Maximizing Resources- Minimizing Cost:

Bruce E. Herman, MD Professor of Pediatrics

Associate Program Director, Pediatric Residency Program Director,

Pediatric Emergency Medicine and Child Abuse Fellowships

Pamela Carpenter

Manager, Pediatric Education

How to get the most of what little you’ve got

Objectives

• Maximizing Resources/Minimizing Costs – Problem, analysis, solutions

• PDs and PCs working together to increase efficiency – Small group exercise

Our Problem

• Future of academic children’s hospitals – Pediatrics special article by our Chair

• Funding – it’s all about the money

• New and changing requirements – unfunded mandates

• Tradition trumps innovation – this is the way we’ve done it

Assessing the Problem

• SWOT analysis • Identify all programmatic processes • Identify cost of all processes • Assess program needs • Prioritize • Maximize resources

SWOT Analysis

• Analytical tool to help an organization develop a preferred future

• Identifies Strengths, Weaknesses, Opportunities, and Threats

• Clinical Experience/reputation* • Structured fellowship education (PFCC)* • University and IHC Quality and Health Services Research Training * • Strong faculty educators • Functional administrative structure in Department, with many resources, and leadership that recognizes value of education • Retention of future faculty from fellowships •Geographical location (large referral base)

• Limited funds* • Change in Intermountain/University policies* • Internal resistance threat of change or elimination of programs* • Recruiting difficulty with academics (lack of alignment of incentives with needs) • Lack of employment opportunities in certain subspecialties •Educational debt

• Reduced funding* • Tradition trumps innovation* • NAS: evolving requirements = increased time/resources required* • Ever growing faculty time commitment • Overcoming possible negatives in recruiting (re: geographical location) • ABP SCTC recommendations • Intermountain IT resources • Difficulties recruiting and retaining foreign trained physicians • Service vs education concerns of trainees

Primary factors

SWOT ANALYSIS: Fellowship Training

EXTERNAL

INTERNAL

Strengths Weaknesses

Opportunities Threats

• Forward thinking (re: faculty succession & cost effective programs)* • Marketing & recruiting* • NAS gives opportunity for innovation* • Collaboration/training between fellowships: directors/coordinators* • Increases national recognition/exposure for fellowship & leaders • Program development • Locating new revenue sources for training • Innovative ideas for increasing fellow education (clinical experiences) to increase revenue • Increase Intermountain branding of Pediatric Care

• Clinical Experience/reputation* • Structured fellowship education (PFCC)* • University and IHC Quality and Health Services Research Training * • Strong faculty educators • Functional administrative structure in Department, with many resources, and leadership that recognizes value of education • Retention of future faculty from fellowships • Geographical location (large referral base)

Primary factors

SWOT ANALYSIS: Fellowship Training

INTERNAL

Strengths

• Reduced funding* • Tradition trumps innovation* • NAS: evolving requirements = increased time/resources required* • Ever growing faculty time commitment • Overcoming possible negatives in recruiting (re: geographical location) • ABP SCTC recommendations • Intermountain IT resources • Difficulties recruiting and retaining foreign trained physicians • Service vs education concerns of trainees

Primary factors

SWOT ANALYSIS: Fellowship Training

INTERNAL

Weaknesses

Primary factors

SWOT ANALYSIS: Fellowship Training

EXTERNAL

Opportunities • Forward thinking (re: faculty succession & cost effective programs)* • Marketing & recruiting* • NAS gives opportunity for innovation* • Collaboration/training between fellowships: directors/coordinators* • Increases national recognition/exposure for fellowship & leaders • Program development • Locating new revenue sources for training • Innovative ideas for increasing fellow education (clinical experiences) to increase revenue

Primary factors

SWOT ANALYSIS: Fellowship Training

EXTERNAL

Threats • Limited funds* • Change in Intermountain/University policies* • Internal resistance threat of change or elimination of programs* • Recruiting difficulty with academics (lack of alignment of incentives with needs) • Lack of employment opportunities in certain subspecialties •Educational debt

Identify Processes

• Use academic calendar • Use line items from budget • Will require help from coordinators

Identify Costs

• FTE breakdown for each process • Using salary information, assign costs to

FTE expenditures for each process • Use budget data to identify

non-personnel costs of each process

Orientation .5 FTE

Identify Costs

• Identify cost of total fellowship per trainee

Costs Per Fellow

Financial Sources Per Fellow

Costs Per Fellow

Financial Sources Per Fellow

~ $100K

Assess Program Needs

• Determine workforce needs – Strategic planning for internal faculty

replacement – Physician needs in the region – Physician needs nationally – Graduation statistics

• who are you training?

Assess Program Needs

• Distinguish needs versus wants (requirements, logistic necessities, morale building, tradition, faculty or PD preferences) – Create a value assessment by staff,

trainees, and faculty of each process, event, and expense

• Allows you to objectively uncouple tradition from the equation

Prioritize

• Perform a stress test – If you had to cut 10% from your program

expenses, what would you cut? – 20%? – 30%?

Maximize Your Resources

• Redistribute resources to match program priorities and requirements

• Look for innovative solutions for efficiency • Don’t recreate the wheel

– See what others are doing – Seek out creative minds

Solutions to Our Problem

Justify fellow need to Department with data collected • PEM fellows – cost effectiveness

Solutions to Our Problem

Justify fellow need to Department with data collected • PICU fellow value

Solutions to Our Problem

• Centralized leadership – Associate Program Director in core

program over fellowships • Trains PDs • Creates shared resources

– A super coordinator in core program • Trains PDs and PCs • Can share resources easily • Common coordinator job description

Solutions to Our Problem

• Centralized fellowship coordinators – Most coordinators doing other jobs for the divisions

(highly variable: 10%-80% of workload dedicated to fellowship)

– Supervised by managers without perspective of program requirements

– Our 8 fellowships can be managed with 2 full time fellowship coordinators in core program

– Develop highly trained, specialized staff with advocates in management structure (super coordinator)

Solutions to Our Problem

• Centralized fellow education for all first year fellows

• Combined fellow orientation

Future Innovation

• Fellowship Farm Club • Shared departmental resources

– Research – QI – Piggyback on the core program

• Advocacy • Career planning resources • Global health

Small Group Exercise