In the home healthcare and/or hospice care disciplines, distributed workforces are becoming increasingly common. The challenges created by managing a workforce that extends beyond a traditional office environment, requires modern, technology-based solutions.

Managing any workforce in the current healthcare environment is complicated, at best. With regulatory requirements, frequently changing protocols, staffing shortages, scheduling fluctuations and changing census levels, workforce management is a more than full-time job. When that workforce is distributed outside a traditional office-type environment, those complications increase exponentially.

Optimizing Operations For Remote Workers

Optimizing Operations for Remote Employees

There are 8 core areas your organization must master to effectively manage your workforce, maximize their productivity and monitor their performance.

Centralized Communication for Remote Workers

Centralized Communication

You communicate with your staff throughout the day. Schedule changes, emergency calls, even traffic updates all need to be communicated to staff members. Centralized communication is the solution to making those communications quick and complete. Important components of a great centralized communications system are:

  • Ability to differentiate between locations
  • Ability to differentiate between disciplines
  • Ability to select multiple disciplines, as appropriate
  • Ability to choose text, email, or upload of documents
  • Ability to identify priority level of messages
  • Ability to see, immediately, who has reviewed your information and who has not
  • Security and encryption

Good centralized communications will not only allow you to manage your workforce more effectively, it has been shown that, if  integrated with patient portals or an informational database, it can enhance patient care and increase overall patient satisfaction. With Medicare using patient satisfaction as one of the reimbursement guidelines, this is an area that cannot be overlooked.


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Online training for new hires in remote work


Even with a distributed workforce, onboarding has traditionally occurred in the office. While most organizations use some online resources as part of their new hire program, a significant amount of the training is still being delivered directly from a senior practitioner. While this solution works for very small census organizations, it doesn’t scale with a growing business (since the senior practitioner can’t be everywhere at the same time) and it’s expensive, as you’re paying for 2 people who are working on a single patient during training or shadow days.

For home healthcare providers, your workforce could be hours away from your central office location. Onboarding in these instances becomes even more burdensome, with the additional costs of travel and accommodations.

The global COVID-19 pandemic has demonstrated an even grater reason for digital onboarding when physical interactions and travel were restricted during the lockdown. Companies without a virtual solution in these situation were essentially unable to train new hires. This is a critical issue during periods when staffing shortages mandate quick entry into the field to meet care demands.

Simply put, traditional onboarding is an unnecessary block to the overall productivity and growth potential for healthcare providers. Employers should have the majority, if not all, of their new hire ramping processes digitized and accessible to anyone, anywhere, at any time.

Successfully designed virtual onboarding programs consist of multiple steps.

  1. Offer Acceptance
  2. Pre-Boarding
  3. Initial Training and Ramp

Offer Acceptance

On acceptance of the offer, there will be paperwork….lots of paperwork. This is an inevitable part of the onboarding process and there is no reason it can’t be completed remotely.

Basic requirements at this stage will include:

  • Contact information
  • Social Security information
  • Tax and eligibility to work forms
  • Payroll details
  • Identification
  • Non-compete and/or non-disclosure agreements, if applicable.

This step absolutely requires the ability for the user to upload documents in a safe, encrypted environment and virtual signature capabilities.


Statistics show that  33% of employees know if they are going to remain with a company long-term within the first week of employment. The largest part of that initial reaction is based on how the company presents its values and business culture during the pre-boarding and onboarding processes.

Pre-boarding is the “welcome to the team” step. Emails from the owner, President or managing director are a nice start. Then, clear direction from Human Resources on how the virtual onboarding program works. Details on technology requirements, with clear directions on completing the onboarding process, as well as contact information in case of question is invaluable.

This pre-boarding step tells your new hire not only how to onboard, it tells them they are valued and an important part of their new company. A poor experience during either the pre-boarding or onboarding process may give the new hire a negative view of your company, reducing motivation and carry-over of any instruction provided.

Training and Ramp

The onboarding process is primarily a time in which your new hire becomes familiar with your corporate mission statement, values, and goals.  It begins to give them a sense of the company culture and how it functions. During this time your new employees begin to learn workflow, patient management techniques, and specific protocols applicable to the type of care being provided by your organization.

It is critical that all information provided is clear and concise. Digital solutions are superior in this regard, as employees can review the provided materials as many times as necessary, until they obtain competency and have confidence in their knowledge.

It is also important that the technology framework used to deliver your ramp training is accessible and reliable. Learning is challenging under any conditions, but technical glitches or a constant need to interact with IT staff that your new employee barely knows is an unnecessary stressor for your employee.

From a reporting standpoint, you should be able to tell, in real-time, where your new employee is on their onboarding process. Reviewing their progress in both completing required paperwork and finishing their training allows supervisors to gain early insight into the overall capabilities of the new hire Employees who struggle through initial training may require additional screening to ensure they are a good fit for their organization, or may need to be assigned additional supervision to provide adequate follow-up training. Employees who complete the training faster than expected may merit an additional knowledge check, to ensure they have retained information important to their role and your business.

Ultimately, a comprehensive digital onboarding process frees owners and senior managers from the necessity of being “hands-on” with every new hire and enables providers to maximize the use of remote workers.

When evaluating a digital training and onboarding solution for your organization, critical components you should consider include:

  • Security and encryption
  • Device accessibility and compatibility
  • Reliability and up-time guarantees
  • Availability of technical support
  • Ability to upload licenses, certifications, insurance information and other compliance documentation
  • Virtual signature capability
  • Ease of updating content and forms
  • Integrated training and education solutions
  • Reporting capabilities on progress and performance

Knowledge and skill checks for health workers

Skillchecks & Compliance

There are 3 main situations where evaluating the knowledge and competency of staff are required for healthcare providers:

  • Annual Regulatory Checks
  • New Hire Validation
  • Protocol and Policy Changes
  • Pandemics and Emergencies
  • Pre/Post Merger Evaluation

Annual Regulatory Checks

All healthcare providers are required to perform skill checks on staff at least once per year. With a distributed workforce, this can be challenging due to proximity limitations, travel costs and scheduling conflicts. Digital knowledge and skill checks are significantly ore efficient in terms of both time and money than the traditional alternatives. Additionally, they provide specific insight into areas of concern and can be integrated into an online training program to provide remedial education where needed.

As part of the annual check, employees should also provide copies of all compliance documentation. This may include items like licenses, certifications, and vehicle insurance, to name a few. Ideally, your certification management system will afford you and your staff a “warning” system, identifying upcoming expiration dates of key compliance documents.

New Hire Validation

As discussed earlier in this article, each new hire is an unknown quantity. No doubt they have passed a background check and their resume indicates they have the basic skills you need, but how do you validate that in a remote work scenario? By introducing online skill checks as a part of your onboarding process, you protect your corporate reputation, as well as the safety of your patients. Evaluation of your new hire’s responses will identify key areas of weakness or lack of knowledge. This enables you or your human resources department, to then direct appropriate training as part of the new hire’s onboarding.

Pandemics and Emergencies

During a pandemic or emergency situation, it is essential that care is provided in accordance with all state and federal guidelines. In conjunction with a centralized communication program, each employee should complete knowledge checks to demonstrate they are fully aware of the latest information.

During the challenging times of a pandemic or emergency, the ability to conduct these checks remotely is paramount. It may be impossible to reach staff and knowing which employees you can safely deploy into h field reduces risk to your business and to your patients receiving care.

Protocol and Policy Changes

Many healthcare providers are blessed to have senior staff with years of experience. But the healthcare industry isn’t static, and protocols, policies, and best practices are constantly changing. Historically, training in these areas for incumbent staff has been delivered through in-service activities or continuing education programs tied to state licensing requirements. However, organizations rarely gain insight into employee knowledge and competency as a result of these activities. 

How well did they retain the information provided in the briefing? 

Who within the company has knowledge and skill necessary to handle certain patient-specific care needs?

Digital knowledge and skill checks are the only cost-effective way to gain these insights, especially in distributed workforce scenarios, where providing in-services isn’t feasible, and there is limited direct contact with employees to perform physical skill checks.

Pre/Post Merger Evaluation

Healthcare, and in particular home-based health care, is a highly active sector for mergers and acquisitions. A key component to any due diligence on these transactions is understanding the quality of staff that are incumbent to the transaction.

Business owners who perform frequent digital skill checks on their employees and can demonstrate a superior workforce can translate that into a better financial return on their exit from the business. Similarly, prospective purchasers can utilize digital skill checks as part of their evaluation of a business before finalizing their offer.

For acquisitive organizations, the ability to deliver comprehensive skill checks across the entire organization as new providers are brought into he fold ensures that the business can deliver the same levels of professionalism and quality of care, regardless of specific workforce location.

Performance Management for Remote Workers

Performance Management

A well-designed performance management system directly tackles the largest employee-related obstacles facing healthcare organizations today.

  • High Employee Turnover
  • Lack of Standard Procedures to Measure Employee Performance
  • Absence of Measurable Goals
  • Inconsistent Internal Performance Reviews
  • Visibility for Employees for Growth Opportunity

High Employee Turnover

The performance management process consists of four components critical to employee satisfaction:

  1. Planning
  2. Monitoring
  3. Developing
  4. Rewarding Performance

100,000 employees in 2500 different organization were asked a series of questions, the responses provided identified the factors that most highly increased employee satisfaction levels and associated employee retention levels. These statements were then correlated against the four critical components of performance management:

  • I know what’s expected of me (planning)
  • At work, I have the opportunity to do what I do best (planning)
  • I have been notified about my progress within the past 6 months (monitoring)
  • Someone at work encourages my professional development (developing)
  • I have the tools I need to do my job correctly (developing)
  • Last year, I had opportunities to learn more and improve in my work (developing)

In the last week, I have received praise or recognition for good work (rewarding performance)

Providing this level of support to your distributed workforce is challenging. You need a digital performance management system. At the heart of that system must be a good communications platform.

Your platform should integrate well with the rest of your management system, including training, onboarding, and recruitment.

It must facilitate 2-way communication, enabling employees to communicate with managers and foster an inclusive environment.

This type of environment fosters employee engagement and retention. It should also feature peer-to-peer communication capabilities, to facilitate communication and problem-sharing.

Lack of Standard Procedures to Measure Employee Performance

A performance management system requires that standards be set and identified in measurable and quantifiable terms. Those standards must then be communicated to the employees. Those employees now have a clear understanding and appreciation for what is expected of them. They can now hold themselves accountable to those standards.

These standards must be integrated into both the job description and in the annual performance goal documents. High performing organizations provide managers with the training and tools to give employees continuous and immediate feedback on their performance including both strengths and weaknesses. Successful organizations provide employees with full access to policies and procedures on the performance management system, including specific expectations for performance provided to them by their managers at the inception of their performance appraisal period.

A digital performance management system, complete with a clear communication platform, offers the most efficient and effective use of finite resources when working with a distributed workforce.

Absence of Measurable Goals

For a goal to be attainable, it must be measurable. You do your employees a disservice if you fail to provide measurable goals. 

Goals should consist of five components for maximum effectiveness.  This formula, known as the SMART goal system, vastly increases the probability of goal achievement. 

Using this concept, not only in your digital performance management system, but everywhere you set goals leads to increased productivity and improved performance in the focus areas.

Inconsistent Internal Performance Reviews

This concern goes hand in hand with a lack of measurable goals and identified standards. Without objective means of performance measurement, senior staff rely on subjective standards. Subjective standards have no place in professional performance management.

Providing set standards, with measurable goals reaffirms to your employees the emphasis on performance and reassures them that their performance, not their personal relationships with staff members, is what they are being judged on.

Establishment of this level of professional performance management system virtually eliminates the risk of inconsistent internal performance reviews.

Visibility for Employees for Growth Opportunity

Distributed workforce employees tend to have limited visibility on careergrowth opportunities. They are in the field, doing their job. You and your senior management are probably not alongside them. How are they to “shine” to those who determine their future potential at your company?

Your digital performance management system eliminates this concern for your employees. They no longer have to be physically “visible”, their manager or managing director can “see” their performance scores virtually, can “see” if they are meeting or exceeding expectations and standards and can “see” their past internal performance reviews.

When that growth opportunity occurs, the employee can feel assured that they’re not hindered by not being physically in the same location as the decision-makers and instead can rely on the honesty and objectivity inherent in your performance management system.

Your performance management system should generate reports on demand, outlining each employee’s status on your determined measurement goals. If your company productivity goal is 1 hour per patient, you should be able to see who is under, at or over that target.

This single step provides you with standard procedure to measure performance, gives your staff measurable goals and allows for consistency in all performance reviews. It gives you the tools necessary to identify your strongest performers and gives you the opportunity to improve the performance of your weaker links.


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Online Training and Education for Healthcare

Training and Education

The training and education of your workforce is crucial. To provide the highest quality of care, your workforce must be provided with best-practice information and the knowledge of how to provide it. When you workforce is spread over different locations, different cities, states or even countries, providing that training and education can be a logistical nightmare.

Modern technology provides a number of common ways to address the issue. Organizations may use a mix of these in order to provide the most comprehensive training possible.

Web Conference for Remote Training

Web-Based, Peer-to-Peer Conferencing

Utilizing software like Skype, Zoom, or GoToMeeting, this style allows an individual to teach a class or lead a training online while multiple recipients sit in virtual classrooms and learn.


  • Ability to share screens, allowing all participants to see the same thing
  • Many programs are free or very low cost
  • Direct Communication with participants
  • Ability to ask and answer questions directly


  • Quality dependent on bandwidth availability
  • Limited number of participants
  • Set, scheduled time required
Web Conference for Remote Training

Dedicated, Web-Based Conferences

You might better know this method as a webinar. Primary players in this area include Zoom, GoToWebinar and AdobeConnect.


  • More robust, with abilities like handouts, chat windows and dedicated dial in numbers for audio
  • Live interaction between participants
  • Recordable and Replayable on Demand


  • Is more complex to setup and operate than a small Peer-to- Peer online meeting.
  • Cost dependent on number of attendees
Web Conference for Remote Training

Self-Directed, Web-Based Training

Web-based testing allows your staff to log-in and complete their education or training at a time that is convenient for them. Using a learning management program, your employees complete interactive, self-directed learning modules. These modules can also be assigned to customize a program that directly addresses deficiencies identified in your skill checks and your performance management programs.


  • Schedule independent
  • Consistency of training message
  • Periodic learning checks or quizzes for on-the-spot skill checks
  • Hands-on participation increases retention levels
  • Current status and completion reports, by employee


  • Less interaction between instructor and participant.
  • Must be updated when policies, procedures or protocols change
  • Requires a learning management system to utilize effectively

Digital forms replaceing paper workflow in health

Digital Workflow

What is digital workflow? The Agency for Healthcare Resources and Quality has identified workflow in general as:

the sequence of physical and mental tasks performed by various people within and between work environments. It can occur at several levels (individually, between people, or across organizations) and can occur sequentially or simultaneously.

Digital workflow is the management of those sequences and tasks electronically or digitally.

There are many types of workflow appropriate for digitization. Here are some of the more common ones you to consider:

  • Approvals for Patient Admission/Discharge.
  • Health Care Directives and Power of Attorney Appointment
  • Medication Allocation and Reconciliation
  • Patient Surveys
  • Patient Orders and Protocols
  • Medical Documentation and Evidence
  • Regulatory Compliance

Approvals for Patient Admission and/or Discharge

Every single time you admit or discharge a patient from your care, you are required to follow the same basic protocols, obtain the same orders, get the same signatures and provide the same discharge information. Digitizing this information would allow you to receive the orders, obtain all necessary signatures, identify and digitally provide all discharge information and provide everything to your patient with much less waiting around. With electronic signature capability, a copy of the document can be sent to all necessary members. Each signs the document electronically and you can see, at a glance, what signatures you are waiting on at any given time.

Health Care Directives and Powers of Attorney

Advanced care planning, which includes health care directives and powers of attorney, are as fundamental to modern healthcare as a stethoscope. 

However, when the unthinkable occurs, identifying code status, decision-making parties, or end of life preferences can be difficult to locate in the emotion of the moment.

Having those decisions a part of the digital workflow documentation removes that challenge entirely.

Regardless of where your staff members may be located, they can access the patient’s written decisions immediately and know what steps, if any, to take on that patient’s behalf. They will know without question to whom they need to turn for decisions not outlined in the Advanced Directives and they will know how to proceed in a confident and professional fashion.

Medication Allocation and Reconciliation

Order medications and making sure they are the correct medication has never been simpler. A message is sent to the physician by your RN or LPN requesting an order. The physician is then able to select the correct medication from a simple drop-down menu. The order is electronically signed and sent automatically to the pharmacy. This simple step eliminates the risk of the wrong medication being dispensed due to human error or an inability to read the physician’s signature.

This method is particularly helpful with refills of medications that the patient has been on long-term or change in medication strengths after a conversation has occurred between physician and RN/LPN. It is also invaluable in medication reconciliation. Having new medications or medication changes automatically updated to the patient’s MAR eliminates the risk of erroneous medication information.

Patient Surveys

With Medicare guidelines linking reimbursement levels and website rankings in large part on patient satisfaction surveys, it is incumbent on your organization to monitor your patient satisfaction levels.

Checking satisfaction at pre-set timeframes – 30, 60, 90 days – allows the opportunity to address perceived shortcomings before they are a problem. This step also helps you identify potential problems with specific employees and take corrective action proactively, whether that is a reassignment, additional training or even termination, as necessary.

Patient Orders and Protocols

Particularly at start of care, there are a LOT of new orders and protocols to establish. Frequently, information received is either incorrect or additional information precipitates a change in care delivery.  This is especially true if your company has weekend or after-hours admissions.

Obtaining fast, clear, concise orders and protocols during this stressful time can be a burden on your organization. The most effective way to do address this is with a digital workflow system.  There is simply no quicker or more effective way to get signed written orders into the patient record and sent to the appropriate provider than utilization of this system. Both your patients and your staff will thank you.

Medical Documentation and Evidence

We’ve all heard “if it isn’t documented, it didn’t happen”. This is particularly difficult when different disciplines are all working with the same patient. 

Automating your documentation helps reduce the risk of something being omitted or misunderstood. Further, it aids in the development of ongoing modifications to the patient plan of care.  

Additionally, since the documentation has been completed in the digital workflow, you know have an evidentiary record of what did or did not occur, should one need to be provided.

Regulatory Compliance

Home Health Care and Hospice organizations have extremely detailed regulatory requirements, particularly related to timeframes to obtain signatures on various documents like admissions, certifications and recertifications. Obtaining all the signatures within the required timeframe is a primary concern.

Offering the necessary documents online, with an electronic signature option, allows all IDT members to sign the documents whenever convenient, whether that’s on a lunch break, after hours or even the weekend, so long as it remains within the regulatory time frame. It also allows you to monitor what signatures are lacking, so you can follow up, as necessary.

Location Verification Health Care

Employee Tracking

Healthcare is a business and, as such, must maintain a level of profitability. You must have the capability of monitoring and managing one of your highest expenditures, your staffing costs. Monitoring your staff’s productivity and performance levels is an integral part of managing your distributed workforce, as well as managing your payroll budget. It is imperative that you know where your team members are, how much time they are spending per patient, and how much time is being lost as nonproductive.

The answer to those questions, particularly when working with a distributed workforce, can be found in an employee tracking system and analysis of the generated reports and information. For example, you may use your digital nursing assessments to identify when an RN or LPN has clocked into a patient’s location and when they clock out.

Your CNAs or HHAs also have plan of care documentation that require in and out times for personal care or other assigned tasks.   These can be monitored for employee tracking and utilized in your performance management system to determine compliance while also providing a system of feedback or remedial training, as appropriate.

Integrated software and API for data in health

Integrated Solutions

With so many challenges to be conquered and solutions to be found, solution integration is the foundation of keeping it all organized. Reducing the number of steps your staff must take to utilize your solutions will increase their productivity. As they become increasingly familiar with the solutions, your employees will become more efficient, which not only increases productivity, it reduces time and expense.

You will find you have more information, at your fingertips, than ever before. It won’t make management of a distributed workforce “easy”, but it will certainly make it less burdensome and give you more time to focus on other key aspects of your business.


Download the Executive Summary of this article and discover how ClinicalHQ can help you be better prepared for a remote workforce.

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Key Takeaways

Working with a distributed workforce is becoming increasingly the norm, particularly in the home health care and hospice industries. However, this style leads to significant managerial challenges in key areas.

Positioning your company for success requires mastery in managing your distributed workforce challenges. Doing so will require digitization and use of technology to maximize efficiency while minimizing costs.

ClinicalHQ provides free, no-obligation, strategy sessions to assess the needs of any healthcare business for pandemic and emergency readiness.

Contact us to schedule a session today.