1 Orientation and Onboarding

2 Objectives Define purpose and structure of orientation at an academic healthcare institution List key components of evidenced based new employee orientation models Identify link between orientation process and employee retention rates

3 LOMA LINDA UNIVERSITY HEALTH 15,350 Employees 4,518 Students733 Residents in 32 Programs and 24 Fellowships 6 Hospitals 8 Schools 10 Institutes 800+ Physicians in 67 specialties and subspecialties Serving over 1.5 million patients each year

4 Behavioral Medicine Center285 ICU Beds 791 Acute Beds 89 Behavioral Beds 61 Rehab Beds 1,076 Total Licensed Beds LOMA LINDA UNIVERSITY MEDICAL CENTER University Hospital 371 Beds Children’s Hospital 348 Beds East Campus Hospital 134 Beds Behavioral Medicine Center 89 Beds Surgical Hospital 28 Beds Murrieta Hospital 106 Beds

5 Orientation Process Purpose Coordinated by Staff Development/HRTo ensure a standardized orientation process and content is provided to all LLUH new employees to facilitate their competence and enable them to function safely within their role To ensure all required regulatory education is provided for new employees To introduce new employees to Core Values Coordinated by Staff Development/HR

6 Core Values (think TWICE)12/11/2017 Teamwork Collaborating to achieve a shared purpose. Wholeness Embracing a balanced life that integrates mind, body and spirit. Integrity Ensuring our actions are consistent with our values. Compassion Reflecting the love of God through caring, respect and empathy. Excellence Providing care that is safe, reliable, efficient and patient centered. Employee orientation is designed around our core values Think “TWICE” – teamwork, wholeness, integrity, compassion, excellence

7 Orientation Living Our Values (LOV) all employeesHiring cycle 2 x month Average 142 employees / month Within 30 days of hire 8 hours General Clinical Orientation (GCO) All clinical staff Average 67 employees / month Within 90 days of hire

8 Orientation General Nursing Orientation (GNO)All nurses Average 34 nurses / month Within 90 days of hire 8 hours Electronic Medical Record Training Required for access to EMR Hands-on training 16 hours for RNS 4 hours for most other roles

9 Orientation Foundations of LOVing Leadership OrientationAll LLUH Manager thru Vice President level leadership Within 6 months of hire or promotion to the leadership position Occurs 2 x’s per year 16 hours Approximately 45 attendees Practical Concepts for Frontline Leaders LLUH Supervisor and Frontline level leadership

10 Department OrientationDepartment specific checklist Competencies Preceptor Checklist / Evaluation Basic Learning Units for Employees (BLUE Book) on-line course Required Regulatory Education for all employees

11 Specialty Nursing OrientationPediatric Nursing Residency Curriculum of classes augmented with staff preceptors 16 week program Twice year Average 40 RNs per session Adult New Graduate RN Program 8 – 12 weeks, depending on acuity Offered quarterly Average 35 RNs per session

12 Leadership CurriculumLeadership Essentials Series Monthly Continuing Education Courses 1 Hour Leadership Education topics Process Improvement Six Sigma, PDCA education 15 hours Professional Growth Courses: Essential Encounters: Communication and Confrontation Skills Essentials of Presentation and Design Writing Performance Appraisals

13 Leadership CurriculumSpiritual Growth and Awareness Cornerstones 2-day Retreat Department Specific Leadership Education LAMP-Quarterly Nursing Leadership Education Transformational Leadership Program

14 Leadership CurriculumFranklin Covey All Access Leadership Education Series Leading At the Speed of Trust 7 Habits of Highly Effective People Leading Across Generations 4 Imperatives of A Great Leader Leadership Modules: Great Leaders, Great Teams, Great Results The Diversity Advantage

15 Leadership Development Faithful Leadership Attributes and CompetenciesImplementation of Leadership Competencies and one Leadership Definition for the organization “A leader envisions opportunities consistent with mission and values; inspires belief in others; rallies support; and delivers results.” Cari Dominguez

16 Leadership Development Faithful Leadership Attributes and Competencies12/11/2017 Leadership Development Faithful Leadership Attributes and Competencies I. Living the Mission, Vision and Values Describes how Adventist healthcare, education and research contributes to the ministry of the church. Develops one’s personal leadership style as a servant leader in the healing, educational and research ministry. Applies a model for workplace spirituality. Describes the relationship between spirituality, healing, educational ministry & leadership. Demonstrates and promotes personal wellness

17 Leadership Development Faithful Leadership Attributes and Competencies12/11/2017 Leadership Development Faithful Leadership Attributes and Competencies II. Shaping Behavior, Delivering Results Builds an effective, engaged and collaborative team Encourages team members to succeed and reach their potential Continuously monitors and strengthens synergy amongst the team

18 Leadership Development Faithful Leadership Attributes and CompetenciesIII. Leadership Skills and Development Understands personal leadership style and ensures professional Growth. Manages people and the workplace environment effectively Performs job duties in an efficient manner Adheres to and understands the financial operations of the organization Generates trust with colleagues, the team and the community A Seventh-day Adventist Organization

19 Leadership Development Faithful Leadership Attributes and Competencies12/11/2017 Leadership Development Faithful Leadership Attributes and Competencies IV. Strategic Planning Identifies organizational opportunities and obstacles Creates and prioritizes goals for the future Makes decisions that are in alignment with the organization’s mission, vision and core values Understands the bridges that connect workplace culture to quality patient care, education, and research business outcomes and financial viability

20 Leadership Development Faithful Leadership Attributes and CompetenciesV. Cultivating Knowledge about the Healthcare, Educational, and Research Environment Promotes quality and patient safety Fosters a culture of ingenuity and continuous improvement Ensures compliance with Loma Linda University Health and government policies. A Seventh-day Adventist Organization

21 Orientation Orientation Advisory Committee PoliciesMembership Policies Orientation Resources Speakers Subject Matter Experts Classrooms Learning Management System Orientation costs per employee Orientation Advisory Committee Membership / Representatives from: Staff Development Ancillary Rep is SD Clinical Educator Human Resources BMC Children’s Hospital (CNO) Epidemiology Patient Safety & Reliability Surgical Hospital University Hospital (CNO) UHC Murrieta

22 Retention Statistics - MC

23 Retention Statistics - CH

24 LLUCH RN Residency Purpose:Evidence-based 16-week comprehensive educational, training residency program. Coordinated by RN Educator/Coordinator, Nurse Manager and Administrative Support

25 Program Structure Requirements to participate:New-Graduate RN with less than 6 months clinical experience RN License with Bachelor of Science in Nursing Designed to transition new graduate RNs from student to: Safe Confident Professional practitioners

26 Orientation Process Comprehensive program comprising:640 Clinical hours 16 weeks Two stages of precepting: Married state precepting Paired state precepting Recognition ceremony at week 16

27 Program Structure Comprehensive program is composed of:Education and curriculum – classroom time. Guided clinical experience with preceptors Supportive components: Mentoring Debriefing Measurement and evaluation: Open forum Residency evaluation Daily and weekly clinical-experience evaluations Employee evaluations at 90-day mark

28 Program Structure Program Schedule:2 cohort per year with acceptance in April and September 25 – 40 residents per cohort 40-hour work week: 2 8-hour class days 2 12-hour clinical days Clinical shifts begin on day shift Transition to night shift at week 12

29 Program Structure Supported Areas: Pediatric Intensive Care UnitNeonatal Intensive Care Unit Cardiothoracic Pediatric Intensive Care Unit Hematology-Oncology Unit Acute Care Pediatrics Unit Acute Care Adolescents Unit Total Care Birthing Center (Labor and Delivery)

30 # Terminations after transferringRetention Statistics Unit Total Incoming RN Residents Retention after 1 year ( residents) Retention after 2 years ( residents) Retention after 5 years (2010 residents) # Transfers # Terminations after transferring Residents retained Total residents RNR 303 249 259 96% 155 197 79% 12 30 40% ------ NICU 93 74 78 95% 46 61 75% 3 9 33% 2 1 Adol. 4 100% Hem/Onc 63 49 51 39 77% 0% 6 ACP 35 31 32 97% 18 20 90% 25% 58-S 28 26 16 22 73% 5 PICU 38 25 27 93% 7 57% 58-C 34 24 67% 60%

31 Retention Statistics Reasons for Separation Reason% of Overall Terminations (93 total) Accept new job 24% Personal 18% No record of reason given 15% Relocation-leaving area 14% Attend school 8% Other resignation Relocation-spouse transfer 4% Contract ended 2% Maternity reasons Family illness 1% Accept new job-LLU Accept new job-LLUMC Murr Did not return from LOA Unsatisfactory work performance

32 Tranfers’ Receiving Unit/DeptRetention Statistics Transfers Within the Organization Home Unit Tranfers’ Receiving Unit/Dept NICU SDI; Surg/Trauma ICU 4200 4800 OB Services; FIT x 2; 4200 x 2; Case Mgmt ACP EPIC; ED; 4700; PICU 58-S ED x 2; ACP; PICU x 2 PICU ED x 2; 4800 58-C 4200; ACP

33 Summary/Conclusion

34 References