Children’s of Alabama increased staff engagement, reduced turnover, and decreased the use of restraints with an in-house certification program.
The challenge
In 2023, Children’s of Alabama experienced a combined voluntary/involuntary turnover rate of 43% among staff in the inpatient behavioral health unit, in part due to the intensity of the work and high patient acuity. Staff also reported that patients were not receiving care up to the hospital’s standards and staff did not feel fully equipped to provide it.
The solution
The turnover data and employee feedback prompted the hospital leadership to seek solutions directly from the source.
“Over the years, I’ve learned if you want know to the best way to provide the best resources for your staff, ask them what they want,” said April Weatherly, director of inpatient behavioral health at Children’s of Alabama in Birmingham. “We didn't want to guess what our staff needed in terms of professional development.”
Hospital leaders surveyed staff about what education they wanted regarding behavioral health. Based on the feedback, a multi-disciplinary team of the hospital’s psychologists, therapists, nurses, and floor staff developed a comprehensive quarterly curriculum, Acute Behavioral Health Certification (ABHC), around four primary topic areas:
- De-escalation techniques. Includes understanding challenging behavior in children with early-life stress, professional boundaries, knowing when to tap out, and avoiding power struggles.
- Self-care. Covers topics such as workplace bullying, emotional wellness and flexibility, and increasing self-awareness.
- Ethical communication. Explores Child-Adult Relationship Enhancement (CARE) skills, hearing vs. listening, judgment, and working with an explosive child.
- Common diagnoses. Includes education around PTSD, psychosis, transgender care, and autism spectrum disorder (ASD), which survey respondents overwhelmingly requested more training on.
Each unit contained a mandatory course as well as four optional electives. Staff input informed the scheduling; courses were held for both day and night shifts and around patient schedules. Weatherly and her team worked with the hospital’s human resources department to develop the educational program to count it toward staff certification. Additionally, funding from a donor and the hospital foundation enabled a $500 bonus for staffers who completed all 20 courses. Participation in the curriculum was also included in the staff’s performance evaluation process.
Importantly, hospital leadership not only supported the curriculum’s execution but also participated in the coursework. “We like to lead from the front,” Weatherly said. “We decided that as leaders, we were going to attend—at a minimum—the mandatory training and sit in the trenches with our staff so they could see us engaging and asking questions; we were very dedicated to this project.”
The results
The hospital’s dedication to these efforts paid off. Among the staff outcomes stemming from the ABHC program:
- Staff turnover fell by 50%.
- 61% of staffers reported being “extremely engaged” at work.
- Nearly three-quarters felt they grew professionally.
- More than 70% said their co-worker relationships improved and felt an increased sense of peer-to-peer accountability.
- The overall workforce increased 25%.
The ABHC training led to significant improvements in patient outcomes as well. Children’s saw a 44% decrease in the use of restraints and seclusions—eclipsing the goal of a 10% reduction.
Most notably, the hospital experienced a 388% increase in de-escalation and rapid response calls. ABHC training on de-escalation techniques played a substantial role in this improvement, as did process changes that Children’s of Alabama implemented: they empowered any staffer to call for rapid response and increased accountability in the way rapid response calls were reported. Now, the charge nurse is responsible for ensuring that all rapid response calls are logged, and a debriefing is held afterward.
The ABHC de-escalation training was also integral in ensuring the hospital staff could absorb such a dramatic increase in de-escalation and rapid response team utilization. “Part of what we’re doing to better serve and better utilize our staff is that when the team arrives, the staff who was originally there backs off,” said Amy Brown, manager of the milieu and behavioral health quality incentives. “Then we don't have so many manpower hours and energy tied up into one situation.”
Next steps
Children’s is working with other departments across the organization to offer content tailored to each patient population, including other areas of behavioral health, physical and occupational therapy, and the emergency department. The team has also moved on to the second level of its ABHC training, focusing on social determinants of health and their impact on behavioral health. The third level of education—currently being planned—will involve trauma-informed care.
Weatherly and Brown’s presentation was part of the session, “Innovative Approaches to Supporting Staff,” at Children's Hospital Association’s 2024 Transforming Quality Conference.
