Building Onboarding, Quality, and Learning Systems in Healthcare Startups with Anna Ballard, PA-C
- Jul 15
- 31 min read
Clinical Onboarding as Infrastructure in Healthcare Startups with Anna Ballard, PA-C
Anna Ballard, PA-C builds clinical onboarding and learning systems inside healthcare startups that are scaling quickly. Her work sits at the intersection of training, operations, and clinical quality, where new clinicians must become productive in environments that are still being defined.
In this conversation, Anna and Helen discuss what it takes to design onboarding without an established system, and playbook. They look at how early-stage teams translate clinical expectations into repeatable systems, why onboarding functions as operational infrastructure, and how time to productivity becomes a defining constraint in scaling care delivery.
They also discuss the transition clinicians make into operator roles. This includes moving from individual care delivery to shaping workflows, competency expectations, and cross-functional execution with product, engineering, and finance teams. Further looking at competency framework development in high-growth environments, support structures for new graduate clinicians inside startups, and how onboarding design shapes clinician readiness.
This episode is relevant for clinicians working in healthcare startups with early operator roles, onboarding and training, and for leaders building systems from the ground up.
Must-Hear Insights and Key Moments
Anna Ballard draws a distinction between medical education and operational readiness in fast-scaling digital health environments.
Onboarding challenges reflect workflow and systems design decisions rather than gaps in clinician knowledge or performance
Training design in startups sits at the intersection of clinical education and operational execution, requiring both clinical and business fluency
Clinicians in early operator roles benefit from developing communication and influence skills to align clinical priorities with organizational constraints
New graduate clinicians require structured support models such as transition-to-practice programs and mentorship systems in fast-changing care settings
Cross-functional collaboration with product, engineering, and finance becomes a core part of clinical leadership in healthcare startups
Effective onboarding design prioritizes what clinicians need to do in day-to-day workflows
Clinical competency must move from checklist completion to structured, stepwise behaviors that ensure clinicians can consistently deliver quality care under pressure in real startup environments.
Words of Wisdom: Standout Quotes from This Episode
" Roles are incredibly important in a system. We can't ‘just’ build this training. It's not just gonna run itself completely. " - Anna Ballard
" There are opportunities to raise your hand and get involved. Just like in that startup I was curious about doing more.”- Anna Ballard
”I definitely had to develop my communication skills, influence skills, and business acumen. It is incredibly important that we have this idea for training and learning.”- Anna Ballard
Clinicians can be labeled as resistant to change, but really a lot of the time it's really a path problem; a workflow problem, an environment, incentives, and culture.” - Anna Ballard
“Training and quality should not be separate functions. They are part of the same system of care delivery.”- Anna Ballard
“ Because the reality is you have the systems they need to learn, they need to shadow into our care model, and they need to be able to feel like they're supported and independent on their own.” - Helen Tanner
“ There's the clinical training and then you have the operational training of how the startup functions and the day-to-day of the actual work within the company.”- Helen Tanner
“I do think, because of where AI is now, and because there are people like you out there supporting this with expertise, people can get to more elevated training quicker than they have in the past.“- Helen Tanner
“The end in mind can be different depending on the stage of what the company, where the company is.” - Helen Tanner
“if you have any desire or interest in growing into other roles, then taking the initiative to expand on that interest and build those business‑fluency skills is key to succeeding in that way.” - Helen Tanner
Mentioned in the episode:
About Anna
Anna Ballard is a PA-C and strategic Clinical Systems Builder with 11 years in clinical practice and 7+ years leading training, quality, and process improvement in growth-stage healthcare organizations. As a former Director of Medical Learning and Development at Curology, she understands both the clinical realities and the L&D systems needed to support scaling teams.
Through Process to Practice, she partners with Clinical Operations and People leaders at Series A, B, and post-M&A healthcare companies — from telemedicine platforms to care coordination services — to build onboarding, training, and quality systems that reduce time-to-productivity while supporting consistent care delivery and clinician retention. She also coaches internal clinical leaders to become strategic training leaders who can speak the language of business and partner effectively with operations and cross-functional teams.
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Blog Transcript:
Note: We use AI transcription so there may be some inaccuracies
Helen Tanner: There is a particular kind of clinician leader who does not just deliver care, they build the infrastructure that makes the care delivery possible at scale. They design the onboarding, they develop the competency frameworks, they figure out how to take what a great clinician knows and make it teachable, repeatable and measurable across a growing team.
Today's guest built that expertise from the inside. Anna Ballard is a PA leader and clinical systems builder with over a decade in clinical practice and leading training, quality and operations inside a growth stage healthcare company. She rose to become the director of medical learning and development at a scaling national telehealth startup, a company that grew to hundreds of employees and hundreds of millions in revenue delivering care to patients across the country through a direct-to-consumer model.
She built the clinical onboarding training systems and competency frameworks from the ground up during that growth phase, making the case that great training is not overhead, it is infrastructure. She now runs Process to Practice, a clinical learning and development consulting practice that partners with series A through post-merger healthcare organizations to scale clinical onboarding and operations without compromising care quality or the clinician experience.
Anna, welcome.
Anna Ballard: Thank you so much, Helen. I'm so happy to be here and also to be a member of the Early Hires community.
Helen Tanner: Well, thank you. So let's start off here. So you practiced as a PA, and at what point did you realize that your path was going to take you somewhere outside of traditional clinical practice?
Anna Ballard: So at my first, job at a federally qualified health center, I was really able to get plugged in to, committees and, learn about, how they managed ethics.
And, also had early exposure to a PA who was a medical director, there. So that was a really, really great early exposure to, like, PAs as leaders. And, I don't think I had the language for it at that time that, I might go on to, have a non-traditional career, but that was kind of an early start.
And then, I joined the high-growth, teledermatology startup as a clinician number 10, I think. And, seeing patients. at the beginning, a mini dermatology fellowship, like learning how to do dermatology, elbow to elbow. And it was a very,undefined, fast-moving environment.
And, because of that,I, I think you probably hear from a lot of guests, there's opportunities to raise your hand and, get involved. And, in that startup I was curious and about doing more. And so, started to see what was energizing me and that's how I, I was able to move into,the roles that led me to where I am today.
Helen Tanner: and you started, on that kind of different path outs- in addition to building on your clinical practice, more in a learning and development role. Is that correct? Like, an onboarding and training role? Or what was that move for you that first gave you kind of that experience to expand upon your clinical duties?
Anna Ballard: Yeah. Yeah, definitely. So, even, informally, I got involved in just new hire training- Mm-hmm ... onboarding programs. So I, built the first formal onboarding program, for our NPs, our PAs, our dermatologists. then as I formalized my role, there's always gonna be knowledge management built into training and onboarding.
So, how do we manage all this information that is critical for our people to do their jobs?also, my role moved into clinical quality and, CME programs and I think I really just, like... we can get into it later, but, all of this kind of, merges together for me with creating a clear path for people.
and so whether that's as a new hire, joining a company and you're, like, in a new environment and you're trying to just do your job and do a really good job, a clear path is important. And, likewise, if there's a new, tech tool that people need to use to do their job, you know, how do we make that, path clear?
and so I think finding those opportunities where I could, organize and I could create clarity out of complexity is how I made that jump into those early roles.
Helen Tanner: take us back a little bit more. So when you, were at the startup and you were there at a early time, you said there was about 10 clinicians- Yeah
telehealth, you know, you were obviously working seeing patients. was there already a learning, an, an onboarding and learning and development? There must have been something, 'cause you were trained. was there something where, there was a request like, we want to take this to the next level.
Who's interested?" Or was it something where you were like, "Hmm, this is great, but I have a lot of ideas and I think we should do it this way. What do y'all think?" how did that come to fruition? What did you
Anna Ballard: yeah, I would say it was probably a, a met in the, met in the middle,
I had a lot of ideas about how to make this more clear and more standardized. I think when I joined, you know, it was very informal and, just sitting by somebody and looking at a slide deck, not really a standard process for that.I had all these ideas for how we could, we could systematize this and make it consistent month over month as we were needing to grow a lot more.
so yes, a little bit probably that I was excited to jump in and had all these new ideas, and then on the other side, my leaders saw, there's an opportunity as we're scaling, we really need to get some systems in place. And Anna has shown that she can do that, so.
Helen Tanner: a lot of people have ideas. And you know, there are people- Yeah ... that have ideas that present them in a way that's kind of solutions-focused, or they present them in a way that makes it tangible and helpful to the manager, the boss, the people who are gonna say the next step of, "Yes, let's try this."
And then there are people that have consistent ideas all the time, and that's just where they stay , you know? Yeah. I guess what... did you have to work on your idea delivery in the sense of, making your ideas presentable to a point where your boss and leader were like, " Okay, Anna, yes, let's try this," or, "Let's show me what you got," or how did you navigate that?
Anna Ballard: Yeah. Yeah, definitely. I think, a lot of people are passionate about, changing Yeah ... bringing about change. And actually, it's really funny that you ask that because I have this li- plaque that one of my bosses gave me that says, right here- Yeah ... "Fight for the things that you care about, but do it in a way that will lead others to join you."
Hmm. And that's a Ruth Bader Ginsburg quote. That's great.
but I think that speaks to what you're talking about- Mm-hmm ... in that, you can be passionate about something and not necessarily convince others that, we need to take action. So over time, I definitely had to develop my communication skills, influence skills, business acumen, I would say.
incredibly important that, we have this idea for, training or for learning, but how do we translate that over to the business side so that, our team members can understand the impact on the business side? So I would say, yeah, communication, influence, and, the business acumen over time definitely helped me get better, at pitching those projects that I knew were important.
I just needed to be able to communicate that.
Helen Tanner: just before I move on, did you have any formal training or development experience in L&D or anything prior to this job, or was this all just learned while you were there?
Anna Ballard: Yeah. This was pretty much beginning. I think in college for a time I, took a few, education classes.
when I had my first job at federally qualified health center, I did get to be a pilot participant in their- Mm-hmm ... very first,PA/NP fellowship. so that was as a participant, but I think that gave me a really early context and really early, exposure to, like, what a, a PA/NP medical provider onboarding program could look like and everything that goes into that, so that it's not just, content or slide decks.
it's a system. there's people, there's a sequence, there's a lot of strategy into what you focus on. So yeah. But other than that, no, I didn't have any formal L&D experience. as I got into these roles, I did take it upon myself, with encouragement from leadership, to learn the m- more of the talent development side, the traditional corporate L&D side- Mm-hmm
and attend conferences and read books and blogs and, podcasts and all that. So kind of a learning as you go.
Helen Tanner: Yes. And I feel like that's so important to do in a startup, And I think that's what ends up setting apart clinicians from staying in clinical practice, which is fine if that's what you wanna do.
Yeah. But if you have any desire or interest into growing into other roles, like you said, I mean, taking the initiative to really expand upon that interest to gain that, those business fluency type skills to succeed in that way is key, so. okay, I wanna spend some time on the build itself, because I think a lot of clinicians- Mm-hmm
are in the middle of this right now. maybe they are leading in an early startup, or maybe they've been tasked now just to expand on an earlier training program. and so now they're asked, to develop something, or maybe they want to. they want to do what you did and be like, I really like this.
I wanna take this to the next level." So what does it actually look like to build a clinical learning and development function from scratch or from the young stages? where do you even start?
Anna Ballard: I always design with the end in mind. So I think that, first of all understanding, likewhat's the business that we're trying to build here?
what playing field are we on? what's the context? And then, considering outcomes, patient outcomes, employee outcomes, things like retention or clinician satisfaction. how happy are, are your clinicians doing this work? and then the next level there is really like what behaviors are going to, support those outcomes.
and that's I think where you can start to put infrastructure in place. I think of it a lot like, curriculum pillars. usually you can narrow down to a handful of high level pillars for a curriculum.after you have those in order, you can narrow down and get into the more of the details. so you have those, high level, pillars of your structure. and then it all comes back to building a system. So again, what's the sequence of the program? Roles are incredibly important in a system. So, we can't just have build this training and then it generally it's not just gonna run itself completely.
so what are the roles? Who, are our, people that are gonna be involved in that? what tools do we need? and that looks very different for a series A company, than it does, series C, D enterprise company. so considering the tools that are right for the team at this moment.
and then putting, of that together into a system that is going to consistently produce an output of your clinical capability, quality patient care
Helen Tanner: That is a very, good overview. I like, thinking of the end in mind. and you mentioned this, but the end in mind can be different depending on the stage of where the company is.
I remember- Yeah ... I was responsible for, recruiting, hiring, training, onboarding everybody as we started, and all the entities. And so we had the first clinician come on, I literally had a checklist on Word, of- Yep ... different things that we needed to go over.
Okay? And then as we got a little further along and I had a little bit more support, I had, an intern who kind of expanded that out a little bit on an Excel with some best practice that I had for her, and this was pre now the advancements in AI that we have.
Anna Ballard: and then we had a basic learning management system, a basic LMS, and I did some, you know, really basic videos that you would watch, and then you could do the few little quizzes at the end, and check, check. and now it's to the point where they've invested in legitimate LMS, but they're now, far along on series B.
Helen Tanner: I always felt like this is never good enough, or this is always terrible. You know, this is just... And I mean, yes, it's not ideal, but the other side of it is, depending on where you are, as long as you have that end goal in mind of, whatever that is at the minute, is it you're in a early phase mode where you have to get just people up and going as soon as possible to see the patient or to do this, and it's not gonna be perfect, and you need to hire somebody that's okay with that,
versusmuch further along, that's- probably, it's not acceptable, you know? Yeah. So I do remember feeling that all the time, and then, looking back and you're like, "Well, you can only do so much with so much." And so, it is an interesting spot to be. And I do think as people listen and they're building what's the end in mind with the state of the company that you're in- Yeah
and the reality of the staff and support that you have. And it doesn't mean it's always gonna be like that, but as long as it's a goal in the future to improve it, it's okay.
Anna Ballard: Yeah.
Helen Tanner: Right?
Anna Ballard: Yes, absolutely. And I think just understanding one thing that's been super helpful for me is the framework of like zero to one, one to 10, and- and 10 to 100 for different stages of scaling.
And that doesn't always, it's not always one for one, like series A, B. It- it doesn't always match up with funding. But- understanding that yeah, when you're going from nothing to just getting it to just doing it for the first time, a Word document, a spreadsheet is- great.
And just understanding the trade-offs with your team. we know that this is not the most technologically advanced, but this is what we need right now. just naming those trade-offs I think can make it so much easier.
and then when you, do get to the, to 100 and you really need some LMS automation to power you through and help you move faster, then there's trade-offs there as well. But, just being aware of them and knowing the- benefits of- your tools at every phase is really helpful.
Helen Tanner: Yeah. And another thing, and again, I do think 'cause of where AI is and there are people like you who are out there supporting this also now and who have this expertise, I do think people can get to a more elevated training quicker than- Yeah ... people have in the past that are- For sure ... wearing a million hats and- a very important one, but a piece of it.
I did also, I do also think it's interesting, I was actually reading, the book from when we were talking about this, that your, the founder of the company that you worked for.
Anna Ballard: Oh,
Helen Tanner: the founder of the company that you worked for wrote this, book about doctors and startups, but it can be translated into c- all clinician leaders.
he was talking about how he had so many good clinicians- Mm-hmm ... A lot of them graduated into non-clinical roles, or not solely clinical roles- Yeah ... because your, strengths were really, found and figured out throughout your time there.
And I, resonated with that part. That was really important for me in hiring, because everybody... Like, there's people who are real strong in clinical ops and wanted to, or wanted to be in quality, and then there are people who really wanted to be involved with the training and the onboarding. And so in this case,
there was two specific people that just were stellar, and I brought them in to really help do, in our case it was home-based primary care, so field training. gave them some opportunity to kind of do some additional work and kind of gain a s- a different kind of title in addition to what they were doing.
And that was a way, right, to hopefully continue them into different leadership roles, also utilize what they were passionate about within medicine. And so I find it interesting I read what was going on there, and then as I met you, and as I continue to meet more in your circle, it seems like that was really nicely emphasized.
And I think that's- Mm ... a really great thing to find in a startup that is going to value clinicians certainly for their expertise in clinical, but also the so many other things to offer.
Anna Ballard: I appreciate you bringing that up. Yes. and I can name two that, I worked at Curology and, you were reading a book by David Lorchur, the CEO and founder there.
AndI also recently wrote an article about just, like, all the diverse career paths that- Yes ... clinicians, that clinicians took, after working at Curology, which I just thought was a really interesting, looking at it from the lens kind of almost an academy company where, all of these people, learned about themselves and then went on to, build new things.
and so I think, to your point, like, for folks who are joining startups now, you can really, see, talk to your leaders and make sure, they're supportive and do your leaders have the capability of, willingness to plug you into areas that you're passionate about, even so you can, test things out and see what you like and see where your strengths are.
I think that's really important.
Helen Tanner: Yeah. And, I, I got off topic, but I just, you know, when you were talking about how many great experiences that you had through that, and then how you really were able to hone those skills, I- it made me think about some of my colleagues who we were able to do the same thing.
And so it's just- Yeah ... such a great thing to find a company and a, leader that will allow you to do that. one of the things I wanted to point out that I think that you talk about in your work is time to productivity when you're building a learning and development and onboarding program, and that's a really important key.
And that was a new, thing, for me to learn about. And I remember the first time that or our CEO and COO mentioned that, and I completely changed the way that I thought about my onboarding. And I do think that's a really important thing that I would love for you to talk about, that term and why it matters so much in this environment.
Anna Ballard: when you're growing and you're scaling in a healthcare startup,
Your revenue and profitability are incredibly important
Anna Ballard: And, training has costs. Onboarding has costs. Not only are you, pulling that person, that clinician out of patient care, care coordination, whatever, their role is. you're pulling them out so they're not, earning, revenue in that way. But then you also potentially have, the salary of the folks who are doing the training.
you've got a lot of resources, that you're being committed to onboarding and training. So
From the revenue and profitability perspective
Anna Ballard: that's why time to productivity is incredibly important. We are in the business of healthcare, and so we really have to be thinking about, that business aspect and is the investment in the onboarding and training, does it make sense?
what I've seen as almost, where this breaks how you can end up with a really long training program almost accidentally is that there's a difference between traditional medical education and an operational capability for a clinician to operate day-to-day in a startup.
So on the one hand, traditional medical education is very, knowledge heavy. It's... You're talking about pathophysiology and diagnosis and treatment frameworks. And then on the other side, we have operational, just how to operate day-to-day, in your role, and that's about workflows, you know, using your technology, escalation pathways.
And so it's really easy especially for clinicians who've come up in the traditional medical education space to just start adding on content and, our clinicians need to know X, and they need to know Y, and they need to know Z, and that becomes really long. and if you can start instead with the behaviors that people need to focus on to do their day-to-day work, you can really start to shrink that.
of course, the medicine is incredibly important, depending on what your specific context is, but really focusing on what do people need to do day to day to operate can really help shrink that a little bit.
Helen Tanner: Yes. And I'm curious your thought here, in a startup, you mentioned, right, there's the clinical training and then you have the operational training of how the startup functions and the day-to-day of the actual work within the company.
Well, let's talk new grads. so we love new grads, obviously love to support the furthering of all of our clinical education and we know we all, we need clinicians out there. in a startup environment I feel there is some challenge there with hiring a new grad in a growing, evolving company.
'Cause on one hand it's great because there's such a formative time, but on the other hand your new grads are very much honing their clinical skills. And so to have to think about that in addition to the constant change that we know is constant in- Mm-hmm ... a startup, I know I've struggled.
And so as, if anybody is listening to this that is a new grad thinking about a startup, I do, just almost with an eyes wide open, like an honest discussion, it's not a no. It's, I mean, great, ask all the questions, learn about it. but just know that there's going to be more than just honing clinical skills which is so important.
So I'm curious your thoughts about that with training and onboarding and perhaps different stages and new grads and versus experienced.
Anna Ballard: Yeah. That's a great point. there's definitely a trend of ... I think it's a choice. Like, a lot of companies will have almost what they call a fellowship or a university, where they really wanna get all of their employees up to speed on their specific way of either practicing medicine or using their proprietary technology.
So I think that's one, avenue. And then there's also specifically focusing on new grads. There's a lot of companies that are doing these transition to practice programs.
Helen Tanner: Ah,
Anna Ballard: yes. Um, and I think just naming that, it's kind of a completely different thing, if you are a new grad and you want to start working in a startup, some of them might have a transition to practice program, and where you can continue to hone your clinical skills while getting some exposure to, you the technology landscape, the fast pace.
I wouldn't say it's like a no, but I think I would just like, if you're a new grad, I would, look for that phrase, transition to practice, and then I would, when you're interviewing, like ask them what, does this look like? how do you support new grads in all the different dimensions, whether that's the clinical piece or, working up on, productivity, or even just learning some of that, the business acumen that you need inside of a, startup.
Helen Tanner: And flipping that let's say you're a leader.
let's say you're building a program or expanding upon a program as you're scaling and you're thinking about, you know, we weren't able to manage hiring new grads in the past, just we didn't have the support. Now we would like to, and we wanna be able to provide this and we wanna grow our pipeline in that way.
what would be two or three things that you might recommend or, suggest that an experienced leader might think about when hiring for new grads or building a program to include new grads?
Anna Ballard: Yeah. taking a wide, a wide lens I think it's not gonna probably work to just sit people down and have them watch, modules, by themselves in isolation.
So I would be thinking about, even if it's virtual, like, what are the opportunities for them to connect with more veteran, more experienced clinicians? I think that can look like a lot of different things depending on your organizational culture. and then, as a leader, I would also be thinking about competencies and- Mm-hmm
you know, if you don't already have a clear set of competencies for your clinicians, start working on it. Because especially for those, new grads, having some sort of a, graduated competency, like a stepwise approach, is really helpful. and it moves it away from just, a schedule or, list of things to check off, to abilities, to behaviors.
and that's really what we wanna see with these new grads, right? Is, like, are they able to repeatedly and consistently provide quality care under pressure? which is just the reality of, healthcare and startups especially. It's, fast-paced usually. so I would think about, getting competencies in place, or evolving it, if you have them and they're not quite up to speed with where you are today.
Helen Tanner: those are really great, examples, and I love basically, a buddy system. Like, you- Yeah ... kinda mentioned that at the beginning. Whatever you wanna call it. Yeah. With, uh, yeah. Big sis, little sis, or big bro, little bro. Yeah. Whatever. But it's, like, an experienced with new. And w- and that could even be just, somebody who's been at the company versus somebody who's new at the company.
But then to pair within, on the newer grad side to experienced grad, I think, that's a plus. cause then also I, feel like in general that's helpful in a startup in general. know- Yeah ... is this normal or, you know, what? Yeah. This is not like, where I came from.
Yeah. So, Yeah ... I love that. Yeah.
Anna Ballard: Yeah. We did buddies at Curology too, and yeah, people loved it. And you just c- it's the connection piece, Feeling connected is so important to how we feel about work. so I think, I love the buddy name. I... Preceptor, whatever you wanna call it. It's just building that in somehow.
Helen Tanner: Yeah. Yeah. Well, thanks for that. I think really helpful. And, so as we talk about holding onto our clinical identity as we enter into more business roles, leadership roles- sometimes there's, a tension that can happen between being the clinical voice and being taken seriously maybe as a business operator.
mean, did you ever feel like you had to choose? I know your the company that you were with was founded, right, by a physician did you ever feel like that, or do you come across that in your work now where that is a tension, and, how do you navigate that?
Anna Ballard: Yeah, I think it's, absolutely still, you know, I think just in any organization, I think that's still a tension. I think there's trends where there are more and more clinicians involved at a leadership level. it's gonna be something to work at for a while.
my tenure, I always saw some patients to an extent, so I kind of had that dual perspective, which I think, helps me be better at both. not to say that that's always what it needs to look like, but I do think that having, designing the workflows and then going and doing the workflows gives you the empathy for the people who are doing it, doing the workflow day in and day out, and can help you see, oh, like we can still improve on this.
and as far as tips for folks and I think it definitely is still happening. it depends on your context. I would just say to get to know like your cross-functional friends and- if you're within a technology company that's doing healthcare, get to know the engineers and your product team members and the language that they use, because that's kind of the language of the business, and how you will be able to influence.
So for example, if your engineering team, you works in sprints or if they are using, Agile with a big A to do their project management, get to know those, terms. and in that way, if you understand the constraints of other teams, it's easier to come in and advocate for the clinical piece when you're speaking those, teams' language.
I think another tip I would also say is just learn, ma- again, make cross-functional friends with your finance team. So, finance is the language of business as well, so if you can, learn the milestones, the cadence for financial planning, and then you can apply what you feel is important clinically to that, financial calendar for the year, for the next three years, you have a little bit more, influence to, again start moving the needle on the clinical side.
Helen Tanner: Excellent. And I want to dive a little bit deeper back into kind of that time to productivity, and this is essentially getting into training systems at scale, which I know is what you really, really focus on now in your work. But, I wanna go back to that time to productivity and point that out a little bit more, especially for people who are tasked for building or looking to get more into this role.
And I just wanna give, and maybe you can give a tangible example, but I'll share one of mine. working in home-based primary care where clinician is out on their own, very heavily tech dependent. and so our training, at the very beginning, maybe up to four to five weeks to be really ready to be able to see a regular number of patients that our company had decided was the right number and then build up from there.
and then we were able to kinda scale it back, and scale it back. and I just remember having this aha moment when it was shared, what I need you to get them to the fastest time to be productive, which means they can be fully independent on their own. We can start putting patients on their schedule.
I mean, five weeks is too long. You know, four weeks is too long. Three weeks is close, you know? Because the reality is you have the systems they need to learn, they need to shadow into our care model, and they need to be able to feel like they're supported and independent on their own. So there is this push and pull of, we all know we've h-had experienced bad training pro-programs in our...
certainly have, where I've been thrown in and the next day, like, go. that's not what we want. But then on the other hand, we can't have the super long training because then they're losing too much money, and, that's terrible in a place that moves with urgency. And so, I think when you're thinking about these, it's not just about training the clinician, in the best way to be kind b-bow-tied perfectly, I's dotted, T's crossed, how we would like it necessarily to be, but it's also thinking of, like you said, the business outcomes how quickly can we get them to start to be productive to where the revenue is starting to come in and there's some breathing room to report back to our investors and whatnot.
So I wanna look, kind of circle back to that 'cause I think that is such an important point. so how do you know if training is actually working in a startup environment? And youAnd then how do you make that case to leadership?
Anna Ballard: Yeah. Yeah, and thanks for your, example. I, think that's, was very, very clear. the way that I think about measuring training, has come from, again, like learning from the typical, corporate environment and corporate talent development. And I think about it with something called the Kirkpatrick Model.
I don't wanna get too in the weeds there, but, probably the most widely accepted model for evaluating training, and there's, four levels. so there's reaction. So, do people like the training? you can get that really easily through surveys. And then there's learning.
So did, people learn the thing? if... Just giving broad examples, with like a before, after, pre, post-assessment- Mm ... you can figure that out. then there's behavior. So are people actually doing the thing in their day-to-day work? then the fourth is results, so your business results.
And that, fourth level at the top is, the hardest one to measure a- or at least attribute directly to the training, because there's just so many variables involved. but it's incredibly important. it's really easy to, focus on, oh, do people like the training?
Were they satisfied? That's really easy to measure and to share with your leadership team. but I think the more impactful way is to, like, turn it on its head and it's, again, start with your business results. what do we want to see? Do we want to be, I'm trying to think of your example. Like, we want people to be seeing a full caseload, of patients at three weeks.
Helen Tanner: that's the business goal. Okay, then, what are the behaviors that we need them to do to achieve that? and then, there's a lot there. I won't, fully unpack that example, but, start with the behaviors, and then design activities for people to practice those behaviors.
Anna Ballard: it's changing the way you're looking at these problems and the way you're, looking at training, by designing with the business outcome in mind. and I get a lot of, Kirkpatrick Model is kind of how you evaluate it, but starting with the business result, I've learned a lot from, a person named Cathy Moore, and she has a process called action mapping, that I would recommend, anyone getting involved in this work just...
You can go Google it. There's lots of, blogs about it. so I would say in that way, you're not having to, like, figure out h- in the end, how does this impact our business, our revenue? You've already started with, the business goal in mind.
Helen Tanner: these are really great, takeaways, um, Anna, thank you so much Yeah And we'll put these names of, like the Kirkpatrick and, your recommendations in the show notes so people can, find those again or they can certainly find you at the Early Hires, community.
But one thing I wanted to mention and ask is, so you work with a number of organizations now, at all stages of their growth and, sometimes infrastructure is inherited, sometimes it's all cobbled together or skipped entirely. What is the most common kind of failure patterns you see, in trainings?
and this is very general, but what's the fastest way to start fixing them?
Anna Ballard: I love it. That's a great question. and it kind of... So the most common failure patterns I think the most common failure pattern is that, training is the solution to everything. and the, same person I mentioned, Cathy Moore, writes a lot about this.
training is not always the solution, and I think a framework that's been really helpful for me to quickly, get in there and, figure this out is the elephant and the rider and the path. the elephant and the rider is a model that has been around for quite a long time, but, the elephant, rider, and the path, I read about in this book called Switch by Chip Heath and Dan Heath.
Again, we can link to that. but it's a book about how to change when change is hard. And, the core of it is, you have this elephant, which represents your emotions, your habits, fatigue. and then you have the rider, who's supposedly directing the elephant, and the rider is,your logical brain, you know, knowledge, things making sense.
then the path is obviously where those two are supposed to go, which represents your environment, your workflow, and your systems. So I think a lot of the time people, just say, "Oh, we need, we need training. We need more knowledge here." it's a people problem.
these don't have the knowledge. and they might label their clinicians as, like, resistant to change, but really a lot of the time it's really a, path problem- a workflow problem, an environment, incentives, culture. And so I think if you can take that, even just broaden your perspective to, like, those three different, the rider, the elephant, and the path, you can get more into, to solutions that might actually move the needle, design, for where the ac- the problem actually is.
Helen Tanner: Hmm. That is a fantastic, Well, it's a picture ... vision and picture. That's a wonderful, yeah.
Anna Ballard: Yeah.
Helen Tanner: thank you for that. so you, have certainly earned a lot of expertise and had a lot of experience in this, and now to the point where you are now, building your own thing and, or have built your own thing, and you have a consulting practice specifically around this work.
Would you like to speak about that and share a little bit more about what you're working on and what
Anna Ballard: Yeah. So I am building, again, ch- onboarding training programs. usually focusing or, you know, series A, series B, but, again, those can all mean different things.
series C even, and then post-merger acquisition if you have multiple teams coming together and you need to basically reinvent or evolve your systems. I'm building those onboarding systems and also integrating them with quality because I think if we build onboarding and quality in silos, it just doesn't make sense, and You'll be redoing it down the road. what I'm really passionate about too is coming in and, and building these programs and these systems for people, while also coaching the clinical leaders who may be new in these roles, and helping coach them and share resources so that they can have the skills to do this long term and, take their company, to scale.
Uh, and really to learn these more strategic business skills that I know you're so passionate about and I'm so passionate about. So, process to practice, that's my business, and that's what I've been working on lately.
Helen Tanner: Yeah. I remember telling you, "Oh, gosh, I wish that I had learned about you a, few years ago," and you brought up you have a number of ways to engage, but one is you can actually build the processes- Yeah
the startup or the company needs to meet the goals that they need.
Anna Ballard: Yep.
Helen Tanner: Or, and and, and/or- Yeah ... you can work with individual clinician leaders who are tasked with doing this and kind of guide and coach them through best practices of and what they could do.
Anna Ballard: yep. Okay. Absolutely. So yep, both of those things or both of them together.
Helen Tanner: Okay. That is very great to know That is so needed, so congrats on taking that, to the next level and launching that. Mm-hmm.
Anna Ballard: So with that, what was the single most helpful resource for you? A person, tool, book, framework, community mindset, and why did it matter as far as joining a startup or navigating in a startup?
Yeah. I think the single, uh, most helpful thing for me has been normalizing the startup life cycle. I think it can feel, when you're building something new with a team, it can feel like you're the first company that this has ever happened to. it can feel really hard. And the lovely thing is that, it's happened thousands of times.
So I would recommend, as early as you can, s- reading and normalizing what the startup life cycle looks like. There's several books. there's one called The High Growth Handbook. There's one called The Hard Thing About Hard Things, by Ben Horowitz, and High Growth Handbook is by Elad Gil.
I'm sure we can link to these.
and then just also that framework of, of breaking things down. Like, are we going from zero to one? Are we going from one to 10? Or are we going from 10 to 100? And then just kind of putting yourself in that, wherever you are along that spectrum.
and that can really start normalizing what you're going through, and that makes your path so much more clear.
Helen Tanner: how has being a clinician shaped the way you operate as a consultant and builder and startup leader, and then vice versa? How has that work shaped how you think as a clinician now?
Anna Ballard: Yeah. I think being a clinician, just really like the diagnostic process. thinking about how I would approach a clinical problem with a structured way of diagnosing. It really applies to so many other domains, like, a training problem or, we have a, need to improve quality.
Well, let's start with diagnostic approach. So I think that clinical piece has translated over to the business piece. And then, from the business side, I think I would say, or the startup side, just like learning about your cross-functional friends and partners. I think that getting to know, again, like I mentioned earlier,what are the words that these teams use?
What's their cadence for getting work done? I think, learning how to operate cross-functionally is a good parallel back to medicine and working as part of an interdisciplinary team and, just having that empathy. Like, that person, they're not asking me something to annoy me.
This is how they need to get their work done, and I think once you understand their world you've walked in their shoes, so to speak, your collaboration can be so much stronger
Helen Tanner: Yes, I was just, thought about an example, when you're talking about cross collaboration with other departments.
when I'm thinking specifically in training, I remember there would be multiple times where I needed a quick report from our IT friends-
for things, something like, I had a request, like, "Helen, I wanna know how many of our providers are utilizing this new internal referral process that we set up?"
and this internal referral process was important because, it perhaps generated us to get more remote patient monitoring out. And, so there were other things dependent on it, and we wanted to make sure that we had trained the clinicians the right process to do the right referral to get the right things and so we could better track and all those things, right?
Mm-hmm. So I needed to call my IT colleagues and beg, beg, "Please, please, please, can you run a quick report on how to get, you know, how many internal referrals have been made in the past three weeks since we changed the training? And then I can go back and report that, and then we can make updates."
And so it's that quickly that things change, right? and start up, where you have to make those adjustments, and having the IT people on your side to kind of maybe bend around their typical requests for these urgent needs. If they're in your good graces and you work together, um, then you can get those.
Kind of a real-world example there- Yes.
Anna Ballard: Love it ...
Helen Tanner: that you may come across. I don't know. I'm sure you have a million of those, but yes, the cross collaboration with our departmental friends is key.
Anna Ballard: So- Love it. I love that example.
Helen Tanner: Well, thank you so much, Anna. This was such a great conversation.
Really, really helpful tips. I appreciate all of the resources and everything you provided. We'll put those in the show notes for anybody interested, and I just really, really appreciate your time today.
Anna Ballard: Yeah. Thank you, Helen. It was lovely to chat with you about learning and development and onboarding, and thanks for having me.
