Create orientation survey that will impress surveyor
Create orientation survey that will impress surveyor
It can help target problem areas early
A western New York agency needed proof that its orientation program for new home health aides was effective before the agency was surveyed by the Joint Commission on Accreditation of Healthcare Organizations.
"We wanted the staff to make sure that what we had taught them in orientation was all that they needed once they started to work out in the field," says Anne Mason, RN, BSN, director of clinical services for Mercy Home Care of Western New York.
The simplest solution was to create an orientation survey that would be given about 60 days after the orientation concluded. (See sample orientation evaluation, p. 58.)
It worked. Their accreditation survey was successful, and the surveys showed they were on the right track with their orientation program.
"Overall, the surveys are coming back very positive," adds Mary Fraser, RN, MSN, quality manager for Mercy Home Care. The nonprofit agency is an organization of the Mercy Health System of Western New York.
One of the most difficult Joint Commission compliance areas for home care agencies has been the Improving Organizational Performance (IOP) chapter, says Nancy Harvey, RN, BSN, senior consultant with Healthcare Concepts of Memphis, TN, which is a private home care consulting firm. It provides educational programs, publications, and executive searches.
"Agencies need a process in place that shows how they are collecting data in a consistent manner and making changes based on the assessment of data," Harvey says.
For an initial survey, agencies need four months of data, and for surveys conducted every three years, the agency needs one year’s worth of information, she adds.
Harvey suggests that creating employee surveys will meet this requirement and help education managers improve orientations and inservices.
The key questions education managers will want to address in the surveys, Harvey says, are the same goals they might be asked to identify by a Joint Commission surveyor: "Show me how you have identified the educational needs of your staff. Show me how you have met the educational needs of your staff, and how do you know your actions/programs have been effective?"
Ways to answer these concerns are to survey staff at the end of orientation, at the end of a probationary period for new employees, upon every inservice or conference attended, and at the time of the annual performance evaluation, Harvey says.
"The last place you also can measure the education needs of your staff would be at an exit interview process," she explains. "You could ask the same exact question to every employee who leaves: Were your educational needs met?’"
Harvey says it’s not difficult to create your own surveys, but there are a few guidelines education managers should follow. Harvey, Mason, and Fraser offer these guidelines:
• Make sure each survey has specific questions that will answer whether your educational goals were met.
Mercy Home Care has employee surveys to cover different educational programs. In addition to the orientation survey, they give staff an employee feedback survey, an inservice evaluation, and a training program evaluation.
Each has a specific purpose. For example, the feedback survey is done by a telephone interview with aides a couple of weeks after they’ve finished training and then again at intervals of three months, six months, and nine months, Fraser says. The training staff calls the aides and asks them 16 questions about the quality of their instruction, ways to improve the program, and staff support. (See feedback form, p. 59.)
At Mercy Home Care, the aides are trained before they go through orientation. Some aides, who have had training elsewhere, will be evaluated for competency only prior to orientation to the agency.
The agency developed the feedback form out of concerns about retention of new aides, Mason and Fraser explain.
"We felt if we could build a bridge between training experience and the work situation, it would help them make a more comfortable transition," Fraser says.
• Keep it simple with questions that can be measured statistically but also leave room for comments.
Harvey suggests education managers limit most surveys to 10 questions that either have yes/no answers or that use a simple 1-5 scale, with one as highest.
"When you create a survey, you need to allow yourself a tool to create a statistical picture of the results," she says.
Mercy Home Care’s inservice evaluation and training program evaluation both have yes/no answers, but they also leave room for employees to add comments or suggestions. (See inservice and training program surveys, p. 60.)
"We offer them the opportunity to make suggestions about client care problems or disease conditions that they’re encountering and wish to learn more about," Mason says.
"In analyzing the results of these evaluations, we can select topics for future inservice training," she adds.
Examples of inservices that have resulted from the aides’ comments include education on death and dying, cultural diversity, ethics, and Alzheimer’s Disease.
• Pay attention to employees’ comments, and make changes to improve staff education based on the feedback.
This can help how education managers improve their inservices and orientation programs, Harvey insists.
Mercy Home Care supervisors learned from some of their surveys that the aides had some confusion about the actual length of a patient’s length of stay, Mason recalls. "One of the things we hadn’t been clear about was these cases turn over very quickly, and they might go in and only stay a couple of weeks."
The aides indicated on surveys that they had expected to stay much longer with patients. So the agency addressed that issue by making it clear to the aides during orientation that their cases might be over in a few weeks, she says.
The employee feedback survey has helped the agency identify potential problems in some aides before the problems grew and became reasons for termination, Fraser says.
"There were workers who were lacking in self-confidence and were uncertain about what to do in certain situations, and so they would quietly withdraw," Fraser recounts.
But the agency learned that they could be helped if early on management had identified their insecurities through the telephone survey.
Survey after they hit the streets
Through use of the survey, Mercy Home Care management learned that the office staff had improved their telephone skills.
Previously, the agency had surveyed clients and found the office staff were given lower scores. So Mercy Home Care focused on improving communications, and it worked, according to the more recent surveys completed by aides.
"Our home health aides quickly set up a positive relationship with office service coordinators, the house staff who were assigned to their cases," Mason emphasizes. "They said on the surveys that the office staff had been courteous."
• Focus on the ultimate goal of improving your orientation program and inservices and training.
Harvey also suggests that education managers survey the staff after they’ve had a chance to work in the field.
The field staff had learned the mission, how to document, and they learned rules and regulations. Their orientation objectives and outcomes were met.
"Then they hit the streets, and the real world rolled in," Harvey explains. "So then we surveyed the staff again at the end of the probation period."
The information obtained from the second or probationary period survey elicited the best suggestions to improve the field staff’s orientation to working independently in a real world setting.
Harvey says agencies have to demonstrate to Joint Commission surveyors that they are listening to staff and using their input as a vehicle of improvement. The surveys will show that.
• Remember that survey questions should reflect the areas that can show how your agency is committed to quality improvement.
"You basically ask questions that reflect the dimensions of performance for your orientation program," Harvey says. The dimensions, used by the Joint Commission, refer to nine areas that need to be addressed. The survey should be able to answer those areas. (See Nine Dimensions of Performance, at left.)
Harvey says that Joint Commission standards require survey processes to be consistent. "Did you survey 100% of staff nurses within two days of orientation, and did you survey the same 100% of staff nurses within one week of the probationary period?"
Also, make sure the data is collected consistently, and show what you did with the data after the survey.
"Don’t ask a question unless you’re willing to act on the answer," Harvey insists.
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