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Becker’s Healthcare Podcast
Building Smarter Workflows: Transforming Onboarding and Optimization in Healthcare
00:11:07
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- [00:00]
A
This is Laura Deardle with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Sachin Gupta, Chief medical officer of primary care and statewide at UNC Health Medical Group, and Jen Balchunas, who is the director of onboarding and optimization at Develop Me leadership coach at UNC Health Medical Group. Sachin. Jen, it's a pleasure to have you on the podcast today.
- [00:21]
B
Thank you. Appreciate being here.
- [00:22]
C
Thanks so much.
- [00:23]
A
Absolutely. Now, I'm excited for our conversation because I know across the board there's a lot happening in the workforce space right now and certainly organizations are bringing on you team members. I want to make sure that we get them up to speed and working efficiently and effectively. So this will be a great conversation for us to have. We're going to be talking more about throughput optimization, workflows, and how really you built a team around that at UNC Health Medical Group. But before we dive in, can you please both introduce yourself and just tell us a little bit more about your work at UNC Health Medical Group?
- [00:55]
C
I'm Jim Balchunas. I'm actually LCN by trade. I worked in clinic for many, many years and figured out I have a knack for workflow efficiency and so came to this side of the world, I would say about 10 years ago. And I'm now the director for onboarding and optimization.
- [01:14]
B
And I am Sachin Gupta. Laura G. Said, I'm the chief medical officer for primary care and statewide for the group. I am a family physician by training and, you know, have kind of gradually moved up that leadership ladder to where I am now. The UNC Health Medical Group is the community facing arm of the UNC healthcare system. There's kind of two big divisions in terms of the academic arm and the community arm. And so for primary care and statewide care, I hope to lead that along with the leadership team.
- [01:50]
A
Fantastic. That's amazing to hear and all great experience, I think, coming into your current roles. Now, could you tell me a little bit more about the onboarding and optimization team? I'm really curious to figure out how you built develop the team and what's worked really well to improve workflows and become more efficient within the process.
- [02:10]
B
Jen, if you don't mind, I'm gonna. I'm just gonna talk a little bit about the genesis of the OT team, but then I'm gonna turn it entirely over to Jen, who is the mastermind of all of this. But you know, one thing that I think we noticed that we had a real gap with was how we onboarded Our clinicians and certainly probably the rest of our. Our teammates that helped to support the clinicians. And also, how do we continue to support our clinicians and teammates as they kind of enter into practice and get settled in? I think that there's this assumption that, hey, welcome to the team, you signed your contract, you're a doctor, you'll figure it out. Good luck. Wasn't working. It created a ton of burnout, a lot of dissatisfaction, frankly, a lot of turnover. And so when we recognized that that was staring us in the face, we realized very quickly. Well, I'd like to say very quickly. Took us quite a while to realize that, but we realized that we had a real opportunity and that was really the genesis of the onboarding and optimization team to be able to create really a seamless experience for clinicians as they onboarded to UNC Health Medical Group and then as they transition from a new hire to a retention hire, and then that understanding that the questions and challenges that clinicians may have in day zero through 90 may look very different than they might have, you know, in days, you know, 90 through 365. And so we really created a very comprehensive program to facilitate that on ramp and then keep you kind of running very smoothly. And so that was the genesis of it and what we were able to create. And Jen has really been the mastermind of it. So I'll kind of let her talk now for about what she's helping to leave.
- [03:57]
C
Yeah, I think working in clinic and really having a good background to see how onboarding works and what happens over time. Right. Things continually change in healthcare. The EMR continually updates. Right. We have new teammates, but everybody's kind of in a different place in their work within the clinic. And so the two sides really have to work together for this to work. The onboarding piece and the optimization piece. And so we onboard clinicians and we onboard front desk teammates and clinical teammates, and we have very detailed programs for that. But if we don't go back to the optimization piece, we continue to be in the cycle where everybody seems to be at a different place in the workflow, in the clinic. And so we really use optimization assessments to bring the whole care team together to get the work flowing together. We focus not just on the in clinic piece, but we focus on the data piece of it. And so before we even go to do an assessment, we are looking at data from beginning to end because the data is going to tell us one piece of the story. And so we literally start with calling, listening to the phone cue Is the phone queue set up correctly to make sure the right phone calls are getting to the right person? And then we begin to move through the entire piece of the clinic, looking at data, work queues charge review, how we take in referrals and are handling them, how we handle our MRIs and CAT scans, we look at in basket for every single role in the clinic. How are we doing in the clinic? Who's handling messages? Do we need to level load amongst the team? We look at signal data for our clinicians. Are they spending a lot of time after hours? Is that something we can help with? Are they not utilizing our abridged tool? And they spend a whole lot of time in notes and that's something we can support them on. Do we have the right teammates doing the right work? And that's really what it comes down to. And when you have a lot of change in clinic, or you have a new practice manager, or you have several new providers, it happens very quickly, right? Where everybody's working and doing the very best that they can, but they don't understand all the time how one workflow impacts the downstream effect of another workflow. And so we go in and do observations in the clinic and we watch every role in the clinic and we really just want to work with the teammates. We want to observe, we want a patient. We want to watch a patient go through the entire flow and experience of their visit. And it's understanding what's going well for that teammate. If they could have one thing that was better, what would it be? And that's typically a question I ask people, but you have to come in as one of the teams, and I think that's what has really made a difference for us in the success of this. We really try to approach this as we are there to support them, to help them get through their day better. Right. That's a very different feeling than corporate or admin coming in to say, you know, these are all the things you should have been doing. That's really not the goal of the assessment. The assessment is to figure out how to make their day better. And how do we do that? By incorporating policies, procedures, standard work, like all those things that we need them to be doing, but do it in a way that feels like we're not asking them to do more work, we're actually making it easier and better for them to do the work that needs to get done. It's a really fascinating process. It builds relationships, I think, super quickly. And you really have to be willing to listen, you know, a lot of times, people just want to be heard when you come in and do the assessment. And so taking the observations, taking what you hear, and taking the data, and that all tells a story of where we need to go and what kind of recommendations we need to make for them.
- [07:44]
A
That's amazing to hear. And I think especially looking at how you're able to not only identify the problem or the challenge and then figure out how to design a new process around them and make it more efficient and effective, but also just the storytelling around it, too, and the relationship building, I think, is something that many organizations miss or don't fully embrace within that process. And so that is incredible to hear how you've been able to. To do that at UNC Health Medical Group and really be able to be more nimble, as I know things are changing all the time. So I'm curious, what have you learned since developing the O2 team, and what pivots have you had to make or adjustments?
- [08:24]
C
That's such a good question. I mean, I feel like we learn every week we learn something that's working well, that we can adjust. I think in my prior role coming into this, I really had this feeling of. Of what this could be and how big it could be and how impactful it could be. And I think one of the things that I quickly learned was everybody wants to be doing the right thing. There's just so much information coming at them. They don't know where to find it, how to get to it. And so part of this is creating resources and materials that are very seamless, very streamlined. So if I'm a practice manager, I know exactly where to go when I'm onboarding a new clinician or a new front desk teammate. And I have everything I could possibly need in one place. Saying that, right. There are a lot of moving parts when we onboard somebody. And having the right people at the table, which starts all the way from recruitment and goes all the way through legal and finance and credentialing. That is still a learning process. And we update our materials regularly. And I think knowing that how impactful one really good assessment can be will trigger multiple assessments. And I think the format in which we kind of handle the assessment after we do that really begins to build that. And I say that because we check in with the team every two weeks. So we go and do the assessment, we make recommendations, we then check in with that leadership team every two weeks and say, like, how's it going? What can we help with? You know, how are things feeling in the clinic? And that really continues to build the relationship. And then 95% of the time when we report back out to leadership, that practice manager will say, you know, oh, I was dreading this. Or it didn't feel great to have my director say, you guys are going to have to do an assessment. But this has been so impactful. And I think learning that, like, it takes, it's just like any word of mouth, right. One practice manager then tells another practice manager, like, man, this changed our whole dynamic. And then right now we have, I think, 11 assessments in progress, which is a lot. Right. And so knowing that we can meet them where they're at and that, you know, one practice manager is going to talk to another practice manager, but coming to it with an open mind is always really important. And I think we learn from them as well and we can take what we're learning and then implement those best practices when we open a clinic, which is a whole other piece of what we do.
- [11:00]
B
So, yeah, I think there's probably a couple things I would add to that. Jen, you said it really well. I think that one thing that we have learned is we can't underestimate the level of trust that this engenders. But also that is needed for this because. And I think Jen and her team are uniquely positioned because they all used to work in our clinics at some point. Point. And so there's this level of authenticity that they come with it. They understand the challenges of the day to day workflow, you know, the, the clicks that you might have in EPIC or the forms that you need to handle or the phone that's written. They understand all of that because they agreed to all of that. And so they really do come in with that perspective. They know how these clinics, you know, the pain points that exist in these clinics. And I think proof of that, the level of trust that it's engendered is that Jen has consistently been rated as one of the most trusted teammates in all of UNC Health because of the work that her and her team do, and that is across teammates and clinicians. So they have really built this level of trust that they seek her team out. Even when we don't say that you need to have an assessment, they sometimes, Jen, you're probably getting pinged all the time, hey, help me with this, help me with that. Because they create these relationships with our clinicians and teammates. So it's really remarkable. And I think that's the power of, you know, this role also. It's, it's getting the right people in front of Your teams to make the work happen because it. It feels more authentic, it resonates, and they. They really understand, you know, the pain points that we deal with as clinicians.
- [12:44]
A
That's fascinating to hear. And, you know, I appreciate you walking us through the process of how things have been developed, and then, you know, the areas where you've been able to learn and continue to evolve and grow the program, and to hear about those relationships that are building and developing because of this process is really helpful. I think. So many times things can get lost in the area of discomfort or when there's not clarity in a strong relationship. And so. So this makes a lot of sense. And it seems like you've got a great team there that truly, truly can
- [13:15]
C
lean on one another 100%. I think you go in a clinic, and typically we're all in scrubs, and we do that for a reason. Right. That feels very different than coming in in my business attire, work clothes, but, you know, I will go into an office and somebody from my team is sitting on the floor and they're doing that because it's really this way to, like, just tell me, tell me what it is about this workflow that you are really holding on to. And that's a very different conversation. Right? And you might go in there and they're building them note templates or whatever. We very much will help on the fly. And I think it only takes one thing to show them that we're helpful. And that also changes the dynamic, right? The fact that we know Epic so well, and I can stand there with them and say, like, hey, you know, I could pull that in your note for you so you don't have to type that. You know, you show somebody one to me is a very little thing. Right. But to them, it's life changing. Right. Maybe that saves them sitting at home for an hour at night writing those notes. To me, what I see is like, something super easy and simple is something that they have gotten in the habit of doing day after day for years and just don't know there's an easier way out there for them. And that's what's amazing about the team, is that they're always learning something in Epic. They're always trying to figure out a way to help them, somebody. And you may ask us a question, and we might not know the answer, but we will come back and internally try to figure it out. And maybe I ask the question, but three days later, a teammate's like, hey, I've been playing with this. And I finally figured it out. And that's the other piece of it, is people know, maybe I don't have an answer for you right now, but I'm going to get back to you and if I don't have the answer, I'm going to connect you with the right resource, whether that's within the medical group or within the healthcare system. I think that's the other piece of it too, being okay saying, like, not your billing and coding expert, but I'm going to get you with the right person. That becomes another point of, like, being that best point of contact because they know they can come to us and we will find them the right point of contact for whatever help they need.
- [15:24]
A
I love it. That is so cool to hear and definitely means a huge difference or makes a huge difference in terms of how you're looking at problems, how you're finding solutions, and then really making sure they stick. Before we wrap up here, I wanted to look into the future as well. And how do you see this program evolving and what are some of the big opportunities for growth and continued development in the next 12 months or so?
- [15:47]
C
I think the role continues to evolve and I even have somebody who's very front desk focused now and out of network insurance stuff, how that impacts workflows in the clinic and teammates. It continues to evolve and expand just even outside of epic workflows. Right. And so we are kind of known as the workflow experts. And that doesn't mean it's just an epic workflow. It can be a clinic. How do we get the patient from point A to point B? And I think that piece of it will continue to grow and expand also. Just specialty knowledge in general will continue to expand over the next year. But Dr. Gupta probably has some thoughts on the growth over the next year as well.
- [16:34]
B
Yeah, I think as we put this kind of optimization lens on things, there's so many opportunities that we have. And I think we also, we say often, like, we want to work top of license, top of license, like, this is the real way to be able to do that. I think one of the exciting things that I've been really, you know, proud to watch Jen and her team kind of navigate is how do we integrate new tools, you know, AI tools into our workflows? Also, this isn't something that existed, you know, I'd say, even a year or two years ago. How do we bring tools that the system has adopted to the front lines? And so that looks like a lot of, you know, education and training at the elbow support. How do we customize it for you. So they had to learn all of these new platforms just like anybody else. And they probably have to know it better than anybody else because they're the ones teaching people. So I think, you know, these AI tools, technology platforms are all going to be coming down the pipe, that we're probably going to be looking to their team to say, hey, help us to launch this. You know, this is an imperative and help us get it out there. So I think there's. There's lots of opportunities for this. I think we still have work to do to create a more seamless onboarding experience. I think as. As more and more trainees and graduates are comfortable using EMRs, that's great, but it may not be our version of our emr, and so there's a little bit of relearning that needs to happen there. So I just think the sky is the limit, you know, for this scene and I'm just really excited to see how this continues to be grow.
- [18:13]
A
Fantastic. A lot of exciting times ahead. Sachin. Jen, thank you so much for joining us on the podcast today. This has been such a valuable conversation. I really appreciate how you laid everything out here and exciting to see the results. So I look forward to continuing the conversation and being able to connect with you both again soon.
- [18:31]
C
Thanks so much.
- [18:32]
B
Thank you for having us. Appreciate it.