Developing a caring, diverse and sustainable workforce to support compassionate and high-quality patient care is a critical success factor for today’s hospitals and health systems. In the post-ACA world, the majority of health care payments are transitioning from fee-for-service to value-based payment models, occasioning substantial changes in health care delivery and placing increased emphasis on the patient perception of their care experience.
In addition, the Centers for Medicare and Medicaid Services is now tying reimbursements to patient satisfaction scores through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients rate their inpatient stay in 27 categories, ranging from communication with nurses, to responsiveness of hospital staff to cleanliness of the facility. In 2012, Medicare began rewarding the best performing hospitals based on HCAHPS scores. By fiscal year 2017, hospitals can lose or gain up to 2% of their Medicare payments based, in part, on these scores. Further, health plans are increasingly moving toward narrow network partnerships with health systems, based on these quality scores.
In response to new reimbursement models, many health systems are developing programs and initiatives to positively impact the patient experience. One health system that is a step ahead is Citrus Valley Health Partners (CVHP). CVHP has identified a significant link between the ability to recruit, train and retain culturally and linguistically diverse staff and delivering high-quality patient experience. Thanks to their innovative approach, and to a 15-year partnership with Los Angeles-based consulting agency COPE Health Solutions, CVHP has built a comprehensive workforce strategy and is equipped to address the radically changing health care landscape.
Partnership Creates the Workforce Diversity Pipeline
CVHP is a 623-bed organization that serves nearly one million residents in Southern California at four locations, including three hospitals, a hospice and a home health facility. In 2000, CVHP was facing a critical shortage of registered nurses (RNs). They routinely had more than 100 vacant positions coupled with high turnover rates. Despite offering competitive salaries and bonus incentives, CVHP struggled to find employees that fit the organization’s mission, vision, and values. Being a forward thinking organization, CVHP was not satisfied with short-term fixes but rather looked for a long-term, cost effective and innovative solutions to its nursing shortage. What started with a handshake between the CEOs of CVHP and COPE Health Solutions to solve one need, grew into a 15-year partnership impacting all aspects of CVHP’s workforce strategy.
Together, CVHP and COPE Health Solutions launched and grew various workforce development programs to build a robust pipeline of future health care professionals. The key programs of this workforce pipeline are:
- Health Scholar Program (formerly known as the Clinical Care Extender Program)
- Student Nurse Scholar Program (formerly known as the Health Professions Training–Nurse Scholar Program)
- Mentorship & Professional Development
- Licensed Nurse Scholar Program (formerly known as the PrepStep-RN Program)
The first program CVHP and COPE Health Solutions implemented was the Health Scholar Program, which connects local college-level students who are interested in health care careers with hospitals and health systems. Participants, known as Health Scholars, learn from, and support staff, by engaging in basic patient comfort care, supporting key system initiatives, and receiving a first-hand introduction to health care delivery. Basic patient comfort care tasks include keeping patients company, rounding on patients to address or relay any needs, and helping staff reposition, feed and ambulate patients. When COPE Health Solutions and CVHP first partnered together, this program was in its infancy and CVHP was looking for solutions. Together, they invested in the growth and development of the program, creating a lasting, engaging, and transformative experience for students and health systems alike.
The strategy behind the Health Scholar Program is to home grow a pool of talented health care professionals, from within the local community, by recruiting and training a diverse group of students who understand the needs of population they serve. At CVHP, Scholars are provided incredibly robust experiences and are exposed to the entirety of the organization. Scholars at CVHP can rotate through approximately forty different hospital departments across four distinct facilities, including medical surgical, the operating room, the neonatal intensive care unit and administrative departments such as performance improvement and human resources. Each CVHP facility has its own specialty and patient population, so students can interact with a wide variety of professionals and patients, preparing them to be the competent workforce of the future.
In addition, CVHP and COPE Health Solutions worked together to further specialize the role of Scholars in certain departments. Through the Patient Experience Ambassador Program, a sub program of the Health Scholar Program, students are further trained on patient interaction and service excellence as they engage with patients in a meaningful and positive way. Due to impressive work done by CVHP and support from COPE Health Solutions, CVHP has been recognized by Press Ganey as being in the top 10 percent all of organizations for improvement in patient satisfaction scores.
Since its inception in 2000, more than 5,100 students have participated in the Health Scholar Program at CVHP, and more than 150 students have chosen CVHP as their place of employment. In 2014, the health system had roughly 500 Scholars who completed 106,340 hours throughout all four CVHP facilities, equivalent to over 50 FTE.
Partnership Addresses Specific Workforce Needs
In 2003, CVHP was struggling to hire nurses who fit with the organization’s patient-centered approach.
The solution came in the form of the Student Nurse Scholar Program (formerly called the Nurse Scholar Program), a nurse mentorship program offered by CVHP and Mt. San Antonio College. Students selected into the program are immersed in CVHP’s culture and receive guidance and support through financial assistance, networking and mentorship opportunities while completing their education. Nurses hired through the program commit to work for CVHP for a minimum of two years post-graduation. Since 2004, the program has mentored 220 nursing students, many of whom have gone on to become successful employees and true advocates for CVHP.
In 2010, the downturn in the economy led to a number of new nursing graduates who were unable to find jobs in the health care industry. As a result, CVHP was inundated with nursing applications and resumes with no real way to determine which applicant would be the best fit for the organization. It was at this time that CVHP recognized an opportunity to develop a program that could train newly graduated RNs, introduce them to the CVHP culture, and prepare them for hire. The Licensed Nurse Scholar Program (formerly called the PrepStep-RN Program), is a 24-week program that enables newly graduated RNs to shadow experienced nurses and attend professional skills development workshops. Essentially, the program provides a “walking” resume for health systems to evaluate prospective employees. Participants volunteer one 12-hour shift per week. The benefits for participants include having face-time with prospective employers and staying active in the health care industry, while keeping their critical thinking skills current. From September 2010 to December 2013, 64 Licensed Nurse Scholars participated in the program. Of these, 22 were hired by CVHP.
Partnership Positions CVHP to be Successful in the Years Ahead
Through the Health Scholar Program, the Student Nurse Scholar Program, and the Licensed Nurse Scholar program, CVHP established a pipeline of potential health care workers, nursing students, and new nursing graduates who are interacting with patients and staff in its facilities on an ongoing basis. The next step was to improve the hospitals’ onboarding process in order to retain that talent at CVHP. To bridge the gap between academic training and professional practice, CVHP implemented the Mentoring & Professional Development Program. This 12-week residency-training program provides the support new hires need to succeed at CVHP. It also helps orient internationally-trained nurses and re-entry nurses into CVHP’s culture. The nurses receive tools, training and patient feedback to improve their skills and move forward in their careers. After the program was developed, CVHP embedded this training into its educational process for newly hired RNs.
Over 15 years and via 5 programs, CVHP and COPE Health Solutions have trained thousands of students, reducing the RN vacancy rate, lowering new graduate nursing turnover, and addressing workforce challenges. Through the COPE Health Scholars Programs, CVHP has also built the sustainable and highly skilled workforce it needs to improve patient experience and ensure the organization’s success.