atrium health’s new manager · virtual coach program nurse managers can be nominated for the...

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Atrium Health’s new manager

onboarding program

CASE STUDY

Nursing Executive Center

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Unprepared managers put people, business goals at risk

Source: Advisory Board Talent Development Division; Advisory Board Employee Engagement Initiative Division; “Nurse Leadership: Being

Nice is Not Enough,” Hay Group, http://www.haygroup.com/uk/downloads/details.aspx?id=2521; Dorgan S, D Layton, et al., “Management in

Healthcare: Why Good Practice Really Matters,” McKinsey & Company, 2010; Nursing Executive Center interviews and analysis.

The cost of an ineffective manager

to have pressure ulcers occur on

units with nurse manager turnover

3X more likely

Both empirical and anecdotal evidence shows that effective managers are an asset to their teams, colleagues,

and the broader organisation. Teams run by excellent managers have 36% lower staff turnover and are five times

more likely to be engaged than teams run by average managers.

It stands to reason that ineffective managers negatively impact the morale of their teams, but the data below

shows that the negative impact of an ineffective manager extends to patient care and hospital operations as well.

in income per bed for each one point

drop on management effectiveness scale

33% decrease

The lack of established habits means that first-time managers have the opportunity to learn and develop leadership best

practices, but the data above illustrates that when it comes to the status quo this transition does not go well. The result?

Frustration, increased turnover, and eventually, ineffective managers. Some of the reasons new managers struggle in

their roles include:

• Success is no longer dependent on their individual actions but on collective achievement

• The struggle to learn new operational systems, processes, and skills that were not previously required

• Inexperience with the skills they need to lead and motivate their teams

• A disconnect between the expectations of the job and the reality of the role

Providing effective training during this important time of transition can give managers the strong foundation to make a

positive difference at your organization.

First-time managers frustrated, underperforming in their new role

39% of new managers said they

had received training

60% of new managers underperform

or fail within two years51% of new managers felt

unprepared for their first role

https://www.advisory.com/


Atrium Health program overview

Atrium Health - 90-days self-directed in-person and virtual operational onboarding

Source: Atrium Health, Charlotte, North Carolina; HR Advancement Center interviews and analysis.

PROGRAM OVERVIEW

90-days self-directed in-person and virtual operational onboarding

CASESTUDY

KEYS TO SUCCESS

Atrium Health 45-hospital health system; 700-1000 new managers annually; • North Carolina, United States

• Focus: Atrium Health’s goal for new leader onboarding is to equip new managers with the

operational skills they need to excel in their new roles. Atrium Health also uses their new leader

orientation, ‘Leading the Atrium Health Way,’ to introduce new managers to curated manager portal

at their disposal for answering any questions that may arise on-the-job.

• Autonomy: Enrollment in ‘Leading the Atrium Health Way,’ the new leader orientation, and ‘New to

Leadership,’ the online module series, is optional for new internally-promoted managers. The online

module series is designed to be self-paced; it is recommended that managers complete the six-hour

program across their first three months.

• Tailoring: Atrium Health offers a number of onboarding opportunities specifically for new nurse

leaders and the nuances of that role. This includes enrollment in a nurse manager fellowship, the

assignment of a preceptor to new nurse managers, as well as opportunities for remote

peer coaching.

• Success: Success is measured through engagement surveys for each training and studies of skill

utilization ninety days after onboarding completion.

• Central role of online manager portal: Though onboarding begins with an in-person orientation,

the main purpose of that orientation is to acquaint new managers with the online manager portal,

‘New to Leadership.’ Teaching managers how to use this resource and integrate it into their workflow

is central to he 90-day onboarding.

• Incentivizing participation through nurse contact hours: Nurse managers are able to count all

onboarding activities towards their state licensure contact hours, to incent internally promoted

first-time managers to participate in the onboarding programs despite their optional nature.

• Augmenting onboarding for new nurse managers: Atrium Health’s new nurse manager

fellowship program begins with the new leader orientation and online modules, but continues into a

9-month long fellowship that thoroughly equips new nurse managers for leadership.




Atrium Health’s onboarding program largely focuses on operational skills training and consists of three key components:

a one-day new leader orientation, an onboarding checklist, and a series of self-service online modules. Each component

builds on the others and should ideally be completed within the first 90-days of a new manager’s tenure.

Question #1: How will we balance providing operational training, leadership

development, and cultural immersion for our new managers?


Focus on operational excellence through self-paced online learning

Leading the Atrium Way: New

leader orientation

New manager

onboarding checklist

New to Leadership:

Self-paced online modules

The online modules cover a wide range of topics ranging from lessons in budgeting to patient communication. They are

part of the overall online resource portal for managers, which is where managers at any stage of their career can turn to for

just-in-time answers to any questions that arise on-the-job. You can see an excerpt of the manager portal below.

• One day session offered every

two weeks

• Introduces new manager

onboarding checklist and portal

• Received at start of orientation

• Covers activities for first 90 days

on the job

• Six hours of content to familiarize

with online manager portal

• Designed for completion within

first three months in-seat




Question #2: How much autonomy will we give new managers to decide

when and how to complete their onboarding?

While some mandatory trainings are in place for external hires, including a new teammate orientation, internally

promoted new managers are given full discretion to make their own choices regarding onboarding enrollment. Part

of this decision is due to the inherent difficulty of tracking all internal promotions in a 60,000+ employee system;

however, the goal of keeping onboarding optional is to enable managers to schedule around existing constraints,

patient needs, and receive resources in a way that works with their individual workflow and responsibilities.


Onboarding programs are fully self-service for new managers

External hires Internally-promoted

Day 1: New teammate

orientation (mandatory)

Days 2-4: Nursing

orientation (mandatory)

Within first 90 days:

‘Leading the Atrium Health Way’ (optional)

‘New to Leadership’ (optional)

New leaders without previous managerial experience, both externally hired and internally-promoted, receive

nudges to take Gateway Essentials, Atrium Health’s two-day leadership development course.

Gateway essentials (optional)

A two-day training course on leadership

development and soft skills

Mandatory for nurse managers

External hires required to attend

‘Leading the Atrium Way’




1) Patient safety and quality, teammate engagement, patient experience,

quality & safety, efficiency and throughput


Question #3: Will we offer ways to tailor onboarding to the individual or will

we use a one size fits all approach?

Due to the focus on operational excellence, onboarding at Atrium Health is uniform for new managers, all of whom are

encouraged to enroll in ‘Leading the Atrium Health Way.’ Additionally, the online modules and resource portal offer the

same content and support to all managers. However, Atrium Health has recently rolled out a set of onboarding

resources specifically for new nurse leaders, including a new nurse manager fellowship which lasts for nine months.

Additional resources offered to support new nurse managers

OPPORTUNITIES FOR NEW NURSE LEADERS

Nurse manager fellowship

A nine-month cohort-based program with six in-person sessions that serves as the

backbone of a new nurse manager’s learning and development at Atrium Health.

Nurse manager preceptor

All new nurse managers receive a preceptor to help them acclimate to Atrium Health

culture and to their new job responsibilities.

Virtual coach program

Nurse managers can be nominated for the virtual nurse manager coach program.

This program lasts for six months and features one hour of coaching per month for

new nurse managers just starting out as leaders.

Open to ~80 nurse managers annually

Each training session corresponds to at least one of Atrium Health’s strategic priorities1

All preceptors receive formal training on how to support their mentees



Source: Atrium Health, Charlotte, North Carolina; HR

Advancement Center interviews and analysis.

Question #4: How will we measure the success of our new manager

onboarding program?

Atrium Health uses engagement surveys after each event to determine participant satisfaction. For ‘New to Leadership,’

the 90-day recommended training, Atrium Health also assess new manager behavior and application of the information

they learned using a level 3 of Kirkpatrick's training and evaluation model. Perhaps the greatest indicator of success is that

on any day, over a 1,000 hits are registered on the online manager portal.


Engagement surveys, utilization studies, and high click rates show success

Our goal for the online resources was to not just build content; it was to build a set

of tools. We’re teaching them how to fish and we’re teaching them what resources

they have available to help them fish.

Rose Le, Director of Learning and Development

Atrium Health

1,000 number of hits to online manager

portal on a typical day



Atrium Health’s keys to success


Source: Atrium Health, Charlotte, North Carolina; HR

Advancement Center interviews and analysis.

- - -

Clinical leaders, such as nurse managers often begin their

leadership role with little to no formal leadership training.

Atrium Health augments the operational focus of their

onboarding for new nurse managers by enrolling them in a

9-month course to teach them fundamental leadership

skills in the context of the nursing profession.

Augmenting onboarding for new

nurse managers

Many new managers go through operational skills training

during orientation, only to find themselves quickly

overwhelmed and unsure where to turn with questions.

Atrium Health addresses this challenge by centering their

new leader orientation around an introduction to the

online manager portal. New managers are introduced to

the full range of online, ‘just-in-time’ resources at

their disposal.

Central role on online manager portal

A risk in making onboarding enrollment optional is that

new managers may not prioritize it during their first

few weeks.

Atrium Health’s solution to this challenge is to count

attendance hours at new leader orientation towards the

contact hours nurses need to accrue to maintain their

state licensure.

Incentivizing participation through

nurse contact hours

1 2

3



Road map

Appendix



Advisory Board resources to support manager development

Below are Advisory Board resources created specifically to support first-time or tenured managers on five

fundamental aspects of the job. Consult our HR’s Guide for New Hire Onboarding for additional support

and tools you can modify to refine your new manager onboarding strategy.

Members of the Nursing Executive Center can access additional support via the Nurse Manager Portal

Find the right candidates to join your team: Hiring the right candidate for a position is a

decision with long-lasting repercussions. Choose poorly and you may end up devoting precious

time and resources towards supervising a toxic employee. To ensure you make the right hire, you

need to know how to get the best ‘read’ on a candidate.

Increase staff engagement : Engaged staff don't just enjoy their jobs and their workplace—they're

inspired to do their best work, and they're willing to go above and beyond to help their organization

succeed. This toolkit has more than 20 user-friendly tools that will help managers make the most of

their opportunities to engage their staff, developed based on tried-and-true best practices.

Provide actionable feedback to direct reports: Many managers find the performance review

process awkward and subjective—which tempts them to give all employees average or high scores.

But inflating ratings sends the wrong message to staff and undermines progress toward

organizational goals. This toolkit includes ready-to-use worksheets, guides, and more to help

managers accurately evaluate staff.

Get more done with less stress: Research shows that we spend 40% of our work time doing tasks

that aren't actually important and don't advance our true priorities. We'll run through three practical

strategies for transforming your approach to your schedule, improving your moment-to-moment focus,

and better planning your workload so that you get more done—with less stress and effort.

Onboard and welcome staff to the organization: This toolkit helps managers efficiently and

effectively onboard new employees with checklists, discussion guides, and more. You will find

tools that equip you to ensure new employees feel welcomed on their first day, supported

throughout their first week, and ready to receive meaningful feedback about their performance

across their first three months.


https://www.advisory.com/research/hr-advancement-center/studies/2014/hr-guide-to-new-hire-onboarding

https://www.advisory.com/research/nursing-executive-center/manager-portal

https://www.advisory.com/research/hr-advancement-center/resources/2014/behavioral-based-interviewing/hiring-manager-guide

https://www.advisory.com/research/hr-advancement-center/studies/2017/managers-guide-to-engaging-staff

https://www.advisory.com/research/hr-advancement-center/resources/2014/managers-guide-to-accurate-evaluations

https://www.advisory.com/research/hr-advancement-center/events/webconferences/2019/management-master-class/how-to-get-more-done-with-less-stress

https://www.advisory.com/research/hr-advancement-center/studies/2014/manager-guide-to-new-hire-onboarding


Want to speak with one of our experts about how to

more effectively train new managers? Contact us at:

[email protected]

About the Nursing Executive Center

Nurse executives lead their organization in shaping new

strategies, transforming the clinical workforce, improving

patient outcomes, delivering cost savings, and managing

countless regulatory requirements—all while navigating a host

of new challenges like new customer demands, competitors,

evaporating margins, high turnover, unprecedented stress,

and workplace violence.

Our member CNOs tell us one of their biggest difficulties in

overcoming these challenges is bridging the gap between

strategy and execution. On one side, some try to just go it

alone—and struggle to pick the right solutions for their

organization. On the other, cost-prohibitive consulting results

in disenfranchised staff, unsustainable results, and low ROI.

We fill the need in between by providing multiple levels of

support backed by 40 years of best practice research trusted

by 1,800 health care organizations. Find out how we help

CNOs and nurse leaders drive strategy and get quicker

results through customizable, vetted solutions.

Learn more about membership at advisory.com/nec


mailto:[email protected]


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Nursing Executive Center

Project DirectorAnne Herleth, MPH, MSW

[email protected]

202-568-7749

Research TeamSara Teixeira Moehrle

Lauren Rewers

Fritz Windover

Managing DirectorKatherine Virkstis, ND

Design ConsultantHailey Kessler

Executive DirectorsSteven Berkow, JD

Jennifer Stewart


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