnership going forward. But I know you guys had an iteration before Kahuna. How important was that ability to show this in an electronic format to your leadership and to the hospital leadership and even to the quote-unquote end-user or the educator; how much of a role did technology play in that journey?
Tammy Richards: 14:32
It was a deal-breaker. I mean, we would not have been able to move forward nor be in the position we are seeing the savings, the cost avoidance that we’re seeing now without it. I remember a conversation with an educator who had moved into a manager role and she said, you know we’ve had a very serious event and one of our units and I was the educator at the time and the nurse who was involved in the event is saying that I didn’t teach her how to do it correctly. And I know I did. And I said well show me the documentation. Show me what your orientation plan was and she said well it’s all in my head.
Tammy Richards: 15:16
And so we were transferring content from not just paper to electronic, but from people’s minds and their memories and their heads to this digital format. And it was so important and so critical and then eventually getting to the point where we could curate that content and create the incredible curriculums that we have today.
Jai Shah: 15:46
And as you look at the various stakeholders that you engage with this content, I know there are different roles that get different value from this obviously. But, I’m wondering if you can talk a little bit about the caregiver themselves and maybe some of the transparency and ability to take ownership of their own careers and what your vision might be there in a future state where this really supports an entire career development framework. And maybe talk a little bit about the educators, the supervisors, people maybe in a management role that has the ability to view across the team of nurses or caregivers. But if you can start with that caregiver role and really, maybe talk a little bit about some vision there in terms of what’s in it for the longterm to have a digitized, curated competency framework.
Tammy Richards: 16:47
Absolutely and I think my personal experience from years ago was and still is one of the top reasons for us to embrace this type of technology and embrace this strategy as we move forward. We no longer have the time to repeat education. I mean we know that there are moments when redundant education’s relevant, but those have to be strategic. They can’t just be because we’ve always done it a certain way, right. So these caregivers know that they want to be able to move from the ICU at a small community hospital to an ICU at a tertiary facility. They know they’re going to be taking care of more critically ill patients, but they don’t necessarily need to start over at ground zero. They’re back to step one. They have to be able to start where their knowledge left off.
Tammy Richards: 17:53
So this is less frustrating for frontline caregivers. If they can move into a position and be given credit for the experience and the expertise they have and then focus their time on learning new stuff, we don’t do that. We tend to just, we’ll bore people to death with a thousand hours of the same old information. And then when they get to a department and they’re actually taking care of patients, all of a sudden now they’re like well nobody taught me that. I didn’t have a chance to learn that. Well, we did. It’s just that it was at the very tail end of that thousand hours. So we have to get rid of the 990 hours that were irrelevant for that caregiver and let’s focus on that 10 hours and make sure that they get it and they’re competent. They feel confident, they are competent and they’re confident. So that when they care for those patients they’re going to be providing the highest quality care possible. I can’t tell you how many times I’ve had conversations with frontline nurses, frontline caregivers who say just that. Well, that was mixed in there somewhere, but there was all of this other stuff that was irrelevant. I need to have customized content for me based on my experiences based on where I’ve worked. And I think that’s where our relationship with you is going to really take us to that level.
Jai Shah: 19:33
And I think Tammy, one of the things that we’re hoping together we can do is provide the opportunity to find talent that may be somewhat or previously was hidden within the organization. So people that are multidisciplinary, but they maybe haven’t done that in the last nine months, they’d been focused on one thing or another, but then a situation like COVID comes up and you really need to pull out all the stops and discover talent within your organization, re-deploy that talent in creative ways. I believe you guys have even supported the frontlines in New York with some caregivers that traveled from your system to New York. But, that none of that really is possible unless you can discover who has what skills and the platform is important for that. So I’m wondering if you can talk a little bit about that in terms of your vision and maybe how that’s gonna play into nurse staffing or caregivers staffing models in the future. As I understand, there is some kind of fundamental changes that are occurring across healthcare with a lot more need for multidisciplinary people who can sell a variety of shifts and needs that come up.
Tammy Richards: 20:53
Yes, absolutely and professional development and career development are really important for Intermountain. Very important to me. I feel without that opportunity of growth we actually become less competent. We may look at people and say, wow, you’ve been in this role for 20 years. You probably know everything. And I think sometimes it’s the opposite. I think if we don’t really focus on career progression/professional development, we’re not doing anybody any favors. And I think from a New York continue to see that went back and supported. It was amazing, amazing nurses, physicians, other healthcare workers in New York, in the midst of incredible surge. We had to know that we were sending our very best to support them. And it is through our ability to look at their history, to be able to have them be able to show their history and what they have accomplished in their career, it’s beneficial from both their perspective, as well as from ours.
Tammy Richards: 22:17
And, you know, you can speak to it. People anecdotally will tell stories about their knowledge and yet we still have, we need to be able to rely on technology to verify, you know we can trust, but verify, we have to be able to verify. And that makes such a difference for us as we move forward. And, and certainly, you mentioned kind of a new care delivery model, as we have found within the COVID-19, is that our caregivers who have historically worked in operating rooms as hospitals kind of pulled back on their surgeries, those caregivers, those nurses, those techs, physicians were asked to support other areas within this healthcare system. It was kind of enlightening for a lot of people, knowing how that wasn’t as scary as they thought it was going to be. Nor was it as hard. You can learn. You can learn to do tasks and become competent in areas that you’re very unfamiliar with.
Tammy Richards: 23:29
And I think it is what we’re finding is it’s going to be the way of the future, right? Where caregivers are maybe hired into a role as a flex caregiver and they flex. Maybe they go to the med surge. Maybe they go to an ICU. Maybe they go to an operating room, but they’re flexible nurses. And the only way you can really feel confident as an organization leadership in those caregivers is that you have documentation of their competencies. That’s where we feel really excited to be able to do that a little bit easier, a little bit better in the future. To send these caregivers to where the need is. So you may have a primary department that you are associated with, but you may be asked to flex and support other departments for the majority of your time.
Tammy Richards: 24:28
And that’s going to be a real paradigm shift in how we provide care and especially at Intermountain because we’re fairly traditional in that way and a lot of our nurses and caregivers are pretty comfortable working in the departments that they were hired to. They’re starting to grasp the vision and the need as a healthcare industry, as well as, you know, our organization. And we don’t want to call off 50 people over here in that hospital and then, you know, we’ve got 50 needs in this hospital that makes no sense, right? So I’ve gotta be able to leverage the 50 who are called off over here to fill the needs and this other location. And that’s where I think the future is going in that direction.
Jai Shah: 25:26
And speaking of data and data-driven decisions, one of the things that we think is a game-changer and have been working with your team on, is integrating EHR data with competencies and what we’re finding is that there’s a lot of potential in terms of insights and using all of that operational data if you will to further help make decisions about where to put a focus on competency. So for instance, getting insights into our assumptions around high volume versus low volume procedures and where those competencies are in play, where you really need to focus on training efforts versus not. I’m curious about your perspective on the idea of EHR data and competency data. So taking real, real-life clinical data and combining it with this competency framework and if you see value as we, as we pursue.
Tammy Richards: 26:28
That’s so exciting to me and now that we have an EHR, we have data that is you know. I think for so long we’ve been spending so much of our time trying to get us so that we can use the EHR in any way, shape, or form, and now we’re really optimizing it, right?
Tammy Richards: 26:48
We’re figuring out how to optimize the electronic health record and we’re gathering data from the optimization and being able to take that data and overlay that with our competencies and be able to say, wow, here’s your hotspots. Here’s your area where we’re not doing so well or we’re having massive amounts of patients in this particular geographic location and yet we’re still orienting to those patients and we don’t necessarily need to orient them to those types of patients. We need to orient to the types of patients that are not seeing. And, you know, in another location, we can leverage the opposite, right? Because we see different patient populations based on the geographic areas in the EHR can help us to understand that. And then we can, again, another layer of curation that we can really fine-tune the learning and the education that goes to those caregivers that are caring for those patients.
Tammy Richards: 27:59
And you know, what can be leveraged just in time and what needs to be taught prior and passed off and documented. And a lot of those specifics will come as we kind of grow this relationship with you. Really excited about that.
Jai Shah: 28:23
And so, you know, one of the things that I think about in terms of the overall, it oftentimes I’ve talked about the people we’ve met along the way who have been very effective at getting competency programs off the ground. And one of the things that often comes to mind for them is the legacy that they’re leaving, not just in terms of the competency framework, but the process by which knowledge is managed and transferred to an organization. Be it in healthcare or another type of organization. And so you know, do you see that this competency framework underlies overall knowledge management and knowledge transfer process within Intermountain in terms of people who are involved in developing and curating this content, gathering that from experts and making it available not only to Intermountain but now to the kind of the healthcare industry as a whole. Is that something that you think about when you think about what the ultimate impact of this program really may be?
Tammy Richards: 29:39
I do. I think knowledge, skills, ability…I just keep going back to my personal experience and my conversation with hundreds and thousands of nurses and other caregivers over the years, being able to say how have we made this easier? How have we made this easier for you as a caregiver? And how have we made this easier for us as an organization to support you? Right? So it’s a two-way street here. And the knowledge we have these caregivers that come to us with this knowledge. They graduated from nursing school. They’ve graduated from therapy school. They’ve graduated and they have that knowledge, but that practical application of a theoretical framework and being able to work in a system that often acts very differently than what you’ve learned in school. Matters to me. It matters to me. I want to see people who’ve gone to school to become a nurse or who have gone to school to become a respiratory therapist, want to stay in that profession. We want them to stay engaged and I feel empowered in that role. And I think the only way you really can do that is by helping them feel competent and confident in the work that they do every day. And that is what I think we’ve been able to accomplish here is really increasing that level of ability. They may have held the knowledge but we’ve now taken their ability and their skills to a new level and that confidence is probably what makes me feel like I’ve really made a difference.
Jai Shah: 31:44
Well, if anything, the last two or three months does show us, we absolutely want those people to stay committed to their profession and how important that profession and their confidence in that profession really is. So one thing that’s clear, Tammy, is your passion for this area and this subject and your approach to how education can be done differently and more efficiently. And I’d like you to maybe just reflect on the sustainment of this program at Intermountain and beyond and what governance or processes, procedures, things that you’ve put in place to make sure this has a lasting impact. And, you know, just wanted to hear a little bit about that.
Tammy Richards: 32:43
Well, certainly gaining support from your highest level executives matters. It’s been easy on one hand because of the cost avoidance that we’ve been able to show through our data. Again, you have to look at people who are very engaged in finance in any industry and there may be a little less I’m blown away by cost avoidance versus actual savings. And I think this is where we can now take the cost avoidance that we’ve been able to identify over the past few years and take this to another level where we can now quantify some savings. That we can actually pull some dollars out of frontline education because they’re getting this curated, highly customized content for them individually, based on this incredible technology. That matters. That is getting our caregivers, their time to productivity is shortened. We have these caregivers in an orientation for a lot fewer hours and that helps us as we deliver high-quality care to our patients. And then we know that those caregivers are getting the right stuff. That we’re not throwing them out, into caring for patients before they’re ready, right? Because we know through our technology, that we can, we can do this right. So that is a message that is pretty well supported by the executives at Intermountain Healthcare. And we know that we would never want to go backward. And Intermountain is innovative. We’re always looking for ways to improve the care of our communities and one of the ways we can do that is by improving the competence for our caregivers and the more competent they are, the more likely they’re going to provide care that has fewer complications and getting our communities back on their feet and helping them live the healthiest lives possible, which is our mission at Intermountain. And I think additional support. Our educator teams at Intermountain, see the benefit. Is it always easy? Absolutely not. Do they want to take shortcuts to make it easier? Absolutely. And it’s one of the reasons we’re partnering with you. The opportunity of having this be seen as more beneficial to the educator. And I know that the system we had before was pretty burdensome in some ways, and yet they still did it. Right? So now we’ve got something that’s going to be really well done. We’re excited to find out what their thoughts are on all of this too.
Jai Shah: 36:04
And we are, I mentioned, very fortunate, very humbled to partner with Intermountain on this journey. And I want to thank you, Tammy, for all of your executive leadership and sponsorship and really outside of our partnership, for continuing to champion a better way to educate and to utilize competency-based strategies in that journey. And thank you and Intermountain for continuing to serve the community in the way that you guys do. And I’m really looking forward to the future together.
Tammy Richards: 36:42
Thank you. I look forward to it as well and there are so many things I’m sure that I haven’t even thought about that Kahuna can help us with.
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Check out our previous episode: Using Competency Management To Staff Up Nurses Amid COVID-19