Using Immersive Technologies to Recruit, Onboard, and Train Direct Care Staff

Posted by Todd Maddox & Tim Fitzpatrick on Dec 19, 2019 10:52:21 AM
Using Immersive Technology to Recruit, Onboard, and Train Frontline Senior Care Staff
Meet Raul, Octavia, and Thomas 

Raul, Octavia and Thomas had been on the job hunt for a while looking for an entry level opportunity in the fast-growing senior care profession. All three were excited for the opportunity to work with seniors and were thrilled when a local senior care facility called them in for an interview. In the interview, each was asked to discuss their credentials, aspirations, and why they wanted to work in senior care. Raul stated that he “wanted to give back”; though, he had no experience caring for an older adult. On the other hand, both Octavia and Thomas had grandparents who they had helped care for in recent years. They both stated that they knew what to expect, yet  neither had any formal senior care experience or training.

All three landed the job, and began a 1-week onboarding process. Onboarding involved a mix of shadowing a seasoned caregiver, and online training. Raul was overwhelmed from the start. He had no idea the job would be so stressful and mentally draining. He wished he had spent some time in the facility simply observing the senior care staff before accepting the position. He left the position 3 days into the onboarding process. He was disappointed that he had spent so much time pursuing a job that he was clearly not prepared for; while the senior care facility was disappointed that they had spent time and resources on a recruit who was not a fit for the position. They wished they could find a way to better evaluate the “fit” between a recruit and the skills needed to work in senior care settings.

Octavia and Thomas fared a bit better, most likely due to their personal experiences caring for their own grandparents. Both found their seasoned caregiver trainer to be well informed and willing to answer questions. Unfortunately, the seasoned caregiver’s schedule was such that there was very little time for the shadowing process. Instead, Octavia and Thomas spent the majority of their time reading training materials and clicking through PowerPoint slides. Both found the online training to be lacking. It was not engaging, was poorly constructed, and from what little time they had shadowing, both felt a serious disconnect between what they would actually be doing, and what they were learning from the online materials. They wished to learn more skills, such as those around mobility safety and medical procedure. They wished to gain a deeper insight into the daily life of a senior; in particular, the physical, mental and emotional challenges. They were reading about these but wished that they could see, hear and touch the world through the experience of the senior. They yearned to “walk a mile in the shoes of a senior”. They also wished for more situational awareness training. In their brief shadowing sessions, it was clear that senior care staff have to think on their feet and be ready to pivot from second to second. They need to deal with stressful and sometimes chaotic situations all while remaining cool, calm, and collected.

Octavia was especially distressed about the onboarding process. During her brief shadowing sessions, she observed the types of technical skills, empathy, and the situational awareness she would need to be successful in her job, but she did not feel like she was gaining any of this from the online training. She talked to a few of her fellow new hires and they agreed, stating that most of their practical learning was on-the-job. Some coworkers told tragic stories about errors that they made early in their tenure that could have been avoided with better training. Octavia feared the end of the onboarding process when she would be deemed ready to work on her own, knowing full well that she was a novice at best. Octavia persevered through the online training and ultimately completed all of it by the end of the onboarding process, but she was so dissatisfied that she began looking for another job immediately. It took a few weeks to find a new position, and exactly one month after being hired, Octavia was gone. She felt bad for leaving, but also felt that the training was sub-par and that she was being set up for failure. The senior care facility was also distraught since 2 of their 3 hires were now gone.

Thomas persisted in hopes that he could navigate the situation and learn on-the-job. He was also informed that there was an ongoing training curriculum, and his hope was that it would be better than the onboarding training, or at least more hands-on. Although the breadth of content was superior to the ongoing training curriculum, Thomas still found it underwhelming and did not feel that it prepared him for the challenges he was facing on the job. As with the onboarding content, Thomas felt that it was largely disconnected from his day-to-day job description — more theory than practice. Even so, Thomas worked hard and gained the critical behavioral skills, empathy and situational awareness needed to succeed in his position. He admits that nearly all of this knowledge was gained on-the-job through experience, and not through the onboarding or ongoing online training. It was also not without mishap. A few stressful situations occurred that could have been tragic, but fortunately, a more experienced caregiver interceded.

A Broader Training Challenge

The story of Raul, Octavia and Thomas is a common one in senior care. Frontline staff turnover is high, and training is often ineffective. Frontline staff need cognitive skills training such as the rules and regulations, details of medications, and the like. Frontline staff need behavioral training on skills such as safe transfer from a bed to a chair or from a chair to walking, as well as basic medical procedures such as the care and maintenance of a central line. Critically, frontline staff also need empathy training. The best senior caregivers can see the world through the eyes of the senior. They can empathize with the struggles of the other family members. This requires an emotional understanding and emotional learning. Finally, the frontline staff needs the broad-based experience necessary to build situational awareness—the ability to know what to do when, and to anticipate change in the current environment. Situational awareness requires behavioral, emotional and experiential learning.

Although the details are beyond the scope of this report and can be found here, suffice it to say that cognitive learning occurs in the prefrontal cortex of the brain, and requires working memory and attention, both of which are limited capacity resources (see Figure 1). Behavioral learning occurs in the striatum, a subcortical structure in the brain and requires real-time immediate feedback to increase the prevalence of correct behaviors, and decrease the prevalence of incorrect behaviors. Emotional learning occurs in the amygdala and other limbic structures, and adds that personal, motivational, and emotional touch to learning. Experiential learning involves the sights, sounds, tactile and olfactory aspects of a learning environment by engaging the occipital, parietal, and temporal lobes of the brain.

Screenshot from 2019-12-19 09-15-39

Figure 1: Learning and performance systems in the brain .

In Figure 2 below, we show the timeline for the typical approach to recruiting, as well as onboarding and ongoing senior care training. Time is on the x-axis, and skills, empathy and situational awareness is on the y-axis.

The frontline senior caregiver journey starts with the recruitment process, most likely in a face-to-face interview between the recruit and the hiring manager (1 hour or so). Credentials, aspirations, and motivation for working in senior care are discussed. This is all about gaining a cognitive understanding of the recruit and their fit with the senior care facility. However, and as we saw with Raul, often a recruit’s beliefs about their fit in senior care, differ substantially from the reality. Ultimately, this mismatch becomes clear, but not until the candidate is hired and is working in the senior care setting. This is sub-optimal and is disadvantageous for both the candidate and the senior care facility. A lose-lose that costs the recruit time, and directly costs the senior care employers 25% of annual compensation for each lost employee - not to mention indirect costs including lost productivity, lower quality of care from poorly trained replacements and disrupted continuity of care.

As outlined above, the onboarding process takes about 1 week. It involves a mix of shadowing and online text-based learning, with the majority of time spent in the online environment. Because onboarding training is predominantly text-based it engages only the cognitive system in the brain, and thus no skill, empathy, or situational awareness is obtained. Shadowing does engage behavioral, emotional and experiential systems in the brain, but because it represents only a small fraction of the onboarding training, the engagement is low. This is why Octavia and Thomas experienced a strong disconnect between the online education and the shadowing training. Online is purely cognitive whereas shadowing broadly engages cognitive, behavioral, emotional and experiential systems.

Screenshot from 2019-12-19 08-52-38

Figure 2: Timeline of traditional dialysis device training .

Once onboarding is complete the recruit is ready to work without supervision. Ongoing, formal training may be available in the form of additional online training, and continuous education in the classroom. Even so, most of the important skill, empathy and situational awareness learning obtains from on-the-job interactions in the senior care facility. Cognitive, behavioral, emotional and experiential systems are engaged broadly and in synchrony. This is valuable but as suggested by Thomas’ experience, it can be fraught with errors, some of which could be dangerous for the seniors, their family, or the staff.

Figure 3 shows the timeline for an immersive technology approach to recruitment, onboarding and ongoing training in senior care. With respect to recruitment, an immersive technology approach would supplement the face-to-face (cognitively-dominated) interview with an immersive “Day in the Life of Senior Caregiving” 360-virtual reality experience. In a brief 5 to 10-minute span, the recruit can experience a “Day in the Life of Senior Caregiving” where they watch the rules being followed or broken — along with the consequences. They might shadow a seasoned professional mitigating a fall, experience the challenges associated with memory loss, or experience the stress and anxiety associated with an unruly senior. The recruit can obtain a first-person virtual experience with an apathetic or non-communicative frontline worker, and experience the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes. An experience like this can reinforce, or bring into question a recruit’s beliefs about their fit with the job. Either way this will make the recruitment process more effective and reduce the time and money wasted by the recruit and the senior care facility.

During the onboarding process, online text-based education can either be replaced by or can be supplemented with 360 VR educational modules. These VR modules can provide all of the same information present in online education, but from an experiential standpoint, and with the emotional context so important in senior care. Critically, immersive education of this sort engages cognitive, emotional and experiential learning centers in the brain in synchrony. This spreads the wealth of information and spreads the burden reducing cognitive load. This speeds learning and retention and primes the learner for behavior change that will emerge during the shadowing training. Critically, and unlike typical online education, VR experiences can be constructed that present the caregiver-in-training with challenging situations that they may rarely see on-the-job, but ones that can be fatal. They can experience stressful situations such as an unruly patient. This builds a broad knowledge base and situational awareness that does not develop with traditional approaches. These VR experiences will complement the shadowing training, and unlike the disconnect that Octavia and Thomas felt, they will feel highly complementary. 

Screenshot from 2019-12-19 09-27-46

Figure 3: Timeline of immersive technology dialysis device training .

Once on-the-job, ongoing VR and augmented reality (AR) training can incorporated. VR or AR could be used to develop expertise in caring for vents, IV therapy, feeding tubes, the care and maintenance of a central line, or even techniques as complex as dialysis. With immersive technology, a virtual instructor can guide the caregiver-in-training. Because the training is one-to-one, and hands-on cognitive, behavioral, emotional and experiential systems in the brain are engaged in synchrony throughout all of the training, which speeds the development of the relevant behavioral repertoire, and quickly culminates in behavioral competence. With VR and AR, the caregiver can get up to speed quicker and stay current more easily on the operation of new medical devices and techniques as needed. (7)

Of course, hybrid approaches are also worth exploring that can provide immediate value for Raul, Octavia, Thomas, others interested in a career in senior care as well as senior care facilities. For example, it would be highly advantageous for a senior care facility to develop a single or a series of “Day in the Life of Senior Caregiving” VR experiences. These could be incorporated immediately into the recruitment and onboarding processes, and would likely reduce turnover, and errors immediately. This could be followed by the development of VR and AR solutions that target behavioral competence with specific medical skills. 

Senior care recruitment, onboarding and ongoing training that incorporates immersive technologies, such as VR and AR, will reduce frontline staff turnover and will lead to faster learning and stronger retention of relevant information. Broad-based behavioral repertoires and situational awareness will develop quickly and naturally in caregivers. Caregivers will be on-the-job ready quickly and with confidence, and seniors and their families will be very satisfied with their care – one experience at a time.


Topics: Senior Care, Onboarding, Training, Caregiving, Learning, Neuroscience, Staff Training, Recruiting, Workforce, Empathy, Aging

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