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Welcome

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Organizational Overview

AGENDA- Learning Collaborative Session 1October 5- 3:00-4:30pm (EST)

Welcome- Review Agenda and Assignments Leadership and Board of Directors Support

Top to Bottom Support from your organization Finances – Program Budget and Financial Implications Featured Health Center- CHAS

Communications and Marketing Accreditation Implications Program Goals and Objectives Progress Checklist Assignments

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questions throughout the session!

We will be using ZOOM Meeting.

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Mission Statement: Johnson City

To expand access to high quality primary care for underserved rural populations by

contributing to the development of the nurse practitioner workforce in an innovative and creative post graduate nurse practitioner ‐

residency program in a nurse led health center‐

Program Drivers: Central City ConcernProgram DriversFor the common good: build workforce to better meet the specialized needs of our patients and increase accessibility of care.For the good of the resident

Confidence and mastery in care of safety net populationReduce attrition, burnout, and distress during the initial postgraduate year (vs. “sink or swim”)Inter-professional education (NPs and MDs)

For the good of the agencyAddress workforce issues: create strong talent pool from which to hireIncrease retention of new providers Increase satisfaction and retention of established providers (dedicated time for precepting, energetic learning environment, opportunities to build clinical teaching skills)Increase patient access: NPs hired post-residency will be fully proficient from day one

Resource Assessment Summary

Physical

• Most sites have decided where Residents will be assigned and have appropriate conference space • Most still need to establish dedicated workspace for the residents

Human

• All sites have started to think about the necessary human capital needed for the program (key staff, preceptors or supervisors, specialty rotations and didactic presenters)

Financial• Most sites still need to establish terms of employment and program budget

Org.• Most sites have presented to leadership, but still need to present to Board of Directors• Most sites have not started to communicate with key organizational departments

Top to Bottom Support

Program DriversMission

Statement

LeadershipTeam

Board of Directors

Key Organizational Departments

Overall Organization

Guiding Principles For Communication

How will the PGR program intersect with your work?

What does the PGR program look like?

Why is the organization launching a PGR program?

Leadership and Board of DirectorsCEO, leadership team and BOD must be fully committed to the training program and allocating the necessary resources

What do they need to know:• Mission Statement and Program Drivers• National Landscape • Outcomes• Program Structure• Resource Assessment• Finances

Develop your presentation and use data to support your case!

Key Organizational Departments

• Understanding the role and support each department will need to provide

• Structure for communicating and completing required tasks

• Identifying leads in each department that your team can work with to implement key program components

• Developing policies and procedures that all parties agree to follow for key program tasks

Finance, Human Resources, IT, Operations, Clinical and Support Staff

Overall Organization Communication and Education

Communicate organization’s plan to launch a post graduate residency program

Stakeholder Analysis Stakeholder • Has something to gain / lose through outcomes of the project

• Has a powerful bearing on outcome of the project

• Is affected by the project

Stakeholder Analysis • Define ways to engage stakeholders to maximize positive impact

• Identify who needs to know about the project

• Develop how the project should be presented/framed

• Assess opinions / thoughts about the project

Stakeholder Grid

Interest Measures to what degree the stakeholder is likely to be affected by the project and what degree of interest or concern they have in or about it

PowerMeasures the influence they have over the project and to what degree they can help achieve or block the desired change

Stakeholders with high power and interests aligned with the project, are the people it is important to fully engage and bring on board.

Stakeholder Communication Plan

• Who are your key stakeholders?• What are you objectives in communicating with them about the project?• What are they key messages you want to communicate?• How will it be communicated?• When and how often will you communicate?

Financial Implications

• Two-year life cycle

• Cash outlay/investment in first year

• Positive cash flow in second year based on retention

• Positive ROI

• Attractive investment due to the potential ROI and the business imperative of growing an expert primary care workforce

What Does Your Chief Financial Officer Need to Know?

NP Residency ProgramResidency Year Costs

• Each Resident will have 1,000 billable visits• 16 hours of Preceptor time per week• Lost visits due to Preceptor time is 1,215

visits• Resident Salary is $65,000 plus benefits • Residency Coordinator salary (employed or

contracted)• Other Direct Expenses are $8,500 per

Resident plus $1,200 for Evaluation Software license

• Net Cash Outlay is about $110K for 2 Resident class and $50K for 3 Resident class

NP Residency Program2nd Year - Return of Investment

• Of those that stay, average total visits are 1,200 more than a first-year primary care provider

• Recruitment costs saving estimate of about $22,500 per retained NP resident

• Marginal Increase in Cash in Year 2 is about $190K for each Resident that is hired permanently

CHC experience: 50% of Residents are hired for continued employment

NP Residency Program - Cash Flow

2 Residents 3 Residents

-150,000-100,000-50,000

050,000

100,000150,000200,000250,000

Year 1Year 2Net

Postdoctoral Clinical Psychology Residency Program

Residency Year Costs• Each postdoctoral clinical psychology

resident will generate 900 billable visits• Requires 3 to 6 hours of Supervisor time

per week• Lost visits due to Supervisor time is about

90 visits• Resident Salary is $45,000 plus benefits

(market rate)• Residency Coordinator salary (employed

or contracted) (if no NP Residency program)

• Other Direct Expenses are $3,500 per Post-Doc plus $1,200 for Evaluation Software license

• Net Cash is about -$42K for 1 Post-Doc and $36K for 2 Post-Docs (assuming Coordinator is needed)

Postdoctoral Clinical Psychology Residency Program

Return on Investment

• Each Post-Doc will have about 300 visits more than a new hire due to ramp-up

• Marginal Increase in Cash is about $49K for each Resident that is hired permanently

CHC experience: 60% of Post-Docs are hired for continued

employment

Postdoctoral Clinical Psychology Residency Program

Cash Flow

1 Post-Doc 2 Post-Docs

-60,000-40,000-20,000

020,00040,00060,00080,000

100,000

Year 1Year 2Net

Direct vs Indirect Costs

DIRECT COSTS INDIRECT COSTS

Resident Salary & Benefits Clinical Support Salaries

Preceptor Salary & Benefits Purchased Medical Services

Coordinator Salary & Benefits Medical Equipment

Laptop IT Infrastructure

EHR License Occupancy Costs

Evaluation Software Administrative Overhead

Medical Supplies

Presenting the Financial Viewpoint toHealth Center Leadership and Board

• From a cash flow point of view, have to take a 2-year view of the Resident class, can’t just focus on the first year

Also, an investment in the future:• Opportunity to train staff in your Health Center’s processes and

delivery of care, reducing costs later on• Opportunity to vet potential staff member for a year before hiring,

reducing turnover and costs later on• Creates network of alumni that can be useful for recruitment in the

future

• Fulfills mission of the organization

Garnering Leadership & Board Buy-In

Learning CollaborativeOctober 5, 2016

CHASx is a way we make decisions about major new ideas from the formation of a concept through the end of a project implementation.

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PROJECT

CHARTER

Project Timeline

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Core Team Recommendations

•Make best effort to have an initial Cohort of 3 NP Residents

• Pursue Provisional Accreditation during first year of program

• Hire a Resident and Student Coordinator

• Join the Learning Collaborative 30

Garnering Board Approval

Dr. William LockwoodChief Clinical Officer

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QUESTIONS?

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Communications and Marketing

Create Webpage

Program email address

NPResidency@

Press Release

Residency Application

Advertisement

Communications and Marketing• Develop a marketing and recruitment plan ( Who, where

and when). Recruitment, Interviewing, Selection to be discussed in future webinars)

• Unique timeline differences for NP residency and Post doc residencies

• For Postdoctoral Psychology Residency Programs- please follow APPIC and APA guidelines

Feb. 27th

Match Day!

Join APPIC Directory

Post program to APPIC listserv

Identify application

deadline and Interview dates

Recruit to local schools

Accreditation Anchors Program Development

Resource Assessment

EMR Is Similar to Accreditation:Documentation process that is

organized, communicates effectively, allows evaluation of the patient

encounter

Mission Drives Everything:Recruitment, Curriculum and

Evaluation,Communications, Administration and

Operations

Mission

Curriculum

Evaluation

Staff

Admin

Operations

Trainee support

Accreditation is one strand; Program is the other.The specific accreditation standards link with the

program components.Together they create excellence.

Aligning your mission, goals, objectives and curriculum

Mission

Goals

Objectives

Mission Goals ObjectivesBroad statement of purpose and reason

Long term target, what you want to accomplish

Presents the overall program domains, i.e., the outline of what content will be offered

Gives rise to the goals

Gives rise to the objectives

Gives rise to learner outcomes

Should remain consistent over time

Should remain consistent with minor modifications

Can be modified as needed, not intended to be measured

Definitions

Domains• Term is used in many different ways• Usually refers to a content area or element in

curriculum, e.g., “Professionalism” in NP residency curriculum standards

• Or refers to a content area or element in a report, e.g., “Program Philosophy, Training Plan, and Objectives” in APA standards

Domains are the pivot point 8 competency domains in NP residency

accreditation guidelines

1. Patient-centered care2. Knowledge for practice3. Practice Based

Learning and Improvement

4. Interpersonal and Communication Skills

5. Professionalism6. Systems-based

Practice7. Inter-professional

Collaboration8. Personal and

Professional Development

Mission Goals Objectives/domainTo develop a professional and clinically competent workforce…

Program graduates will exemplify professionalism…

Program participants will demonstrate a commitment to carrying out professional roles and responsibilities

Program graduates will be clinically competent practitioners

Program participants demonstrate knowledge for practice of the….nursing sciences…to provide evidence-based care

Example….

Domains cont.

• You can group the domains into 3-4 general concepts to generate your goals (backward) and objectives (forward)

• The guidelines are a standard for you to meet, not necessarily a template to use as you develop your own goals and objectives.

Objectives vs. Learner Outcomes

• Program objectives are general and not intended to be measurable. They present the overall outline of what the program will offer. The objectives introduce the curricular domains, of the program, eg: Patient-Centered Care, Professionalism, Clinical Practice

• Learner outcomes are a measurable benchmark, the intended results within each curricular domain. They demonstrate what the learner will actually do, and often use Bloom’s taxonomy of action verbs. How you measure their achievement of outcomes is your evidence that your residents are learning and doing what you said they would learn and do. These are sub-domains in the guidelines.

About Bloom’s Taxonomy

Quick example cont.Curricular domain: Professionalism

Objective: Program participants will demonstrate a commitment to carrying out professional roles and responsibilities

Learner outcomes: 1. Demonstrate respect for patient dignity, privacy,

confidentiality and autonomy 2. Demonstrate accountability to patients, society and the

profession

Mission

Goal 1: Clinically competent

Domain/Objective: Patient-centered

Patient-centered Learner outcome #1

Patient-centeredLearner outcome #2Domain/Objective:

Knowledge for practice

Goal 2: Professionalism

Domain/Objective:Interprofessional

collaboration

Domain/Objective: Commitment to

professional roles

How to visualize their alignment

NP v. APA• NP guidelines are more prescriptive regarding

competencies and outcomes

• APA guidelines ask the program to develop objectives for the competencies

Domains/competencies in APA residency guidelines

• Use term “domain” differently—domain of entire program, not just curriculum

• Use “competencies” where NP refers to domains• Domain B: Program Philosophy, Training Plan, and

Objectives: 3. the program specifies education and training objectives in terms of residents’ competencies expected upon program completion

APA: “demonstrate an advanced level of professional psychological competencies, skills, abilities, proficiencies, and

knowledge in the following content areas:”

a) Theories and effective methods of psychological assessment, diagnosis, and interventions;

b) Consultation, program evaluation, supervision, and/or teaching;

c) Strategies of scholarly inquiry;

d. Organization, management, and administration issues pertinent to psychological service delivery and practice, training, and research;

e. Professional conduct, ethics and law, and other standards for providers of psychological services;

f. Issues of cultural and individual diversity that are relevant to all of the above.

Domain B: content areas

Competency a: Assessment,

diagnosis, interventions

Competency a Objective #1

Learner outcome #1

Competency a Objective #2

Competency e: Professional

Conduct

Objective:

Objective:

How to visualize their alignment

Evaluation of Learner outcomesFormative: Usually at the mid-point of a program or unit of study, but can occur more often depending on the design of the program

Summative: At the completion of a program or unit of study.

Tools/strategies: Evaluation tools must mirror the Learner outcomes and objectives. How will you know that the resident “demonstrates respect”? Examples: observation by preceptor, submission of written documents, presentations, etc.

More to come later about this!!

Using the Progress ChecklistPurpose

1. To help you track your progress on the items you have selected to work on

2. To help us identify where you need more help

3. To help your coaches identify areas in which you need more encouragement and reminders

Team name: Date:

What is your team's progress on implementing the following?

Have not started

Started working

on it

Working on it

Making

progress Completed

1 2 3 4 5

GENERAL

Define goals and develop a shared aim. Example: Improvement of workforce development.

Define specific, measurable outcomes and objectives.

Ensure that each team member is competent to perform their defined and delegated functions and tasks. Example: Provide education and support for staff providing involved in didactic, clinical, and supervision activities for residents.

What to do….• Send it back to us Friday Nov 4, which is before

the 3rd session Nov 9 • Can be completed during a team meeting or the

coach can complete it separately based on conversations with team members

• Just check the box or color it in • Display it as you work• You will do this again midway through and at the

very end of the Learning Collaborative

AssignmentsDue October 28th

1. Develop presentation and if possible present to leadership/board (if have not already done so)

2. Develop program budget3. Complete Communications and

Marketing timeline template4. Complete Progress Checklist

Next Session November 9th

Q&A

Please use the Q&A feature to ask questions