A Wise Approach to Training and Compliance: Connecting to Purpose

Undertaking a project to personalize learning for 4,300 employees and track the compliance of 29 different communities might overwhelm the best of us. But with the right tools and enthusiastic leadership, American Health Partners is taking the charge and running with it.

With the varied markets and locations the company serves, keeping tabs on certifications, clinical competencies, regulatory requirements, changing reimbursement models, and reporting needs is a mammoth responsibility, which Ta-Tanisha Thomas quickly recognized when she stepped into the role of Human Resources Compliance and Education Administrator in March 2018. But she faced up to the challenge and asked for help.

Although the company was already using the Relias learning management system (LMS), Thomas discovered that her organization was not getting the full value. Many employees were accessing the Relias LMS only once a year during the annual compliance training season. “The system was totally underutilized for what we actually needed it to do,” she observes.

Based in Franklin, Tennessee, American Health Partners serves an array of post-acute and acute healthcare needs for seniors across six states through its different business units:

• American Health Communities operates rehabilitation, skilled nursing, and long-term care facilities.
• Tennessee Quality Care provides home health and hospice services.
• Unity Psychiatric Care operates behavioral health acute-care hospitals for seniors.
• TruHealth provides nurse practitioners and physician assistants for nursing home partners.
• Rehab America provides physical, occupational, and speech therapy services.
• AmPharm pharmacists fulfill pharmaceutical needs of nursing home residents and patients.
• American Health Plans offers institutional special needs plans (I-SNPs) for seniors in long-term care.

As learning administrator for so many divisions, Thomas quickly recognized that a system upgrade promised the help she needed to keep the diverse staff roles in different locations compliant. So she made a plan and set out on a mission.

She first gained approval for an upgrade to the Relias standard learning package, which contains advanced clinical courses and additional functionality, such as a requirements tracker and a policies and procedures dissemination tool. Since then, she has learned the ins and outs of the Relias LMS and educated employees on the benefits of taking courses for professional development throughout the year.

Recognizing the importance of competency development, American Health Partners has established an education task force supporting learning across its divisions. In consultation with the task force and senior leaders, Thomas proposed a three-phased plan to elevate training for all staff in every business unit using the Relias LMS:

• Orientation
• Annual compliance training
• Job-specific education plans

Giving each employee a job-specific training plan will ensure that their online education is meaningful for their role and will “help them connect to purpose,” Thomas asserts. By bringing consistency, continuity, and meaning to staff education, the organization can elevate the care provided in each facility.

Giving each employee a job-specific training plan ensures that their education is meaningful and helps them “connect to purpose.”

Ensuring Best Practices

Promoting a cohesive culture and standardized policies for all the company’s divisions and locations is a continual challenge. Relias is helping the multifaceted organization disseminate best practices during orientation and create a consistent look and feel for the brand of American Health Partners. Now, “everybody is seeing the same thing” when they join the organization, Thomas notes.

One area getting special attention is the I-SNP division, which is targeted for substantial growth in the next few years, making training a priority for staff members who work with the Medicare Advantage patients served by I-SNPs. A specific goal is for TruHealth’s nurse practitioners and physician assistants to engage in education that will standardize best practices and enhance their ability to serve the total health of patients in skilled nursing and long-term care facilities who qualify for Medicare Advantage.

Improved Healthcare Compliance Training

Besides its growth plans, American Health Partners must ensure that its divisions and employees are continuously meeting all federal and state requirements. Thomas notes that the company’s leaders are giving diligent attention to “ensuring that everyone is compliant and 100% complete on their training.”

Tackling Challenges

Specific challenges the organization has faced include:

• Clinicians may work at different facilities, where procedures and cultures may vary.
• Systems and procedures are changing under the Patient Driven Payment Model (PDPM) and the Patient-Driven Groupings Model (PDGM).
• Administrators need to monitor healthcare compliance training in multiple divisions and locations.
• Usage of the Relias learning management system was spotty, focused on annual compliance training.
• Learners lacked the ability to make quick fixes, such as password resets, so those tasks fell to the administrator, draining work time.
• Ensuring receipt of corporate policies was difficult when floor staff didn’t have corporate email.

Aiming to promote staff development, Thomas emphasizes that Relias online learning is part of the total value of employment with the company. Staff members can enroll in elective courses and take charge of their own professional development.

“We know that sometimes employees leave,” Thomas acknowledges. “But you take that education and the training that you’ve earned with you.” When employees recognize the value and take advantage of the learning options, that can be a tool for combating turnover.

Using the additional education, tools, and functionality provided by the Relias standard package upgrade, the organization also is implementing targeted education in certain areas, such as improving customer service and preparing new supervisors with the skills for successfully managing teams.

Increasing Comfort Level

While aiming to elevate learning in certain areas, at the same time Thomas is driving LMS permission levels down the chain of command. Giving learners and their managers more control over their online education saves time and hassles for everyone.

Early on, Thomas became overwhelmed fielding a high number of calls to reset passwords and help people log in again, reset tests, and so on. Recognizing the need to give staff more agency over their own learning, she pushed the ability to change passwords down to the individual learner role and the authority to reset tests down to the supervisor level.

Thomas also went back to the basics with training sessions she calls Wise Owl Wednesdays. These sessions encourage staff and supervisors to get comfortable with the system and self-enroll in courses that will enhance their professional outcomes. Held on the first Wednesday of the month, Wise Owl Wednesdays focus on how to use the Relias LMS, update personal information, change passwords, and so on.

An increasing number of the company’s employees are now taking advantage of online learning that fits their own personal schedules. Course completions increased 128% between 2017 and 2018. By inserting a Google Analytics code in the system settings, Thomas has been able to track additional usage statistics. Her figures show that user sessions showed a marked increase between 2018 and 2019. For example, user sessions increased 108% from Q2 2018 to Q2 2019. For the 12-month period from July 2018 to June 2019, user sessions totaled more than 155,000.

Held on the first Wednesday of the month, Wise Owl Wednesdays focus on how to use the Relias LMS, update personal information, change passwords, and so on.

System Integration Benefits

Another payoff has been the integration of the learning and HR systems. The organization’s relatively new human resources information system (HRIS) can now share information—such as employee email addresses—with the Relias LMS. Similarly, the HRIS can receive information about course completions to aid in tracking compliance.

Having previously worked in compliance at the corporate office, Thomas understands the importance of having all staff receive corporate policies and attest to having read them. Some employees do not have corporate-issued email addresses, so communicating new policies was previously a challenge.

Now Thomas frequently uses the Relias announcements feature for distributing policies along with related courses. This feature ensures that the employee sees and acknowledges the policy before moving on to the training.

The Relias Policies and Procedures tool allows for accountability across the organization. Administrators use the tool to be sure everyone understands and acknowledges the standard expectations. “So there’s not a space to say, ‘Well, I didn’t know,’” Thomas notes.

Because the Relias LMS has the ability to notify employees that their courses are due soon, to deliver needed training, to track completions, and to report on trends, she says, it has become “the go-to tool” for staff.

Standardized policy dissemination can help with staffing challenges as well. In some regions, the company’s nursing home sites share nurses and certified nursing assistants. If a clinician leaves one site to work at another, the transition is smoother. “Definitely, there’s some culture change there,” Thomas acknowledges. “But the process, the procedure—they match. It keeps us from liability in that way as well. It’s tremendous.”

When new team members join and begin managing the health plans division (I-SNP), in different states, Thomas can orient them with standard guidance about how to enroll new patients in the plan. “Granted you’ll have your different state variances with laws and regulations,” she notes, “but we are able to support our brand because of that consistent orientation.”

Keeping Up With Regulations

The ability to ensure that standard procedures are followed is vital. In the different business units American Health Partners operates, the education directors have been able to monitor training needs via Relias crosswalks, which show how courses map to specific state and federal rules and regulations.

In terms of federal policies, several organizational units have faced changes instituted by the Centers for Medicare and Medicaid Services (CMS) under PDPM for skilled nursing facilities and PDGM for home health and hospice providers. In preparation, administrators felt a pressing need to support team members navigating the starkly different terrain.

Recognizing that the CMS regulatory shifts might increase stress and uncertainty among team members, Thomas made sure department leaders were familiar with Relias change management courses. Referring to the classic business book Who Moved My Cheese, she extends the metaphor with a laugh: “Who moved my cheese? The government did! And you’ve got to go find it!”

To keep up with PDPM and PDGM, administrators alerted all clinical and rehabilitation staff about related Relias course offerings. In addition, the company now offers its own custom training through the Relias LMS.

Developing Competency

Some specific concerns under PDPM and PDGM are tracking and developing staff competency. American Health Partners is using Relias skills checklists, part of the standard package, to build competency charts for tracking and reporting its progress in preparing leaders, clinicians, and caregivers for the new CMS models.

Thomas also has used features of the LMS to bring more control to individual learners. Employees can reset their own passwords instead asking her to do it. Supervisors can reset custom compliance courses for employees to retake if they did not pass the test.

“I know that every touch I make with Relias, because of the training our employees receive, is affecting someone at the bedside. And that, for me, is enough.”

Putting that power in the supervisor’s hands has changed supervisor-employee interactions and encouraged a coaching conversation. Before resetting the test, the supervisor can ask the employee where the gaps in understanding are occurring and then can explain further. That way, supervisors can ensure that their employees know how to perform skills correctly “always and every time,” Thomas emphasizes.

As an administrator, Thomas clearly takes personal satisfaction from improving client care via training. “Relias is my boo!” she enthuses, pointing to the learning features, administrative tools, and support that make her job easier.

In managing the LMS and employee learning, Thomas’s overarching philosophy is to have all education “connect to purpose.” Working at the corporate human resources level, she doesn’t actually see the people who are receiving care. “But I know that every touch I make with Relias, because of the training our employees receive, is affecting someone at the bedside. And that, for me, is enough.”