MHA-FPX5022_GarciaMartina_Assessment4-1

1 Training Plan Martina Garcia Capella University MHA-FPX5022: Human Capital Management Dr. Wanda Allen December 2023

2 Training Plan In the August 2023 employee engagement survey at Margolis Medical Center (MMC), among the inpatient and emergency department nursing workforce, nearly 38% of respondents said they would consider leaving the hospital if offered a job elsewhere, 36% of nursing reported experiencing symptoms of burnout, and 31% of respondents indicated they felt a lack of support from management for them as a person. In addition, patient satisfaction scores associated with nursing communication have fallen steadily in the previous 12 months, with two of the medical/surgical floors routinely failing to achieve scores above 70%, putting them in the 30 th percentile nationally for nursing communication and likelihood to recommend. In a qualitative analysis of patient and family member perceptions of nurse communication, the ability of nurses to communicate clearly, authentically, and most importantly, empathetically had the largest influence in the participants of nursing quality (Ng, 2019). In response, the Human Resources (HR) department at MMC conducted a series of focus groups with staff from two departments with the lowest scores in employee engagement and patient satisfaction, and from two departments with the highest scores. The responses from the lower performers were compared to the higher performing units to identify common themes and contributing factors. A few themes emerged from the focus groups. First, the two low-performing departments never fully recovered from the stress, burnout, and turnover from the COVID-19 pandemic. Second, staffing shortages had resulted in a high degree of employees working extra shifts and not being able to carve out time for ongoing professional development. Third, the leaders from the low-performing departments demonstrated a high degree of disengagement and burnout, which was identified by staff as a contributing factor to decreased morale in their units. Subsequently, the HR team determined that implementing an evidence-based empathy and compassion training program for nursing staff could improve morale, personal resilience, joy at work, and service delivery to patients. The following training plan proposes a multi-phased implementation of Stanford University’s

4 health care setting by Sinclair et al. (2021) indicated that in the 45 studies included in their final review, 53% of staff trained were nurses, with providers (including midwives) comprising 22%, and 29% representing a variety of other clinical and non-clinical staff. Moreover, as Kerr et al. (2020) identified in their systematic review of nurse training interventions, nursing staff are the health care workers who spend much of their time in direct contact with patients and the patients’ support teams, and are often challenged with complex and fraught conversations, including end-of-life discussions, sexuality, disease-specific issues, home environment, and family dynamics. In subsequent phases of the rollout, the training will extend to additional floors, nursing areas, and clinical and non-clinical areas, with ongoing cohorts of learners going through the program to accommodate new hires (Sinclair et al., 2021). The first phase of the training rollout will also include a concurrent train-the-trainer component for nursing leadership for all inpatient, emergency and ambulatory surgery areas, including unit directors, charge nurses, relief charge nurses, and clinical educators. This group also includes the nursing house supervisors who provide a critical role in de-escalation and service recovery during evening and weekend shifts. This will not only address the ability of leaders to increase their compassion and emotional resilience but enable them to cultivate a culture of compassion in their respective departments. As the number of leaders with training capacity in the organization increases, the training can be cascaded to other departments and disciplines without depending on the organizational development team or outside training. This strategy is in keeping with the cost-benefit analysis of social and emotional training conducted by Belfield et al. (2015), which highlighted a Swedish program that leveraged a train-the-trainer approach for 1,028 learners. This strategy was able to decrease the costs associated with the intervention from $540 per student to $170 per student. It also resulted in stronger employee engagement, as managers with strong mentorship skills serve as a trusted sounding board, advisor, and advocate during period of high stress (Fallon & McConnell, 2014). Topics and Delivery Description In the Sinclair et al. (2021) study, they identified the core components that enable a successful compassion training program: a strong evaluation strategy, significant short- and

5 long-term outcomes, and a high degree of concordance in training topics and delivery mechanism. Fundamental training topics include articulating an operating definition of compassion and how it is expressed (although the definitions used vary greatly across interventions); defining competencies that can be demonstrated and assessed; incorporating best practices in adult education that integrate multiple teaching methods to engage adult learners (such as video, group discussions, individual reflection, and didactic) and convey the competencies required; addressing barriers or resistance to the interventions; evaluating and sustaining practices over time; and including perspectives of peers, supervisors, participants, and patients into the evaluation methodology (Sinclair et al., 2021). The Stanford CCT curriculum meets all the above criteria and is recommended for MMC (Goldin & Jazaieri, 2017). Overwhelmingly, the study by Sinclair et al. (2021) indicated that the most effective programs were those that were conducted from six to 10 weeks, usually for at least an hour each session. Between sessions, participants would conduct self-reflections and at-home exercises to build their competencies in each session’s topic. Additionally, each cohort is evaluated over time (anywhere from three to 12 months later) to assess whether participants were using the training they had received in their daily work (Shuster et al., 2023). This can be a hard sell for health care organizations struggling with staffing shortages, as they tend to resist having staff out of the schedule. It is critical to reinforce that investing in compassion training is a strategy to support staff retention, reduce absenteeism, and increase morale (Pehrson et al., 2016). Training Format The CCT program is typically instructed in-person with 20-30 participants and led by at least one facilitator to manage group dynamics (Goldin & Jazaieri, 2017). Each class is approximately two hours in length and taught on a weekly basis for eight weeks. Sessions follow a similar structure: an introductory guided meditation, small group reflections on the previous week’s homework, didactic on the new topic with interactive exercises by participants to build skills, a longer guided meditation that reinforces the topic that is recorded for home use, a debrief, then assignment of the new homework, and closed with a final activity related to the

7 The user training phases feature concurrent training of all members of a department with multiple cohorts of 25-30 participants per eight-week course. With approximately 90 staff members per department, three concurrent cohorts would be taught each cycle. Once each department completes training, the next department will begin. This approach will continue with two-month cycles until all departments have been trained. In the meantime, instructors will continue their training through virtual education sessions with their Stanford mentor and group sessions with fellow instructors-in-training for a year until they are certified (Goldin & Jazaieri, 2017). See Appendix B for a proposed timeline. Budget In developing the budget for implementation of the CCT Program at MMC, the HR department used the ingredients method recommended by Belfield et al. (2015), differentiated between the initial development phase and end user training. Within end user training, costs are categorized as personnel, facilities, and materials. Within the personnel category are the estimated costs associated with “non-productive” time of staff members pulled from their normal schedule to participate in training (2015). Assumptions in the calculation of these costs are the estimated current rate of turnover per unit of 30% per year, the estimated hours required by the instructors to adapt training materials for the MMC staff, and the anticipated 3% cost of living salary increases per year. Facility costs are minimal, reflecting the catering costs for provision of snacks and/or meals, depending on the timing of the classroom instruction to minimize impact on patient care. One assumption influencing the facility costs is that by holding the classes in the hospital classrooms, there are no additional rental fees for classroom space (Belfield et al., 2015). Additionally, the ability to produce electronic versions of materials and virtual hosting of videos on the intranet limit the financial impact of printing costs or the creation of DVDs (Goldin & Jazaieri, 2017). See Appendix C for a detailed budget. Evaluation Criteria As part of a robust evaluation plan for the CCT Program at MMC, HR recommends fidelity to the program by using the evaluation methods used by the program authors (Goldin &

8 Jazaieri, 2017). The authors utilized pre- and post-intervention surveys of participants’ awareness of empathic and mindfulness behaviors, their ability to regulate emotions and focus thoughts, their empathic awareness of suffering in others, and their ability to act to reduce suffering. Sampling methods include daily assessments during the program, one week after, and then three, six, and 12 months after completion of the training (Goldin & Jazaieri, 2017). During each cohort, participants will be asked to evaluate each session’s content, instructional tools, and the facilitator’s delivery (Belfield et al., 2015). Additional evaluation methods will include pre- and post-training interviews with patients from department to determine their experience with staff undergoing training and whether staff acknowledged and validated patient feelings, and patients felt safe to express themselves freely (Pehrson et al., 2016). Finally, to ensure that the program is meeting organizational needs, outcome measures will include employee engagement survey scores to determine if there is an increase, decreases in turnover rates, and improvements in patient satisfaction scores (Sinclair et al., 2021).

10 training in health care.   Academic Medicine: Journal of the Association of American Medical Colleges ,   96 (7), 1057–1070. https://doi.org/10.1097/ACM.0000000000004114 Suprapto, S., Lalla, N.N., Mulat, T.C., & Arda, D. (2023). Human resource development and job satisfaction among nurses. International Journal of Public Health Science , 12 (3), 1056- 1063. http://doi.org/10.11591/ijphs.v12i3.22982

11 Appendix A CCT Weekly Session Topics Session Content 1. Introduction to the course and mindfulness. The first session offers an overview of the course and expectations for participation. Basic skills in breath regulation and awareness are reviewed. 2. Focusing the mind and emotional regulation A deeper dive into mindfulness, discussions of patterns of responses to stress, and the psychology of mindfulness. 3. Cultivating compassion for loved ones. Discussion focuses on the feelings experienced with loved ones and their impact on interpersonal interactions. 4. Cultivating compassion for oneself. Discussions shift from compassion toward loved ones to applying similar principles to the self. 5. Engendering joy, gratitude, and connection with one’s feelings. Focus on self-compassion includes self-acceptance, recognizing and minimizing self-judgment, freedom to experience joy, and staying present in one’s emotions. 6. Embracing shared humanity and appreciating others. Discussion shifts to human suffering and cultivating awareness of it in others. Identifies shared fundamental needs of the human experience with focus on in-group members. 7. Belonging, interconnectedness, and compassion for others. Building on previous lessons, compassion and suffering reduction methods are applied to out-group people and more challenging targets to encompass all humanity. 8. Tonglen | Active compassion practice Participants are trained in Tibetan practice of tonglen , which visualizes taking the suffering of others and replacing it with kindness, healing, and peace. Note . Curriculum content adapted from “The Compassion Cultivation Training Program” by P.R. Goldin & H. Jazaieri, 2017, The Oxford Handbook of Compassion Science . Copyright 2018 by Oxford University Press.

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14 Appendix C CCT Budget INSTRUCTOR TRAINING & COURSE DEVELOPMENT Q1 Q2 Q3 Q4 Q1 Totals CCT Train the Trainer 3 x $6,500 $19,500 $ - $ - $ - $19,500 Airfare: $600 x 3 $1,800 $ - $ - $ - $1,800 Hotel & Incidentals $3,000 $ - $ - $ - $3,000 Course Dev’t & Ongoing Instructor Training | Hours x hourly salary ($45) $9,000 $5,000 $ 3,780 $3,780 $ - $21,560 Total For Development $33,300 $5,000 $3,780 $3,780 $ - $45,860 END USER TRAINING Q1 Q2 Q3 Q4 Q1 Totals PERSONNEL             Staff Non- Productive Time $ - $328,050 $328,050 $328,050 $337,891 $1,322,041 OPERATING EXPENSES Facilities (Catering) $ - $4,000 $4,000 $4,000 $4,000 $16,000 Training Materials $ - $500 $500 $500 $500 $2,000 Other (incidentals) $ - $250 $250 $250.00 $ 250.00 $1,000 TOTAL END USER EXPENSES $ - $332,800 $332,800 $332,800 $ 342,641 $1,341,041 TOTAL TRAINING EXPENSES $ 33,300 $337,800 $336,580 $336,580 $685,283 $1,386,901