Bon Secours has learned and benefited from HeartCode in numerous important ways:
- Efficient record-keeping and tracking to stay current with re-certification status
- Accurate assessments of individual learners’ strengths and weaknesses
- Improved staff confidence which leads to quicker response to a code
- Clear identification of staff who struggle with CPR to enable reassignment of their role
- Consistent skill training across all participants
In 2010-2011, a Health Resource & Services Administration (HRSA) Workforce Development grant of nearly $500,000 was made to Bon Secours Memorial College of Nursing to develop a Simulation Center. As part of the implementation plan, a strategic decision was made to approach Bon Secours Health System to seek their involvement in implementing HeartCode®. This overture proved invaluable in gaining operational support and in extending the reach into the clinical setting. Essentially, the ability to partner with the health system—hospitals, clinics, and other providers—provided an excellent laboratory for proving the worth of the initiative.
In today’s value-based environment, there is less room in budgets for taking staff off the floor to take part in requisite training and recertification. This fiscal reality coupled with the quality of the program resonated with the leadership at the Bon Secours system, making for a relatively easy decision to proceed at the health system level.
One clear example of recognizing the need to maintain a customer-first mindset was the plan put in place to reach out to staff at doctors’ offices. Implementing the program in physician practices required a distinctly different approach in the deployment of the HeartCode curriculum. The business reality is that physician offices are reluctant to close the practice for part of a day to enable staff to complete education requirements.
In assessing the reality of how best to deliver education to a physician office staff, several important factors came into play:
Taking physician office staff offsite for education requires costly time and travel.
- Appointment times for patient care are interrupted and need to be rescheduled.
- Revenue for the practice is adversely impacted.
- Valuable time is lost coordinating logistics of offsite training events.
Historically, the best clinicians are tapped to be educators and, in doing so, tend to rely on how they themselves have learned.
Holly Pugh, Director, Clinical Simulations Center, Bon Secours
As with almost all of healthcare in today’s environment, where change is the norm, planning and delivering staff education is not a static endeavor. No matter how successful a program launch has been, resting on laurels can never be part of the plan. Adult learning theory, usability of media and material, and continual need for adaptation all contribute to the necessity for monitoring the effort – and modifying process and procedure where needed. Pre-planning is the key to making and implementing needed improvements.
As a key component of the initiative, Bon Secours began working with HealthStream to implement HeartCode throughout the system. The first step in the rollout was important. The decision was made to implement the learning initiative incrementally, rather than to attempt a system-wide implementation from day one. This step-wise approach was to introduce HeartCode in eight Virginia hospitals, plus emergency rooms and physician offices in the initial rollout. This decision was key to the eventual success of the effort.
Following, in 2012, facilities in Florida, Kentucky, Maryland, and New York went live among approximately 28,000 employees on the East Coast—at least 50% were trained. New hires began receiving HeartCode as part of a two-day onboarding experience.
Bon Secours first developed a specific approach to be delivered to new hires. For introducing HeartCode to new employees, a blended approach was deployed for Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS). Those employees that were new to ACLS and PALS providers needed slightly more hands-on coaching. With that in mind, Bon Secours conducted a 2-day class for ACLS and PALS where HeartCode modules are interspersed with other topics. It’s a form of stealth education in that HeartCode is treated as a complement to other learning that is presented.
For all staff, the use of HeartCode training began with Hands-On Sessions skill checks at assigned times. These sessions were delivered via 30-minute appointments during the initial year of training.
As the program at Bon Secours evolved, important change management strategy and tactics came to the forefront. When any programmatic change was needed, there first needed to be a compelling reason for that change, and all involved—from educators to students – were kept apprised of planned changes and why those changes were necessary.
The principles of internal marketing became useful in creating an understanding of the rationale for change and the education needed to make that change successful. Elements of introducing change, included:
- Development of FAQs based on experience
- Previewing any changes as far in advance as possible
- Posting updates on the organization’s intranet
- Providing the forum for staff to ask questions online
As special arrangements for physician practices, a number of program design changes were made, including:
- Educators make appointments at the clinics and bring Voice-Assisted Manikins (VAMs) onsite.
- Skill checks are staged in a dedicated room in the practice.
- Staff completes training at self-selected times, within the flow of their daily schedule.
- There is always an instructor present to assist, if needed.
Physicians love this approach for many reasons, especially when it relates to the most efficient use of their time. And, staff loves it. No classroom!
Holly Pugh, Director, Clinical Simulations Center, Bon Secours
The results of transitioning to HeartCode were encouraging from the beginning. Not surprisingly, perhaps, educating staff learners using this new method did require an adjustment period. That was anticipated. With educators, however, the benefits of using HeartCode became readily apparent. Educators soon saw the advantages, most notably that HeartCode was an efficient and consistent way of providing adult learners with the repetition required to learn and retain new skills. Providing the requisite amount of repetition by continually scheduling time off the floor was no longer cost-effective, and this innovative delivery of content was a timely solution.
Though they adjusted relatively quickly, perhaps the biggest hurdle to clear on the part of educators was adjusting to teaching in a new way after they themselves had been taught in the more traditional classroom setting. The natural inclination was to follow that same path and perpetuate “the old way” of learning.
Staff acceptance and comfort levels have since increased to the point that 4-hour blocks of HeartCode skills training and certification are made available. Students can walk in without an appointment and complete their Hands-On Sessions.
After 4 years, people have gone through the program twice and are comfortable with it. Not only have hospitals and clinics bought-in to the new way of learning, so had the staff.
This acceptance—and enthusiasm—on the part of staff resulted in some important changes that made use of HeartCode even more efficient:
- Manikins are made available at every hospital in easily accessible stations.
- Students transitioned to Hands-On Sessions with no appointments needed.
- Learners have help available, but they access the training on walk-in basis and do self-checks.
With the overwhelming success of HeartCode, planning for expansion is not only exciting, but it’s a necessity. One area of future focus is the expansion of the program into the Med/Surg floors of the hospitals. Although codes occur less often on Med/Surg floors, staff still need to know what to do in a code situation. Enhanced HeartCode training will concentrate on the first few minutes spent with the patient before the code team arrives.
In the case of physician offices, this simulation training will prepare clinic staff for what actions to take before the EMS arrives. In addition, higher level mock code training will be carried out with code teams, critical care staff and tele-unit teams.