This article is part of the HHCN+ membership
For many home diagnosticians, oasis (results and assessment information set) is often a source of fear. If staff are not properly trained in oasis, home healthcare providers face a set of issues, including increased staff turnover, administrative burdens, inaccurate Medicare reimbursements and ultimately poor patient outcomes.
Ensuring employees are familiar with oasis includes new challenges as the ongoing workforce shortages are increasingly hiring employees who have no experience with oasis. Now, more than ever, organizations must invest in robust training programs and continually evolve their training strategies, industry experts told Home Health News.
According to Valarie Johnson, Director of Business and Clinical Integration at Wellsky, the document, which is the OASIS portion of the comprehensive assessment, has negative implications for home care providers. Clinicians often feel “unprepared” for the time it takes to complete an assessment and the time it takes to complete it and for them to “fear” the communication with the institution that follows.
“They are repeatedly afraid of (quality assurance) QA cascades,” Johnson said. “Therefore, there may be a hostile relationship to ensuring that an oasis is an accurate assessment. In many cases, clinicians do not want to leave the home health industry or enter the home health industry due to the level of required documentation, including the OASIS assessment.”
Wellsky is a technology company that provides software and expertise to clients, including from home hygiene and hospice franchises.
For interim home health and hospice providers, one of the biggest risks of hiring someone without previous oasis training is the chances they may leave.
“There is always a risk in hiring someone with no experience,” Angela Rhodes, Vice President of Operations Excellence for Interim Health, told HHCN. “It's really about ensuring you're successful in the right kind of training and the right kind of support. I think the biggest risk you have is spending a lot of money training someone to decide that it's not just for them.”
Based in Sunrise, Florida, Interim Healthcare operates more than 330 franchise locations, providing home health, senior care, hospice, palliative care, pediatric care and medical staff services. The franchise provides 25 million hours of home care per year to 190,000 people each year.
The clinician's experience, revenue, and the likelihood of wasted investments are far from the only risk of inadequate experience and training. According to J'Non Griffin, senior vice president of Simitree, OASIS knowledge issues have a trickle-down effect on almost every aspect of home health care operations, including payments.
“Inadequate oasis responses can lead to lower outcomes and payments at the institution,” Griffin said. “In addition, sales of staff and inexperienced field staff lead to increased back office burdens, including reduced productivity by QA staff seeking to ensure proper assessments.”
Simitree is a technology-enabled consulting platform for acute and behavioral health agencies, including Oasis services.
Staffing trends
The lack of experience in oasis is a “historical problem” exacerbated by a recently worsening labor shortage, Griffin said.
Experts agreed that as the available pool of experienced clinicians becomes smaller and more popular, new recruits are increasingly welcomed with less experience.
“Whenever I first joined the industry, you always wanted someone with two years of experience in home hygiene,” Rhoads said. “Now we'll see people become more and more open, except for these leadership positions. They're still trying to get people with a lot of experience there. How we have to see that clinical foundation and fall into home health.”
Johnson said agents can “hire people who can hire” because of high levels of sales and clinicians' dissatisfaction.
Even hiring experienced clinicians doesn't always guarantee the level of oasis expertise you need. Even if the clinician has experience with another home healthcare provider, they may bring about “bad habits” that are difficult to break with them.
The labor shortage also created an additional layer of complications for providers. Home healthcare providers often require clinicians to care for patients, which shortens training. This will make the clinician less confident in his job and perpetuate the clinician's complaints.
How today's institutions train clinicians
Due to the different levels of oasis experience, there is no one-size-fits-all approach to training new employees. It is important to run a consistent, non-negotiable training framework that allows employees to have the learning style and flexibility to accommodate existing knowledge, Johnson said.
The interim provides the franchise with general processes and tools, with most of the franchises using a training system called Life, which represents “learning for excellence in the interim franchise.” Life includes basic orientation to the oasis and several courses to help new employees get used to the oasis. After that, most franchises allow employees to spend a little time providing care at home. After gaining in-person experience, the interim will provide a more comprehensive education on oasis.
“We have a module that promotes complete oasis education, focusing on quality of care, very much on the regulatory items and methods,” says Rhoads. “Then they have the ability to design training and assign a one-on-one way to refresh, or a more targeted refresher course. The modules are broken down so that if you're really struggling with the best way to assess a particular area, you can rethink that training.”
Interim's corporate creation training is provided via asynchronous e-learning.
According to Johnson, industry-wide oasis walks are one of the most used and trained methods for data collection. It was designed to encourage patients to not only ask questions about the patient, but also to encourage viewing and observe.
Some organizations have evolved their walk methods. Wellsky developed what is called the “Trott” method. This is based on the aspects of Walk's data collection to connect the collected information to patient care. The acronym for Trott combines thoughts, demands, observations, translations and teams to encourage clinicians to work together beyond the walks and across fields to create a more holistic care plan.
According to Johnson, the method provides a great framework for orientation, education and home health training. However, regardless of the amount of in-person or online training, experiential learning in this field is still necessary.
“The asynchronous learning modules are important and they have their own place, but they have to be part of a broader training strategy,” Johnson said. “When choosing this type of learning fragment, I want to look for a truly engaging module that incorporates retention strategies throughout the module. Spreading online or asynchronous learning and adjusting it to a practical experience is much more effective than intensive data dumps.”
Oasis training requires agents to focus on simplifying topics and creating easy-to-memorize strategies to reduce the “overwhelming” nature of the oasis.
According to Johnson, the home healthcare industry is increasingly understanding the importance of continuous and on-site training. Still, she said, “As an industry, I don't think we need training.”
How agents will train clinicians tomorrow
Keeping your program fresh and attractive is a gold standard for oasis training, with plenty of in-field experiences.
The interim is currently taking part in a “trip” to overhaul the oasis training program by investing in “microleurning.” Creating smaller training segments requires investment from agents, but each segment produces faster, especially for an institution with certified nurse educators with staff.
“Whenever we're talking about creating an hour of learning… we can spend 10-12 hours of learning for that time,” Rhoads said. “It's just I'm talking to you for an hour. So, when you start talking about a training session within 10 minutes, you'll really reduce that. You're not “what do you need to know to do your job” or “you need to know all the situations and specific situations that could be wrong.” And you rely more on that experiential learning. ”
According to Johnson, technology could become part of Oasis' training.
According to Johnson, solutions powered by artificial intelligence (AI) have emerged to reduce the burden on clinicians doing OASIS assessments. These solutions can ultimately lead to instantaneous guidance from the clinician while the clinician completes the assessment. With new technology, agents need to add additional training to speed up the latest innovation.
Currently, agents need to commit to innovative and well-built training programs to increase OASIS compliance.
“Because investing in education is a shortcut, and the first thing that is usually reduced, and there are many hidden costs from things you haven't seen,” Johnson said. “We try to listen to learners, ask them how they want to learn, and provide them with the opportunity to meet their needs, and keep it fresh, and provide multiple ways for people to learn.
