in acute care: two -...

© Baylor Institute for Rehabilitation – Hospital Division Property of Hull, Thut, Scott, Belcher, Canas, Smith. Must receive approval for reproduction.

INNOVATING ENGAGEMENT AND PROFESSIONAL GROWTH IN ACUTE CARE: TWO APPROACHES

Baylor Institute for Rehabilitation

Hospital Division

Combined Sections Meeting 2018

New Orleans, LA

February 21-24, 2018

2 © Baylor Institute for Rehabilitation – Hospital Division Property of Hull, Thut, Scott, Belcher, Canas, Smith. Must receive approval for reproduction.

Speakers

Brian Hull, PT, DPT, MBA

Director of Rehabilitation, Baylor Institute for Rehabilitation - Baylor University

Medical Center in Dallas, Baylor Sammons Cancer Center, and Baylor Medical

Center at Waxahachie.

Cathy Thut, PT, DPT, MBA

Director of Rehabilitation, Baylor Institute for Rehabilitation - Baylor Scott & White

Medical Center Irving and Baylor Scott & White Medical Center Grapevine.

Andrew Belcher, PT, DPT, CWS

Manager of Rehabilitation, Baylor Institute for Rehabilitation- Baylor Scott &

White Medical Center – Grapevine, TX

Rene Canas, PT, DPT, CWS

Manager, Baylor Institute for Rehabilitation- Baylor Scott & White Medical Center -Irving, TX

Roslyn M. Scott, PT, MPT

Manager, Baylor Institute for Rehabilitation - Baylor University Medical Center –

Dallas, TX

Abigail Smith, PT, MPT

Manager, Baylor Institute for Rehabilitation – Baylor Scott & White Medical

Center – Plano, TX

The speakers have no financial or nonfinancial relationships related to the content of course to disclose.

Course Objectives

1. Discuss several innovation, change management, behavioral economic theories and strategies applicable to an acute care practice.

2. Apply theories to two successful case studies. 3. Create collaborative strategies to advance professionalism within your hospital

practice by engaging frontline staff in change strategy and program design. 4. Evaluate the effectiveness of the clinical ladder as a value-based tool and

understand how to manage potential roadblocks.

Session introduction

For the most part, innovation seems to be a hit or miss activity. When we are discussing

innovation the first question that comes to mind is what will this cost my organization

followed by how will this impact my productivity and cost to provide services.


What we know is that organizations must first define what they value and then determine

how to balance the cost with efficiency and effectiveness. We believe that investing in

the non-BTU/RVU activities will benefit the organization in the long term financially

through recruitment effectiveness, retention of staff, improved quality of care,

professional engagement, increased efficiency in the delivery of care, and improved

patient outcomes.

We also believe that the approaches that we will be sharing with you will address some

of the environmental issues in which you practice. At the core of the session is how to

develop a culture of innovation that effectively uses your organization’s resources and

enhances professional development at all levels.

Our Email Addresses

Brain Hull – [email protected]

Cathy Thut – [email protected]

Roslyn Scott – [email protected]

Andrew Belcher – [email protected]

Rene Canas – [email protected]

Abigail Smith – [email protected]

mailto:[email protected]







Original 2012 Baylor Institute for Rehabilitation Clinical Ladder

Expectation Influence of expectation

Proficient Therapist Senior Therapist

CQI participation Team

Journal Club Team

Staff orientation Team

Supervise students; support staff

Dept

Mentoring staff Dept

Lead team/dept wide project Dept

Active participation in research Dept

Department operations management

Dept

Department program development

Dept

Professional organization involvement

BIR System

Serve on hospital/ BIR wide committee / council

BIR system

Content specific mentoring BIR system

System program development BIR system

Research lead author External

Publication External

Prof service External

Teaching External

The check boxes should help guide the clinical ladder, yet not deem the duties as

exclusive to the title. Appropriateness will be determined by input of the manager and

director in conjunction with the professional portfolio.

© Baylor Institute for Rehabilitation – Hospital Division Property of Hull, Thut, Scott, Belcher, Canas, Smith. Must receive approval for reproduction.

Clinical

•Patient Care Mgmt

•Journal Club

•Staff Orientation

•Program development

Education

•Student supervision

•System educational program development

•Professional School Involvment

Leadership

•Dept operations

•Management of staff

•Organization leadership

Community Service

•Government affairs

•Support Groups

•Professional Organization involvement

Research

•Participates in study

•Publication of study

•Presentation of study


Professional Expectations for Staff, Proficient and Senior levels only

Clinical 1 2 3 4 5 Patient Care Management (Choose all that apply)

Manages his/her patient schedule independently

through the fiscal year

Actively participates in

huddles/rounds, per facility guidelines

Schedules patients for department/team

on a consistent basis

Therapist in charge for hospital,

“Go-to person” for

CC/SW/Nursing (Ongoing

throughout the year)

Development of discipline

and/or content specific

competencies Supervision of

patient care delegated to PTA’s, COTA’s and Technicians

Back up to department/team

scheduler, as needed

Back up therapist in charge for the

hospital (occasional), as

requested

Consistently initiates and recognized by

teammates as demonstrating

altruistic behavior with caseload management

(i.e. taking extra patients to support team involved in projects; initiates

picking up extra/weekend shifts on a regular basis)

Clinical Implementation of Best Practice Guidelines (Choose only one)

Consistently implements and

documents All BPG’s

(= or > 60%)

Consistently implements

and documents All BPG’s

(= or > 80%)

Consistently implements and

documents All BPG’s

(= or > 90%)

Journal Club and/or Book Club (Maximum of 6 points)

Attends Club (Frequency determined

by department)

Presents at least twice at Club (Frequency determined

by department)

Organizes and leads Club

Staff Orientation - Including New Hire and Float Staff (Choose all that apply)

Occasionally assists with new hire orientation,

shadowing and/or cross training of therapy staff or other disciplines

Serves as primary preceptor for new

hires 1-2 new hires = 3

points 3-4 new hires = 6

points 5+ new hires = 9

points

Responsible for managing the

orientation process

for all new hires (Including current forms, binders,

etc.)

EHR trainer for the department


Clinical Ladder Calibration Tool

Clinical (Use drop down boxes)

List Specific Item (Score points in

next column)

Score Comments

Section Total 0


Clinical Ladder Quarterly Summary

Name: Level Discussed: Date Reviewed:

Man on the Moon Statement (MOTM)

The Acute Care Therapy Division of BIR will be a Top 3 hospital-based rehabilitation provider by 2020.

Goal/Focus for Fiscal Year (Top 3 Statement):

Professional Responsibilities: Minimum points to achieve/maintain professional level:

See details of all responsibilities in Professional Responsibility Grid

Current Point Total:

Quarterly Summary of Accomplishments

Note: Pressing "Alt" and "Enter" at the same time while within a box will allow you to start a new paragraph within the same box.

Clinical: Education: Community:

Leadership: Research:

Plan for next quarter:

Overall Comments on Progress towards Clinical Ladder Goal:


Clinical Ladder Educational Addendum

To be completed if any Type B education or other substitutes for Type A is utilized.

Date: # of Hours: CE Type: A B New: Y N

Title:

Location/Audience: # of Attendees:

Completed

Planned

Objectives if Type B:


Title:


Completed

Planned



Title:


Completed

Planned



linical Ladder Survey

The current clinical ladder is easy to understand.

With the current clinical ladder, I see opportunities to become involved in: a) My department b) My hospital c) The system d) The community e) None of the above

Compared to the previous ladder, the revised clinical ladder is easier to understand.

The current clinical ladder has given me a better understanding of how I can contribute to a) My department b) My hospital c) The system d) The community e) None of the above

Compared to the previous ladder, I see more opportunities to become involved in: a) My department b) My hospital c) The system d) The community e) None of the above

Compared to the previous ladder, the revised clinical ladder has given me a better understanding of how I can contribute to: a) My department b) My hospital c) The system d) The community e) None of the above

I am motivated to advance professionally as a result of the current clinical ladder.

I am motivated to advance professionally as a result of the revised clinical ladder.

The current clinical ladder gives value to my current work.

How satisfied are you with BIR's clinical ladder compared to your previous employer?

The current clinical ladder requirements are clear and equitable across the BIR system.

YES NO

Did you participate in the clinical ladder prior to the revamp in October 2015?

Compared to the previous ladder, the revised clinical ladder gives value to my current work.


How to replicate this at your facility/organization

Find what is of value to you as an organization

• Hospital leadership / Organizational strategic goals:

Find out what your employees value and what makes them feel valued

• Why are your employees working in your organization?

• What is important to them and makes them feel valued?

• Professional development?

To create a clinical ladder for you and your staff, consider the following:

Intrinsic motivators – identify with goals

Rewards of ladder – monetary vs physical

Identify what engages your employees

Build trust in you, the informal leaders and the ladder tool

Use informal leaders as decision architects

Promote positive outlook on a clinical ladder

Concrete expectations

Staff emotions – make it real and applicable


John Kotter’s 8 Step Process of Successful Change

1. Create a Sense of Urgency-help others see the need for change and the importance of

acting immediately

2. Pull Together the Guiding Team-A powerful group with leadership skills, credibility,

communication ability, authority, analytical skills, and a sense of urgency

3. Develop the Change Vision and Strategy-clarify how the future will be different from the

past and how you can make the future a reality

4. Communicate for Understanding and Buy In-make sure as many others as possible

understand and accept the vision and the strategy

5. Empower Others to Act-Remove as many barriers as possible so that those who want to

make the vision a reality can do so

6. Produce Short Term Wins-Create some visible, unambiguous successes as soon as

possible

7. Don’t Let Up-Press harder and faster after the first successes-Be relentless with initiating

change after change until the vision is a reality

8. Create a New Culture-Hold onto the new ways of behaving, and make sure they

succeed until they become strong enough to replace the old traditions.

-Kotter, John P., and Holger Rathgeber. Our Iceberg Is Melting: Changing and

Succeeding under Any Conditions. New York: St. Martin's, 2006. Print.


Baylor Institute for Rehabilitation

New Graduate Education and Development Series Curriculum Month 1: General Medicine Part 1

This is an introductory course for new graduate therapists practicing in an acute care hospital

setting. The course will include patient advocacy, strategies for discharge planning for a variety

of patient diagnoses, management of patients with psychological disorders, and communication

strategies used with patients and other healthcare providers

Topics Include: Advocacy, D/C Planning, Communication Strategies, Psychology

Month 2: General Medicine Part 2

This is an introductory course for therapists practicing in the acute care hospital setting. The

course includes outcome measurement, imaging and diagnostic testing encountered by the

rehab professional. Common laboratory tests will be reviewed including normal and abnormal

values. Basic pharmacology will be reviewed with emphasis on the impact of pharmaceuticals

on therapeutic intervention.

Topics Include: Acute Outcome Measurement, Imaging and Tests, Pharmacology, Lab

Month 3: Cardiopulmonary System and Treatment of the Acutely Ill Patient

This is an introductory course for therapists practicing in the acute care hospital setting. The course is a case study describing cardiopulmonary diagnoses and their impact on rehabilitation. It will review the rehab professional’s assessment and intervention with the acutely ill patient incorporating principles learned in the preceding courses in general medicine. Best practice guidelines for the cardiopulmonary patient will be discussed as well as specific strategies concerning interventions in the presence of cardiac surgery, impaired ventilatory strategies, global deconditioning, poor activity intolerance, Passy-Muir valves, trachs, and Dysphagia. Topics Include: Interdisciplinary PT, OT, SLP Acute Care of the Cardiopulmonary Patient. Includes case study, evaluation and treatment planning. Month 4: Neurology This is an introductory course for therapists practicing in the acute care hospital setting. The course will begin with a review of the signs and symptoms of Neuro trauma and the impact on the rehab professional’s assessment and intervention on this patient population. The anatomy, physiology, and presentation of patients with traumatic brain injury will be discussed including the incorporation of a multidisciplinary approach to the treatment. Finally, the course will cover facilitation techniques for patients with dementia Topics Include: Brain Injury and Trauma, Dementia and Mentation, Stroke Month 5: Oncology This is an introductory course for therapists practicing in the acute care hospital setting. The course will begin with a discussion on the signs, symptoms, and general problems affecting a patient with cancer. This course offers a more in depth review of pain management using both pharmaceutical and complimentary methods. The course will end with a discussion on a palliative model of care including emphasis on effective communication and the role of the rehab professional in end of life care. Topics Include: Acute Care Oncology, Pain Management, Palliative Care


Month 6: Orthopedics

This is an introductory course for therapists practicing in the acute care hospital setting. The

course will begin with a discussion of hot topics in acute orthopedics. Participants will work in

teams to design a plan of care for patients with hip fracture, orthopedic spine, and total joint

replacement patients. Specific clinical decision models will be discussed.

Topics Include: Series Capstone Lectures and Cases with Joint Replacement, Spine,

Orthopedic Trauma and Hip Fracture


Presenter Application

Full Name with credentials and certifications:

Example: John Smith, PT, DPT, MBA, NCS

Schools attended and all degrees attained

Major places worked and positions held including current:

BIR System and hospital involvement including councils, program development, etc.:

Professional involvement and positions held including state/national professional groups,

universities, research conducted, etc.:

Community group involvement:

Personal interests:

How I would present this topic:


Gantt Charts for Project Management

Course and Tasks Early Planned P Completed Delayed

7/18 7/25 8/1 8/15 8/22 8/29

Objectives complete/received

Speaker CV received

Schedule Received

Course Description Received

Room Reserved P P

TPTA CCU Submitted

P

ASHA CEU Submitted

P

ASHA CEU Approved

P P

Brochure Developed

P P

Registration Out P P P

Registration Finalized

P P

Handouts Received

P P P

Email Confirmation

P P

Catering Ordered P

Handout Packets Made

P

CCU Issued and filed

P P

Analysis of Course evals completed


BIR Hospital Division New Graduate Education Series Presentation Development Worksheet and Expectations

Presenter: ______________ Presentation Title:_ ____________ Next Presentation:______ Overall Recommendations:

1. Review BIR Notes to Speakers booklet each cycle 2. Set up detailed timeline and meeting planners for yourself and with your mentor each cycle 3. Present clearly above what is taught in graduate school, and above what your colleagues

with a couple years of experience would know. Attendees do not need basic information 4. Focus on functional application – what it is really like in the clinic since the new grads are

fresh with the latest didactic. Stories and case studies with group discussion are effective 5. Consider including 1 page quick reference summary of critical course information 6. Mandatory Sections: 5 minute review of basics to bring all the audience to baseline – no

more and 5 minutes of Q&A time at the end 7. Recommended Sections: 10 minutes of hot topics and latest research on your topic, and 10

minutes of advanced case study discussions with mandatory audience participation 6 Months Before: ____/_____/_____

Review existing audience feedback and Speaker feedback forms and create plan to further develop based on overall trends (you can’t please everyone, but we can always improve). What is needed?__________________________________________

Set up timeline to complete revisions and meetings with mentor: _____________

Start new review of literature and discussions with at least 3 experts in the field to keep up to date 4 Months Before: ___/___/___

Spoke with the following 3 experts (physicians, surgeons, expert clinicians in the field): ____________________________________________________________________ Asked each about: latest research, hot topics, provide an advanced case study

Are all disciplines (PT, OT, SLP) well represented in your education?

Completed literature review of at least 10 articles, at least 5 less than 5 years old. Subsequent literature reviews should review new scholarly updates in the last 12 months and incorporate as appropriate. Use at least 5 articles in your presentation.

3 Months Before: ___/___/___

Complete revisions from feedback, discussions with experts, and new literature reviews

Meet with mentor and entire presentation team to have complete presentation run through to review how entire presentation flows

2 Months Before: ___/___/___

Final version sent to designated education coordinator for review by system education councils Final Step: Practice! What are your engagement and presentation techniques throughout? Check for timing and overall segues and flow and another review of prior speaker feedback. Practice more!


Professional Presentation Inservice and Mentor Group

9:00-12:00

Purpose: Provide therapists with expert mentoring on the topic of professional presentation and

individual consultation on their specific professional presentations in development as needed.

Target Audience: All disciplines of rehab and acute therapists with questions on how to present

or make the presentation they are working on a great one. Ideal for newer presenters actively

developing their presentation.

Attendee Requirements:

Attendees would need to attend with working outline or Power Point and ready to

actively discuss where they are in development and what specific questions or advice

they are seeking from our experts. Bring a laptop or hardcopy of the materials you need

expert guidance.

Schedule

9:00-9:10 Welcome and Introductions

9:10-9:40 Presentations 101, part 1 – Building Power Point presentations

9:40-10:10 Presentations 101, part 2 – Delivering presentations

10:10-10:45 Panel Discussion and Q&A from expert presenters

10:45-11:00 Break

11:00-12:00 Individual guidance by experts on course and presentation

questions


BIR Education Speaker Feedback Form Speaker Name:__________________ Presentation:____________________Date: ______________ Rating Guide Use this guide when assigning numerical ratings to the categories on the evaluation form:

5. EXCELLENT; worthy of special praise and recognition. 4. VERY GOOD; the speakers ability in this category is above average for his/her level of experience. 3. ACCEPTABLE; the speaker’s performance in this category is satisfactory. 2. SHOULD IMPROVE; the speaker should work to improve his/her performance in this category. 1. MUST IMPROVE; the speakers performance in this category is a barrier to effective communication

and requires immediate attention.

CATEGORY RATING RECOMMENDATIONS

Overall Presentation Content 1 2 3 4 5

Preparation (well-researched, organization,)

1 2 3 4 5

Opening (attention getting, led into topic )

1 2 3 4 5

Body of Speech (logical flow, points supported by examples and quality evidence )

1 2 3 4 5

Transitions (smooth, easy to follow )

1 2 3 4 5

Conclusion (effective, clear take home points )

1 2 3 4 5

Multimedia Usage (PowerPoint, Video, Live Demo, Props )

1 2 3 4 5

Overall Delivery 1 2 3 4 5

Engaging Audience (challenging them to critically think and problem solve using learned content )

1 2 3 4 5

Voice (volume, variety )

1 2 3 4 5

Language (appropriate to topic and audience )

1 2 3 4 5

Manner (confidence, assurance, sincerity, enthusiasm)

1 2 3 4 5

Physical Actions (gestures, body movement, eye contact, facial expression )

1 2 3 4 5

Crutch Words (and, like, you know, ah, um, or er. (specify ) ______________

1 2 3 4 5

Other ( specify ) ______________ 1 2 3 4 5


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