Too often, when developing onboarding content in a healthcare setting, instructional designers and trainers face a conundrum: Should they emphasize compliance as the imperative, or should organizational culture trump compliance during onboarding sessions. The bad news is there’s no one-size-fits-all answer. The good news is that you can have your cake and eat it too.

Read on to understand what we mean.

Stressing compliance at onboarding

With so much at stake from non-compliance, healthcare leaders rightly (and some would say overly so!) focus on compliance. Onboarding training must, however, emphasize that the rules and regulations in any healthcare delivery environment aren’t in place just to protect patients. They serve all other stakeholders in the healthcare environment too – including doctors, nurses, clinicians, and external healthcare partners.

Onboarding is the ideal time to introduce trainee and graduate healthcare professionals to the compliance framework of their new jobs. But it is also the appropriate opportunity to remind seasoned professionals from other institutions, who may be coming onboard, about the finer aspects of compliance as it relates to specific healthcare services offered by their new employer.

The best approach for instructional designers, to aid newcomers to the organization overcome compliance challenges, is to create onboarding material that fosters an organizational compliance culture. You can accomplish this by helping employees understand the role and importance of various facets of the compliance framework, including:

  • Health Insurance Portability and Accountability Act (HIPAA)
  • Protected Health Information (PHI) and medical records,
  • Occupational Safety and Health Act (OHSA)
  • Patient Safety and Quality Improvement Act (PSQIA)
  • Affordable Care Act
  • The Emergency Medical Treatment and Labor Act (EMTALA)
  • Hospital Readmissions Reduction Program (HRRP)

Many organizations offer online compliance training for a broad spectrum of healthcare companies. Administrators and training managers not only get access to thousands of compliance-related courses and resources online, but each healthcare facility can also create their own compliance courses based on specific regulatory requirements. Trainers can integrate such tools as part of the overall onboarding process.

Greenville Health System (GHS), which serves its community through 14,330 employees, affiliate physicians, interns, volunteers, students, and allied health professionals, faced a significant challenge on two counts: Onboarding and regulatory compliance. Staff not only needed training on organizational culture, like valuing the importance of safety and strict norms around sexual harassment but also on the necessity for stringent compliance to regulatory standards, like HIPPA and International Classification of Diseases, Tenth Revision (ICD-10).

By introducing online systems and services, GHS not only significantly reduced onboarding time to just 48-hours, but it was able to dramatically improve ICD-10 compliance as mandated by U.S. healthcare regulators in 2015.

Another very useful tool to use during onboarding sessions, to inculcate a compliance culture, is discussions around real-life examples of the impact that non-compliance may have on the organization. Good case studies to consider include:

Discussing such cases at onboarding sessions can reinforce the importance of compliance, while also highlighting the organizations’ culture of strict compliance to new inductees.

Culture of onboarding excellence

Detractors of the “Focus on organizational culture during onboarding training” message make the point that culture is something newly hired healthcare workers will eventually learn, once they’ve been in the institution for a while. Compliance (or lack thereof!), on the other hand, has immediate repercussions. Therefore, according to that faction of the “Compliance versus Culture” debaters, onboarding training must provide greater stress on compliance.

While stressing compliance during onboarding is paramount, anectodical evidence {Bauer, T. N., Bodner, T., Erdogan, B., Truxillo, D. M., & Tucker, J. S. – (2007). Newcomer adjustment during organizational socialization: A meta-analytic review of antecedents, outcomes, and methods} suggests better onboarding outcomes result when addressing broader aspects of organizational culture during onboarding – or “organizational socialization”, as authors of the research call it.

In fact, compliance and culture are two of the four-pillared onboarding best practices suggested by the Society for Human Resource Management (SHRM). Together with the two other pillars:

  • Clarification – communicating clear expectations about job requirements; and
  • Connections – making new workers aware of formal and informal networks to facilitate success in the workplace

these best practices not only help with onboarding and orienting new employees, but also with easing the transition from newbie to veteran workers, and long-term employee retention.

Like for any other organization, onboarding training for new inductees in a healthcare setting must cover:

  • Organizational norms, values, and traditions
  • Employee expectations: Remuneration, promotion, recognition, training, career progression
  • Employers expectations: Performance standards, performance measures, adherence to company policies and procedures – and compliance
  • With healthcare being a sector especially susceptible to stress and burnout, it’s important to make new inductees aware of support networks and counseling services offered by the organization

Other aspects of onboarding training around organizational culture, that are especially relevant today include:

  • The organization’s policies around sexual harassment
  • Whistleblower processes and protections
  • Organizational social media policies and practices

When wrapped around other standard onboarding best practices, such as having a formal onboarding process and identifying “named” mentors, teaching new hires about corporate culture pays huge dividends. The key, however, is to provide each newcomer the training they need, and not overload him/her with extraneous material.

Biotech company Thermo Fischer Scientific prides itself on its Corporate Social Responsibility (CSR) and its corporate culture that revolves around its 4i Values – Operational Integrity, Colleagues, Communities and Environment. Onboarding and supporting a global workforce of 70,000+ healthcare researchers, technologists and scientists can’t be an easy task. The company used technology to segment its onboarding guidance by language and role, thereby supporting thousands of new employees to access only information relevant to them. The result: Reduction in training time by 6 months!

San Luis Valley Health (SLVH) used a technology-driven solution – Nurse Residency Pathway – to improve its onboarding and orientation process. Implementing the evidenced-based training program not only significantly reduced nurse turnover – from 26.8% in 2012 to 7.1% in 2018 – but led to creation of a better nurse residency environment.

Two sides of the onboarding coin

In any healthcare setting, compliance and culture training go together. They are, in fact, two sides of the same onboarding coin. While it is an essential component of every major activity in a healthcare setting, including the onboarding process, healthcare leaders cannot guarantee compliance through punitive enforcement alone. There also needs to be a culture of valuing the importance of compliance across the organization.

Therefore, business leaders and HR/Training managers must sow the seeds of that cultural appreciation at the earliest for it to bear fruit. Typically, that time is during the onboarding process when new hires learn about a broad set of organizational cultural norms and values.