Dragon Naturally Speaking e-Learning - Training

Monday, October 29, 2012

Skills agenda to be prioritised at House of Lords debate

The benefits of developing higher level skills in the workforce will be discussed in the House of Lords today.

Organised by Semta, the sector skills council for science, engineering and advanced manufacturing, representatives of small and medium sized firms from across the UK will hear from leading figures in advanced manufacturing on how the skills agenda is evolving and making a real difference in the workplace.

Richard Hamer, education director and head of early careers at BAE Systems, will promote the benefits of the Advanced Manufacturing and Engineering Higher Apprenticeship, which has been developed to combine practical skills with a higher education qualification.

Jo Lopes, head of technical excellence at Jaguar Land Rover will talk about the innovative Advanced Skills Accreditation Scheme (ASAS) based on the car giant's own successful scheme and developed with Semta to provide a flexible programme of Master's level training, which is now available across the sector.

Representing SMEs, Andy Robinson, chief executive of Bedfordshire-based Automated Technology Group, will talk about its own academy, opened last month, to provide structured training to both school leavers and graduates.

Semta's chairman Allan Cook CBE, and UK operations director Lynn Tomkins, will also speak at the event hosted by Baroness Wall.

"It is fantastic to have three employers speaking about how the development of facilities and new qualifications is helping to address the real skills challenges we are facing," said Ms Tomkins.

"We need all businesses in advanced manufacturing and engineering, but in particular SMEs, to work with us to find the best solutions for their business.

"Semta research indicates that industry needs to recruit and train 82,000 engineers, scientists and technicians across the UK by 2016, while 363,000 of the current technical workforce is qualified below world class standard and needs to be skilled up.

"Events like today provide a fantastic opportunity for businesses of all sizes to share experiences and learn what is available to ensure these targets can be met."

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RSA collect employee engagement gong at PM Awards

Insurance company RSA picked up the award for employee engagement at this year's People Management Awards.

The group was praised for an imposing scheme which helped to boost engagement levels within the business. In a fantastic night for the organisation, RSA was announced as the overall winner of the 2012 People Management Awards.

Five years ago, the insurance firm was experiencing low morale, generating disappointing financial returns, managing board takeovers and struggling to recruit the right talent. However, by recognising the capability of its own leaders, RSA was able to turn the situation around and now proudly claims to be "the world's most engaged insurance company".

In addition to improved mean engagement scores at RSA, the organisation was able to clearly demonstrate the impact this has on the business. RSA's ability to highlight a positive correlation between a team's engagement levels and customer satisfaction, as well as new business growth, clearly demonstrated the value of its employee engagement programme.

Speaking on the awards, Peter Cheese, CEO at the CIPD and member of the final judging panel for the Awards, said: "RSA provides a positive example of how and why employee engagement levels should be a focus of improvement for employers. We know that strong employee engagement drives higher productivity and better business outcomes and it was great to see this demonstrated via RSA's work.

"RSA impressed the judges with the extent and depth of measures used to boost engagement at the organisation and its commitment to the programme despite dealing with organisational change. Initiatives such as RSA's 'leading through change' training programme, provided to all of its 1,100 managers and its 300th birthday celebrations which engaged employees in committing 40,000 hours in volunteering and raising £750,000 for good causes, particularly stood out."

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Skills issue to be at the forefront of third sector conference

The skills gap within charities will be discussed in detail at this year's training and skills conference hosted by the third sector.

Martin Baker, founder and CEO of The Charity Learning Consortium, will be sharing his insights and looking at ways o stretch your training pound at a time when budgets are restricted.

Baker will join Graham Leigh, director of Strategic Partnerships at Skills - Third Sector in a special workshop which will be looking at low and no cost ways to develop talent in the sector.

The event, Our People Our Skills Our Future, features Dame Mary Marsh, director of the Clore Social Leadership Programme, former chief executive of NSPCC and newly appointed to lead a review into leadership and skills in the third sector. The conference will provide a great opportunity to learn about the implications of the skills review, as Dame Mary Marsh will be sharing a platform with Civil Society Minister Nick Hurd MP, who appointed her to lead it.

Baker said: "It's been a great week for learning and development in the third sector, with the announcement that Dame Mary Marsh is to lead a review into leadership and skills. So the Our People Our Skills Our Future conference is incredibly timely.

"I'm delighted to be sharing my knowledge of free and affordable ways to build essential skills on a charity budget, chief amongst these being collaborating with other charities - together charities can achieve so much more than when they face challenges alone."

Our People Our Skills Our Future is part of Skills - Third Sector's ongoing work to support the development of an ambitious, skilled and adaptable third sector workforce. Presenters will be encouraging delegates to share and collaborate, and think of their colleagues (staff, volunteers and trustees) as strategic assets.

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Creativity needs to be added to hard work, professor urges

Creativity and innovation need to be added to hard work and competitive prices for the workplace to be successful in the future.

That was the view of futurologist Dr Carl Rohde, who spoke at the Youth Enterprise show recently.

A recent survey from AXA Business Insurance has revealed that most parents are prioritising hard work over creativity for their children in order to make sure they have a successful career. Dr Rohde believes that there needs to be more of a balance.

He said there will be four different working layers of society in the future and predicts:

1 A rise in the number of well-paid professional and managerial jobs

2. A decline in the number of middle paid and skilled jobs

3. A rise in the number of routine low paid service jobs

4. A growth in the number of 'bad jobs' that offer poor conditions of work, minimal rights and little security.

He said: "To be able to compete in the top layer you must add creativity and innovation to hard work. I see the world becoming flat and competition for these jobs will be truly global. At the other end of the scale, work in some of the layers will not be a good place to be."

AXA's survey found that less than a quarter of parents think it is primarily their responsibility to teach their children about new things.  Instead they feel it is up to the schools and colleges.

Some schools are tackling this head on. The Aldridge Foundation sponsors entrepreneurial academy schools and sees creativity as a key attribute in developing self-starting, highly motivated and confident people who can make full use of every opportunity for personal and community success. 

Darrell Sansom, managing director at AXA Business Insurance, said: "What Dr Rohde said was very thought provoking. We have a history of creativity and innovation in this country and we need to make full use of that strength to give our young people and small businesses the best chance of success in the future workplace."

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CIPD: Don’t become complacent in talent battle

Ensuring benefits packages are engaging and motivating has become a greater concern for reward professionals than attracting and retaining staff.

That was a key finding in the latest reward risk survey from the Chartered Institute of Personnel and Development, which reveals that attraction and retention of key employees has fallen out of the top ten list of concerns for the first time since the survey began in 2010, while increasing pensions costs has crept in to the top ten for the first time.

The top concern remains, for the second year running, that employees don't appreciate the value of the total reward offering. Meanwhile, employee attraction and retention have moved from 1st and 6th places in 2010 and 9th and 10th places in 2011, to 11th and 12th in 2012.

Other reward risks that have moved up the table of concerns in the past year include:

• Employees don't understand performance and behaviour requirements (moved from sixth place to fourth place)

• Incentives not motivating (moved from eight place to fifth place)

• Inability to communicate desired performance and behaviours (moved from eleventh place to seventh)

• Increasing pensions costs (moved from thirteenth place to tenth place).

Charles Cotton, rewards adviser at the CIPD, said: "It's encouraging to see reward professionals thinking more strategically about rewarding the behaviours and performances that contribute to business success, but attracting and retaining key talent is always crucial - in the good times and the bad. Even in a stagnant labour market, key talent can find opportunities to move onward, so reward professionals shouldn't be too complacent while they wait for the economy to eventually pick up.

"With automatic pension enrolment kicking off in the UK, it is not surprising that pensions cost has become a top ten risk that needs to be managed nor that it is predicted to be the second highest reward risk in the next couple of years. What is surprising, however, is that the underperformance of pension funds is still not regarded as a major risk for many of our respondents.

"Even defined contribution plan sponsors should review the performance of the funds, especially their defaults, if they and their employees are going to derive a good outcome from this workplace benefit."

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UK ranks highly for creating a diverse workforce, research reveals

The UK ranks fourth internationally for creating a diverse and inclusive workforce, according to a new survey published by member-based advisory firm, CEB.

The in-depth report into diversity and inclusion reveals that almost two thirds (63 per cent) of UK employees stated their organisations are actively promoting workplace diversity through relevant policies and programmes. In contrast, APAC countries rank worst globally for workforce diversity with Malaysia (56 per cent), New Zealand (52 per cent) and Singapore (49 per cent) among the worst performing.

However, the survey questioned whether employers can cope with the impact of creating a more diverse talent pool and policies, with only two in five UK employees (42 per cent) believing their organisation is effective at building a diverse workforce.

The research, which is highlighted in CEB's study, 'Creating competitive advantage through workforce diversity' also identified an aging workforce as a particular challenge to diversity in both the UK and US markets. It suggested there is a need for businesses in these markets to develop and implement diversity policies which address the needs of older employers in order to effectively create a more diverse workforce. 

These findings, however, contradict current UK economic trends which have seen employers favour older, more experienced employees ahead of younger new recruits. This is coupled with changes to the pension age which has increased over the past year and will continue to do so until 2020. 

The discrepancies between the data and current policy and trends indicate that employers are challenged with balancing the business need against the practical needs of an increasingly diverse and ageing workforce.

Chris Ellehuus, managing director of CEB, said: "It is encouraging to see UK business lead the way in promoting policies for diversity but they now need to refocus on business solutions concerned with each diversity need. Organisations must recognise that not every need is a global problem - while an aging workforce is a UK challenge, attracting women to business is more prevalent in China - and as such, regional variations must be considered, particularly within global businesses.

"The changes required to create a truly diverse and productive workforce need to extend beyond regulation and be placed within the core of the business, from the recruitment process to the overall business objectives.

"Our members have also identified organisational barriers to building diversity which needs to be considered, one being a lack of common objectives between promoting diversity and the overall business objectives. They also suggest that there is often a lack of commitment from business leaders to address diversity issues which can severely hinder the creation of more diverse organisations.

"Our research, however, found that recruiting from a diverse talent pool increases an individual employee's discretionary effort and their commitment to the business. As such, business leaders need to ensure that relevant local objectives form a part of the overall business plan in order to successfully create a diverse workforce that is mutually beneficial to both diversification and the overarching business needs."

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Talent Q programme up-skills recruitment team at Lloyds

The technical skills and personal effectiveness of the recruitment team in Lloyds Banking Group has been improved thanks to a development programme by Talent Q.

The assessment specialists designed a nine day programme around the learning needs of 14 participants and incorporated its assessments as pre and post measures of behavioural change. The participants went through a bespoke 360 degree feedback process to understand how their behaviour is perceived by others and completed a personality questionnaire to explore how their own personality traits impact on their work.

The resultant programme featured five modules and was delivered for two cohorts over nine months. It covered best practice in recruitment, innovative sourcing strategies, how to improve the candidate experience, influencing and negotiation, objective assessment approaches and the latest developments in employment law. It also examined the operations of the wholesale and commercial division, to help the recruitment team to better understand the needs of the business.

"When you're competing in a global market for top talent, you need to invest in the skills of your recruiters," said Michelle Rajkumar-Clifford, head of recruitment for wholesale & commercial at Lloyds Banking Group.

"We wanted to equip our team with the knowledge and skills they need to deliver a best practice recruitment process and a positive candidate experience. We also wanted to establish ourselves internally as a team that understands both the requirements of the business as well as how to work with colleagues to achieve an effective outcome."

The participants undertook an assignment and presented the results to their peers. The 360 degree feedback process was then repeated to assess the behavioural change. The results showed across the board improvements, with significant increases in areas such as strategic thinking, entrepreneurial thinking, adaptability to change, innovation and achievement-orientation.

"The programme completely rejuvenated the recruitment team," she added.

"They'd been working together for over three years so they' d become established and perhaps set in their thinking. They're now more excited about their work, more confident in dealing with hiring managers, and senior stakeholders, and better able to embrace change. In a recent employee engagement survey, they achieved one of the highest engagement scores of any team across the group resourcing function."

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Partnership to address issue of dementia

Experiential learning solutions provider Toolwire has teamed up with Norfolk & Suffolk Dementia Alliance to help tackle the issue of dementia.

Toolwire has provided a series of interactive experiences called Toolwire Learnscapes designed to help employees in commercial outlets to understand how they can support members of the public who are living with dementia. This initiative was developed as a result of the Prime Minister's challenge on dementia, which was launched in March 2012.

The Alliance is working closely with schools, colleges, commercial partners and local authorities to improve awareness and understanding of the condition and to provide greater support for people with dementia. The Toolwire Learnscapes initiative is an integral part of the Alliance's educational campaign.

Willie Cruickshank, director at Norfolk & Suffolk Dementia Alliance, said: "In Norfolk there are estimated to be around 13,000 people with dementia although only 34 per cent of the population has received a formal diagnosis. People with dementia and their carers often talk about stigma and social isolation.

"They report losing friends following their diagnosis, seeing people cross the street to avoid them, feeling lonely, and struggling to use local services. Research among the general public has shown that this often is due to the fear and misunderstanding of dementia. People living with dementia also want to remain independent for as long as possible.

"In support of the Prime Minister's Dementia Challenge, we have partnered with Toolwire to deliver a series of sensitive and practical interactive tools to show people how to cope with different scenarios in an effort to educate and inform.  Ignorance is the biggest obstacle in shifting preconceived ideas about dementia. Creating dementia friendly communities will take time, but we believe that Toolwire Learnscapes will help bridge the enormous gap that currently exists between fear and understanding when dealing with people with dementia."

Toolwire has produced a series of short online episodes featuring common challenging scenarios involving a person with dementia.  During these episodes, participants interact with characters in a café and supermarket setting. By enabling participants to 'learn by doing' in a safe, controlled environment, the learning tools will better equip them to support people living with dementia in real life. 

Sarah Frame, EMEA director at Toolwire, said: "Experiential learning tools, such as Toolwire Learnscapes, differ significantly from the role-play typically included in traditional e-learning or classroom training. These rich, authentic virtual environments can be used to replicate complex situations involving emotional topics such as sensitive health issues, domestic violence, and child protection. 

"Enabling individuals to experience these issues first-hand allows them to more fully understand complex issues and determine a more positive outcome through their own actions. We are proud to work on this initiative to improve knowledge about a condition that touches so many people across the UK."

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OEB programme premieres VIDEO EDUCA

The challenge of video as the new language of learning will be addressed head-on at this year's ONLINE EDUCA conference in Berlin.

The global e-learning conference for the corporate, education and public service sectors will this year feature a series of expert-led video sessions under the name VIDEO EDUCA.

The VIDEO EDUCA sessions will focus on all aspects of using video in learning, ranging from the practical production process to learning practitioners' experiences. In the opening plenary session, the award-winning documentary maker Michael Grigsby will deliver a keynote speech on the role of video in education. As well as making nearly 30 acclaimed films, Grigsby co-founded the Abingdon Film Unit, which works with secondary school pupils to create short documentaries and animated films.

Participants will have the unique opportunity to have their own videos critiqued by industry experts such as Steve Anderson, executive producer of BBC's Question Time, in the pre-conference video masterclass.

Taking place on Wednesday 28th November, the masterclass will provide participants with a detailed overview of using video to communicate learning, as well as insider knowledge of the production process. From script to screen, the masterclass will cover the key areas of filmmaking and ensure that all participants leave with the tools and techniques to make video a successful component of learning resources, whatever the budget.

"Video is a powerful and increasingly prevalent learning tool," says international media executive Adam Salkeld, curator of VIDEO EDUCA.

"Generation Z's learners are typically highly sophisticated consumers of video as well as native video makers. Educators need to respond to this major shift in the way media content is used and perceived by current generations to ensure effectiveness."

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Partnership sees the launch of supermarket foundation degree

Morrisons staff are set to get the chance to improve their skills with the announcement of a foundation degree in supermarket operations.

The initiative launched by the supermarket chain and the Logistics Institute at Hull University Business School will see the store's staff obtain skills and knowledge in leadership and logistics in order to enhance the business' competitiveness.

The bespoke, part-time industry foundation degree has been formulated by the Logistics Institute alongside the University of Hull's dedicated Knowledge Exchange team and in close consultation with the major supermarket chain. It will provide cutting-edge training to the Morrisons logistics division.

Nathan Clements, HR director for manufacturing and logistics at Morrisons, said: "Efficiently moving food to our stores and customers - come rain or shine or even snow - is one of the most vital parts of any supermarket business. This degree programme will ensure that we can develop the best managers for the weekly challenge of managing a supply chain that serves 11.5 million customers every week."

The programme incorporates modules covering academic and management skills, operations management, as well in-depth leadership and logistics study. The blend of leadership and logistics modules are delivered in a block format allowing the employees to attend without impacting their employment responsibilities and a part of the course will be delivered at one of Morrisons sites to enhance the learning via on-site engagement.

The aim of this specially designed programme is to closely connect theoretical learning with the workplace environment. As part of the programme, students will tackle three business improvement projects - two from within the organisation. They will present their findings to their management team and implement positive changes within their working life.

Director of the Logistics Institute, David Grant, added: "We are delighted that Morrisons has chosen us to deliver on this programme.

"The Logistics Institute has worked hard to ensure that the programme is challenging but balanced, with plenty of support for students and good progression routes to a full degree should the students wish to continue.

"It is our belief that the chosen students will learn and progress rapidly on the programme and become a real asset to the Morrisons brand in the future."

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Soft skills development is top priority in L&D, study finds

Leadership training has been overtaken by soft skills development as the top priority for organisational learning in the coming year, a new study finds.

After being ranked as the top priority since 2009, a survey from learning content specialists Video Arts reveals that 63 per cent of L&D professionals will now prioritise the soft skills of their employees over leadership training during the next 12 months.

Other key areas of focus for L&D are customer service training, professional skills development and compliance training.

Martin Addison, CEO of Video Arts, said: "Leadership development has been the top priority in our survey for the past three years, as many organisations have believed that the secret of greater success lies in more effective leadership.

"This year it has been pushed into second place as L&D teams are increasingly recognising that technical qualifications and knowledge are not enough; employees also need soft skills for organisations to be successful.

"Issues of personality, attitude and behaviour have a big impact on performance in the workplace because they affect how well people are able to communicate face-to-face and work effectively with others."

The report also asked L&D teams about how they deliver training and their plans for the future. Findings revealed that face-to-face training is still widely used, with 81 per cent of organisations using classroom learning. E-learning (79 per cent), coaching (72 per cent) and experiential learning (53 per cent) remain popular options, while newer forms of delivery are also gaining ground, most notably virtual classrooms and mobile learning.

Interestingly, a growing number of L&D teams (51 per cent) are now using e-learning to provide soft skills development. E-learning is also used for compliance training (53 per cent), health and safety training (47 per cent); leadership and management training (42 per cent); induction training (42 per cent); professional skills training (34 per cent) and customer service training (37 per cent). A further 18% of L&D practitioners who don' t use e-learning say they plan to implement it in the future.

"E-learning is enjoying a resurgence and our data shows that organisations are increasingly using video in e-learning to provide a richer media experience," Addison said.

"It used to be that e-learning courses were used more widely for 'hard skills', such as IT training, compliance and health and safety but the need to provide cost effective training, combined with the availability of better courses and better IT support, seems to be encouraging more organisations to use e-learning for soft skills development."

Elsewhere, one in five organisations claim their training budget will be increased over the coming year; 53 per cent say it will stay the same and 27 per cent expect it to be cut.

Not surprisingly, 86 per cent of L&D teams use video in their training, predominantly as part of classroom training (71 per cent); for short pieces of bite-sized learning (56 per cent); for online training (29 per cent); in self-authored e-learning courses (27 per cent) and to support one-to-one coaching (21 per cent). Video is primarily used in soft skills development (60 per cent); leadership and management training (55 per cent); customer service training (51 per cent) and professional skills training (38 per cent).

The most popular applications for mobile learning are soft skills development, leadership and management training, professional skills, product training and customer service training.

"Advocates of m-learning claim it delivers learning at the point of need and that users are more likely to participate because of the bite-sized format.

"We expect that more L&D teams will consider m-learning as a delivery option in the future," Addison concluded.

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Training budgets stand firm despite poor economy, study finds

Employers are still investing heavily in staff training and skills despite the sluggish economy, according to a new survey by the Association of Accounting Technicians.

The commissioned report into employer attitudes towards qualifications and skills revealed that more than nine in 10 (92 per cent) bosses expect to invest either the same or more time and money into staff training and skills next year as they have during the past 12 months.

Of those surveyed, nearly half (44 per cent) expect to use more in-house training and almost a third (31 per cent) expect to focus more on remote learning resources.

Jane Scott Paul OBE, chief executive of AAT, said: "A lot has been made recently of businesses taking fewer risks, sitting on capital and refusing to invest profits. But this research paints a very different picture. Employers are clearly committed to improving staff qualifications and skills, but they're not just treading water - instead they are looking for new ways to provide staff training.

"The focus on in-house training and remote-learning shows there's a desire to make resources go further, along with concerns about staff spending too much time out of the office."

The survey also found that employers are changing the way they provide staff training. Almost half of employers (44 per cent) say they would like to see more downloadable learning resources such as podcasts and vodcasts, and almost two-fifths (38 per cent) are considering increased use of live e-learning. However, smaller employers focus more on personal interaction with almost two in five (38 per cent) saying they prefer staff to be taught face-to-face, compared to just one in ten large employers.

Further findings highlight how businesses are looking beyond simple financial measures when making decisions about staff training. Just more than half of employers (51 per cent) believe a main benefit of improving staff qualifications and skills is increased staff commitment and retention. Only a quarter believe a main benefit is the ability to charge more for the work of their staff.

Paul added: "Employers are not just looking at their bottom line when making decisions about staff training. Most recognise that improving staff skills is an important way to increase staff commitment to their organisation. Staff retention has become a far greater concern than the potential financial rewards of better trained staff.

"Businesses have been much maligned recently for a perceived lack of investment in their staff. But employers are showing far greater commitment than they're given credit for. They now need to get the message out there that they are supporting their staff and are committed to improving their skills and qualifications."

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LPI launch capability map for the learning sector

The Learning and Performance Institute has launched a capability map which will help provide a clear definition of skill sets applicable to learning professionals.

For individuals working within workplace learning, the map will provide a way to self assess skills across nine categories and against 27 pre-defined skills. Users are then able to create a personalised profile report which provides an overview of their current skills across four competency levels.

The profile reports generated by the capability map will prove invaluable for recruiters looking to identify skills associated with specific L&D roles. The map also aims to create a common language for skills and personal development for workplace learning professionals.

Nick Bate, director of L&D recruitment specialist, Blue Eskimo said: "I think that the LPI capability map is a very useful foundation to benchmarking competencies within the learning/L&D arena. From a recruitment perspective I believe it will help Blue Eskimo more effectively gauge candidate skills in the real world and align these to relevant job opportunities that we are recruiting for."

The map has been in development for more than a year, and Jane Hart, founder of the Centre for Learning and Performance Technologies is one of many contributors to the map and believes it will help users recognise a new wave of L&D skills: "As we move into a new era of workplace learning, learning professionals will need a range of new competencies and skills. The new LPI capability map will therefore provide a useful framework to help those in the profession understand what is required to become a competent practitioner," she said.

Craig Yetter, director of enterprise learning strategy at GlaxoSmithKline was one of the first people to review the map. He said: "Having a sound learning capability map will allow organisations to drive consistency in learning and segment the many roles in learning to provide focus and opportunities for career growth either from within the learning function or as a secondment for leaders looking to expand their knowledge in this area."

For more information on the capability map, click here

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Wednesday, October 17, 2012

M&S staff need to be trained properly, Skillsoft warns

E-learning solutions provider Skillsoft has expressed caution after the recent announcement by Marks & Spencer to recruit thousands of staff during the busy Christmas period.

The recruitment drive by M&S will see 20,000 staff join its UK and Republic of Ireland stores this Christmas, 5,000 more than last year.

Tony Glass, vice-president of corporate sales at Skillsoft, said that it's good that job opportunities are being made available, but warned that if staff are not trained properly, the initiative could do more harm than good.

"While it's great to hear that Marks & Spencer is planning to recruit 20,000 more staff to help with the busy Christmas period they need to approach this in a strategic and targeted manner. With such a large onboarding of staff in a short period of time, it is vital that M&S has sufficient training programmes in place to help new starters get up-to-speed as quickly as possible," he said.

"While the majority of recruits are likely to be temporary employees, they will all be seen as representatives of M&S so need to be provided with a targeted induction plan and overview of key processes and policies. The danger when bringing in a high volume of staff is that they fail to be briefed adequately on important areas such as health and safety, gross misconduct and customer service. 

"By introducing appropriate e-learning programmes early on, if not before these new employees even start their contracts; this can prove a valuable training method, saving money and resources, while enabling new hires to complete compulsory training. Training can also be shared easily across the different stores within the organisation, while new hires can complete the various modules in their own time.

"Companies like M&S will regularly employ additional seasonal staff to cope with busy periods, but if new staff are not trained properly from the outset, bringing in extra resource could do a business more harm than good."

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Young people to get career insight at skills show

Young people will get an interactive insight into career paths available to them at the Skills Show exhibition in November.

TBG Learning, one of the country's leading youth and adult learning organisations, is hosting an interactive 'guess the career' challenge on their stand at the UK's biggest skills and careers event.

Visitors to TBG Learning's stand will pick a career card and dress up in their chosen profession. Competing against a friend they will take on the challenge to be the first to guess their opponents job title against the clock.

Successful competitors will be in with a chance of winning an Apple iPhone 4, while everyone will be pictured in the outfit of their chosen profession and will receive a picture as a memento.

David Umpleby, head of programme delivery at TBG Learning, which has more than 20 learning centres nationwide, said it is hoped the interactive quiz will act as a good ice-breaker.

"The quiz will be something a bit different to what other exhibitors are doing and will be a good way to help break the ice with young people joining us on our stand.

"The Skills Show is the UK's biggest skills and careers event and is a perfect opportunity for us to showcase our services to support young people to progress on to college, an apprenticeship or into work.

"We deliver a range of learning programmes to thousands of young people through our nationwide learning centres and work with hundreds of employers across the country to provide training, apprenticeships and employment opportunities.

"As well hosting our own quiz we're also looking forward to being quizzed on the various learning routes we have available to young people, from apprenticeships to NVQs - and we're confident we'll have all the answers!"

TBG Learning will be on stand 1077 at the Skills Show at the NEC in Birmingham from November 15 to 17. The event is expected to attract more than 100,000 visitors over the three days.

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CEOs believe in the value of learning, research reveals

More than nine in 10 business leaders will either maintain or increase their training budgets in the next 12 months, a new CEO study finds.

A report conducted by OpinionMatters on behalf of Skillsoft, surveyed 500 CEOs of businesses with more than 250 employees across 13 business sectors and found that CEOs are placing emphasis on the value of learning.

Nearly half of the CEOs interviewed by Skillsoft said that a length of a course was more important than deciding its content and the format of the delivery was largely irrelevant.

The importance of professional development was further underlined by the fact that a surprisingly low number of the CEOs cared about cost: just 13 per cent listed it as their most important consideration, and measurable return on investment from training mattered most to only seven per cent of respondents.

Firms at the smaller end of the scale had slightly different priorities. An even higher proportion cared most about course length (49 per cent), and cost also mattered more, with 12 per cent listing this as the top priority.

"This research shows that business leaders increasingly appreciate the value of learning," said Kevin Young, managing director, SkillSoft EMEA.

"However, while training budgets themselves are not being cut, the time businesses have available to undertake training sessions is clearly shrinking. Courses need to be more succinct and to-the-point than ever, delivered in highly relevant, bite-sized pieces. Cost may not be a priority for the CEO, but it will and should matter to the training and development team, and we work hard to set the standard in cost-effective learning with a measurable ROI."

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Innovation is a key driver of business success, research finds

Innovation is currently the key driver of business success and will be in the future, according to 83 per cent of business leaders.

Research released today by Allianz Insurance highlights how business leaders believe that innovation can help their businesses to achieve higher profits, engage employees, stand out from competitors and deliver growth.

Despite the importance of innovation, there are signs that the challenging economic environment is causing leaders to refocus their attention.

Findings reveal that nearly one in four (24 per cent) reported that the double dip recession has pushed their innovation programmes further down their list of priorities.

Worryingly, the study suggests that innovation has become less important to UK business over the past year, as business leaders feel that barriers to innovation within their business are; a lack of money (27 per cent) and a focus on other business areas (18 per cent). 

Allianz is encouraging UK businesses to devote time and energy to supporting innovation - a key driver of growth.

Allianz Insurance's CEO, Andrew Torrance, said: "It is understandable that some business leaders believe that in difficult financial times, innovation should become less of a priority. At Allianz, however, we will continue to foster an innovative spirit as we believe it makes us a better business in a number of ways, including engaging our employees and generating income, as well as making valuable operational savings."

The research conducted with 500 UK company leaders found that many recognise innovation as making a positive contribution to their organisation - 72 per cent of business leaders acknowledge that their business is innovative to some extent. An additional four in 10 believe their current focus on innovation makes them more successful and 26 per cent believe it helps them enter new business areas which is key to maintaining a competitive edge.

Torrance added: "Through our own experiences and understanding of innovation and the successes it can bring, we believe British businesses can use innovation as a weapon in their armoury to move through the double dip recession with optimism and excitement about what the future holds.

"In my view the creative spirit that innovation brings is something British businesses cannot afford to lose, even in the most difficult of financial climates."

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Monday, October 15, 2012

SkillsActive welcomes move to prioritise vocational training

The move by Labour leader Ed Miliband to prioritise vocation-based training has been welcomed by SkillsActive, the Sector Skills Council for learning.

Speaking at the Labour party conference in Manchester last week, Miliband promised to transform the lives of those who didn't go to university, with a focus on training and apprenticeships.

Ian Taylor, CEO of SkillsActive, believes that vocational training is a powerful tool to develop potential and enhance the skills of young people.

He said: "We welcome Ed Miliband's and the current government's move to prioritise and promote the value of vocation-based training and apprenticeships. One of the biggest challenges facing employers today is finding recruits who are ready for work. Vocationally-based training is the most powerful tool to develop potential, enhance skills, and magnify young people's chances of getting work.

"At a time of high youth unemployment, we really need to draw on the wonderfully inspiring legacy of the recent Olympics and Paralympics, when thousands of staff and volunteers worked together with outstanding athletes to make the games such a splendid success. We need to make employers aware of the great contribution young people can make to their workplaces."

Taylor championed the benefits of work placements, and said the experience young people gain from them can be invaluable in helping secure full-time jobs.

"It is a difficult landscape for young people today, yet many employers cannot find work-ready staff," he added.

"Young people going to university face high university fees, yet academic education fails to equip many of them with the right sets of skills and attitudes for the work place. This is why we need a much clearer focus on vocational education, alongside quality academic education.

"Business-led work placements, well-designed apprenticeship programmes and other relevant vocational initiatives deliver more focussed sets of skills increasing the chances of young people getting jobs."

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Companies not ready to keep top talent, study finds

More than 70 per cent of senior management are worried about retaining staff when the economy picks up, new research finds.

A study commissioned by integrated training services provider Thales Training and Consultancy reveals that only 41 per cent have a clear strategy in place to account for top talent moving onto other jobs.

The study acknowledged three areas as critical to retaining staff: clear communication, more flexible working hours and investment in learning and development courses.

When asked specifically about investment and commitment to L&D courses nearly two-thirds(61 per cent) of respondents highlighted that their organisation is placing a greater emphasis on learning programmes as a way of keeping top talent, and a staggering 85 per cent of those asked stated that investment in L&D influences attracting and retaining new staff. Others complained that economic recovery could lead to staff moving on to competitors (80 per cent) and with recruitment costs as a premium this highlighted a worrying trend.

Rachel Kay, business development director of Thales Training and Consultancy, said: "These figures clearly show that in the current economic climate learning and development has become a powerful tool to retain and attract top talent.

"The study also revealed that despite the clear call for action, nearly half of respondents claimed that L&D investment is not supported at board level.

"In times of economic uncertainty it comes as no surprise that budgets will be squeezed and finance diverted to other parts of the business, but these findings should drive the industry into ensuring L&D is fully supported at all levels. After all, 71 per cent of directors asked believe it is fundamental to business success."

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IMC join Towards Maturity’s ambassador programme

Talent management solutions provider IMC has joined benchmarking company Towards Maturity's growing ambassador programme.

The programme sees companies coming together as ambassadors for change, striving to identify and develop good practice, in addition to raising awareness and driving the whole learning technology industry forward. They also share a common passion for ensuring that independent advice is freely available to all.

Towards Maturity's annual benchmark isan online learning technology study that provides its participants with personalised benchmark reports to help improve the impact of learning technologies in their organisations.  Both the study and personalised benchmark reports are free as a result of the programme.

Dr Dirk Thissen, regional director of Northern Europe at IMC, said: "With more than four million people in more than 1,000 companies and public institutions putting their trust in our products and service, we pride ourselves at promoting good practice.

"We are proud to support the outstanding work by Towards Maturity's ambassadors to increase learning technology good practice globally."  

The 2012 Benchmark Study is currently analysing how organisations' learning strategies are responding to uncertain economic times, including how this climate is affecting budgets, technology changes and the building of talent. It also looked at the impact learning technologies are having in organisations of different sizes and sectors. Furthermore, it will uncover the hype verses the reality of learning technology trends, whilst detailing drivers, barriers and benefits.

Laura Overton, managing director of Towards Maturity, said: "We are delighted that IMC has joined our growing ambassador programme.

"We are seeing an increasing trend to benchmark not only in the UK, but internationally. IMC's global perspective will be invaluable to help ensure that more organisations are aware of the effective practices that really make a difference."

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CMI: Managers have no confidence in Coalition policy

Managers and leaders believe that the Government's austerity programme is having a negative impact on their organisation.

That was one of a number of findings in a study released today by the Chartered Management Institute, which shows that almost one in five (19 per cent) leaders have no confidence in the Government's economic policy.

The report, The Economic Outlook, surveys managers up to CEO levels every six months about how the economic situation is affecting business. The latest study revealed increasing levels of concern when it comes to issues including access to finance and barriers to growth.

According to the research, numerous managers are not convinced that debt reduction measures are working, with 65 per cent telling CMI they expect the amount owed by the public purse to increase over the next 12 months.

The majority of bosses feel, however, that the Coalition has an important role to play in improving their current lot - 69 per cent reject the idea that the Government can do little to affect their organisations' circumstances. Top of bosses' policy priorities was simplification of the tax system, backed by 89 per cent of respondents. Skills development was also high on the agenda - 85 per cent called for tax breaks for investment in skills and 70 per cent believe employers should be given more control over this investment.

CMI's chief executive, Ann Francke, said: "Getting Britain back on its feet requires measures to boost management confidence. We need commitment to a wide range of complementary measures, spanning everything from education and training to fiscal and monetary policy.

"Everyone knows things continue to be tough for British business and today's report shows that those steering firms through the recession are crying out for support. Organisations that invest effectively in management and leadership development perform better, so it's no surprise that measures to help them do this are near the top of employers' wish lists."

In line with managers' concerns about access to finance, 86 per cent said the Government should urgently stimulate bank lending to businesses while, at a time of rising youth unemployment, 81 per cent want apprenticeship funding to be increased.

"At the halfway point of the Coalition's five-year term, a worrying number of measures of economic health appear to be stagnating or worsening. Those on the ground trying to make their businesses work are still under pressure to cut costs, still insecure in their own jobs and still don't see things changing any time soon," Francke concluded.

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No set hours or defined offices will be the norm, says academic

Tomorrow's workers will be entering a completely different working environment, a trend predictor will tell future business leaders this week.

Speaking as a guest of AXA Business Insurance at Youth Enterprise Live, futurologist Dr Carl Rohde will talk to 15- to 30-year old budding entrepreneurs and jobseekers about his predictions for the future of the workplace.

Professor Rohde's provocative insights will explore in detail 10 drivers of change in the workplace of the future:

1. The world is now truly global - you will encounter competition from all over the world

2. Creativity and innovation will be key to successful performance

3. In order to be good, really good, you must not only know what your potential consumers, customers and employees want today, but rather what they'll want tomorrow

4. The future will show four different layers of society. They will do different kinds of work, with different degrees of income, independence and freedom

5. Many of the best will become urban nomads - a new generation of professionals roaming the globe in pursuit of highly skilled career opportunities

6. Jobs for life? Forget it!

7. Set hours for skilled labour will be a thing of the past.

8. We currently switch between the online and offline worlds. In the future, the lines between the two will become totally blurred. Call it: Onlife

9. Top down leadership will be inefficient and unacceptable in the eyes of the best. Leaders will need to be inspiring coaches

10. Whatever you do and however immense your talents may be, if you don't deliver on time, you'll never reach the top

"In the workplace of the future, you'll need to be prepared to work hard, harder than any generation in modern history, in order to succeed," Rohde said.

"Increased competition in the jobs market, from all parts of the globe, will break down a number of geographical barriers and make it even tougher to find work. Moreover, once you're in a professional position, it' s likely you'll be 'onlife' 24 hours a day, seven days a week, year-round."

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Thursday, October 11, 2012

Telemedicine: How It Can Work for Your Medical Practice

As a child, I never dreamed I would be able to communicate with a person several thousand miles away while looking at their face via video. Now, we can not only communicate via video with our family and friends, we can receive medical treatment from our providers.

Telemedicine is here and being utilized. Though there are some uncertainties regarding if, how, or when private payers are going to cover telemedicine, Medicare and Medicaid programs are utilizing the advances in technology to assist in treating our rural communities.

Medicaid coverage and eligibility varies by state. However, Medicare is clear on their coverage and position. Medicare does consider a telecommunications system to substitute for a face-to-face encounter in specifically allowed situations and areas.

Here's how it works:
• The Originating Site is considered to be the location of the Medicare beneficiary at the time the service is being furnished via telecommunications. This site must be located in a rural health professional shortage area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA).

• If you are located in an MSA, remember you can still participate by creating a relationship with a facility that is located outside of an MSA. These locations need qualified specialists to assist with their patients. Many times, patients living in rural communities need specialized care but do not have the means to travel. There are many opportunities for both sides.

• The Distant Site is considered to be the location where the practitioner is furnishing and receiving payments for the telehealth service. Eligible practitioners include:
o Physicians
o Nurse practitioners
o Physician assistants
o Nurse midwives
o Clinical nurse specialists
o Clinical psychologists/clinical social workers (cannot bill for CPT 90805, 90807, and 90809)
o Registered dietitians or nutrition professionals

• An interactive audio and video telecommunications system must be used that utilizes real-time communication (exceptions: Alaska and Hawaii).

• A few of the services covered by Medicare telehealth include:
o Consultations
o Office or other outpatient visits
o Individual psychotherapy
o Psychiatric diagnostic interview
o Follow-up inpatient telehealth consultations

• The distant provider submits the claim utilizing the same CPT/HCPCS codes they would normally with a modifier "GT" which alerts Medicare that it was a service provided via telemedicine (Alaska and Hawaii utilize the modifier "GQ").

• The originating site is allowed to bill for the service by utilizing the HCPCS code Q3014. The allowed reimbursement amount is minimal, but the ability to treat patients with a specialist who would not normally be available raises the quality of care level higher than ever before.

If your practice is interested in tapping into the telemedicine market, here are a few things to investigate and consider:

• Equipment can vary from a few hundred dollars to several hundred thousands of dollars.
o Webcam, computer & Facetime/Skype – this is the most cost effective process. The investment would range between $200 and $500.
o Mobile unit – $20,000 to $50,000
o Room unit – approximately $100,000

• Internet Connection - The key is being sure you have high speed Internet that will allow you to effectively communicate in a live environment, as well as an appropriate router with security functionalities.

• Licensure and Credentialing - Providers would need to be credentialed for the facility they are providing services.
• Medicare requires an 855I & 855R if the provider is located in another state.
• Other payers vary, so be sure to check before providing services.
States vary on licensures and would need to be investigated.

Other Considerations:

• Malpractice does vary and should be investigated.
• Policies and procedures should be developed to cover telemedicine processes, along with appropriate forms and consents.
• Staff would need to be trained on all policies, procedures, and best practices.
• Market opportunities with FQHCs, RHCs, hospitals and other providers with needs.

Even though at times the concept is hard to grasp, providers such as radiologists have been utilizing telemedicine for years just not in a live video environment. The sky is the limit to where the advances in technology are going to take the medical field. After all, 10 years ago who would believe we would be utilizing e-mail and the Internet to the magnitude we do today.

Find out more about Chastity Werner and our other Practice Notes bloggers.

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Healthcare Change: This Time, It's Real

In the 15 years I've been covering the healthcare business, one question has vexed me more than any other:

Why can't healthcare be more like other industries? Bankers figured out in the 1990s that leveraging information technology to allow people to see their own records and initiate transactions whenever they want just makes good sense, so they've deployed everything from ATMs to mobile apps to this purpose. Retailers have always understood that managing customer traffic efficiently is crucial to profit margins, so more of them are installing self-checkout machines.

Trucking companies know the value of fuel preservation and accident reduction, so most rigs now include satellite technology that tracks drivers' speed, lane changes, and hard brakes.

Healthcare, though, is stuck. The Institute of Medicine recently calculated that we waste some $750 billion a year on bloated bureaucracy, outright fraud, missed prevention opportunities, and needless tests and procedures. The only surprise is the size of the waste. I'm certainly not naïve to healthcare's inefficiencies, yet even I was struck by the number: $750 billion. Every year.

"That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout," noted The New York Times.

We've just about reached the point where healthcare's unsustainably high costs will actually be sustained no longer. America has major needs on virtually every other front, from education to infrastructure to our national debt, and Medicare's trust fund is scheduled to run out of money in 12 years. We really can't afford to continue wasting that much money, and we won't. The cuts in Medicare payments to healthcare providers called for in Obamacare — and those cuts are no bluff, they're law — are going to force providers (especially hospitals) to reduce costs or go broke.

What does it mean? Three things at least:

• Physicians have more power than they know, if they're willing to leverage it, and I think their power is increasing right now. I realize that's a strange thing to say. Yes, healthcare is becoming more institutionalized as hospitals seek to increase market share and drive economies of scale. But that means hospitals need your cooperation more than ever. They've always wanted your referrals but now they need you to be their partner. That's why so many of them, even as they acquire practices and try to hire more and more staff physicians, are fretting about how to create cohesive internal physician cultures. Are you considering hospital employment? Looking at selling your practice? Now's the time to leverage your power. Start by asking yourself: What do you want from your relationship with the hospital? And what are you willing to give?

• Information technology is going to change the way healthcare is managed in this country, mostly for the better. I understand that making changes in your work style, as any new technology requires, is a slow, painful, and frustrating task. And while I'm no apologist for the EHR companies, some of whom have created poorly designed products over the years, a paper system that misplaces charts and requires patients to carry them around from one provider to the next is indefensibly archaic. It's also over.

• The transition from our fee-for-service healthcare economy to one that pays for outcomes is underway, but the transition will be long, slow, and never entirely complete. You'll always get compensated for the services you perform (provided of course that the service is covered by the payer). Changing the economics of American healthcare is going to take many, many years. And you'll always be paid something for the services you perform; but a little more of your income each year will be tied to your ability to demonstrate that what you're doing is working.

Change is coming to healthcare, at long last. Physicians can't stop the change — not this time — but they can be a powerful force in shaping it. If they so choose.

Bob Keaveney is the editorial director of Physicians Practice. Tell him what you think at bob.keaveney@ubm.com or on Facebook: Unless you say otherwise, we'll assume that we're free to publish your comments in upcoming issues of Physicians Practice, in print and online.

This article originally appeared in the October 2012 issue of Physicians Practice.

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Vaccination Programs: Giving Medical Practices a Shot in the Arm

With flu season fast-approaching, now is a perfect time for physicians' practices to evaluate their vaccination offerings. In spite of the fact that the United States has the world’s most effective vaccine system, recent statistics released by the Agency for Healthcare Research and Quality (AHRQ) show that less than 70 percent of children receive all recommended vaccines.

Many of your patients may ask why shots are still recommended for diseases that we don’t hear much about, but the fact is vaccines prevent about 14 million infections and save 30,000 lives per year. Maintaining up-to-date records on your patients and matching the information to current vaccination recommendations from the Centers for Disease Control can open up opportunities to improve the health of your patients and boost the practice’s bottom line.

As a physician, you know that if patients stop getting the protection that comes with vaccines and booster shots, more people will become infected with diseases. In the US, on average between five percent and 20 percent of the population gets the flu and more than 200,000 people are hospitalized from seasonal flu-related complications each year.

Despite the advances in technology and development of both children’s and adult vaccines, medical practices have seen a general decline in the volume of vaccinations. Not only are some parents misinformed about the safety of vaccines but competition from non-traditional providers such as chain drug stores, grocery, and big-box retail pharmacies have lured patients with low prices and convenience.

To respond to this, physicians' practices need to make it as convenient and affordable for patients to get vaccinated whether it’s a seasonal flu shot, pneumonia, shingles, or other disease. This can include proactively reminding patients when they are due for a vaccination at the point of care, or through phone call or e-mail reminders. Equally important, physicians must ensure that they have a proper supply of vaccines and a variety of delivery methods to treat all types of patients.

In the past, shortages of some vaccines have been a concern. However, medical practices that work with group purchasing organizations (GPOs) may not realize that they are at an advantage in respects to vaccine cost and supply. A GPO can help practices solve vaccine cost and supply issues by offering access to contracts with multiple manufacturers which ensures availability and best pricing. Many also offer electronic ordering and direct-to-practice fulfillment which reduces the time from when an order is placed to when it is delivered.

If your practice is already working with a GPO, be sure to check their vaccination portfolio and resources and see what they offer. For practices not working with a GPO, here are some important questions to ask:
• Is the contract portfolio broad? Does it include a number of leading vaccine suppliers?
• Does the contract assure “best pricing” to deliver the needed vaccines at the lowest available cost?
• Do the contracts with suppliers offer the latest vaccination technology and delivery?

Take a fresh look at your practice’s vaccination program and see if there are opportunities to increase rates.


The CDC offers these tips to increase vaccination rates.
• Create a standing order in the practice that stipulates all patients meeting certain criteria should be vaccinated. Educate all practice staff on the existence and content of the standing order.
• Create a computerized patient record reminder that alerts practice staff when a patient is due for a vaccination.
• Flag the patient’s chart with a color-coded vaccination reminder for the physician to see prior to visiting with the patient.
• Create and implement a direct mail reminder program and telephone follow-up for patient vaccinations. An approved script for staff to use for telephone follow-up assures that the patient receives accurate, consistent information about vaccines from your practice.
• Provide an influenza vaccine information statement that can be handed to patients with their personal information forms to be updated upon check-in at your practice. The statement should present the facts about the vaccine, what it is for, and recommended vaccination schedule. Patients should be asked to indicate if they fall into any high-risk groups and they should be able to opt in or out of having the vaccine. The information statement also provides the physician with an opportunity to have a personal dialog with the patient about influenza and the important role vaccination plays in preventing the disease.
• Prepare a personal health record (PHR) for every patient outlining an individually-tailored preventive care schedule, including recommended times to receive vaccinations. Wallet card size PHRs are popular patient practice takeaways.

Dena Kitchens is senior director of physician services at Provista, a leading supply chain improvement company based in Irving, Texas. E-mail her here.

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Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.

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Negotiating the Sale of Your Medical Practice

The sale of physician practices to hospitals continues at a steady pace. For those physicians currently considering an offer to acquire their medical practice (or who may consider it in the future), today’s blog will talk about some issues that require attention when negotiating the sale of your practice.

1. Make sure all the important points of your deal are captured in the Letter of Intent (LOI). Too often, my physician clients fail to take the time to negotiate the terms which are “deal breakers” at the LOI stage, only to find the hospital is unwilling to stray from the LOI when it’s time to draft the final documents. The LOI is the most important piece in determining whether the parties have a deal that both sides can live with. Make sure you bring legal counsel into the negotiation process as soon as you are presented with an LOI that the practice is willing to consider. When my clients call me after the LOI is already signed, there is little I can do to improve the deal or correct misunderstandings.

2. An LOI will usually have a provision that does not allow you to negotiate with other parties after the LOI is signed until the final documents are executed or a certain date is reached (and the parties have failed to consummate the transaction by such date). Physicians who are trying to play different potential buyers against each other for the best deal must understand they may no longer be permitted to “shop” the practice once the LOI is signed.

3. If a practice wants its employees to be treated a certain way once the practice is acquired, this expectation must be made clear to the buyer. This includes protecting staff from being reassigned to a different position or location or from being terminated following the sale. In addition, be sure you are familiar with your existing employment contracts. Even if the practice is going to be sold, the practice must honor the notice provisions (and other promises) in its existing contracts, particularly for those employees not being retained. When it comes to informing employees about the sale of practice, be strategic. Informing staff too soon can lead to anxiety and the departure of those who feel uncertain of their future. A meeting with staff once it seems that a deal is likely is advisable. Sharing information and providing assurances can go a long way to preserve your best employees.

4. Electronic health records are an issue often overlooked at the LOI stage; however, if the practice acquired its own EHR which is still not fully paid for, and the practice will be unable to use it following the sale, this issue must be addressed. The hospital may be unwilling or unable to cover the additional cost of the unusable EHR and the debt must be addressed with counsel to see if it impacts the ability to complete the transaction.

A related issue can arise if the EHR is tied to a hospital/system other than the one which has made the offer to acquire the practice. It may be necessary to coordinate the transfer of electronic information from the old EHR to the hospital-buyer and avoid potential gaps in access to information. Not surprisingly, cooperation from the non-purchasing hospital is often not forthcoming.

5. If your practice will collect its own accounts receivable following closing, be sure you understand how this will be accomplished. Most hospitals are not willing to allow their staff (your old employees) to collect the old accounts receivable during work hours. Often a hospital buyer will agree to collect accounts receivable on behalf of the practice (based on a percentage of collections) or will allow the practice to pay hourly for use of the staff. This is something that should be discussed at the LOI stage.

In my next blog I will cover some of the compensation, covenant, and termination issues that should be addressed in negotiating to sell your practice. If you have particular questions about the process that you would like to see answered, please let me know!

Find out more about Ericka Adler and our other Practice Notes bloggers.

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Medication Reconciliation Opportunities and the Medicare AWV

Do you know every prescription and over-the-counter medication your patient is taking? The Medicare Annual Wellness Visit requires you to review a list of all their medications from all their providers.

A recent poll by the John A. Hartford Foundation found that 33 percent of patients did not have a regular review of their medications.

Medication errors occur in nearly one out of every five doses given to patients. ADRs cause more than 100,000 deaths a year, one of the top five causes of death. If eliminated, ADRs could save the United States $2 billion a year.

Seniors who are eligible for the free AWV take the most medications and therefore are at the most risk for an ADR. For example, interactions among prescribed medications result in more than 50 percent of emergency department visits by seniors (Budnitz et al, 2007) and one in four seniors receive a medication they should not have been prescribed (Aparusa & Mort, 2004; Salazar et al 2007).

Seniors often see more than one provider and take OTC medications they hear about from the media and friends. Medication reconciliation from a basic drug-to-drug interaction analysis can be provided by most EHRs and pharmacists, but only when they know all the medications a patient is taking.

More complete analysis is provided by the newest science known as “personalized medication prescribing or personalized medicine” which uses pharmacogenomics and pharmacogenetic testing.

The patient’s DNA is analyzed to determine the patient drug metabolizing gene variants. The most studied enzymes are the members of the Cytochrome P450 family of about 50 liver enzymes. They account for about 75 percent of the total number of different metabolic reactions, such as the 2C19 effect on Plavix (clopidogrel). The FDA is so committed to using genetic information to better tailor therapeutic dosing that it has required a “black box warning” on Plavix that says mutations in a patient’s genetic profile may render them unable to respond to the drug and places them at increased risk for heart attack and stroke. They list over 100 other drugs and combinations on their site which could indicate ineffective treatment due to genetic profiles.

The AMA has been developing resources that aim to enhance physicians’ understanding of pharmacogenomics. Among those are a CME course on pharmacogenetics, plus a brochure on the genetic variation that influences warfarin(Drug information on warfarin) dosing.

The most effective analysis of medication interaction is to analyze not only the drug-to-drug interaction, but also the drug-to-DNA interaction. More effective still is to conduct cumulative interaction testing on the effect of each drug as a combination with the genetic profile.

Patients can be separated into genetic classes of poor, intermediate, normal, and ultra-rapid metabolizers of drugs based on their enzyme variations. When a patient who is a poor metabolizer of a particular drug, like a patient with a poor CYP2C19 taking Plavix, he/she will process the drug more slowly or not at all, resulting in increased levels of the drug in his bloodstream and the potential for side effects and toxicity. For an ultra-metabolizer, the standard dose may be ineffective as the drug is processed too rapidly to have its full effect.
Genelex Corporation , a CLIA certified genetic lab in Seattle, has a thorough software program to provide pharmacogenetic analysis, including cumulative testing, which is covered by Medicare. They provide testing supplies direct to the physician and assume the full cost by charging insurance and Medicare.

“Eventually, everyone will have his or her own drug profile” says Frank Giardiello, MD, professor and Chief of Gastroenterology at Johns Hopkins.

Editor’s Note: The author is a paid representative for Genelex in the state of Florida.

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Understanding Fair Market Value: A Guide for Physicians

Last week, I detailed recent case law regarding medical practice leases and avoiding big trouble from the federal government. Now let's look at what you can do to stay safe:

Step One: Is Medicare/Medicaid involved? Are you accepting Medicare and Medicaid patients which you may refer to your landlord for treatment? If the answer is “no,” federal law is not implicated.

Step Two: Understand, the law. You are required to know it. In fact the OIG takes the position that below-market office space rental is offered for the purpose of inducing referrals.

Step Three: Do not assume every business lawyer, medical malpractice defense lawyer, or real estate professional does know the law. I have personally spoken with many malpractice lawyers who ask, “What’s a Stark Law?”

Step Four: Do your “due diligence.” During negotiations, you must find out what fair market value is for office space in your location. This may require the retention of a Health Lawyer or a fair-market-value expert who specializes in hospital lease negotiations. While this is a pain, if you haven’t already, you must think of “compliance” as simply a cost of doing business.

Step Five: Haggle (and document the haggling). The hallmark of a “sweetheart deal” would be that an offer is made to you, and you replied, “Wow, that is too good a deal to pass up.” This isn’t always a bad thing – is simply could be. The offer of office space should start with a proposal per square foot, with provisions for finish out. The rate per square foot should be in line with other rates for comparable space. Naturally, finish out allowance will depend upon whether or not the landlord must pay to make the space suitable. If the space was vacated by a prior tenant and nearly perfect “as is,” then you should get a lower rate per square foot.

Step Six: Document the Safe Harbors in the lease. Recall that a violation of the False Claims Act or the Civil Monetary Penalties Statute law usually requires some showing of a “Knowing” violation. It is therefore important to show in the lease that “compliance” was top of mind. This will not be a problem if your landlord is a hospital. The hospital will certainly include this language in the contract. But if your lease is with a smaller practice, either a single doctor or a small group, you may be handed a standard real estate lease form. Put an addendum on it which complies with Stark and Anti-Kickback Statute Safe Harbors.

Understand, none of these steps will absolutely guarantee you won’t be sued. You cannot control whistleblowers. You can only control your actions. Adopting and implementing good compliance practices simply offers your best chance that a whistleblower law firm will decline to accept the case, or that an OIG agent will elect to quietly pass you by.

Find out more about Martin Merritt and our other Practice Notes bloggers.

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Personal Health Record Usage and Medical Practices

Patients say they want transparency and instant access to their healthcare information, yet most remain on the sidelines when it comes to using these tools. Maybe that's no surprise when many physicians are still getting up to speed on EHRs. That may change — and soon. Stage 2 of the federal EHR meaningful use incentive programs requires that eligible providers make more healthcare information available electronically to more patients starting in 2014 — personal health records (PHRs) can help physicians reach that goal.

Still, meaningful use is not the primary motivator for PHR adoption, say medical practices using the technology successfully. Instead, it is driven by patient expectations, adept integration of information systems, and demands for value from physicians, patients, and payers.

So far, the PHR installations that seem to gain the quickest acceptance from patients share three elements: user-friendly technology, tie-in to a medical practice's website, and the encouragement of physician advocates.

Here's more information on what's driving the adoption of PHRs, what value they bring to practices and patients, and key tips for implementing them and encouraging patients to use them.

Patient expectations

Although recent surveys indicate disinterest in PHRs among patients — about 10 percent of Americans used them in 2011, according to Deloitte Center for Health Solutions — Brock Morris, chief information officer at Redmond, Wash.-based Pediatric Associates, hears a different story from parents of the practice's patients. That's probably no surprise, he says. Many of the parents bringing their children to the 85-physician multisite practice also work for the city's top private employer, Microsoft Corporation. "The parents of our patients tend to be a technically-minded demographic," Morris says. "We get asked all the time: 'What new services and solutions can you provide us?'"

PHRs, he adds, are a natural extension of his patients' parents' everyday experiences. "The parents are used to having information at their fingertips and being able to control it. They are frustrated when they want their child's immunizations or a growth chart and are told they have to wait a few days. In almost every other environment today, people get information quickly and can manage it themselves."

As younger, more tech-savvy patients become more active users of medical practices, the drive toward PHR adoption will increase. Indeed, Morris notes that younger generations of patients, including the parents he hears from at Pediatric Associates, gravitate to websites, text messaging, and other forms of communication.

Improved capabilities

Pediatric Associates is one of several practices around the nation involved in pilot testing interfaces between Microsoft's Web-based HealthVault PHR and their EHRs — Greenway's EHR in the case of Pediatric Associates. The approach aims to tie PHRs to EHRs via websites and, potentially, tie both to the medical devices patients use at home.

Morris says the beta version his practice is trying out allows parents to pull continuity-of-care documents (CCDs) about their child's care from the EHR and into HealthVault. Parents also can hook up their child's glucose monitor — and soon, other home health devices — to electronically enter data into the PHR to share with the child's medical team.

The pilot projects hope to overcome a barrier hobbling the prospects of free-standing, or "untethered," PHRs — lack of tight integration with a patient's clinical records and his provider's website.

Any individual can use HealthVault on the Web or via apps to create untethered accounts. But because HealthVault also supports common exchange formats, like CCDs, it essentially becomes a tethered system capable of electronically connecting with home health devices and a configured EHR. 

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Mass. Tries 'Open, Transparent' Approach to Malpractice Claims

A new Massachusetts law could be setting the stage for future reforms regarding how you disclose and perhaps even apologize for medical errors. 

The law, part of Massachusetts’ recently passed Healthcare Cost Control Bill, is the first ever to enable a disclosure, apology, and offer (DA&O) program across different practice environments and insurance arrangements.

Under the DA&O program, physicians will disclose medical errors to patients and they will be able to apologize to patients without the apologies being used as an admission of liability against them in court. A pilot program is underway at seven hospitals in the state.

“We have a pilot that will be looking at the effects at these seven hospitals over a 3-year period, but really, this is the fundamental type of transformation to a new and better model to deal with adverse outcomes without having to resort to litigation,” emergency physician Alan Woodward, chair of the Massachusetts Medical Society’s Committee on Professional Liability and a past president of the organization, told Physicians Practice.

The program also entails:

• A 182-day “cooling off period” while both sides try to negotiate a settlement.
• Full disclosure and apologies made by physicians to patients when a mistake occurs.
• An investigation into why the mistake occurred and establishment of systems to prevent future similar mistakes.
•When warranted, financial compensation offered to injured patients.
• Patients will have the right to consult an attorney to advise them of their rights and to evaluate the fairness of any offer or to bring legal action if they so choose.

“The whole concept here is to replace what is a very onerous, inefficient, adversarial system with an open, transparent model where physicians can advocate for patients rather than viewing them as the enemy when something goes wrong; where instead of blaming individuals, we look at how you fix systems to prevent recurrences,” said Woodward. In addition, he said that the legislation will take “the fear out of the system,” and therefore, reduce defensive medicine.

A similar DA&O program may be down the road for you. Woodward said the hope is that the program will become a national model. 

“What we’re doing here in Massachusetts is taking a model that’s been very successful in closed hospital systems and trying to create an environment where it can be implemented — and it’s volitional — but can be implemented statewide,” said Woodward, noting that the University of Michigan, Stanford, and a host of other hospital systems have implemented similar models successfully.

Since instituting its program, the University of Michigan Health System has cut litigation costs by $2 million a year, and medical liability claims have fallen 40 percent, according to American Medical News.

What do you think of the Massachusetts model? Would you participate in a program like this as a physician? Why or why not?

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Medical Necessity: Physicians Need to Prove It to Payers

As frustrating as this sounds, the insurance companies really are running the healthcare industry. Yes, I said it, out loud for all to hear.

Each insurance company has a definition of “medically necessary” (or medical necessity) and one may have a different set of standards than another. You don't really know what those are until you receive the denial for payment. The other area where they really tie your hands, whether in the treatment room or hospital, is what treatment codes they will authorize and which ones they won't — restricting you from providing the very best service to the patient.

I read an article the other day about how physicians and a patient are actually suing HealthNet for not paying a claim after they authorized it, stating "not medically necessary."

I, personally, have had experience with this type of situation back in 1998. I had obtained the proper authorization from Blue Cross to have a procedure done. Two days in the hospital followed and I ended up with a $35,000 bill from the hospital, physician, anethesioligst, labs, etc.

Blue Cross denied all of the claims because “it was not medically necessary” despite the due diligence of prior appointments stating that it was indeed necessary. Luckily, I was taught the difference between right and wrong, persistence, and how to respond when I feel like I'm being pushed around. I fought back. For two years.

I wrote letters to Blue Cross asking them to pay these bills. I “cc'd” all of my physicians, and they luckily stood behind me. After two years of receiving denial EOBs in the mail, I'd had enough. I sent a very thick notebook of all correspondence between myself and Blue Cross to the California Department of Insurance. Within two weeks, I received a letter from the department stating my claims had been closed and paid by Blue Cross. It took them two weeks. It took me two years and much persistence. Can you imagine how many people do not get the treatment they need and deserve because of an insurance company stating it is not medically necessary or worse, have to pay all of those claims themselves?

Insurance companies are also known for restricting what types of services you may provide a patient. It's filled in right there on the authorization. You can do “this,” but not “that.” You want to be paid, so you go along with it. How frustrating this must be for you and the patient!

So what can you do to make sure your patient is treated the way they need to be, and that you are still being paid for your service? Work with the insurance companies. Yes, I said that out loud, too.

Be diligent and when verifying benefits and asking for authorization, be sure to ask the rep if code XYZ is covered under the patient's plan, and if not, which one is equivalent is covered. If you need to write a letter of medical necessity, do it. Show them that by providing a specific treatment, it will help the patient in the long run, and cost the insurance company much less in cost.

Will allowing a patient physical therapy avoid surgery? Explain that in your letter. Can a series of treatments provide pain relief so that the patient no longer needs expensive medication? Explain that, too.

It's all about communication. Do your very best upfront to be as open and honest with the "why"s of the treatment the patient needs, and you are more likely to take back the control of who is really treating a patient. You.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.

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Physicians Survey Sheds Light on EHR Implementation Anxieties

In addition to being overworked and financially overextended, physicians are concerned about the effect EHRs will have on the care they provide patients, a recently released survey of 13,575 U.S. physicians reveals. 

The mammoth-size, 100-plus-page survey — commissioned by The Physicians Foundation, a nonprofit organization with members drawn from 20 signatory medical societies and associations — covered a number of areas, from feelings about finances to attitudes about patients. But it was, arguably, the comments and answers to technology questions by physicians that reflected a lingering sense of EHR anxiety among the medical community.

More than 69 percent of physicians surveyed indicated they have implemented EHRs. But not all of them believe their EHRs have improved (or will improve) quality of care.

Fewer than half (46 percent) of physicians who have implemented an EHR indicated their system has already improved quality of care or that they anticipate it will. Another four percent noted their EHR has, so far, decreased quality, but they expect things to turn around.

But one-third of those with EHRs — 31 percent — said their EHR has either had no effect on quality or has not improved quality, nor do they expect it to do so. And more than ten percent of EHR-holding physicians indicated the technology has actually decreased quality of care.

Physicians didn’t hold back their emotions about EHRs in the survey’s comments section. Aside from quality-of-care issues, one big complaint was the lack of compatibility and interoperability among EHRs.

“Until all doctors are on the SAME electronic network it’s a complete waste of time and money,” noted one physician. “There are so many different EMRs that are NOT compatible with one another.”

Another big issue is the cost of EHRs, especially for small practices.

“It would be a significant financial hardship (actually, financial impossibility) for me to begin using electronic prescriptions and /or EMR,” wrote one physician, who described himself as a solo practitioner with one full-time nurse and one part-time employee. “Not only the equipment and software costs, I simply do not have the revenue to hire someone nor the time to enter patient data, demographics, etc into a system of that kind nor the revenues to hire an IT person to manage and maintain it."

Walker Ray, vice president of The Physicians Foundation and chair of its Research Committee (and former practicing pediatrician), said he’s not surprised. Many physicians are already so overwhelmed with primary concerns — such as potential Medicare and private payer reimbursement drops, and the erosion of autonomy (not being able to give the care they want in a highly-regulated environment) — that implementing EHRs and adjusting to them can be highly stressful. 

“EHRs are seen as a necessity as much as a disruption,” Walker told Physicians Practice. “It takes significant distraction to implement EHRs. They will increase quality, [however], there’s no evidence they’re going to save physicians money.”

What does surprise Walker is the sheer number of physicians who have adopted EHRs, though it should be noted that the survey showed attitudes and adoption varied by age and other demographic factors.

“Younger physicians are a little more optimistic that electronic medical records can improve care,” said Walker.

Indeed, 63 percent of physicians age 39 and younger expressed optimism over the ability of EHRs to improve quality of care, compared with 47.5 percent of physicians age 40 or older. And primary-care physicians expressed more optimism than specialists, as did female physicians.

“As far as the EHRs go,” says Walker, “there is quite a diversity in physicians’ opinions on whether they’re going to help or not.”

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