Justification for Onboarding Onboarding & Retention (OAR)

1. Justification for OnboardingOnboarding & Retention (OAR) March 20, 2013

2. Donna Ecclestone, Associate Director, Duke PDC Physician Integration/Onboarding Building a Physician Integration Program at Duke Medicine

3. Physician Lifecycle • The Onboarding stage focuses on the effectiveness of bringing new physicians onboard by aligning them with the organization’s culture and systems. • Onboarding includes familiarizing new physicians with an organization’s protocols, processes, and standards. • When onboarding is done effectively, physicians feel included as a member of the organization. • Well-designed programs promote collegiality and introduce new physicians to others with whom they will interact.

4. Benefits of Proper Onboarding • Improved retention rates • Centralized form management and collection • Standardized protocols/processes • Reduced duplication of effort • Improved time to productivity • Improved employee satisfaction • Improved communication

5. Duke’s Reasons Why • A formal, centralized, onboarding program validates Duke’s strong commitment in the success of our newly hired faculty. • Positive onboarding experience reduces turnover and increases rate of retention. • Centralized onboarding ensures all new hires are treated with same “customer service” focused approach. • A centralized process reduces work load in every department and yet increases efficiencies throughout the system. • Onboarding creates the environment where newly hired physicians feel valued and have central contact for all needs/concerns.

6. Duke’s Physician Integration Dept. • Two employees, originated 3/09 • Part of Faculty HR department – which includes physician recruitment, benefits, and payroll • Key clientele: New faculty members (100-120 physicians per year) and division/department contacts • Charged with streamlining the onboarding process for all new members

7. What We Do • “Welcome committee” • Resource for onboarding updates/policies • “Extra set of hands” for departments/ divisions for onboarding tasks (135 onboarding steps!) • Coordinate “new member” networking events • Interface with Duke entities to streamline processes • Report to leadership on “pulse” of new members

8. What We Did • Created an onboarding committee • Developed a global onboarding template • Implemented a new physician checklist • Conducted regular “check-ins” with new members • Hosted a new member networking event • Proposed a standard schedule for a new hire’s first few days • Launched website and created monthly flyers with onboarding updates/resources

9. Program Development Tools • Communication with new hires (pre- and post hire) • Regular meetings with division/department contacts • Pre- and post-hire surveys • Templates • Websites • “Canned” software

10. Keys to Program Success • Define a starting point (use surveys info for current status). • Establish a benchmark goal. • Get your stakeholders actively involved. • Implement customer serviced based program. • Report out your progress, adjust plan as needed. • Realize little steps will make big changes over time. Keep moving forward with persistence. Faberge effect will happen!

11. Remember…First impressions are lasting Doctor who was left to figure out computer system himself Doctor and his mentor

12. Maranda Judd, Manager, CHS Physician Integration & Retention Building a Physician Integration Program at Carolinas HealthCare System (CHS)

13. Timeline

14. Collaboration with Physician Leadership Physician Network Leadership Council Leadership & Professionalism Committee Draft Charge: Develop and monitor systems and initiatives that improve the professional development, satisfaction and leadership abilities of our PSG providers, which will in turn, enhance the quality of patient care.

15. Research Methods

16. Information Gathering

17. What Our Docs Were Saying “More training on computer, specific to the office/hospital, etc…”* “To be able to follow a physician for the first day or two would have been helpful to get to know the system, procedures, etc.”* “The physician orientation should be separate from that of other employees. It should be more structured and should take into account all issues pertaining to the physician employment as done in almost every organization this size.”* “My first week was not “office ready.” My computer didn’t work and a lot of items were not taken care of prior to me starting.”* *2011 CHS New Physician Surveys

18. Cost of Physician Turnover: Hard Costs The cost of physician turnover is estimated to total appropriately $1.26 million per physician by the 2010 AMGA/Cejka Search Annual Physician Retention Survey

19. Cost of Physician Turnover: Soft Costs

20. Projected Physician Shortage As projected physician shortages continue to rise (see chart below) in the coming years, Physician On-Boarding/Integration and Retention will become increasingly important in an effort to reduce physician turnover. Projected Physician Shortage: All Physicians* *Source: AAMC Center for Workforce Studies, June 2010 Analysis

21. Physician Integration at CHS Today • Dedicated staff (hired first two Physician Integration Specialists in July 2012) • 20 physicians onboarded through the new process; currently onboarding 62 physicians; expect to onboard approx. 160 by the end of the year • Personalized process for each new physician • To date, with the new process, all start dates have been met Support from hiring departments/practices, as well as new physicians • More effective communication between support departments and key players (manager, lead physician, etc.) involved in the physician integration/onboarding process • Support from new physicians, hiring depts./practices and support departments

22. Thank You! For more information, please contact: • Donna Ecclestone, Associate Director, Duke PDC Physician Integration/Onboarding • Donna.Ecclestone@duke.edu • Maranda Judd, Manager, Carolinas HealthCare System Physician Integration & Retention • Maranda.Judd@carolinashealthcare.org