1. We will begin shortly…
Welcome
1

2. Using Zoom
 Turn your webcam on!
 Please remember to
mute yourself during the
presentations.
 If you have a questions,
you may un-mute
yourself and ask after
each presentation, OR
use the Q&A button

3. Organizational Overview

4. AGENDA- Learning Collaborative Session 1
October 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
We will be
taking
questions
throughout
the session!
We will be using
ZOOM Meeting.
Turn your webcam
on!

5. 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

6. Program Drivers: Central City Concern
Program Drivers
For 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 population
Reduce attrition, burnout, and distress during the initial postgraduate year
(vs. “sink or swim”)
Inter-professional education (NPs and MDs)
For the good of the agency
Address workforce issues: create strong talent pool from which to hire
Increase 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

7. 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

8. Top to Bottom Support
Program
Drivers
Mission
Statement
Leadership
Team
Board of
Directors
Key
Organizational
Departments
Overall
Organization

9. 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?

10. Leadership and Board of Directors
CEO, 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!

11. 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

12. Overall Organization
Communication and Education
Communicate organization’s plan to launch a post graduate residency program

13. 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

14. 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
Power
Measures 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.

15. 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?

16. 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?

17. NP Residency Program
Residency 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

18. NP Residency Program
2nd 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

19. NP Residency Program - Cash Flow
-150,000
-100,000
-50,000
0
50,000
100,000
150,000
200,000
250,000
2 Residents 3 Residents
Year 1
Year 2
Net

20. 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)

21. 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

22. Postdoctoral Clinical Psychology Residency Program
Cash Flow
-60,000
-40,000
-20,000
0
20,000
40,000
60,000
80,000
100,000
1 Post-Doc 2 Post-Docs
Year 1
Year 2
Net

23. 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

24. Presenting the Financial Viewpoint to
Health 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

25. Garnering Leadership
& Board Buy-In
Learning Collaborative
October 5, 2016

26. CHASx is a way we make decisions about
major new ideas from the formation of a
concept through the end of a project
implementation.
26

27. 27
P
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28. Project Timeline
28

29. 29

30. 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

31. Garnering Board Approval
Dr. William Lockwood
Chief Clinical Officer
31

32. QUESTIONS?
32

33. Communications and Marketing
Create
Webpage
Program email
address
NPResidency@
Press
Release
Residency
Application
Advertisement

34. 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

35. Accreditation Anchors Program
Development

36. Resource Assessment

37. EMR Is Similar to Accreditation:
Documentation process that is
organized, communicates effectively,
allows evaluation of the patient
encounter

38. Mission Drives Everything:
Recruitment, Curriculum and
Evaluation,
Communications, Administration and
Operations

39. Mission
Curriculum
Evaluation
Staff
Admin
Operations
Trainee
support

40. Accreditation is one strand; Program is the other.
The specific accreditation standards link with the
program components.
Together they create excellence.

41. Aligning your
mission, goals, objectives and curriculum
Mission
Goals
Objectives

42. Mission Goals Objectives
Broad 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

43. 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

44. Domains are the pivot point
8 competency domains in NP residency
accreditation guidelines
1. Patient-centered care
2. Knowledge for practice
3. Practice Based
Learning and
Improvement
4. Interpersonal and
Communication Skills
5. Professionalism
6. Systems-based
Practice
7. Inter-professional
Collaboration
8. Personal and
Professional
Development

45. Mission Goals Objectives/domain
To 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….

46. 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.

47. 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.

48. About Bloom’s Taxonomy

49. 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

50. Mission
Goal 1: Clinically
competent
Domain/Objective:
Patient-centered
Patient-centered
Learner outcome #1
Patient-centered
Learner outcome #2
Domain/Objective:
Knowledge for
practice
Goal 2:
Professionalism
Domain/Objective:
Interprofessional
collaboration
Domain/Objective:
Commitment to
professional roles
How to visualize their alignment

51. NP v. APA
• NP guidelines are more prescriptive regarding
competencies and outcomes
• APA guidelines ask the program to develop
objectives for the competencies

52. 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

53. 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;
a) 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.

54. 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

55. Evaluation of Learner outcomes
Formative: 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!!

56. Using the Progress Checklist
Purpose
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

57. 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.

58. 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

59. Assignments
Due October 28th
1. Develop presentation and if possible
present to leadership/board (if have not
already done so)
2. Develop program budget
3. Complete Communications and
Marketing timeline template
4. Complete Progress Checklist
Next Session
November 9th

60. Q&A
Please use the Q&A feature to ask questions