How CMOs Should Onboard Clinicians Using a Systematic Approach

Formal onboarding helps to ensure that new clinicians are successful in clinical practice, CMO says.

Onboarding is about more than helping clinicians navigate the hiring process.

According to the recently published Physician and Clinician Onboarding Research Report by the Association for Advancing Physician and Provider Recruitment (AAPPR), successful onboarding programs integrate clinicians into an organization, acquaint clinicians with an organization's culture, and provide clinicians with resources and support to help them excel in their new role. AAPPR compiled this data from a survey it conducted in collaboration with Jackson Physician Search and LocumTenens.com.

Providing effective clinician onboarding is pivotal in a health system's success, according to Pranav Mehta, MD, MBA, CMO of HCA Healthcare American and Atlantic Groups. HCA Healthcare, which features more than 180 hospitals, has more than 45,000 employed and affiliated physicians.

"It is critically important that we orient those physicians in a systematic way and approach," Mehta says. "We spend time onboarding them as they come from outside of our organization into our practices. That gives us the ability to make sure they are successful in clinical practice."

The AAPPR research report, which is based on survey data from 236 recruitment professionals and 1,550 clinicians, has several key findings:

• Clinicians who had a positive onboarding experience reported being highly satisfied with their job 56% of the time, but clinicians who had a negative onboarding experience reported being highly satisfied with their job 19% of the time
   
• 89% of healthcare organizations reported having a formal onboarding process for all new clinicians
   
• 57% of clinicians reported receiving a formal onboarding process
   
• 32% of clinicians reported receiving an informal onboarding process
   
• About 40% of survey respondents reported that their onboarding process ends within the first month, while about 40% reported that their onboarding process was three months to at least a year

The AAPPR report also found that clinician onboarding has four primary benefits for clinicians and their healthcare organizations.

Retention and job satisfaction: Effective onboarding programs boost job satisfaction and clinician retention. Onboarding helps clinicians feel more valued, increases their productivity and performance, and enhances their engagement.

Time to productivity: Onboarding accelerates the time it takes for new clinicians to start providing patient care.

Quality care and safety: Onboarding familiarizes clinicians with the policies, procedures, and systems that support quality care and safety. Onboarding also helps clinicians to understand and adhere to best practices, quality standards, and compliance requirements.

Culture: Onboarding acquaints clinicians with the values, mission, and culture of a healthcare organization, which boosts teamwork and a sense of belonging.

HCA Healthcare's onboarding model

HCA Healthcare provides both orientation and onboarding for clinicians, according to Mehta.

"When I think about the elements of orientation, they are time-bound and specific," Mehta says. "There are basic things clinicians need to know, which includes exposing them to issues related to HIPAA and the electronic health record."

The onboarding for clinicians includes training in leadership skills as well as leadership development, according to Mehta.

"We make sure they have exposure to the skills they need to succeed in a practice setting," Mehta says. "Onboarding is a little more detailed and granular than orientation—it is in depth and longer."

The onboarding process for clinicians at HCA Healthcare is conducted in the first year of employment. New clinicians are surveyed 90 days after hire to make sure the health system is capturing their voices and feedback, Mehta explains.

The best practices for onboarding at HCA Healthcare include having standard training, according to Mehta.

"No matter what state you are practicing in, we want clinicians to be exposed to some of the concepts around leadership, alignment, quality, patient safety, and other things they need to know to be successful in their jobs," Mehta says.

In terms of alignment, clinicians want to be connected to HCA Healthcare as an organization, Mehta says, which is bolstered by the surveys that are conducted with new clinicians 90 days after hire.

"Based on the feedback we receive, we can find out about the barriers physicians are experiencing in the inpatient and outpatient settings," Mehta says. "Then the executive team can work with clinicians at the local level, market level, and national level to mitigate barriers."

Mehta recommends focusing on a culture of safety as another clinician onboarding best practice.

"We want to make sure that clinicians feel they are part of a team that is committed to patient safety," Mehta says. "Ultimately, focusing on patient safety in onboarding results in better patient care and outcomes for us."

For clinicians, there is a strong correlation between a positive onboarding experience and job satisfaction, according to Mehta.

"It is a strong link, and it is a positive link," Mehta says. "What we are hearing from our clinicians is that they want an onboarding process that is effective, efficient, and meets their needs."