Health Care System Integration: The Logistics of Meeting Ambulatory Care Clinical Orientation Needs in a Complex, Geographically Diverse Health System

Problem/purpose: To promote consistent clinical orientation experiences and clinical practice in a complex health care system with two separate human resource departments and diverse practice settings.

Design: Partnership among nursing professional development practitioners, ambulatory care services leadership and human resources departments to provide an integrated clinical orientation for new and transferring staff members.

Setting: Ambulatory care services at an academic health system in the southeast

Participants/target audience: New hires and transfer employees starting at the organization’s hospital-based clinics and the physician practice clinics.

Methodology: In order to provide consistency of orientation information and documentation as well as consistent care across practice locations, discussions were held with key stakeholders in both organizations under the broader health system. While not all aspects of orientation could be combined due to separate HR departments and benefit structures, the clinical components and leadership presentations were combined to provide a consistent message and vision to new and transferring employees. Logistical challenges included where to hold orientation sessions, parking for off-campus orientees, essential orientation elements for new hires at greater geographic distances, creating one set of policies for all ambulatory care locations, and creating specialty-specific “competency-based orientation” (CBO) documents instead of clinic-specific CBOs.

Results/outcomes: After partnering with the key stakeholders and collaborating to meet essential integration components, the combined orientation began in February 2018. In the following 12 months, approximately 350 new hires and transfer employees have attended the integrated ambulatory care orientation. This has provided a format for all ambulatory care employees to meet with executive leadership within ambulatory care services and to receive consistent communication on patient care goals and strategic vision, in addition to making a personal connection between leaders and new clinical staff. All RNs, LPNs, and medical assistants are also provided with information on clinical resources and complete a medication knowledge assessment utilizing these online resources. In addition, clinical staff complete learning modules and in-seat education on the electronic medical record, as well as participating in a class to complete their level I CBO (level II and level III are completed in their clinics). Most recently, an ambulatory care skills lab has been added to orientation, which includes a dosage calculation test, medication administration review and skills demonstration, EKG lead placement, and an emergency response drill (first five minutes of a code). Results have been positive from both orientees and leaders and documentation of the orientation elements has improved.

Implications for future practice: With increased health care system expansions, other organizations may benefit from a similar approach to integrating orientation for a consistent experience and standardized practice and documentation.