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Redesigning the Onboarding Process
Summary
Impact Statement:
Cecil County Health Department (CCHD) redesigned the onboarding process for new staff. As a result, most new staff reported that they understand their role at CCHD and found the onboarding process to be informative and useful. Onboarding education can improve staff members’ ability to meet community needs.
Summary:
CCHD redesigned the onboarding process for new employees, volunteers, and interns in order to better engage, educate, and empower new staff. The quality improvement (QI) project identified key topics to be addressed during orientation, developed a new orientation with online resources that replaced a paper handbook, and created an onboarding checklist to ensure that onboarding is completed consistently. New employees who complete the onboarding process are asked to provide feedback via a survey. The feedback so far has been very positive.
Organization that conducted the QI initiative:
CCHD
Citation:
Coulter, D. Public Health Quality Improvement Exchange. Redesigning the Onboarding Process. Tue, 04/11/2017 - 14:03. Available at http://phqix.org/content/redesigning-onboarding-process. Accessed April 24, 2024.
Background and Aim
Aim statement:
By October 1, 2015, CCHD will redesign the orientation process to better engage and empower new hires, volunteers, and interns. Success will be measured by having 100% of new staff answer “Agree” or “Strongly Agree” when asked the following follow-up survey questions:
• “I felt that the Division Introduction portion of the onboarding process was informative and useful.”
• “I felt that the Health Insurance Portability and Accountability Act (HIPAA) and IT portion of the onboarding process was informative and useful.”
• “I felt that the Training Requirements portion of the onboarding process was informative and useful.”
• “I felt that the Public Health portion of the onboarding process was informative and useful.”
• “I felt that the State Employment portion of the onboarding process was informative and useful.”
• “I understand my role in the division.”
Need For The QI Initiative:
Workforce development was determined to be a major area of concern for CCHD during the strategic planning process. The employee training specialist, along with CCHD senior management, realized the need for a more thorough orientation and onboarding process to better engage, educate, and empower new staff.
Area for Improvement:
Before this onboarding QI project, new employee orientation consisted of a 1-day session providing an overview of CCHD and its six divisions and a review of different policies and procedures. After this 1-day session, employees reported to their divisions to begin work. Orientation within each division varied greatly, and many employees were left with little knowledge of what happened outside of their own program. The onboarding QI project has expanded new employee orientation to an onboarding program that spans two half-day sessions providing staff with more information on CCHD, public health, and the population CCHD serves; a more detailed introduction to each division; training requirements for new employees and opportunities to get more job-related training; an overview of HIPAA and IT requirements; information on state employment; an introduction to QI and accreditation; and a tutorial on various tools that are used daily. The QI project has also led to more standardized orientation within each division, as well as a greatly expanded 30-day onboarding process to ensure that new employees are empowered in their job.
Root Cause:
Several problems were identified using a fishbone diagram. These include employees not being able to retain the information presented, having poor time management skills, and being pulled in too many directions upon hire; CCHD providing inadequate resources with dated information that is not maintained, and not building enough time into the day for orientation; and the process being inconsistent between divisions, lacking ownership within divisions, being poorly organized, and providing ineffective, underused manuals.
Planning and Execution Details
QI Implementation:
A multidisciplinary team consisting of staff from each division was assembled to examine the current orientation and onboarding process and to determine where improvements could be made. The team implemented a Plan, Do, Study, Act (PDSA)/Plan, Do, Check, Act (PDCA) cycle. The program is to engage and empower new hires, volunteers, and interns. The process starts on their first scheduled day and ends 1 month later. Success will be measured by an evaluation of satisfactory or above on a follow-up survey of new staff and management after the onboarding process.
The team examined the current approach to orientation using a fishbone diagram and identified problems (listed above) to address. Next, using a control-influence matrix, the team chose which problems they could most effectively address. These included insufficient time being allotted to new hire tasks, inconsistency between divisions, providing too much information to retain at once, and having unclear expectations and unclear ownership of tasks.
The team then identified a list of potential solutions. Using a brainstorming activity and affinity diagram, they identified key topics to be covered. Potential solutions included creating a checklist, having online resources to replace the paper handbook, using source documents to avoid information becoming dated, ensuring that new hires are engaged in the process, and ensuring a better means of communicating between groups involved in the process.
The team developed the following improvement theory: “By creating an inclusive, connected, and current onboarding program, Cecil County Health Department will engage new staff in our mission and empower staff to be successful.”
To implement the solutions and test the improvement theory, the team created a new online orientation presentation, developed an onboarding checklist, created an online onboarding resource, created a survey to evaluate the effectiveness of the new orientation and onboarding process, and piloted the new process with two existing employees.
During the Study/Check phase, the team received positive feedback from the pilot and continues to receive feedback through a survey that is sent to new hires after the 30-day onboarding.
The team decided to adopt the changes, finalize the survey instrument, and educate supervisors and senior management about the new resources and expectations for the orientation and onboarding process.
Finally, the team established future plans to have divisions base their orientation on the department-wide orientation, create video introductions for each division, use developed materials to promote public health and CCHD at a local high school’s career day, and improve the follow-up tour procedures for CCHD.
QI Methods:
QI Tool Documentation:
Initiative Dates:
2/5/15 to 10/1/15
Initiative Duration:
Between 6-12 months
Methods of evaluation:
An online survey is sent to all new hires who complete the onboarding process. A copy of the survey is included as an attachment.
New hire training continues to be monitored at the employee level, ensuring that requirements are met on time. Toolkits provide a means to track onboarding progress as the new hires settle into their job roles. Compliance with the allotted schedule is addressed with each division.
Other Information:
Customized presentations were created for merit staff, contractual staff, consultants, students, and volunteers.
Supplemental Materials:
Sample of materials produced
Storyboard
Supplemental Files:
| Attachment | Size |
|---|---|
 Onboarding Presentation.pdf | 4.31 MB |
| Onboarding Checklist_Division of Special Population Services.pdf | 130.64 KB |
| CCHD Onboarding QI Storyboard.pdf | 230.56 KB |
Results
Measurable QI Outcomes:
1. Onboarding Survey Results
Seven new hires completed the survey. The percentage of new hires completing the onboarding process who answered “Agree” or “Strongly Agree” to the following survey questions was measured:
• “I felt that the Division Introduction portion of the onboarding process was informative and useful.” (100%)
• “I felt that the HIPAA and IT portion of the onboarding process was informative and useful.” (85.7%)
• “I felt that the Training Requirements portion of the onboarding process was informative and useful.” (85.7%)
• “I felt that the Public Health portion of the onboarding process was informative and useful.” (100%)
• “I felt that the State Employment portion of the onboarding process was informative and useful.” (75.0%)
• “I understand my role in my division.” (100%)
New employees who completed the survey also answered that they accessed the onboarding folder at least once (85.7%) and used the onboarding checklist (100%).
2. Employee Engagement
CCHD anticipates a positive impact on engaging staff who have worked at CCHD for fewer than 5 years. This will be measured through the annual Employee Engagement Survey. CCHD also anticipates a reduced turnover rate among new hires.
Other QI Outcomes:
1. Organization of new hire materials and compliance with state and local policies has improved.
2. CCHD establishes a professional, organized, and current impression with new hires from their first day. Providing new hires with tools for success shows CCHD's commitment to a long and productive working relationship.
3. New hires feel they have a go-to resource in the onboarding session presenter as a result of the working relationship immediately established on the first day of work.
Future Plans:
The new employee orientation and onboarding materials will be routinely reviewed and updated. An intern was brought in to help create a more personal introductory video to each division. A second tour of CCHD is being completed a few weeks after an employee is hired to allow him or her to better digest the information being shared. CCHD hopes to solicit more volunteers to conduct these tours to make them more engaging. Using the department-wide onboarding process as a template, each division within CCHD will also create a similar process that is specific to its division.
Information about the Community
Population Size:
Population Characteristics:
Cecil County is located in the northeast corner of Maryland, adjacent to the Delaware and Pennsylvania state lines. Cecil County has rural and urban landscapes. The county seat is located in Elkton, Maryland, and the county has eight towns and seven unincorporated communities. The county has an estimated population of 102,843. The majority of Cecil County residents are white (88.9%), with 7.0% of the population being black or African American. An estimated 4.2% of the county is Hispanic or Latino. Cecil County residents younger than 18 years make up 23.3% of the population, and residents aged 65 or older make up 14.3% of the population. The median household income in Cecil County is $65,124, and 10.6% of the population is in poverty. The percentage of residents aged 25 or older who are high school graduates is 87.4%, with 21.8% of residents aged 25 or older having a bachelor's degree or higher.
Information about the Health Department
Local/State Relationship:
Mixed
Local Health Department Governance:
Mixed Governance- LHDs in state have more than one governance type›Mixed-Shared- LHDs in state have more than one governance type, but my LHD is governed by both state and local authorities.
PHAB Accreditation Status:
Accredited
Annual QI Initiative Frequency:
QI activity level:
Organization Type:
QI Staff Information
Total number of Staff on QI Team:
11
Total number of FTEs on QI Team:
1.20
QI team members:
Role in the Initiative:
Team leader
Role in Organization:
Agency Trainer and QI Coordinator
FTE:
0.30
Name (Optional):
Jen VanLandingham
Role in the Initiative:
Team member
Role in Organization:
Communicable Disease Program Manager
FTE:
0.10
Name (Optional):
Bonnie Ryan
Role in the Initiative:
Team member
Role in Organization:
Coordination of Community Services Supervisor
FTE:
0.10
Name (Optional):
Dale Smith
Role in the Initiative:
Team member
Role in Organization:
Adult Counselor—Addictions
FTE:
0.10
Name (Optional):
Donna Johnson
Role in the Initiative:
Team member
Role in Organization:
Environmental Health Specialist Program Supervisor—Community and Recreational Sanitation
FTE:
0.10
Name (Optional):
Gabe Alli
Role in the Initiative:
Team member
Role in Organization:
Office Clerk—Health Promotion
FTE:
0.10
Name (Optional):
Robin England
Role in the Initiative:
Team member
Role in Organization:
Network Specialist
FTE:
0.10
Name (Optional):
Lisa Pennell
Role in the Initiative:
Team member
Role in Organization:
Emergency Preparedness Secretary
FTE:
0.10
Name (Optional):
Paula Ball
Role in the Initiative:
Team member
Role in Organization:
Personnel Associate—Human Resources
FTE:
0.10
Name (Optional):
Carmen Jordan
Role in the Initiative:
Team member
Role in Organization:
Communicable Disease Nurse
FTE:
0.10
Name (Optional):
Susan Sawyers
Accreditation Details
Contact Information of the Submitter
First Name:
Daniel
Last Name:
Coulter
Organization:
CCHD
Submission Status:
Completed
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Comments
In your survey, you asked if
In your survey, you asked if the info shared during the orientation was "informative" and "useful". I wonder if staff need more time to determine if the info was truly informative and useful. Maybe I missed this in your write up, but did you do a 6 and or 12 month follow-up survey? Would be interesting to know if information shared during orientation actually helped staff do their job a few months down the road.