NCA PGR Session 2 Slides
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NCA Post-Graduate Residency Learning Collaborative - Session 2 Slides
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NCA PGR Session 2 Slides
- 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
- 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
- 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
- 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
- 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.
- 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
Hinweis der Redaktion
- We have 12 health centers participating from 9 states. 2 of these health centers are participating with the intention of starting a residency for Post-Doc Clinical Psychologists while the other 10 will be implementing a residency program for Nurse Practitioners. We are thrilled to have such a diverse, and widely spread group of health centers from around the country.
- Coach- Betsy Kappes
- Coach- Lauren Land
- Will need to gain the buy-in and support of everyone in your organization – from the top to bottom – your stakeholders For all of your stakeholders you should use a common message and language that all tie back to your program drivers and mission statement – which gives the program a clear purpose Start with getting the commitment from your leadership team (which many of you already have) Present and get the full support and commitment from your BOD Communicate the project with key organizational departments Lastly, overall organization education and support
- For all of your communication you should use the guiding principles to inform your key stakeholders. You will want to communicate a consistent message across the board but should adapt it for each stakeholder.
- Should present to both your leadership team and board of directors. The presentation will have much of the same information for both parties but adapt your content based on the audience. National– what does the national landscape look like for PGR programs, history, growth, future opportunities Outcomes – outcome data for existing programs (retention, clinical outcomes, visits) – current research showing impact and effectiveness of programs Resource assessment – what resources will be needed to implement the program Finances – Financial commitment and Return on Investment – Bob Block will be talking with you in more detail about how to present the financial data to your leadership team and BOD
- Key organizational departments will need to understand how this program will intersect with their work and also the support the program will need from their teams. Using the communication guiding principles – you will want to tell them why, what, and how. The most important for this group will be the how – how will the program intersect with their department and specifically, what will the program need in terms of support.
- Overall – you will want to educate your entire organization on the launch and implementation of this new Post Graduate Residency Program. Using your common message – you will want everyone to understand why the organization is starting the program and what does it look like. It is critical when you launch your program that everyone in the organization understands these key principles so that they can fully engage with and support the residents and program. Having a greater understanding of the mission and drivers helps staff most actively support the program. You can communicate with these groups in a variety of ways – small group meetings, all staff meetings, grand rounds – and may want to do a series of communications with them over the life of your program planning.
- As part of this learning collaborative we will be providing opportunities to integrate QI tools that your team can use. A Stakeholder Analysis is a process where you assess the groups or individuals that will be affected by a new project, group them according to the impact the project will have on them and then use this information in your approach and communication to them. Who are your stakeholders – we provided larger buckets of leadership, BOD, key departments, and organization – but you should think of this on a more detailed level - List out key organizational departments (finance, HR, IT, etc.). Who is including in the overall organization (providers, nurses, MAs, front desk, BH staff, etc.)
- Stakeholder Grid helps you to map out your different stakeholders based on their interest and power with the project. Those with HIGH interest and HIGH power (ie leadership) need to be fully engaged and actively influenced and communicated with. Providers may fall into the category of HIGH interest but LOW power so you will want to keep them informed on the project. You can plot where each stakeholder sites on this grid to figure out how you need to approach them
- Use this communication plan to lay out your stakeholders and the objectives and messages you want to communicate.
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- We want to invest in changes that make the most sense for our patients, staff, and organization, and we want to balance our resources so we don’t take on more than we can handle. The Leadership Team reviews new project proposals and makes decisions based on resources, risks, objectives, and how the project supports our mission.
- Last session, you identified the drivers for your program and completed a resources assessment form. Using these two steps as a foundation, You have your driver – it is your mission. Write it down – document it. You’ve already begun to use the accreditation standards as your anchor for building out your program. Virtually every set of accreditation standards has a mission requirement. Literally by writing it down and describing the direct link between your program’s mission and the organization’s mission, you’ve already begun to complete the documentation for the Standard about mission. Now on to your resources assessment … Next slide please Thu 9/29/2016 12:00p - 1:00p Thu 9/29/2016 12:00a - 1:00a Where: https://chc1.zoom.us/j/975767824
- You’ve begun a needs assessment for administrative and operational components of your program by completing the resource assessment. You’ve taken a look at physical resources, financial resources, human resources, and organizational resources. The accreditation standards will give explicit guidelines on the outcomes that will be indicators of successful program administration and operational management. Use the accreditation standards for administration and operations to find your end points, and then work to get from the needs assessment to the end points. Again, document the process, the outcomes, and how you evaluate success. Accreditation becomes your anchor or reference as you design the various components of your program. A key component of the design and implementation process is documentation. As you think about documenting your program development, and documenting your program’s activities once it is up and running, Think of the EMR – you see a patient, and you always document the elements of the visit. Next slide please:
- The medical record is the determining factor in how you interact with your patients. However, it is designed to reflect good practice. It documents what you’ve done and what needs to be done. It is a consistent way of organizing your communications about a patient. It is a consistent way to keep records so that others know what has been done. This is just like accreditation. Accreditation serves a similar function. Accreditation is about protecting the public and promoting best practices. It is a way of organizing and reporting your program’s activities so others can evaluate what you have done. Especially at this point in your process where you are designing your program – the components of accreditation will serve as an anchor for success. They are a blueprint for designing and implementing your program.
- In the same way that the EMR organizes the activities of the patient encounter, accreditation provides a way to organize and present your plans to others – executive leadership, community partners, professional colleagues. Going back to where we began – with your mission statement. The mission statement should drive every aspect of your program design, implementation and evaluation. As you communicate with others, always use the mission statement as your opening and closing. It is why what you are doing is important. It is how you will make a difference to your community. It is also the core messaging in your marketing and communications outreach. In a very concrete way it drives program development. There is a saying in instructional design: Design backwards, Implement forwards. So design ‘backwards’ from your mission – the mission is your starting and ending point. Then think about what your ‘final product’ – your trainee ‘’ will look like. How will they function – what will they do . How will they represent your field? Then design evaluation measures that address the endpoint. Then create curriculum that address the endpoint. Make sure that the curriculum and evaluations are integrated and create feedback loops. Use that information in communicating with your audiences.
- In the same way that the EMR organizes the activities of the patient encounter, accreditation provides a way to organize and present your plans to others – executive leadership, community partners, professional colleagues. Another analogy. Think of a diamond with many facets. Individual facets are essential to the whole. Together the facets create a beautiful gem. Your program is the diamond. Accreditation gives you a way to build out each facet so that taken together, you have a beautiful gem. And each facet is essential. Each standard drives the development of one facet of your program. If one is missing or less developed, then it impacts the integrity of your program. Accreditation integrates all components of your program. It is likely that each of you has participated in other accreditation activities. Perhaps with the Joint Commision or PCMH status with NCQA. They have standards. You measured your programs against the Standards. And you make revisions in your program to meet the Standards. Here we’re doing the same thing, just starting from the very beginning of building your program so that they meet the Standards from the very beginning. We are building out your diamond.
- Think of accreditation as part of the DNA of your program. In a very concrete way, accreditation can drive program development – Programs are always works in progress. The accreditation standards are unchanging, and the standards define the components of every program. However, while every program has the same core components of mission, curriculum, evaluation, etc, each one is unique. There is a saying in instructional design: Design backwards, Implement forwards. So design ‘backwards’ from your mission – the mission is your starting and ending point. Use the standards to structure the components. Then think about what your ‘final product’ – your trainee ‘’ will look like. How will they function – what will they do . How will they represent your field? Then design evaluation measures that address the endpoint. Then create curriculum that address the endpoint. Make sure that the curriculum and evaluations are integrated and create feedback loops. Use that information in communicating with your audiences. You design backwards and deliver forwards. Implement forwards by recruiting the right trainees and preceptors, training preceptors and staff, delivering a meaningful and targeted curriculum that is created to prepare participants for success. Success is measured by creating a program that is mission relevant. Each component of the program should be mission critical. Your Administration and operations need to support the curriculum – although this is a bit like the chicken and the egg – you need specific organizational support to even begin designing and delivering a curriculum, but the organizational support needs to know what kind of curriculum and support you will need before they can deliver. The bottom line is, know where you are going and keep your eyes on the target. Keep the mission in mind! Let the Accreditation Standards provide outcome measures that guide your program development. Build your diamond. That’s it for today. Handing off to our next speaker, Dr. Kathleen Theiss. Hi Kathleen…
- Everything from your program mission to your evaluation methods should align: use the same concepts throughout What do you want to accomplish: goals, objectives/domains How will you demonstrate that you accomplished it: learner outcomes/domains and learner evaluation
- You can group the domains into 3-4 general concepts These become your goals Your objectives come from your goals
- You can group the domains into 3-4 general concepts These become your goals Your objectives come from your goals
- Goals: Professionalism and Clinical Competence are among your goals Program graduates will exemplify professionalism….. Program graduates will be competent to practice independently…. Objectives: Professionalism and Clinical Competence are two of your curricular elements. You can have more than one objective for an element but try to keep it to just a few. Program participants will demonstrate professional behavior in their relationships with patients… Program participants will demonstrate competence in clinical practice…