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Department of Medicine Sub-Specialty Support Staff Restructuring

Department of Medicine Sub-Specialty Support Staff Restructuring Confidential: Quality Improvement Material Collaborative Team David Katz, Donna Epley, Jacqueline Foulk, Juanita Kizior, Jane LaMarre, Jacqueline Pikes, Katina Shehie, and Rosetta Sramek

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Department of Medicine Sub-Specialty Support Staff Restructuring

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  1. Department of Medicine Sub-Specialty Support Staff Restructuring Confidential: Quality Improvement Material

  2. Collaborative Team David Katz, Donna Epley, Jacqueline Foulk, Juanita Kizior, Jane LaMarre, Jacqueline Pikes, Katina Shehie, and Rosetta Sramek Richard Novotny, Sue Plancon, and Marilyn Hauser Fahey Team Picture Confidential: Quality Improvement Material

  3. BACKGROUND The 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. Confidential: Quality Improvement Material

  4. PURPOSE/GOALS-OBJECTIVES: 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: • 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 Confidential: Quality Improvement Material

  5. Organizational Characteristics After Restructuring Organizational Characteristics Before 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 • 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 Confidential: Quality Improvement Material

  6. Before Director of Administration Division Administrator Division Administrator Division Administrator Allergy Rheumatology Immunology General Internal Medicine Pulmonary & Critical Care Infectious Disease Dermatology Endocrinology Admin Secretary Admin Secretary Admin Secretary Senior Secretary Senior Secretary Senior Secretary Senior Secretary Admin Secretary Admin Secretary Senior Secretary Fellowship Program Fellowship Program Fellowship Program Fellowship Program Residency Program Confidential: Quality Improvement Material

  7. After Director of Administration Division Administrator Division Administrator Division Administrator Education Coordinator 4 Fellowship Programs 1 Residency Program Admin Secretary Admin Secretary Admin Secretary Admin Secretary Admin Secretary Admin Secretary Allergy Rheumatology Immunology & Pulm & Back up to Infec Dis Dermatology & Back up to Endocrinology & General Internal Medicine Pulmonary & Critical Care & Back up to Rheumatology & Infec Dis Endocrinology & Back up to Dermatology & General Internal Medicine Infectious Disease & Back up to Pulmonary General Internal Medicine, Dermatology & Endocrinology Confidential: Quality Improvement Material

  8. 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 Confidential: Quality Improvement Material

  9. SOLUTIONS IMPLEMENTED Integration 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 Confidential: Quality Improvement Material

  10. 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 Confidential: Quality Improvement Material

  11. After Restructuring Before Restructuring 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 Salary and Benefit Costs Confidential: Quality Improvement Material

  12. Testimonials to Results “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 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 “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 Confidential: Quality Improvement Material

  13. ANALYSIS 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. NEXT STEPS • 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

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