At Fuel, one of the most common questions we hear is, “How would you describe the difference between onboarding an employee and integration?”
I think it’s worth sharing with you where the term integration came from.
For those of you who are not familiar, Fuel Medical provides business resources for ENT practices, medically based audiology practices and universities across the country. As part of those resources, our HR team supports practices with all their recruiting and hiring needs, and our professional development team helps with training and culture development.
As you can imagine, these resources often overlap. Over the past 18 months, these two teams have been busier than ever before. Although employee retention and turnover are contributing factors, it’s not the driving force for the increased demand. When we boil it down, it’s really caused by a cascade effect that starts with a shortage of experienced talent and filters through a fluctuant culture. Let me explain.
The Cascade Effect Starts a Downward Spiral
- Shortage of Experienced Talent—It’s hard to find experienced people to fill some of the positions that have been left open as a result of the Great Resignation. Our recruiting team has had to change its recruiting process to look beyond the requirements listed in the job description. When identifying the strongest candidates, we now have to look beyond relevant experience and consider candidates with strong cognitive abilities, a willingness to learn and effective communication styles. This means we are transitioning a “different” type of employee into our organization. This employee may not have applicable experience; instead, they possess a tremendous aptitude. Now it’s our job to onboard them into their new role.
- Static Onboarding—The onboarding process must now include a comprehensive integration into the business as a whole—not just the position the new employee was hired for. We have found that when an employee understands the impact of their work on the bigger picture, they are more engaged, motivated and less likely to leave.
In truth, we don’t see comprehensive integration happening very often in workplaces. We’ve heard multiple stories of a new hire lasting a month or two—or, in some cases, one day—before they realize they are not going to get the support they need to be successful and quit. Employers then have to go back to the hiring drawing board, which, as we all know, takes time.
- Increased Turnover—This is where we see the turnover ripple effect come into play. Current employees are now carrying an increased workload and are distracted from doing their assigned jobs because losing a capable colleague has impacted their performance. Now your high performers become disgruntled and start to leave.
- Flaws in Your Culture Are Exposed—Morale dips, burnout increases, and staff begin to disengage from their work, which, in turn, has a negative impact on the organization’s culture. You’ll know there are flaws in your culture when infighting and finger-pointing replace teamwork and collaboration. Insubordination replaces initiative, and apathy replaces motivation. Your culture is no longer in alignment with your brand or your strategy for growth and success.
- The Patient Experience Declines—The true key to patient loyalty and satisfaction is our employees. They are the ones delivering the patient experience. Research shows that a key differentiator from one practice to the next is not so much the services they provide—but the actions of the people providing those services. And that is a product of your culture. The patient experience starts to decline as a reflection of the employee experience.
And now it feels like you are in a downward spiral, which is not only uncomfortable but also makes you feel like there is no way to break the cycle.
We’ve watched this cycle repeat itself in practices for the past two years.
Onboarding vs. Integration
The good news is that there is an upward spiral as well—AND what we’ve found is that it starts with recognizing the difference between onboarding and integration.
Onboarding is usually the process of teaching a person how to perform the duties of their job. In some cases, a checklist may be followed, but most of the time, it’s show-and-tell, walking the employee through how to complete a task in a step-by-step fashion.
We use the word integration to describe being intentional about assimilating a person into your culture, teaching them the duties of the job and connecting that person to the performance of their colleagues and the goals of the organization.
An Example of Integration
We are no longer hiring people who are “plug and play.” That means there may be gaps in our training, and we will have to spend more time establishing the basics. For example, an experienced scheduler already knows the importance of picking the correct appointment type in the system. This is because they’ve seen and experienced the consequence of doing it wrong. A new person who’s never done scheduling before sees picking the appointment type as a simple data entry task—they don’t understand their role in setting the tone or the pace for the entire visit.
You can tell them over and over that they must select the appropriate appointment type, but until they understand how that task connects to their colleague’s performance and the position it puts their coworker in when it’s wrong, they won’t understand how their role fits into the big picture.
The Performance Network Interview
This is where the value of a performance network interview can help.
Rather than telling the employee, let them discover it on their own. Not by doing and failing (although that is one method), but by having the employee interview a medical assistant, a provider, or the biller. During the interview, the new employee asks a series of pre-written questions. Questions like:
- Describe your typical workday.
- How will we interact on a regular basis?
- What are some of the most common challenges you deal with?
- How does my job impact your success?
- If I have a question, what’s the best way to approach you?
- What are three things I can do to ensure success in my role?
Obviously, these are just sample questions—you can come up with a list of questions on your own.
Ultimately, the goal is to allow that new employee to learn from their colleagues how they all work together toward one common goal. Additionally, you’ve also created a moment for your new person to build a connection and are not leaving it up to chance that it might happen. It also saves you time in not having to do all the teaching yourself.
A performance network interview is one way to be intentional about assimilating a person into your culture, teaching them the duties of the job, and connecting that person to the performance of their colleagues and the goals of the organization.
Now Let’s Talk About the Fundamentals:
You interviewed a great candidate, you loved them, and you’re excited to have them. But they’ve never done this job before. When it comes to training you have to start from scratch with this new employee—they’re not coming to you with an established foundation in health care that you can build upon. Now, you have to teach the fundamentals. That will take time, but it will be worth it in the end. Let me give you an example.
Using our example of a new scheduler, addressing the fundamentals means explaining in detail why there are eight appointment types for audiology–which means going beyond providing a description of each. One way you can get the scheduler to truly connect to the different appointment types is if they can diagram the patient journey and identify how the different appointment types coincide with each phase of the journey for that hearing loss patient.
Have the employee simulate what the patient goes through and actually experience the different appointment types in the order they progress. In essence, have the employee be a hearing loss patient and walk in their shoes. Have them check in and fill out the new patient paperwork, sit in the waiting room, get a hearing test, simulate a consultation and experience a fitting. Let them wear a pair of hearing aids.
It might seem like a lot of effort to go through for a scheduler to learn the different appointment types, but the new employee will gain so much more from the experience than learning how to pick the correct appointment.
At Fuel, we find so much value in this process that we’ve designed a workbook to help guide the new hire on the patient journey. At the end of the exercise, they sit down with the administrator and the audiologist to discuss the answers to questions like:
- What is the value of a hearing test? Answer this question from four different perspectives: patient, ENT, audiologist and practice.
- What did you learn from this experience that will help you in your role?
- Why should a patient work with our practice vs. getting hearing aids from Costco or purchasing them online?
- Describe the patient flow for a patient with hearing loss and how the appointment types connect to each phase of the journey.
Going through this process allows the employee to experience firsthand what they are hearing from you—and from a learner’s perspective, it’s a much more impactful way to learn. Also, keep in mind that visuals go a long way. It’s OK if you don’t have any visuals; have the employee write stuff down or diagram a process. Have them build their own visuals.
In a recent article posted by Forbes Magazine, I read that “mentoring is a proven approach to accelerate leadership and employee development while increasing retention, engagement and productivity.”
As we look for innovative ways to continue to foster an environment of collaboration and connection, another program we find effective is assigning a buddy to each new employee. A “pseudo” mentoring program is designed to tackle one of our newest workplace challenges—new employee integration.
I say “pseudo” because the approach we recommend is much less formal than a full-on mentoring program. The program is designed to connect a new hire with a buddy from a different department to work with them over a limited period of time (approximately two months).
Although there are no rules or boundaries, I think it’s important to establish a few guidelines to help put you on a path to success.
Four Simple Goals of a Successful Buddy Program
- Give employees a feedback loop outside of the traditional routes.
This is important for new hires. Navigating the internal politics, culture and relationships in a new company can be the most complex part of adjusting to, and succeeding in, a new role. When you have a buddy, who is removed from judging performance, it makes it easier to ask questions, vent about small things and open up about fears, worries and the inevitable stumbles.
- Reveal a different side of the company.
Retaining talent requires some creativity when it comes to growth. Some individuals are happy to stay in the same position for five or more years, while others want movement and new challenges to remain happy. By pairing a person up with someone from another department or team, we can expose the employee to new knowledge about the way the business is run and hear from people with different ideas and perspectives about the practice.
- Expand relationships beyond those we interact with every day.
A buddy program encourages individuals to branch outside of their assigned role to contribute their expertise cross-functionally.
- Allow opportunities for reverse mentoring.
I think it’s important to note that the buddy relationship is not necessarily senior versus junior. There is a lot that can be learned from people entering your practice with diverse backgrounds, a fresh perspective and best practices from other organizations.
We have the buddy program at Fuel, and we consistently get positive feedback from the new hire as well as the buddy they are assigned to. New hires find value in connecting with people outside of their everyday encounters and gain a perspective from the organization that may be overlooked during traditional onboarding. The “buddy” appreciates the opportunty to be a part of integrating the new employee into their role.
We find it’s an effective way to be intentional about assimilating a person into our culture, teaching them the duties of the job and connecting that person to the performance of their colleagues and the goals of our organization.
Let’s Get Started
Hopefully, you now have some insight into what we mean by integration and some actionable ideas you can use to get your integration program off on the right foot.
If you want to learn more or have us help you put together an integration program customized for your practice, please contact us—we are here to help!
You can contact me directly, or reach out to your Fuel regional team.