Streamlining Success: Cutting Orientation Time with Standardized, Competency-based Training in Inpatient Rehabilitation

Research Objectives: To decrease new employee full-time orientation for all physical therapists, occupational therapists and speech and language pathologists.

Design: This was a quality improvement study to analyze and improve resource effectiveness.

Setting: 88-bed Inpatient rehabilitation facility.

Participants: Rehabilitation professionals including physical therapists, occupational therapists, and speech and language pathologists.

Interventions: Evaluation of previous orientation process was completed through review of policies and procedures, new employee handouts, and forms put forth by the department and organization. Multiple focus groups were conducted with stakeholders including staff-level and senior-level therapists and managers from all disciplines to identify barriers to efficient orientation processes. The focus group concluded that the main barrier was unclear expectations of the new employee and preceptor. A list of week-by-week clinical goals was created specific to each discipline for the new employee to set expectations. A comprehensive checklist of orientation needs was created for managers and preceptors. A new employee competency was developed using key content areas of quality/safety, evaluation, treatment, psychomotor skills, goals and discharge planning, documentation, and communication for each discipline. A biweekly meeting schedule was established to discuss performance and progress towards goals with discipline specific managers, the preceptor, and the clinical educator. Preceptors were educated about the new orientation procedure. Orientation time was tracked and analyzed to test the effectiveness of the new procedure.

Main Outcome Measures: Duration of orientation for full-time staff members of all disciplines in weeks.

Results: Average orientation time decreased from 7.0 weeks (n= 12 new employees) in 2022 to 5.1 weeks (n= 12 new employees) in 2023 after implementation of the new process. Also noted, the range in orientation times amongst individual therapists was diminished with a range of 14.3 to 2.4 weeks in 2022 and 8.0 to 2.3 weeks in 2023.

Conclusions: Based on literature about nursing orientation, we used a competency-based and standardized process, which decreased the duration of orientation and reduced resource inefficiency in the department. This approach provided new employees with support and resources to successfully transition to independent practice through a standardized process. Through this standardized approach, we were able to identify continued learning needs. Based on a systematic review conducted in 2021, more research is needed to determine effective strategies to maximize efficiency in orientation processes.

Author(s) Disclosures: Nothing to disclose