MARYLOU HAGEN, PA-CUNIVERSITY OF WISCONSIN HOSPITAL

DEPARTMENT OF SURGERYAPP SUPERVISOR

Improving APP Workforce at a Department level

at a Department Level

University of Wisconsin Department of Surgery

The Department consists of 7 divisions. A total of 67 Advanced Practice

Providers.

Prior to 2015

APP Leadership structure was at a division level

APP’s were self-governedLed to inequities and inconsistency across

the department Role utilization Time off Holiday coverage Call Practice concerns

2015 - Supervisor role initiated

UW Health Director of Advanced Practice Providers

Leads over 380 APPs in 17 clinical departmentsRecognition that structure needed to be

imposed to create meaningful changeSupervisor role initiated for large departments.

Supervisor requirements

1) Clinically active2) In the Department for at least 3 years3) Consistently meeting performance

expectations of Department and UW Health.

Department of SurgeryAPP Supervisor

Position Description written50% FTE assigned Hospitals funds:

Annual stipend of $7500 50% of the current APP’s salary.

Clinical work decreased by 50%

APP Supervisor Reporting Structure

Reports to the Department ChairReports to the Department AdministratorReports indirectly to UW Health Director of

Advanced Practice Providers.

APP Supervisor Roles and Responsibilities

Promote, educate, utilize, and optimize APP’s across the Department

Address issues related to clinical safety, quality, and professionalism for APP’s

Collaborate with team leads to implement department or division specific orientation and competency in new employees.

Develop quality and performance metricsHold monthly team lead meetingsHold quarterly Department meetingsLeave and payroll approval for team leadsAttend monthly APP Supervisor meeting

APP SupervisorSelection Process

Recruitment process initiatedOpen to all practicing APP’s in the

Department of Surgery. 10 applicants – all interviewedThe interview process led to additional

applicants. 3 finalists were identified and supervisor

was chosen.

Immediately recognized that this was too much for one person to

do.

Team Leads

Due to the large number of APP’s in the Department, team leads were named for each division. Vascular (8APP’s) General Surgery (16 APP’s) ENT (7 APP’s) Pediatric Surgery (4 APP’s) Transplant (8 APP’s) CT surgery (16 APP’s) Plastic Surgery (4 APP’s)

Team Lead Roles and Responsibilities

Requirements: Practicing APP in the Department for at least 2 years Meets performance expectations for UW Health and

the Department of Surgery

Team LeadRoles and Responsibilities

APP role optimization in the divisionOrientation of new team membersAdvocacy for APP’s in the divisionStaffingCall scheduleTime card and leave approval for division

APP’sLiaison to Department of Surgery APP

APP Team LeadRoles and Responsibilities

Administrative time 0.1 FTE – this is not protected time $2000/ year stipend. Paid by the division.

Is $2000 enough?

Communications and meetings – Team Leads

Monthly meeting with APP supervisor 2nd Tuesday of the month at 7 am Review staffing and recruitment Discuss current issues, changes, upcoming events,

and current initiatives.

Communications and meetingsAll APP’s

Quarterly Department of Surgery APP meeting. Held once every three months at 7 am – breakfast

provided. Past and future topics:

Billing Avatar scores Time study/role evaluation Metrics for merit Organizational initiatives ICD-10

Communications and meetingsAll APP’s- “get to know”

Email sent bi-weekly to all APP’sFun questions askedPhoto included 1) what do you miss most about being a

kid?2)who was your favorite teacher and why?3)what is the worst movie you've ever seen?4) what is the best gift you've ever received?5) what is your favorite flavor of ice cream?

“Get to know”

A great way to make personal connections. Feedback has been fantastic

“I feel valued” “finally get to know my colleagues” “I’ve never seen this person before, now I can say

hello.”

Initiatives and projects

Role evaluation/time study Outside consulting firm identified 40% of what APP’s

were doing was non-APP work $2 million dollar loss in inappropriate work placement Initiated role evaluation/time study Separated duties into APP and non-APP. Able to compile data into personal, division, group,

and department. Next step – discuss with hospital administration to

better utilize APP’s and work at the top of their license.

Name: Date:Role: APPDivision:

Task PerformedTime Estimate

(min) AM PM Total

patient care in clinic - solo 0

Patient care in clinic - team (MD)

0

Scribing 0

Charting or dictating 0

Placing orders / ordering patient supplies

0

Coordinating patient care - appts/consults/testing

0

tracking down medical records 0

performing H&P's 0

OR (first assist) 0

OR (non-first assist) 0

Review test results 0

Calling patients to discuss test results

0

In offi ce or inpatient procedures

0

Rounding 0

patient and family teaching - in person

0

FMLA/paperwork 0

managing or changing clinic schedules

0

answering in-basket triage calls

0

answering in-basket scheduling questions

0

patient teaching - phone (meds, surgery, etc)

0

travel time between hospitals- not too and from work

0

rooming patients 0

fill in as appropriate: 0

Note: Only fill in the grey cells.

Activity TIme Percentage Averages & APP vs. Non-APP Role Ac-tivities

Activity TIme Percentage Averages & APP vs. Non-APP Role Activ-ities

Patient care in clinic - team (MD)

19%

performing H&P's18%

patient care in clinic - solo

8.95%Placing orders / ordering patient supplies

7%

Rounding6%

Calling patients to discuss test results

6%

OR (first assist)5%

patient and family teach-ing - in person

5%

After Hours Calls/emails/texts

4%

In office or inpatient procedures

4%

Review test results3%

pts email comm.2%

OR (non-first assist)2%

travel time between hospitals- not too and

from work1%

tracking down medical records4.86%

Coordinating patient care - appts/consults/testing2%

Scribing1%

Activity Time Percentage Averages & APP vs. Non-APP Role Activities

90.76% = APP Activities 9.24% = Non. APP

Initiatives and Projects

Critically looking at current work flows and utilization before approving new or replacement positions in divisions.

At times APP’s being poorly utilized are being replaced with RN’s or MA’s when the primary duties are record gathering, triaging, medication management, and care management.

Initiatives and Projects

Reviewing appropriate placement of APP positions. Medicine versus Surgery

Initiatives and Projects

Investigated areas of job dissatisfaction – retreat

Initiatives and projects

Performance evaluations and merit. A common evaluation was developed for all APP’s in

the organization For the first time the Department will maintain the

evaluations Merit had been distributed as assigned – now will be

given based on metrics so differentiation can be substantiated.

Initiatives and Projects

New performance metrics Chart completion Project development Quality improvement initiatives Citizenship Avatar scores Length of stay Presentations/staff education Precepting Division specific metrics

Department Value

Recognized go-to person with APP questions.APP’s have an advocateConsistent rules are created and appliedCredibility to understand and change clinical

work flowsAPP’s working at the top of their license

Lessons learned in the1st 6 months

Consistency is everything. Exceptions create problems.

Equality among the APP group is vital. Applying consistent practices upsets those with

special deals.Those employees may leave.Results are a stronger team.

Communication is key.Leading and managing is hard work!!

THANK YOU

QUESTIONS?

hagenm@surgery.wisc.edu