In healthcare, the most transformative innovations arise when frontline teams are empowered to solve critical challenges. The University of Maryland Medical System (UMMS) is a prime example. To improve the speed, quality, and consistency of nurse onboarding, clinical leaders partnered with the system’s in-house innovation center, iHarbor. The result was a powerful nurse orientation assessment application that meets UMMS’ needs and shows potential to reshape how systems assess nursing readiness.
The Problem
Nurse onboarding is foundational to high-quality, safe patient care, yet it is often fragmented and inefficient. Until 2019, the University of Maryland Medical Center (UMMC) relied on paper forms that were easily misplaced or never returned by preceptors, leaving critical information to be exchanged informally rather than through standardized reporting.
This made it hard to track progress or flag new nurses who needed help. Additionally, the one-size-fits-all approach to nurse onboarding made it difficult to truly assess nurse readiness. Where are they struggling? Where are they excelling? The results at UMMC were inconsistent and occupied critical resources.
COVID19 magnified these weaknesses. Susie Williams, then a full time practicing bedside Senior Clinical Nurse at UMMC, was frustrated by the manual orientation workflow. The process was slow and new nurses and preceptors alike needed more direction. Susie recognized that something needed to change to improve the process.
Innovative Nursing Onboarding
The first improvement was simple: Williams replaced paper forms with online submissions for preceptor assessments. Next, she created workflow automations that would reduce administrative burden and bring consistency and visibility into nurse readiness assessments.
As adoption grew beyond a single unit, Williams partnered with Danielle Evans, Director of Clinical Education and Development, to make the solution more scalable. Together, they recognized the need for a formal, research-backed definition of “practice readiness.” A landscape review showed external tools were insufficient. Drawing on evidence and frontline experience, they created UMMS’ practice readiness definition and identified eight core competency domains to anchor the tool’s measurements and assessments.
Evans noted that “being a nurse is multi-factorial, so we understood that you didn't need just to assess one or two things. Nurses needed to show competency in each area and show continuous progress.”
These competencies became the backbone to what they called the Orientation Assessment Reporting System (OARS). With structured assessments and automated tracking, preceptors saw how each orientee progressed across domains. It showed where new hire nurses excelled, struggled, and needed support. Orientation shifted from a uniform timeline to an individualized pathway that enabled flexibility and accuracy, and preceptors acknowledged the improvements.
Williams recalled “I would say to preceptors ‘this is what the orientee’s score is right now’ and ask if they agreed with the assessment. They were consistently saying ‘yeah, that’s accurate.’”
They strengthened OARS’ reliability, standardized scoring, and ensured the process could scale. Research also validated that OARS reliably measured practice readiness. When they presented the work at the ANCC National Magnet Conference®, interest surged from leading health systems—a clear signal that OARS filled a real need beyond UMMS.
Performance of OARS
As of January 2026, OARS is deployed across 125 UMMS units with substantial impact:
- $3.1 million in cost avoidance.
- $855,000 in cost avoidance in the first half of the current fiscal year.
- 86% of preceptors reporting OARS is easy to use.
- 2,758 nursing shifts reduced, reflecting faster readiness velocity.
In an era of thin margins, every gain matters. Every shift saved and every better-prepared nurse improves both financial performance and care quality.
iHarbor – Maturing OARS for Scale
Eventually, OARS hit its limits with the original workflow management system. The sheer volume of data, automations, and calculations simply outgrew the platform. Scaling systemwide required an enterprise solution.
That’s where iHarbor stepped in. To take OARS to the next level, they needed resources and a long-term support plan. iHarbor provided the engineers, product developers, and infrastructure necessary to formalize OARS into a modern platform with a dedicated database, user-friendly interface, robust analytics, and enterprise-grade scalability and reliability.
Looking ahead, iHarbor plans flexible frameworks for added configurability for different hospitals or specialties in addition to deeper analytical data for actionable insights. These enhancements position OARS for full deployment across UMMS and set the stage for use by other health systems across the nation.
Conclusion
OARS shows what’s possible when frontline expertise meets institutional innovation support. What began as a nurse-driven fix for an outdated process is now a validated, scalable platform that drives readiness, strengthens care quality, and saves millions in cost. “The OARS story is one of the main reasons iHarbor exists,” says Warren D’Souza, SVP, Chief Innovation Officer at UMMS. “We helped bring the innovative vision of our nurse entrepreneurs to life by providing resources and an environment to try new things and then scale them to the enterprise.”
UMMS looks forward to seeing where this internally grown innovation goes.