Strength in Numbers: Increased Improvement With Relias Onboarding and Relias OB

The challenge

In 2015, Providence Health System (prior to merging with St. Joseph Health) experienced a major crisis with low nursing engagement due to staffing issues and a lack of development and growth opportunities. The system was faced with 3,000 open RN positions, 390 unmet demands for specialized nurses that agencies are unable to provide, and ranked in the 61st percentile in Press Ganey’s National Patient Loyalty Index database. The nursing staffing crisis was costing the system an estimated $125 million annually in nurse agency spending.

The change

Providence aimed to provide a standardized approach to residency, fellowship, and preceptor training to lead improvements in retention, engagement, and patient experience. To lead this effort, a Clinical Academy was created as part of the system’s Nursing Institute which fostered nursing quality, academic partnerships, and scholarship opportunities. Additionally, the system looked to Relias Onboarding and Relias OB to improve nurse staffing and patient care.

OB meets OB: onboarding and obstetrics

Providence began using Relias OB in 2014, and was an Advisory Council member of the Mothers and Babies First Project, co-sponsored by Relias and AWHONN (a project created in response to the national rise in maternal mortalities and obstetrical claims that mobilized the nation’s perinatal safety leaders to improve care for women and newborns).

Based on the system’s success in improving care for mothers and babies through Relias OB’s assessment-driven education, Providence implemented Relias Onboarding in January of 2018 because of the solution’s:

• Adaptive learning technology
• Alignment with ongoing learning and development with Relias OB
• Ability to track knowledge scores and comparison across groups
• Adult learning best practices within the instructional design (i.e., interactive, case-based scenarios)

“Using the onboarding content on hire and continuing with the Relias for OB content is a great way to layer education as well as to keep track of progress and learner needs with the analytics built into both programs; our new nurses are learning the same best practices and up to date content that our current staff are, which means we have a common language”
–Marta DeVolt, MN, RN-BC, RNC-OB, Sr. Program Manager, Clinical Academy and Perinatal/Neonatal Educator, Providence Health & Services

The impact

With the success of Relias Onboarding and the Clinical Academy, Providence has not only continued to improve learning outcomes for labor and delivery nurses, but also significantly improved the system’s nursing staffing/engagement challenges as outlined below.

• April 2019 fiscal year turnover for nursing was 22% lower than the system average (26.0% vs 20.3%).
• 2019 Q1 fiscal year turnover for Clinical Academy was 67% lower than the system average (26.0% vs. 8.5%) and 58% lower than the all nursing average (20.3% vs 8.5%).

Since starting the Clinical Academy, the system has sustained significantly lower turnover rates and saved millions each year — an estimated $22.1M (May 2016 – April 2019 based on turnover avoidance for Clinical Academy enrollees compared to all nursing turnover) and an estimated $3.6M for Q1 of 2019.

• Managing preceptor and charge nurse initial expectations and offering excellent preceptor training and support.
• Creating flexible blended learning models to accommodate different environments.

DeVolt noted, “We were excited to add the new Relias Onboarding content to Relias OB and it did not disappoint! As we’ve been using the program and working with Relias, our program has continued to improve and will keep evolving — Relias has been a great partner. Next, we will be working towards a distance learning platform to reach our more remote hospitals and provide more flexibility with how our facilities interact with our content.”

Continued success

Providence has achieved nothing short of impressive results in continuing to focus on high quality care for its mothers and babies, while significantly reducing the system’s nursing shortage. The system plans to continue its successful strategy with its Clinical Academy while also addressing “lessons learned” along the way, such as the importance of:

• Focusing on critical information for face-to-face time with educators.
• Involving current staff in simulation training and classes.
• Providing tools for independent learning and peer teaching.