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Agrace’s Training Priorities
Agrace’s Clinical Education program is led by Stephanie Wipperfurth, RN Education Manager. Her team focuses on onboarding, initial education and ongoing competency for clinical hospice staff, using tools such as Qstream, just-in-time resources and simulations.
Agrace’s Clinical Education team routinely collaborates with other teams throughout the organization to support clinicians based in multiple locations, ensuring they have the supplies and resources they need to provide quality care and support in the field. Most of the agency’s hospice and palliative care services are provided in patients’ homes or in long-term care facilities across 19 counties of southern Wisconsin.
Stephanie’s team also strives to have a positive impact on Agrace’s CAHPS scores, a measure of consumer sentiment on their quality of care. According to the Centers for Medicare & Medicaid Services (CMS), the CAHPS® Hospice Survey is a national survey of family members or friends who cared for a patient who died while under hospice care. The results are published on a CMS comparison website, so families can make the best care decisions for loved ones who are seriously ill.
“The survey looks specifically at factors like symptom management. How are we managing pain? How are we managing shortness of breath? Are our clinicians providing effective training to caregivers? Are our clinicians being respectful?” explains Stephanie.
CAHPS survey data not only reflects quality of care, but it could also eventually impact Agrace’s reimbursement rate from the federal government, as a majority of their hospice patients are on Medicare. It’s critical that Agrace diligently trains their staff on best practices to provide high-quality care that is reflected in sustained and improved CAHPS scores.
Training Challenges Agrace Experienced Before Implementing Qstream
When evaluating technology solutions for providing clinical education, Agrace looked to solve a few key challenges, including gaining better insight into training needs and overall program performance.
“In education, it is difficult to come up with success metrics,” says Stephanie. “We know that initial staff training is a bombardment of information. It’s often overwhelming, and it’s impossible to absorb it all. Our ongoing strategy was conducting presentations, but there was no way for us to measure the success of it or focus on changing any specific behavior.”
When Covid hit in 2020, Stephanie and her team knew they had to make some changes to meet the needs of their dispersed clinicians. “We wanted to be progressive to achieve our expansion plans, while reaching people who are miles away from us and busier than ever. We thought, ‘Is there a way to improve our education and make it stick at the same time?’”
She and her team had tried creating smaller modules that mimicked microlearning using other tools—with little success. “The problem that we had is we couldn’t modify the education in it to ‘Agrace-ify’ it and push our specific protocols.”
Agrace staff also completed a yearly competency exam. This exam was nerve-wracking for clinicians and a point of concern when mentioned during interviews. Stephanie says, “I can’t imagine this contributed to staff satisfaction.” She and her team were investigating alternative solutions.
Why Agrace Chose Qstream As Their Microlearning & Knowledge Reinforcement Partner
The Agrace team had heard the buzz around microlearning and ultimately selected Qstream to provide a quick and convenient way to learn.
“Qstream met all the requirements for the problems we were trying to solve. Our clinicians are very busy, and they’re scattered all over the state,” Stephanie says. “It’s not sustainable to continue to pull them away from the bedside or for us to travel to a million different places.”
Qstream is a microlearning platform that delivers short bursts of information to learners directly in the flow of work and then reinforces that information over time, using scientifically proven algorithms that employ the spacing and testing effects. You can read more about the science behind Qstream, which was developed at Harvard Medical School, here.
Agrace also saw the value in Qstream’s analytics. Stephanie notes, “I can actually create goals for learning based on the analytics within Qstream, improve that learning as it’s happening and disseminate that information to the leaders who can continue to enforce best-practice principles.”
Qstream’s analytics include real-time engagement and proficiency metrics at the team and individual level so organizations can pinpoint trends, including critical knowledge gaps, and take action.
“We chose Qstream as a way to teach about symptom management and keep molding and challenging our clinicians,” Stephanie explains. “But the bigger picture is it could eventually impact how we’re reimbursed as a hospice organization.”
Ultimately, their goal is to support a growing organization. “We need to have a robust education plan that is accessible to all learners—no matter where they are,” Stephanie says. “So in terms of education, Qstream has put us leaps and bounds ahead, helping us to be proactive in planning for future expansion.”
Finally, Agrace partnered with Qstream to improve staff satisfaction related to completing required clinical education. With the implementation of the platform, not only would Agrace offer more convenient education opportunities, but they could also do away with the annual competency exam that garnered negative feedback. They are now able to focus on small bits of education over time to engage clinicians and sharpen their skills.
To complement their simulation-based education, Agrace uses Qstream to deliver scenario-based questions to improve caregivers’ critical thinking and ensure they’re current on best practices.
The Results
Agrace set out to achieve a 10% proficiency increase for clinicians—which includes a mix of hospice nurses and social workers—and beat it by 200%! They boast a 20% increase in proficiency and a whopping 97% engagement rate across all Qstream challenges.
“Our staff really love it,” says Stephanie. “Our leaders can monitor the progress of their direct reports, and we’ve built our own system to hold our staff accountable to complete the Qstreams—and be responsible for knowing and applying the information that’s shared.”
Agrace’s Qstream Training Topics:
- Goals of Care
- Medication Management
- Agitation and Restlessness
- Anxiety Symptoms
- Pain Symptoms
- Advance Directives
Qstream collects feedback from participants and Agrace has received some rave reviews:
“I enjoyed it being spread out; it was only taking 5 –10 minutes for each question vs. a ton of questions at one time.”
“I liked how easy it was to do at any point in the morning when I received the notification of my next question to complete, as my caseload was really busy through much of the time we did the Qstream. It offers flexibility, when needed.”
Qstream’s analytics have been a game changer in terms of generating actionable insights around employee knowledge and performance. “Qstream gives me hard data to say, ‘Hey, this works,’” says Stephanie. “It’s exciting in the education world to be able to slice and dice data and dig down to answer questions like what are we really good at—and where are we struggling? We can then decide to introduce new concepts through Qstream.”
Additionally, Qstream’s analytics highlight areas for intervention, and several coaching opportunities were carried out for Agrace employees. For instance, Qstream has helped clinicians standardize the use of the Palliative Performance Scale, a tool used to assess the functional well-being of a patient and determine care as they near the end of life. “Before Qstream, our nurses were all over the map on how they would use the scale,” Stephanie explains. “So we created a Qstream question on the topic and validated that hypothesis.” Agrace was then able to use Qstream to re-educate nurses on how to properly use the scale, seeing a 70% increase in proficiency on the topic.
Qstream’s feedback function also uncovered that Agrace’s nurses had a desire for more advanced education. As a result, they’ve made it a point to include further learning opportunities within subsequent Qstreams. “We’ve used Qstream to essentially tell our nurses we hear them and have given them the option to learn more than what they would’ve ever had access to,” Stephanie says. “This certainly speaks to the engagement of our clinicians.”
Deanna Rymaszewski, Clinical Educator MSW, leads the social worker education efforts and uses Qstream to identify where her team is struggling. “It gives me concrete data so I can create training that is more specific to their needs,” she explains. “Social workers have told me that they find Qstream useful, too, and have approached me with certain tricky scenarios they think should be addressed. It’s been a great way to engage staff.”
“Qstream has enhanced their critical thinking,” Deanna adds. She references a Qstream question about a patient who needed to transfer hospices. A social worker reached out to her, asking to understand the more nuanced piece of this situation. “She was doing some active digging on her own, reaching out for further guidance and instruction that was purely led by her, so that was pretty fantastic.”
Rebecca Kahl and Liz Bernhardt, both Nurse Educators at Agrace, tout Qstream for the positive impact it’s had on their clinical staff. “I was a nurse in the field who had to take that end-of-the-year competency exam, and I understand the extra stress that it caused,” says Liz. “I love that we’re able to take that away and sort of sprinkle in the education throughout the year and learn what we need to focus on based on previous scores. This allows us to deliver and test that knowledge in a way that’s less stressful for the clinicians.”
Rebecca adds, “I appreciate the practice-in-the-moment approach that Qstream offers. If they get a question right or wrong, and probably more importantly if they get it wrong, they can review the explanation and have immediate correction and education.”
“Our education is cyclical, and we tend to focus on certain things during a certain part of the year,” Stephanie says. “This was a problem because our nurses would learn about opioid conversion one month but then forget about it the other 11 months. Now, they are more comfortable with opioid conversions because we are covering the topic throughout the year.”
As a result, Qstream has become a staple in Agrace’s learning ecosystem, according to Stephanie. “Qstream is a major piece of the pie in all of the interventions and implementation of education that we do here. It allows us to be more objective in the training we are doing and the results we are getting. Our education is no longer siloed, it is definitely strategic.”
For more information on how Qstream serves the healthcare industry, click here.