department of medicinesub-specialty support staff restructuring confidential: quality improvement...

Department ofDepartment ofMedicine Medicine

Sub-Specialty Sub-Specialty Support StaffSupport StaffRestructuringRestructuring

Confidential: Quality Improvement Material

Collaborative TeamDavid Katz, Donna Epley, Jacqueline Foulk, Juanita Kizior,

Jane LaMarre, Jacqueline Pikes, Katina Shehie, and Rosetta SramekRichard Novotny, Sue Plancon, and Marilyn Hauser

Fahey Team Picture


BACKGROUNDThe Department of Medicine conducted an operational assessment in an effort to proactively identify opportunities for cost savings and service improvement.

Because 6 Sub-Specialty Divisions within the Department of Medicine (Allergy-Rheumatology-Immunology, Dermatology, Endocrinology, General Internal Medicine, Infectious Disease, and Pulmonary and Critical Care Medicine) were situated together in the Fahey Building (1st Floor), these areas became the focus of discussion to consider how positive change might result if creative consolidation, integration, and collaboration efforts were implemented.

The planning process completed, and implementation shortly followed. Understanding that Loyola staff members would be critical for success, a priority was established to ensure that the resulting environment would be one that strives to promote teamwork, professional development and employee satisfaction.


Create an organizational structure within the Department of Medicine (1st Floor Fahey Divisions) that would allow for cost savings and improved service with specific focus on the following goals-objectives:

PURPOSE/GOALS-OBJECTIVES:

• Match expense to revenue (Cost Savings)

• Improved operational performance and service though consolidation and integration

• Graduate Medical Education (GME) program improvements

• Create a work environment that emphasizes teamwork, promotes integration and collaboration, and offers challenge and opportunity


Organizational Characteristics

Before Restructuring

• 10 Support Staff FTEs

• 6 Divisions operating independently

• 5 Educational (GME) Programs operating independently

• Minimal integration between Divisions

• Varied workloads within Divisional and individual responsibilities

• Minimal coordination/consistency with Divisional policies/protocols


Organizational Characteristics

After Restructuring

• 7 Support Staff FTEs

• 6 Divisions operating in a more integrated, collaborative manner

• 5 Educational (GME) Programs operating under the coordination of 1 individual

• 1 designated Administrator responsible for coordination of support staff

• Systems to allocate shared resources to areas of need

• Shared systems and protocols between divisions

Director of Administration

Division Administrator



SeniorSecretary

AdminSecretary

Senior Secretary

AdminSecretary

Senior Secretary

SeniorSecretary

AdminSecretary

AdminSecretary

SeniorSecretary

AdminSecretary

Infectious DiseaseEndocrinology Dermatology

General Internal

Medicine

Pulmonary & Critical Care

AllergyRheumatologyImmunology


ResidencyProgram

FellowshipProgram

FellowshipProgram

FellowshipProgram

FellowshipProgram

Before

Director of Administration

Endocrinology& Back up to Dermatology

& General Internal

Medicine

Pulmonary & Critical Care& Back up to

Rheumatology & Infec Dis

AllergyRheumatologyImmunology& Pulm & Back up to Infec Dis

Infectious Disease

& Back up to Pulmonary




EducationCoordinator

Dermatology& Back up to

Endocrinology& General

InternalMedicine

General Internal Medicine,

Dermatology &Endocrinology

AdminSecretary

AdminSecretary

AdminSecretary

AdminSecretary

AdminSecretary

AdminSecretary


4Fellowship Programs

1 Residency

Program

After

SOLUTIONS IMPLEMENTED

New Organizational Structure

• Allowed for reduction of 3 FTE positions

• Created cross-coverage and defined back-up systems between individuals and Divisions

• All support staff positions standardized at Administrative Secretary level of responsibility

• Established designated Administrator responsible for coordination of Support staff

• Established “Education Coordinator” position responsible for coordination of all GME programs


SOLUTIONS IMPLEMENTEDIntegration and Collaboration Protocols

• Implemented “shared” protocols/ procedures including establishing a Shared network drive, creating shared EPIC In-Baskets, and developing shared calendars in Groupwise

• Expanded electronic access for all staff to ensure efficient use of EPIC, Lawson, Corporate Express, Web-on Call and all Loyola systems

• Implemented improved Phone coverage standards and protocols

• Standardized signage, phone listings, voice-mails, and employee ID’s in an effort to promote consistency, teamwork and service

• Established regular “Team” meetings


SOLUTIONS IMPLEMENTED

Consolidation of Educational (GME) Programs

• Established 1 primary contact with GME office to represent all 5 GME programs

• Centralized systems/policies for Internal reviews, RRC site visits, interview/ranking systems, in-service examinations, orientations, and special projects

• Protocols implemented to foster consistency and collaboration among the 5 GME programs

• Reviewed/improved day to day support consistent with new organizational structure


RESULTS• Cost Savings $132,000.00 (28% Reduction)

• 100% Live Phone Coverage

• Increased integration and teamwork creating a friendlier, more cooperative and more supportive work environment

• Improved Educational (GME) Programs and support


BeforeRestructuring

AfterRestructuring

Salary and Benefit Costs

Testimonials to Results

“The Fahey staff has done a remarkable job with working together as a team to share ideas and implement improvements in all areas. The project’s success, thus far, has clearly hinged on their collaborative efforts.” David Katz, Division Administrator


“I have seen a significant improvement in support to me and the Division as well as a clear presence of a cooperative spirit within the Fahey group.”

Edward Gurza, M.D., Director, Division of General Internal Medicine

“The staff was outstanding in their efforts to expand Dermatology’s resident complement for next year and coordinate our recent internal review of the program.” James Swan, M.D., Dermatology Residency Program Director

“Although skeptical, at first, with the new structure, I was very pleased with how Rheumatology’s first round of interviews were planned and conducted under the new structure.” Elaine Adams, M.D., Director, Division of Rheumatology

“The Department of Medicine's recent initiative to centralize programs, thought a significant break with traditional academic medical centers, provides the essential underpinnings to true program administration and development. Allowing an individual to focus exclusively on the educational mission, to perform accreditation tasks more frequently , and to be able to identify and adopt best practices across programs will undoubtably improve our accreditation periods. Similarly in the current fiscal crisis, such a transition makes complete fiscal sense.” Dorothy Jambrosek, Admin Dir, Med Staff Affairs and GME

Although only several months post implementation, initial review of the restructuring indicates substantial achievement of stated goals of cost savings, improved performance and service, Educational Program (GME) improvements and an enhanced work environment.

• Solicit ongoing input from Faculty, Residents, Fellows, Staff, and other stakeholders to identify areas for further improvement• Continue communications/reviews to ensure optimal organizational structure is maintained• Attempt to identify additional Service Improvement opportunities• Attempt to identify additional work environment improvement opportunities

ANALYSIS

NEXT STEPS

department of medicinesub-specialty support staff restructuring confidential: quality improvement...

Documents

service improvement

support staff ftes

minimal integration

critical care medicine

subspecialty divisions

floor fahey divisions

improved service

revenue cost savings