Special Report: Improving Staffing Quality

Self-appraisal is key to training new employees

Facility’s training program has nine modules

Training new staff to follow the hospice team model requires a comprehensive approach that helps people new to hospice make the transition to the hospice philosophy, and that helps create a better understanding of the role of each hospice discipline.

"Whichever discipline new employees are, they need to get comfortable in their own shoes in being with dying people and talking about end-of-life decisions and hearing others’ beliefs and values without pushing their own," says Joy Berger, DMA, BCC, MT-BC, director of the hospice institute at the Alliance of Community Hospice & Palliative Care Services in Louisville, KY.

The alliance has a holistic approach to hospice staff training that empowers people to provide the best front-line care and turn the squeaky wheels into advocates for the partnership of hospice teams and management, Berger says. "Our hospice is the first accredited Practice Development Home Health Agency in the United States," Berger says. "This was through Leeds University in the United Kingdom. A group of 12 to 15 care providers went through training, goal setting, and implementation for developing leadership in every person within the scope of their jobs."

However, the chief component of the hospice’s training and education is its nine-module staff orientation session. "We guide and empower the new employees to apply the information coming from the orientation presenters to their own job descriptions and roles," Berger says. "They do self-appraisals throughout the orientation process."

The orientation involves 30 presenters to cover three hospices, two inpatient units, and three bereavement centers, Berger says. "Within this, we have educational tools and some reflection synthesis pieces built into the week for them to reflect on changes from their previous job roles," Berger says. "We put a lot of emphasis on how their role fits within the whole organization, including the clinical team, the finance department, and the thrift shop where goods that have been donated to the hospice are sold."

For example, an employee who works in the thrift shop will need to understand that thrift-shop donations often come from bereaved families, Berger notes. "We emphasize the importance of the person doing the medical records to understand the interdisciplinary team concept and know the time line of the patient and family," she says.

Here’s how Berger’s orientation program is structured:

Understanding "who": Module one involves sessions that describe hospice staff, employee and regulatory requirements, human resources, and contact information. Module two has a Hospice 101 session, along with sessions that describe hospice patients and families and their psychosocial, physical, and spiritual needs. This module is followed by a self-awareness exercise.

Trainees responsible for synthesizing info

On Monday mornings, the orientation begins with the image of a compass and the question, "What does being oriented mean?" With the compass metaphor, new employees are told it’s their responsibility to process what they learn and synthesize information with what they know about their own skills and discipline, Berger says. "I ask them after each session, What is it you really understand?’" Berger says.

Understanding "how": On Tuesdays, sessions in module three discuss the admissions process, visiting patients, interdisciplinary plan of care, emergency needs, documentation for clinical staff, and job-specific applications for non-clinical staff. In module four, employees are taught how the hospice provides care at and after death, including a focus on bereavement care.

"At the end of Tuesday afternoon, after everything has been so stressful — discussing the timetable of patients from admission through death and bereavement — I go in and have them do the Hokey Pokey," Berger says. "I play off of the song, saying, When you come in here in the morning, you put your whole self in, and when you leave in the evening, you take your whole self out.’"

Employees trained to assess grief risks

Part of the hospice’s clinical process is assessing risk among survivors for complicated grief, and there’s a specific tool that’s used to assess that risk, she notes. "So it’s important the employee makes a visit to the funeral home and greets the family with You did a great job’ and How are you doing?’" Berger says. "We also do some assessment for what kinds of complications might set in, and we make sure the appropriate people know about our bereavement services."

This also is discussed during the module about the patient, death, and the family.

Job and regulatory details: On Wednesdays, the fifth module focuses on specialty services provided by the hospice, including music therapy, volunteer services, inpatient units, continuous care and caregiver training, and child and adolescent grief. The sixth module discusses regulatory issues and policy details, including personal wellness, performance improvement, corporate compliance, privacy regulations, infection control, employee health and safety laws, and volunteer services.

In the first session, the music therapist comes in and describes the use of music therapy with hospice patients and how referrals are made for the service, Berger says. Music therapy and the other specialty services are not used by every patient, but every employee needs to know they are there and available, she adds.

Putting financial, productivity, and community pieces together: On Thursdays, new employees learn in module seven about financial stewardship, productivity standards, customer service, and computer use. In the eighth module they are provided an overview of cultural diversity, local public relations in the community, personal and professional boundaries with patients, hospice ethics, and their personal career paths and future.

The hospice’s chief financial officer had asked to conduct a financial stewardship session so employees would understand how the organization makes and spends money and how each employee’s individual decisions may affect the team and the hospice’s overall health and well-being, Berger says. "We are a nonprofit organization, but the CFO also says, We’re a not-for-loss organization,’" Berger adds. "We have to provide financial stewardship and be productive in our day."

Employees are asked to do a self-appraisal on Thursday afternoon. The self-evaluation summary encompasses these seven items:

  • My greatest strengths I bring to this job are:
  • Reflecting on my "self-appraisals," my previous experience, my "Job Description," and my self-knowledge, my greatest learning needs are:
  • I know I’ve done a really great job when:
  • A fear for me in this new job is:
  • An important hope for me in this new job is:
  • Currently, I find feedback and support for myself from:
  • In the days, weeks, and months ahead, I will look for new feedback and support through:

Closing ritual affirms individuals

"We close with a ritual in which I use a Buddhist chime, and we affirm each person in that room, their strengths, fears, and hopes," Berger says. "That has always been rich and meaningful, and we’ve been doing this module every month since April 2003."

Specific nursing information: The ninth module on Fridays is specific to RNs and LPNs, and includes information on patient care guidelines, durable medical equipment, advanced pain management, medication titration, case management issues, hospice pharmacia, forms and documentation, symptom management, and comfort in the chaos of care.

The key to the comprehensive, week-long orientation program is to give employees a jump start on setting personal learning goals rather than having them wait until their first year’s job appraisal, Berger notes.

"We are helping them set their own goals, and it might be to learn the computer system or to learn more about a particular medication, or it might be for a social worker to learn more about advance directive forms," Berger adds. "One person said her greatest learning curve is to learn more about cultural diversity and to be more open in herself, and that is huge."