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BOBBY: Hello and thank you for tuning into the Becker’s Healthcare Podcast series. My name is Bobby Zarr, and I’m the senior director of healthcare at uPerform. Today I’m joined by Kelley Williamson, who is here to talk to us about how UCHealth keeps their staff informed, prepared, and supported through Epic go-lives, upgrades, and workflow changes with a standardized, and scalable approach to change. Kelley is an experienced healthcare leader with over 14 years of experience in software training and support. She is currently the director of IT for UCHealth and is responsible for the training strategy, curriculum development, and ongoing support for UCHealth and their core applications, including Epic. And I can tell you she’s a valuable friend and partner to uPerform, and I’m excited to have her on the phone today.

Hey Kelley, welcome and thank you for taking the time to speak with me today.

KELLEY: Thank you for having me, and thank you for making me sound so good. I really appreciate that.

BOBBY: Oh no help needed to make you sound good. Alright, let’s jump right in, because we’ve got a lot to share with our listeners today. I think I’m going to throw at you the very first question.

When many of us think of UCHealth, we think of a health system that is at the forefront of innovation and isn’t afraid to do things differently. Can you give us a little background on what drove UCHealth to rethink it’s training program?

KELLEY: I sure can. So UCHealth started out probably about almost ten years ago, and we were a one hospital system, and we had about 5,000 employees. And I would say we implemented Epic at that time. So, we did a large big bang at that time and had everything – ambulatory, inpatient, pretty much all the applications except some of the new ones Epic has now. But when we started that, about two years into it, after rolling it out and trying to get things smooth, the organization decided to go ahead and start with acquiring, affiliating, you know, community connect, all those type of things. And so since that time, we’ve actually grown to a 15 plus hospital system, and then over from 5,000 employees over to 30,000 employees.

And when things happen like that, when you have that much growth and you have that many hospitals and clinics coming onboard, and the clinics and stuff, we’re in a constant state of go-live. So, if you think about it, we have probably over 20 clinics that are coming on every single month and then every 18 to 20 months or 24 months and stuff, we have hospitals. With that much growth, you have to relook at the processes and the things that you have in place. You can’t live on what you’ve done before, because you have many more employees to communicate with, many more employees to make sure they have the information they need at their fingertips.

We also had lots of old processes in place. We had Epic Central, which was a SharePoint site. It worked and it was great when we had it and we were a small hospital system with 5,000 employees. But once we started growing and we had affiliations, and so we would have different workflows for affiliates and all those types of things, Sharepoint was just not the way to go to be able to do things. We would go in there and if you could, you know, to give you a great example, you would search for blood administration documentation. The only problem is, it wouldn’t show you by your role. It would show you everything that it would pull up, and there may be 80 documents that would pull up for blood administration, anywhere from a tip sheet to a quick start guide to a job aid to, I don’t know, like a Visio or something like that. And then you had to figure out what you needed.

So we definitely knew that that was not something that was sustainable for the long run. We also had a Learning Management System in place and we really had to look at how does that information get shared. It’s, you know, with Learning Management Systems, you pretty much assign things out. Somebody takes it and then they, you know, they say they’ve taken it, you capture that information more like compliance, and that was not something we needed for our growth either. And then we also had constant contact for communication. So we were, you know, always looking at a better way to, you know, get the information out. But of course, with Covid and just healthcare being crazy right now, communicating by email is not always the way that you need to be able to do it.

So, a lot of our challenges, of course, were sustainability. With the old systems that we had in place or the processes, we couldn’t keep things updated because, like I was talking about with blood administration, one of the documents you searched may go back to 2010. So there wasn’t an easy way to keep those things updated and just understand what we were trying to do.

And then just to give you a little bit of background too…About three years ago, our CIO had a big meeting with all of leadership and training and said “we need to revolutionize. So figure out better, bigger ways to make sure our end ours and our staff, by role, by everything, have the information they need.”

It’s less cumbersome, it’s less emails, you know, it’s high tech, high touch, all those type of things. So we definitely had to really quickly figure out what we are going to do with, of course, Covid hitting and everything else. But really looking at who we were going to be when we decided to grow up and what our future was going to be, which was scary, but also very, exciting.

BOBBY: Yeah. Many people think of growth as being linear and you’re just on this track and you add this and you add that and you add this user. For you guys, it’s exponential. I can only imagine trying to use the old training processes. It was difficult enough when growth was linear. When you go and, you know, it’s exponential, and spreading in all different areas in every direction, I can imagine it was just tough for you guys to manage and required a new approach. So in looking at that new approach, what benefits have you experienced by taking that new approach to training?

KELLEY: There is a lot of benefits. I would say that one of the very first things, and this was, and I would say this is, the reason for uPerform is that we needed to put the kind of road signs on the road map.  So if somebody was, let’s just say they were having an issue with triage or something like that, they needed to be able to have things right at their fingertips. And you know, thinking about having the old SharePoint sites in process or developed, you don’t have things at your fingertips. If you are a clinician, you have to stop what you are doing, you have to think about where you can go and get that information. Then you have to go outside of Epic, especially because most people are in Epic, go find that information, search, hope you find it (because nothing is assigned by role), and then turn around and hope that information that you found out of the 80-some documents helps you with what you need to do.

So I know that those type of process and stuff didn’t help us. So being able to put the road map  on, so basically the road signs on the road map and get the car out of the garage and right where people need it was very, very important to us. That was one of the reasons why we had to figure out what we were going to do, how we were going to do it better.

It also, some of the benefits is having one source of truth. You know, we have Epic Central, which was the SharePoint site; we had people that were creating other types of SharePoint sites; we would have you drives; you would have people that were on their emails. Everything was everywhere for training. And there was many different places that things were being created. So having one source of truth at everybody’s fingertips was very, very important. And then also our affiliates. I mean, our affiliates are very important to us. And having them being able to have a say in what we’re creating, or being able to create their own type of information, their own content, was really, really important to us.

That is something that we’ve been moving into and we’ve been branding; branding their creation of materials and stuff in their own colors and their own look and feel, which is important. Some of the benefits too, of being able to take off our UCHealth branding name for our affiliates, so that they could print anything at any time, was wonderful.

And then also just going and rethinking and digital approach is we’re moving away from face to face training. And I think a lot of organizations right now are doing that. And I think Covid was kind of the fork in the road that a lot of organizations had to rethink how they did things.

And so our design right now and our future is talking about trainers becoming coaches. So trainers in the classroom is a really, really good thing. And there’s a lot of information that’s shared. But really where the rubber meets the road is when the trainer can actually go out and say, ‘Okay, it looks like you’re struggling in these areas.’ And let’s go ahead and have an intervention or a lunch and learn or something like that. That’s our future. So we’ll be able to actually, so rearranging what we’re doing and having uPerform to have all the materials and all the things at the fingertips is really what’s going to make the difference for us.

It’s going to create efficiencies. It’s saving money as far as no travel costs. But then it’s also getting that standardized curriculum and that standardized coaching to really help people get better and better at their jobs, which means eventually, hopefully they get to spend more time with their families and those types of things, which I think are very, very important to people right now.

BOBBY: Awesome. I couldn’t agree more. I love the imagery that you use of the roadmap and road signs along the roadmap. That specific delivering of content and help and support at the moment of need inside of Epic. I know you guys are using a lot of the Epic integrations. We’re trying to deliver as much content as possible at that moment in the need, so putting those signs up for the users so they get the right direction and the right direction from the start or inside of Epic. Can you speak a little bit to the uPerform features that you’re using that enable you to provide that moment of need?

KELLEY: I sure can. So, definitely we are going to be using the [Epic F1] help integration. So, we’ve got the F1 dashboard, which is really important. So, if you’re just looking at uPerform, I mean what a great way and stuff to be able to design your own F1 dashboard. So, being able to have search at the very top, because of course that’s the most important thing most people are going to search for things like blood administration, those types of things that they need. But having the ability to have if they just click on F1, they can actually look and say ‘Okay. I need to go here. Here’s my link to be able to do that.’ But custom design it for your organization to exactly what your end users need, I think is phenomenal. I don’t think we’ve ever had that kind of capability to be able to quickly and stuff, get things at the fingertips to the end users. We’re also looking at – we have uPerform in the main menu, so when they’re looking at the toolbar across there, they can click on it right away. And then also making sure, you know, like embedding. So we’re going to be working with our analyst teams to embed all the tip sheets, simulations, videos. All real microlearning, so very small, but putting those right at the fingertips. So if we know– let’s just say there’s an example like the Falls Predictive Model. When that came out, there was a whole bunch of like policy information, but help information, about what you need to do with your patient to make sure that they’re safe with falls, or if they’re at a certain level, what do you need to do? So being able to embed that information and have those quick tips and tricks and help and things is really, really important.

That’s a game changer. I would say our organization probably five years ago never was – it was always like ‘Nope, don’t embed in Epic.’ BPAs, all those kinds of things. You know, you put too much in front of the clinician, it just becomes just like out there. Now they’ve completely changed, and I would give a lot of credit to uPerform bringing that forward. They’re really changing the organization. They’re saying, ‘let’s put the road signs on the roadmap,’ which is…it warms my heart, but it’s also just wonderful. The other things that we’ve done and some of the features too is…Working with uPerform, it really changes the way that you – it makes you rethink and it changes the way and stuff that you’re going to deliver training for your future and for your staff, clinicians, roles that are out there.

And so we’ve actually put together, and we started asking questions about ‘what do we need to do? What’s the future going to look like? Are everything that we’re putting together, is that going to meet the needs?’ So we’ve actually started an IT training governance committee that has our CNEs, which is the executive CNO, and CNOs, and vice presidents, and all kinds of individuals; very small, but a group that is going to help us make those strategic decisions.

So, uPerform is definitely our future. So what do we – what does it need to look like? How do we best address the needs that are out there? If nurses aren’t able to read emails because of the COVID patients and everything else, what’s a better way to deliver that? Is it to embed the links? All that?

And so from that governance committee, to work groups, to actually figure this out and present back for decisions is phenomenal. It’s – like I said – I don’t want to use the phrase again, but it’s a game changer for UCHealth of how we’re going to deliver for our clinicians and how we’re going to make sure that people get the information and the help when they need it.

BOBBY: That’s awesome. Thank you for circling around to clinicians. Because I think today clinician burnout, whether it’s nurses or providers, is at an epidemic level. And KLAS has shown – in a recent KLAS study showed – that there’s a direct correlation between satisfaction with the EHR or with Epic and burnout in the organization. What’s been the feedback from your clinicians since switching to uPerform and the vision for just-in-time?

KELLEY: It’s been really positive. So probably about – so COVID, when it first happened, we moved everything to on demand, so prerecorded modules for all of our training, etc., because we knew that we couldn’t sustain face-to-face training.

So when we sent it out, especially to our affiliates – so clinician affiliates and everything – they’re like ‘This is fabulous. Thank you for allowing us to choose when somebody needed training – when they needed the information – and then be able to take it anytime, anyplace, anywhere.’ So, that was not having to travel, not having to worry about having an extra resource to set up the training room, because maybe Zoom wasn’t working or Teams wasn’t working, all those things. The feedback was tremendous.

Same thing for, because like I said, we did this all right when COVID hit, so it was in March, and we spent probably 30 days when everybody else was out of the office to get everything set up. We also made sure that we worked with the organization, said ‘Okay, if you’ve got nurses that are coming from outpatient that need to go to inpatient and not have to sit through training or face-to-face remote training…” We actually put together, like, surge RN training that was pre-recorded so people could know exactly what they needed to work within as far as the capabilities or workflows, and then they could quickly – if somebody was moving over the next day – they could quickly take the training and then they could show up and be ready to work. Those things are, like I said, was really good and having that availability. And if we would’ve had uPerform at the time, we would’ve actually created simulations verses more recorded type of things. And then that would be that ‘see one, do one,’ which would have been even better. More of that six times to long term memory is really, really important.

But to be able to say – and look at the feedback and stuff – we can support them in many different ways now than we ever could before, and we can support them kind of anyplace, anytime, anywhere and have things at their fingertips is our future and that’s where we need to be. And I think that’s where most organizations are trying to achieve; they just maybe not have figured out what that’s going to look like.

BOBBY: One of the constant – and really the greatest constant – in healthcare is change. That’s the one thing you can count on is change. I think Covid accelerated – that we were all used to change in healthcare – Covid put that into a hyperdrive, so to speak. Sounds like with the growth that you all have experienced and then Covid on top of that, it brought to bear the need for more agile implementation and change tools. With Epic continually involving new rollouts, new regulations, of course all the things that Covid taught us out there that was rolling out, new workflow changing, how are you guys keeping your clinicians informed and prepared for change?

KELLEY: Great question. I think this is something that everybody struggles with. No matter how long you’ve been in the organization or how long your organization’s been with Epic, all that. I think we’re constantly looking for bigger, better, more concrete ways, I think, and stuff to communicate and really talk about change. Because yeah, moving from anywhere from a 16-18 month upgrade model to every quarter, it’s like you just get done with one upgrade and you’re starting to review NOVA notes and everything else with Epic, and you’re starting your next one, and your end users are like ‘Wait a minute. I’m just learned what you changed a month ago.’

And so that’s always difficult and stuff to manage that. So we have – we definitely have internal marketing campaigns that we’ve done for F1, for any other integrations and stuff that we’ve done. We’ve done – we’ve got a newsletter, which we do through Constant Contact. So that goes out. I would say there’s probably 15 different newsletters, because there’s many different groups that this is broken down into. Like the physicians get their own newsletter. Then there’s nursing and then there’s an overall. So we have those. We have right now – marketing would tell you it’s a great rate – they’ll say we’ve got I’d say 45% of the individuals read those newsletters. But then if you think about it, you’ve got 55% who don’t. So to me that’s scary. I know that those are good numbers, but that means I’ve got 55% of the population or roles and stuff that don’t know that we just had an upgrade and the changes that are happening. I think that looking at putting things at the fingertips…so, if there is a big change in Falls [Prediction] Module or something like that, making sure that people are notified and if that communication from with inside uPerform and it comes from our CNO, which is more impactful than coming from IT training, I think it is – like I said – it is changing our future, and it’s allowing our CNO when she found out about that she would be able to communicate through that and be able to attach documents and then look and see who read it, who didn’t, and all those type of things is really going to change how we roll out communications at our organization.

And I think, truthfully, because we just had a conversation with the governance committee this morning about burnout. Burnout is huge in the organizations, and it’s not – there was always burnout before, but with Covid has – and especially in Colorado right now, because our numbers are skyrocketing – there’s just so much coming at people that it’s hard to focus and it’s hard to – if a charge does happen or an upgrade does happen, like what are the changes and what do I need to know and do I – does it affect me right now? And if it doesn’t, then can I just move on and take care of my one to 5, 6, 7, patient ratio that they need to be able to do?

But it’s also about reducing. I think it’s a little bit about reducing the burnout with our affiliates. When you’re affiliating with another organization – and a large organization – you know you want to be heard and you want to be able to have the right information for your staff and your either clinic or hospital needs.

And so being able to have a system where you could design or have them help design things – and that’s not normally a model they usually have in place when you roll out an Epic implementation – is really helpful. When you know that they’re – if you’ve got data and stuff and it shows that your affiliates are calling in and they’re calling the help desk a lot, which is usually not a satisfier, because they can’t get their questions answered or they’re – to be able to capture that and say, ‘okay, let’s create something for your staff and put it at their fingertips’ is just a great thing to be able to have and just be able to have those tools in place and be able to use uPerform and figure out all the different ways we can use it to help, and especially not just in Covid times, but for our future is exactly where we want to be, and we’re excited about it. We can’t wait to – I mean, I would say we scratch the surface with uPerform of what we can do. But with it training, governance, and the talk and what we need to do, we’ve got a bright and rosy future ahead, and I can’t wait to see what else we can do and how we can redesign things.

BOBBY: Well, we can’t either. We are so thankful for valuable clients, like UCHealth, that have provided us guidance and direction on our roadmap. We recently had a roadmap session with you, got some great feedback, great ideas, some terrific ideas for innovation, as well as use cases for uPerform. Some of those ideas I could probably articulate, but I think they’d be better coming from you. When you think of our joint plans as partner, what do you see for expanding the use of uPerform at UCH?

KELLEY: So when we started out the implementation of uPerform we went the route of documents and simulations. So making sure that all of our tip sheets, commonly known with Epic and stuff, that whatever they were we put them in levels. Like what was the most important, least important. And then we recreated those inside of uPerform. And it was a good place for us to start. I would say other organizations may start with courses or different areas.

Our next step is our courses. We’ve got – since we’re moving more to a coaching model – we have a lot of courses that are in our Learning Management System. They were recorded with Adobe Connect software and they were also – we were using Panopto videos, which is a kind of a recording software that has now been retired out of the organization.

So I would say – and I’ll just be as blunt as possible – because I know I’m known for that. But I would say our courses are hanging on by a thread, and we’re managing them right now. Adobe Connect recordings and those types of things, but we are having to manage them. We shouldn’t have to. It should be just as easy as something changes, upgrade changes, go in, make a screenshot change, change a note – those types of things – which you can do in uPerform and then have that course just behind the scenes that nobody even knows that there was changes made. It’s just updated.

Those are definitely our next big step is moving all of our courses into uPerform. We have about 78 right now, just new hire courses that we need to start developing, and that’s going to be on – that’s on our roadmap of the next six months. And the n also helping end users work with other applications.

So that was definitely one of the other things we looked at uPerform – that it was not just Epic – that you could actually create just things at the fingertips for the end users. It’s also other applications. I know you guys have probably a list of like – I think it was 200 or 250 applications?

And I would say most hospital healthcare organizations have those applications. So our next big step is Lawson and Kronos. It used to be known as Kronos, but now it’s known as Dimensions. So our affiliates – when they sign agreements with us, a lot of them actually take on Lawson and Dimensions. So being able to create that inline help, it’ll make a huge difference with our affiliates. It’s being able to have that help and not have to call into the analyst team to get the basic question answered or just what’s the next step in the workflow. Those type of things is phenomenal.

We’re also looking at how do we figure out where people are struggling for our coaches. All those kind of things. So just really making sure that whatever we’re putting together and what we’re building for our future is going to give us the information to help, for us to be able to support our end users from the back end. So making sure that we can get them home to their families faster. Making sure that if they’re struggling, they can get the information right away. And they probably – and I would say this would be my dream, because they would use less and less of the help desk and more of and more of the tools that are right at their fingertips.

That would be our vision for the future. And I know that what we’ve been talking about with uPerform and stuff, that’s going to be able to help us do that.

BOBBY: Alright, I’ve got one last question, and this is really a trick question for you. We recently were in San Diego meeting with a group of CIOs who are aware of physician burnout. They were aware of the struggles. They were aware of the demands that were put on them by the constant need for change. But they were unaware of the correlation of training to those struggles and their success. Many of are still using traditional training methods to try and achieve the results, trying to accomplish with the EMR and their other applications and to bring about change with their organization. If you had the ear of those CIOs, what would your advice be to them for helping drive change in their organization?

KELLEY: Great question. The ear of the CIOs…I would say, and this is something that we did. And I know I shared this when we were going through the project plan and we were implementing uPerform that – I mean we’ve been tried true training for a long time. I’ve been doing training for a long time. Many different organizations. It rocked our world. But that was a good thing. That’s not a bad thing. It’s more of… When you’re looking at what you’re trying to do or trying to accomplish for your end users, question everything you do would be my first thing, is what I would say. It’s that we all get caught up in looking at the same things over and over. And so, okay, let’s just develop a tip sheet. Let’s develop these different things.

Your organization is probably at a different pace than training is, and so it’s really sitting back with your organization, or key leaders in the organization, or work groups and things, and then asking the hard questions. The things you may not want to hear. Like when I told the IT training governance, ‘Don’t worry about hurting my feelings.’ And my first question to them was, ‘Is there roadblocks that IT Training has put in place that has caused you either hiring more individuals or having to step in and do something?’ All those kind of things.

And I said, ‘Don’t hurt my feelings and just tell me what those are, because those are the things we need to look at. So, we’ve got to figure out – and I knew what we had to do is we had to figure out what was best for the organization, but not just easiest for the training team. So if that meant redesigning how we offer information, redesigning what we needed to do, that was going to be important to really help our organization. Not just the organization, but the people within the organization to meet their goals.

And it’s just – don’t live on your laurels. You’ve done something wonderful. Great. Celebrate it. Celebrate it with the team. But then figure our what your next step’s going to be. What is that future? And what tools do you have in place and stuff to get you there? I guarantee you, uPerform is definitely one of those.

BOBBY: Great answer. Thank you so much, Kelly. I think that is everything I had to ask you about. Appreciate your time. Thank you for sharing the digital training methods that UCHealth uses to offer more effective onboarding, empowering the clinicians to master Epic with just-in-time learning and support out there. Anything else that you would like to say in closing to our listeners?

KELLEY: I would just say that the future’s bright and it’s – what a great time, even though with everything going on in the world and stuff, but what a great time to really figure out what you want your future to be. And it’s not – it’s training, but it’s also like, how do you want to work with the analyst teams? How do you want to get things at, you know, the right information to the right person at the right time? This is the time to do that and to question, like I said earlier, question everything that you do. Really look at what you’re sharing, how you’re sharing it and then go out and talk to your end users. Is what you’re doing the right way? And if it’s not, now is the time to redesign.

BOBBY: Thank you very much, Kelley. This podcast is sponsored by uPerform. uPerform is a just-in-time learning and support platform that bolts onto your EHR, ERP, HCM, and other enterprise apps to centralize software training and support with tools that accelerate content creation and delivery. uPerform empowers users with the access to the right information at the right time, specific to their role, creating more productive users and increasing clinician satisfaction.

You can tune into more podcasts from Becker’s Healthcare by visiting the Becker’s podcast page at beckershospitalreview.com.

Thank you very much.