Using Competency Management to Staff Up Nurses Amid COVID-19

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Welcome to CompetencyCorner, 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: 0:15
Hi. I’m Jai Shah, Co-founder and CEO of Kahuna Workforce Solutions. In today’s podcast, you’ll hear a unique perspective regarding the impact of COVID-19 from Intermountain Healthcare. Specifically, we’ll discuss how these unprecedented times have shifted priorities for leadership and talent development and how Intermountain’s unique competency approach has allowed them to respond. I’m pleased to have with us today, Brie Dance, Intermountain’s Learning Curation Consultant, and Ashley Sandoval, Intermountain Healthcare’s Employee Health COVID Triage Team Lead. Brie and Ashley, can you introduce yourselves and talk a little bit about your history with Intermountain?


Brie: 0:53
My name’s Brie Dance and I have been with Intermountain for 14 years in a couple of weeks here, I must’ve started when I was 12 years old. Anyway, I started as a brand new registered nurse with Intermountain on a pediatric float pool at a pediatric referral center in Utah and over the course of the last 14 years have moved into a variety of roles within our system, mostly focused on education, whether on a unit level or a regional level. And over the last nine years, I have focused on aligning and developing a competency framework to standardize nurse competencies for our entire organization.


Ashley: 1:49
So this is Ashley Sandoval and I actually started with Intermountain Healthcare when I was 18 years old. I applied for a position as a float pool CNA and had no clue what that was I just knew that I wanted to be in healthcare. So I stayed as a float pool nurse for 13 years after that. I worked at McCady hospital in Ogden, Utah, and ended up loving float pool and a passion for training and helping other caregivers just show compassion to patients that I see. I became the unit educator at that time. And I really had a great opportunity where I was orienting people to 13 units at a time brand, new nurses, one summer, we oriented over 60 employees and had a great opportunity of really helping people find their passion and sometimes they’re passion was staying in float pool and sometimes it was finding a new home in the hospital or in a different facility. And while I was doing that education, I found a passion for simulation training, where we had people actually physically doing what they needed to do in an emergency situation and transitioned as a simulation, a system simulation coordinator, and helped build the simulation program to the point of accreditation in Intermountain Healthcare. And as I was stealing the simulation program and saw how important, the way you communicate and work together as a team. I was able to develop and grow and move into a position for Leadership and Organizational Development. And what I learned is I have a passion that if you have a strong leader, the strong leader develops a strong team. And so that has been my goal is to have one of those amazing nurses that come into the leadership role, be able to be an amazing leader too. With all of this COVID fun, as part of the human resources team, I was identified as a person that would be able to help support employee health as employee health and leadership and organizational development are one are under the human resources on the umbrella. On March 15th, I was called on a Sunday night and asked if I could help develop a team that would be taking phone calls from health care workers to see if they needed to be tested for COVID and so since March 15th I developed a team of 35 caregivers that are redeployed nurses and APPs that are helping take care of caregivers. So I never thought this was where I would be. But it’s been a pretty amazing 19-year journey with Intermountain.

Jai: 4:28
So Intermountain has obviously a great reputation in the market and is always mentioned as an innovative and kind of cutting edge healthcare brand. So can, can you guys describe the, uh, maybe Brie or Ashley, can one of you describe, Intermountain as an organization and how they value, kind of their place in, in being a leader in healthcare?

Ashley: 4:55
Yeah. Well, one of the things I’ve noticed in leadership development, as I am working more with our executive leaders and hearing the passion that our executive leaders have for doing the right thing. And I’m seeing that as we enter into the COVID, let’s do the right. We had caregivers that weren’t working from home, or they were always working in offices that we’ve immediately transitioned into doing the right thing, getting them into, increasing the social isolation. Intermountain is one of the largest employers in the state and holds a huge responsibility to make sure that we’re leading. We have thousands of employees, and we are responsible for supporting their incomes and supporting their viability during this stressful time and so we’ve had flexibility and learning to be agile learners and agile teams has been incredible. One of the things the, and organizational development team has even done is we recognize leaders need to learn how to lead in a different way. So in November, we had started developing a program called Leadership Accelerated that taught leaders and short spurts of education, over a webinar typesetting. And in November we thought, Oh, well, let’s just try it. It’ll be something new. And now, as we are in May, we’re running about eight to 10 classes a week for leaders and caregivers to learn how to be more agile, efficient leaders in this time and it’s all done over webinars.

Jai: 6:38
So in terms of, you know, it sounds like COVID has certainly changed the way that you think about the skill sets and the competencies required to be a provider in this space. Can you talk a little bit about the type of maybe information or data that’s been requested or some of those priorities and how they’ve shifted and maybe how you’ve reacted to that Ashley in your position?

Kahuna for Healthcare Digital Competency ManagementAshley: 7:06
Yeah, well, I think plays into where I am right now is a perfect example. So I am leading a team of 35, it’s dwindled as our, as we’re starting to open into a providing more services for our patients. But what we’re saying seeing is that we needed to be agile, fast learners. And so I had a group of nurses who have always provided bedside care, have loved and had a passion of bedside care. They were surgical nurses. I think I have almost 20 pregnant caregivers on my team and we needed to be agile and figure out a way that a caregiver could be taken care of as a high priority member of Intermountain quickly and efficiently if they started developing symptoms of COVID. We knew that if we had a caregiver that was sick, working on a unit, the likelihood of spreading COVID it significantly increased and would impact the community as a whole. And so we built, overnight, we built a process where we taught bedside nurses to get on a computer, work from home, complete assessments of what’s going on with the caregivers and order testing with the support of, the support of APPs. And so it’s been very interesting, all of a sudden our nurses that we’re used to doing very, you know, bedside care starting IVs, assessing the patient, now had to sit in front of a computer, learn how to use new programs, Excel, spreadsheet, data and analysis, and become completely new learners in a very agile way. And it’s been amazing. I had one of our caregivers, 64 years old, she says, yes. She said, I don’t know how to open a new browser on a computer. That’s just not what I do. And now here she is working with about five screens up at the same time, taking care of caregivers all digitally at home.

Jai: 9:07
So three, you know, as someone who’s been responsible for content curation, that seems like you’d be really chomping at the bit that’s involved or, uh, to have your team involved in and developing and helping support that type of skillset development.

Brie: 9:25
Yeah. I think, you know, Ashley’s team has been instrumental in, you know, our organization. Like she said, doing the right thing, staying on the forefront of ensuring access to care, making sure that the caregivers who are taking care of these patients during a pandemic are themselves taken care of and safe. And what we see, what COVID has brought to light is the rapid shift and evolution of healthcare. Right? So, you know, we had a, uh, a worldwide pandemic which required a completely new focus and, you know, we saw surgeons not operating, imaging machines, not running, anything other than nonessential critical scans. We saw, uh, you know, just worldwide that completely different shift in healthcare to conserve resources and ensure that we had the equipment and ventilators and beds available for the surge of COVID patients. That’s the immediate problem today, but what’s been bubbling underneath that for really the last decade is that healthcare is evolving and, uh, patient matrixes are changing rapidly and organizations, you know, to keep our lights on and ensure that our, our communities have access to care at a lower cost, have got to be able to adapt and change the way that we operate to ensure that care is available and that we can deliver it at a lower cost so that our communities can engage and afford to access health care. And so Ashley’s team really remobilized really quickly to meet a specific need related to COVID. From my perspective as a content curator and a product manager for the content, the competency framework that serves our clinical caregivers we have to be prepared not only in the pandemic but in the ongoing evolution and change of healthcare matrixes and patient populations. We’ve seen siloed units, progressive care units become mixed acuity units. Patients are staying in the ICU as a shorter amount of time. Patients are staying on traditional acute care floors longer so the need to upskill and rescale caregivers has to be done really quickly. And in order to do that, you’ve got to have a way to train them and help them learn in new ways. I think Ashley touched on this in a really critical way. We don’t have days that we can spend in classrooms, retraining people. As Ashley mentioned, they’re offering these leadership courses and really short bursts of innovative remote and instructor-led learning that meets the demands of leadership’s time and availability. We do the same thing with our curated content. We offer it in packages that are consumable, that can be done and delivered quickly so that caregivers can be remobilized where they’re needed without a huge strain on the organization’s resources.

Jai: 13:00
So, Ashley, in your experience. I know you’ve worked for Intermountain for obviously a long time and I’m just curious in terms of whether this, you think is unique to Intermountain’s ability to do this because of their approach to developing talent or is this something that, you know, generally healthcare systems are in a position to be this nimble. Is there something special about the Intermountain development process that allows this to happen?

Ashley: 13:36
Well, I think that our Mark Harrison, when he joined our organization and began leading our organization several years ago, he told us to be agile leaders. Be nimble. Be ready for change. You know, try something, get out there and try something. And we have people scared. I don’t want to try. I don’t want to fail. And he told us flat out, get out there, try it, fail. You fail, it’s fine. Try something else. And that was a scary thing for healthcare workers to be heard you can fail. Try it. Just try something different. And now what we’re seeing is we’ve been challenged to see, do something different, do something better and be more efficient and more agile for years. Here we are. We are now being told in two months time, I know you’ve been here surgical nurse for the last 15 years but now I need you to go to a med surg floor. And I used to laugh at being a float pool nurse for over 10 years. I was like, Oh, I’m three hours into a shift and you need me from mom and baby to cardiovascular. Okay, sounds good. I’m ready to change. And the other nurses would tell me there’s no way, I could do that. And I see now in our healthcare organization, our nurses need to be ready and agile and limber and ready to just move and say that’s where I’m needed, okay I’m going to figure it out. The leaders see okay that that’s where they need the support. Okay, I’m going to figure it out. How do I make this happen and how am I not afraid to make change? Mark Harrison spoke to us during employee appreciation week, last week during HR. And he said we can’t go back to being afraid. We have to continue being agile learners and leaders.

Jai: 15:31
Do you find that there’s engagement among your clinical staff, your caregivers, in terms of the excitement of being able to do those different, different things and challenged by different opportunities?

Ashley: 15:44
Yeah. I have had an amazing experience. One of my caregivers came to our team. She went first to the public call line and was, and was taking calls from the community as they had questions about COVID and transitioned to our team and started taking calls from caregivers. And she got pulled back to her unit about two weeks ago, as they started opening, opening surgeries further. And she called me and she said, you know, I have to tell you, I have had this itch to grow and to learn for the last year and a half and I have been afraid. She said, I, I wasn’t sure I could do it. I wasn’t sure I could learn and she goes I just learned two new jobs and two new roles in a one month period of time, now I know I can do it. And so I was able to utilize some of my coaching and development skills and work with her as she’s building her resume and she’s no longer afraid to grow and afraid to take that next step in her career. So it’s a perfect example of we’re ready. We just sometimes need to be pushed just a little bit to get there.

Brie: 16:56
I think Ashley is completely right. And I think when we engage our caregivers it’s showing them that you’re valuable, there’s a place for you, we’re here to give you the visibility to see where the opportunities lie, and then to give you the resources to get there. And when you take away, you know, change is, is scary, no matter what for, for a lot of people, because w you know, doing what you’ve done every day for 15 years can get pretty comfortable and safe. But when caregivers or employees know that there’s a pathway in visibility for their growth and that the organization is investing in them, I think they naturally become more excited for that when you’re, when you shield them from that visibility and opportunity and just mandate change. I think that’s where you get fear, but we’ve been under the helm of an incredible CEO for the last, what is it? Three or four years, Ashley, and I think three, three. And he’s, he just, I can’t remember. Yeah. He’s but he’s one of the most powerful change agents I’ve ever encountered and, uh, puts it into play as an opportunity and that our caregivers are valued. And I think initially that was scary for a lot of caregivers, but, we’ve seen incredible growth and our nearly 40,000 employees over the last three years under his leadership and incredible growth in our tools that we put into place in the organization to enable it to happen.

Jai: 18:37
Yeah. So that, that’s the point I was gonna want, maybe want to drill down on a little bit, is change is scary, but the way to manage change often is with a baseline process instead of information and transparency and having a culture that supports that change. But that only happens if you’ve developed some tools and enablers to guide you through that change. So, Brie I know that’s a big part of the competency framework development effort, somewhat unique that you’ve developed all that content internally instead of just gone out and purchased it and made it specific to Intermountain. So maybe you can talk a little bit about how your role in particular or your group, how they’ve helped build that culture, and support that culture.

Brie: 19:32
Yeah. So again, I really want to give credit to, you know, a lot of our leaders, we’ve been under the leadership of Tammy Richards and this really. Several years ago, we came together looking for opportunities to become more efficient as an organization and to align as an organization. And what you’ll find in healthcare is that organizations, especially highly matrix ones are looking for ways to align their system and processes to a greater degree. Intermountain has put a lot of focus on that for a lot longer than most organizations have and we are much further down that journey that I think you’ll find many organizations to be. But as part of that, we looked at how do we ensure that our caregivers, our nurses, our respiratory therapists, our IS teams, our finance teams, you know, every one of our nearly 40,000 employees, how do we ensure that they get the best from us every day, that they get the resources they need to work to the top of their job description, and then how do we offer them, visibility and a pathway to growing with us, instead of leaving us. We understand that you know, turnover happens. People want growth, they want work-life balance, they want flexibility, they want pay increases. And how do we structure our training and to provide that to them. And so under the leadership of Tammy Richards, we’ve worked for nearly a decade now to identify what is it that our caregivers do in their roles every day? What is it that Intermountain has a duty to document and keep record of so that we can ensure that our patients are getting the best of us, that our accreditation agencies, when they come to survey us, have the information that they need readily available and then ultimately, ultimately as part of that, what are we, how can we package it in a way that when a caregiver decides to look for a new opportunity, or we have a change in a patient matrix, or we open a new facility or heaven forbid a pandemic happens, how do we remobilize or have the right caregiver at the right place at the right time? And what that came down to in the most basic sense was a competency framework where we looked industry-wide, we tried to license it because, you know, licensing content, quite frankly, is most of the time cheaper than building it. And, we just couldn’t find anything that was built in a way that really focused on what the tactical day to day jobs actually are in healthcare. You could find packages where you could read about a competency. You could read about a topic, you could take an online test, but at the end of the day, as an organization that takes care of people and some of the most stressful, high-risk times in their lives, we care that our employees can assimilate and perform a behavior and we are, we are the stewards of that documentation. And so because of that, we built our own framework, that is really very simple.


It focuses on the tactical behaviors that nurses actually perform in the roles that they are naturally employed in, whether that’s acute care nursing or emergency nursing, or telehealth and we structured it in a way that we partnered with our clinical programs to focus on the best of what Intermountain does in evidence-based research and care process modeling. And we wrote statements that are focused on performance-based measurements that allow a caregiver who may work in a surgical area for 15 years to then move to temporarily fill a telehealth role, to take the best of what they know and let us identify the gaps so that we can quickly fill those in without necessarily providing them with a full-length orientation. And over time, it’s saved Intermountain an incredible amount of training dollars, but it’s also helped us capture and keep employees within our organization because they know that they, their training, that they’ve already done matters, that we see it, we value it, and that we aren’t going to spend time retraining them in areas that they’ve already become experts on.

Jai: 24:25
And Ashley do you see these changes that we’re now, you know, kind of experiencing as a result of COVID being more permanent than, than temporary in terms of, you know, the rise of telehealth and, you know, obviously there was a trend in some ways to those types of services but has this accelerated a more permanent shift in, in your view and are you kind of aligning your priorities to do fit that?

Ashley: 24:56
Yeah, absolutely. I, I think if we look for leaders, we had talked in leadership and organizational development, we offer one of their first leadership courses, it’s called Leading One Intermountain. And one of those, one of the sections in that two-day course is how are you going to develop the people around you? What are their individual development plans? What opportunities are you giving them for growth? And as Bree talking about how we’re giving them these opportunities to complete the skillsets that give them the opportunity to move further, more easily. I feel like we are now going to have a culture of nurses that understand, and leaders that understand my nurse needs to be able to do this, that for their normal role and this. And be prepared and feel confident and competent to go to another unit and do something out of their norm.

Ashley: 25:59
And so what we’re seeing is this concept of teaming in such a greater way. As we look at how are we going to team with some of our telehealth experts to come on and be a support for me say, I’m a nurse that normally works a medical floor, and now I need to go to an increased acuity unit where I’m maybe not as comfortable as I’ve always been but I know I have to tell a critical care team on my back ready to help me the minute I need them through the telehealth team. And so all the stuff, not in everything we’ve been building as a support, we have our tele-infectious disease docs. We have all of these telehealth teams. I feel more confident as a bedside nurse to do those skills. Because I have this team of experts that can work from Cassia, Idaho, into St. George and Las Vegas. I have someone that’s an expert. I can get ahold of it any time, and it significantly increases my comfort and the support I feel while I’m on a unit.

Jai: 27:12
Well, I want to thank you guys very much for this conversation. I think it’s, it’s a very important topic in terms of managing in a time of change having transparency into skill sets and a couple of things that I just would summarize in terms of what I’ve heard in this conversation. One is leadership is, is extremely important in, in this journey and it sounds like Intermountain, and we know from experience Intermountain has the right leadership to encourage a culture and underlying culture that is supported with processes and data and systems that have been built over a very long period of time. And so as we wrap up here, Ashley, I’ll start with you. Any last thoughts about where leadership and development needs to go relative to a new operating environment?

Ashley: 28:16
Yeah, I think the biggest thing we have been talking about is teaming across boundaries and working with the teams through the whole organization, not just at your own hospital, we’ve been talking about that for a couple of years now. The reality is there. We now are an entire organization supporting each other and we need to be ready to do that. So teaming across these boundaries of through a whole entire state. And then, the other thing is being agile. We need to be learners that are ready to move forward, ready for change, and ready to support court caregivers through that change.

Jai: 29:00
And Bree, I think we both know that that ability to work across a system, especially when you’re as large as an Intermountain only happens if you have tools and systems that allow that to happen. So maybe some closing thoughts on, you know, the tools that you’ve put in place and how that has supported culture at Intermountain.

Brie: 29:24
Yeah. And it to do what Ashley’s talking about, you, at minimum, you’ve got to have, you know, two components. One, you have to have a framework that’s agile in itself and simple that it scales in the thousands in the millions. We have 4.2 million competency validations in our, in our organization that are documented digitally. And, you have to have a framework that allows that visibility and the transferability so that you can work cross-functionally in teams. The other thing that you got to have is a digital process to capture that. To get the most out of your people data, you can’t trust, you know, by somebody’s word that, yeah, I can do that because there’s too much on the line here. We have lives on the line. So you have to have a digital platform that allows you to do that.

Brie: 30:20
And that is why we have, you know, have this partnership with Kahuna. It is for the scalability of this digital transformation and Dr. Harrison, our CEO, again, just a transformative leader, talks about how Intermountain as an organization, we’re going to lead digitization in healthcare. And part of the way that we’ll do that is through the Kahuna software solution and our competency framework. The solution allows you to scale and give visibility into what your workforce can do and puts it not only gives you visibility, but puts it into meaningful play. And I think, you know, in the last three years, there’s been this undercurrent where we know things have to change and healthcare. And Intermountain’s been further down the road and, and we’ve, we’ve started on that journey a lot longer ago than that, but we’ve been to several learning and development conferences focused on healthcare.

Brie: 31:25
And we’ve seen that the current is getting stronger, right. And whereas before healthcare systems were maybe hesitant to embrace competency frameworks that weren’t their own or thought that their digital solutions were working, I think that we’re seeing that there’s an acknowledgment we’ve gotta be able to scale. And what COVID is put into play is we have got to not only be able to utilize our internal talent but look at New York we’ve gotta be able to take the best of the resources out there and be able to remobilize them in areas that are in crisis and under fire. And we were fortunate to be able to send a hundred of our caregivers to New York, to serve the patients of New York City and, and to offload a little bit of the burden of the caregivers at hospitals on the East coast.

Brie: 32:26
And I think what we’ll see is that healthcare systems will recognize the need to I think you’ve, you’ve coined the term Jai, this digital, this digital passport of competency and getting the most out of our people data. And I see a future where we become more transparent and willing to share that data. It, you know, I don’t know how it happens, but there’s, you know, there’s a lot of red tape there with, you know, proprietary information and whatnot. But I see a future where we share as more like-minded organizations so that we can do the right thing for patients outside of Utah and Idaho and Montana. That we can do the right thing, create more access, and lower the cost of delivery for patients all over this country. And I think COVID was the impetus for that. And I think the solution that Intermountain and Kahuna have come together to offer will be one of the engines that drives it.

Jai: 33:28
Well, I, I really look forward to digging into some of those use cases where you know, you guys supported, uh, the, the frontline in New York. And I think we can do that in a future conversation, Bree and Ashley, I want to thank you for the conversation today. It was great, great insights. And thank you for everything you guys do, uh, the communities that you serve. Great. Well, you guys have a great rest of your day and we look forward to hosting another podcast soon.

Thanks for joining us on this episode of CompetencyCorner. For more resources like this podcast, be sure to head over to our website at where you’ll find up to date white papers, case studies, blogs, and more all about competency management. Be sure to subscribe and tune in for our next episode!

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