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Atrium Health’s new manager
onboarding program
CASE STUDY
Nursing Executive Center
advisory.com/nec
programinquiries@advisory.com
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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
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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.
advisory.com4© 2020 Advisory Board • All rights reserved • WF2301208-02
Source: Atrium Health, Charlotte, North Carolina; HR Advancement Center interviews and analysis.
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?
Atrium Health - 90-days self-directed in-person and virtual operational onboarding
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
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Source: Atrium Health, Charlotte, North Carolina; HR Advancement Center interviews and analysis.
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.
Atrium Health - 90-days self-directed in-person and virtual operational onboarding
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’
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Source: Atrium Health, Charlotte, North Carolina; HR Advancement Center interviews and analysis.
1) Patient safety and quality, teammate engagement, patient experience,
quality & safety, efficiency and throughput
Atrium Health - 90-days self-directed in-person and virtual operational onboarding
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
advisory.com7© 2020 Advisory Board • All rights reserved • WF2301208-02
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.
Atrium Health - 90-days self-directed in-person and virtual operational onboarding
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
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Atrium Health’s keys to success
Atrium Health - 90-days self-directed in-person and virtual operational onboarding
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
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Road map
Appendix
advisory.com10© 2020 Advisory Board • All rights reserved • WF2301208-02
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.
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Want to speak with one of our experts about how to
more effectively train new managers? Contact us at:
programinquiries@advisory.com
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
advisory.com12© 2020 Advisory Board • All rights reserved • WF2301208-02
LEGAL CAVEAT
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Nursing Executive Center
Project DirectorAnne Herleth, MPH, MSW
herletha@advisory.com
202-568-7749
Research TeamSara Teixeira Moehrle
Lauren Rewers
Fritz Windover
Managing DirectorKatherine Virkstis, ND
Design ConsultantHailey Kessler
Executive DirectorsSteven Berkow, JD
Jennifer Stewart
655 New York Avenue NW, Washington DC 20001
202-266-5600 │ advisory.com
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