onboardPLUS Improves Engagement Productivity and Retention

CHALLENGE

The need for pediatric subspecialists has never been more acute, and the supply is extremely limited. This is the environment in which Dayton Children’s seeks to fulfill their mission that focuses on being the health care resource to all children of the Miami Valley regardless of their socioeconomic status. Once physicians are recruited, there is a strong sense of urgency on their part, and the hospital’s, to ramp up into a productive and satisfying practice and to begin treating the 290,000 babies, children and adolescents seeking their care through outpatient and inpatient services every year.
Yet, process, policy and communication barriers often needlessly delayed the full integration of physicians into their practice. The leadership of Dayton Children’s physician services determined that – in addition to the negative impact on access to care – the broken onboarding process was measurably impacting physician engagement, satisfaction and revenue production. There were also unacceptable collateral costs in terms of high turnover and inefficient recruitment, which compounded the lack of access and revenue impact.

SOLUTION

With at least 10 different hospital and group practice departments who touch onboarding, Lisa Coffey, Vice President, Physician Services of Dayton Children’s, convened an integrated task force to deconstruct the complex process of onboarding new physicians. Through the use of Lean techniques, they rebuilt it to be
simpler, more efficient and faster.

The framework and consultation provided by Tiller-Hewitt established an integrated and rigorous approach to physician onboarding and navigation. Through a rapid improvement event, conducted by their certified Lean Advisor, Tiller-Hewitt assisted the team in completing the identification and removal of barriers and redundancies.

The year-long physician mentorship program, critical to retention, was structured by Tiller-Hewitt under the direction of their Onboarding Coach/Mentor, a physician credentialed with both a master’s degree in healthcare administration and professional development certification. Dr. Ranjana Sinha, Dayton Children’s Medical Director of Inpatient General Pediatrics, was Lead Mentor, providing physician leadership and representation of the medical staff on the onboarding task force. She also ensured that new physicians and their mentors were matched for compatibility and shared commitment to program goals.

RESULTS

Dayton Children’s implemented onboardPLUS and achieved measurable improvements within the first two years. Their astounding results, include: a reduction in credentialing time from 322 to 84 days, acceleration in getting physicians working at full productivity from 14 months to 5 months; and reduction in turnover from 11.6% to 2.7%.

RETURN ON INVESTMENT

Helping new physicians achieve full productivity levels nine months faster can enhance revenue by an estimated $600,000 per new physician in the first year. This is an industry estimate based on the reported $787,790 in annual revenue* generated by primary care pediatricians. Potential revenue enhancement could be higher for subspecialists.

The high return on investment is secondary to the community benefit of having greater access to quality primary and specialty pediatric care due to lower turnover and greater recruitment success.

CRITICAL SUCCESS FACTORS

Through the process of reinventing Dayton Children’s onboarding process, the team learned key lessons:

• Combine technology and human interaction to ensure coordination, consistency, collaboration and communication:
  • Establish effective communication channels.
  • Create a shared drive for single-access checklists and real-time status updates.
  • Maintain the discipline of monthly meetings during which all departments are represented to provide necessary input and focus for timely decision making and accountability for implementation.
• Identify an onboarding lead to facilitate communication and connect the dots.
• Celebrate success and report evidence that the onboarding task force helps everyone to be more effective.
• Return to Lean Value Stream Mapping when changes in regulations, policies or other factors require the process to be re-examined.
• Extend onboarding activities with defined milestones through the physician’s entire first year.
• Provide administrative and physician leadership that is committed and visible.
• Set measurable goals and report key dashboard metrics to executive leadership.
• Continually seek feedback from physicians who recently completed the onboarding process.
• Define for new physicians the expectations/timelines for completing the necessary paperwork.
• Assign a mentor with the expectation of maintaining informal contact on a structured basis over a full year.

*2013 Physician Inpatient/ Outpatient Revenue Survey, Merritt Hawkins

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“The onboarding staff was terrific. Highlights for me were meeting all key physicians in the hospital, rolling out a marketing plan, and accessibility of onboarding staff.”

“Dayton Children’s has the onboarding process figured out!”

“Onboarding very organized, was able to get into the clinic quickly.”

Perspectives from new physicians at dayton children's

Mentoring Makes a Difference

Dayton Children’s selects mentors who are highly engaged as seasoned ambassadors for the hospital and who can effectively guide the new physician as he or she navigates the organization’s cultural and operational landscape.

While compatibility between the mentor and mentee is key, being in the same division, or even being a physician, is not a requirement for serving as a mentor. The ability to commit to a regular schedule of informal meetings and the willingness to help detect and solve any issues before they escalate are critical to successful mentorship.

Dayton Children’s vastly improved retention rate is consistent with industry surveys that correlate mentorship with reduced turnover. Furthermore, offering an effective
mentorship program is a significant competitive advantage that new physicians value when being recruited.

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