M. Courtney Hughes, Ph.D.


This spring, Relias Learning embarked on one of its most ambitious undertakings in putting together the second edition of its State of Staff Development and Training report. A follow up on the 2015 version, this year’s report is significantly larger with responses from more than 5,000 healthcare professionals across the continuum of care. 

Within post-acute care, we identified issues related to barriers to staff development and training, the importance of licensing and certification, and training technology utilization that are particularly relevant for small to midsized organizations.

Small to mid-sized organizations with less than 200 beds account for more than 90% of all long-term care facilities and serve more than half of long-term care residents in the U.S. However, our findings show that these organizations are more likely than large organizations to have difficulty training their employees due to staff shortages and lack of time. The challenges for training at small to mid-sized organizations require an integrated solution, and part of that involves investing in skilled workers to meet both compliance requirements and performance goals that directly impact profit and reimbursement dollars.

Findings from the report that stood out for the post-acute care market included:


  • Online training. Use of online training versus face-to-face or written material training was lower the smaller the organization’s size. Online training is one strategy to save time and costs, two areas that can prove challenging for small to mid-sized organizations.
  • Learning management system (LMS). Advanced methods for tracking and delivering online training and assessments such as using an LMS was 20% lower for small organizations than for large organizations. An LMS can help organizations reduce compliance failures, prove compliance during an inspection, and manage performance improvement training goals and progress.
  • Licensing and certification needs. Over 90% of all post-acute care organizations surveyed, independent of organization size, reported that staff development and training is extremely important to the licensing and certification needs of their staff. 

First, assess where your organization fits in the context of the above findings. Do you offer online training and an LMS to meet your organization’s compliance requirements and performance improvement goals? Additionally, assess your prospective and current employees’ knowledge and skills to evaluate strengths and weaknesses. Structured employee assessments can be part of an integrated solution to overcoming staff shortages and compliance failures.

Next, if you find that your organization is facing the barriers of staff shortages and lack of time, implementing technology-based solutions such as online learning and an LMS can help overcome these barriers in a cost-effective way. Across the industry, we found that long-term care organizations value the individualization, flexibility, and topic variety that come with online training offered through an LMS. With an LMS, staff members can see exactly what training they need and can access courses at a time convenient to them.

Small to mid-sized organizations are used to prioritizing their employees, with many of these entities stemming from a “family feel” environment where they remember having just a handful of employees. Offering adaptive, flexible learning opportunities and a management system to track training goes hand-in-hand with the attitude that their employees are an essential part of their business. Technology implementation is a logical step as these organizations grow and serve a greater number of residents.

Lastly, successful implementation depends on several factors. Right at the top is leadership buy-in along with executives, nursing directors, and front-line managers acting as first adopters of the training technology. Long-term care facilities of a smaller size may have an advantage over larger facilities since their leaders often have greater contact with the employee population. If leaders support training technology utilization, employees witness this and may act in accordance. Furthermore, communication from organization leadership about the importance of the training technology and its link to quality improvement has fewer organizational layers and physical locations to cross.

Small to mid-sized long-term care organizations may not have employees on staff to serve as facilitators to assist in implementing learning management systems and analytic programs. Instead, these organizations may hire external consultants or depend on their technology vendor to serve this role.

What is the impact on quality?

Long-term care organizations report quality improvements after rolling out online education initiatives. Sister Kevin Patricia Lynch, administrator for the St. Patrick’s Home Rehabilitation and Health Care Center in the Bronx, NY, a larger skilled nursing facility, stated one of the benefits her nursing home experienced after implementing an online education curriculum: “[O]ur staff has become more observant about acute changes in residents.” Such improvement in the quality of care at facilities of any size is a key motivator for implementing online staff training systems. It’s just a matter of time before that quality improvement translates to better health outcomes for residents.

At the end of the day, healthcare professionals at small to mid-sized long-term care organizations must still meet licensing and certification needs just as their counterparts at larger organizations; our study showed staff development and training plays a huge role in facilitating this. In addition to meeting external requirements, it is imperative that long-term care staff at these facilities achieves and maintains clinical competencies that translate to higher quality care for their residents.

M. Courtney Hughes, Ph.D., MS, is the Senior Researcher of Healthcare at Relias Institute and author of 2017 State of Staff Development and Training: A National Perspective on Healthcare Performance Improvement.