Increasing Usage, Adding Resources, and Building Support

1. Increasing Usage, Adding Resources, and Building Support Allen J. Giannakopoulos, Ph.D. Baptist Health South Florida Corporate Director Information Technology Process Re-engineering and Operational Process Support, Customer Advocacy and Knowledge Reports Development

2. What are the Issues at Hand? • Budgeting for operational success. • Utilization of the Sim Center – occupancy rate and the amount of space that is actually occupied. • Allocation of resources to provide training staff and staff to train. • Gaining commitment.

3. Budgeting • Last year’s survey: • No annualized budget: 52% • Budget created before opening: 24% • Created in the first 3 years: 18% • Created after that: 6%

4. Budgeting = Existence • Where have all our SIM dollars gone?

5. Budgeting = Existence • Where have all our SIM dollars gone?

6. Capital vs. Operational Dollars • Last year’s survey: • “Competition for budget dollars is an important on-going issue” – 92% agreed or strongly agreed!

7. Capital vs. Operational Dollars • But: • “We did not overspend on equipment” – 75% agreed or strongly agreed! • “We did not overspend on infrastructure” – 84% agreed or strongly agreed!

8. Capital vs. Operational Dollars • Capital expenditures are typically one-time events. • However, capital expenditures are the gifts that keep on giving – mainly, operational expenses. • In each case, there has to be an operational budget created or modified to cover the added costs.

9. With SIMs Alone…. • Room allocation. • Closet / storage allocation. • Transport costs. • Staff for maintaining and cleaning the SIMs. • Scheduling staff. • SIM support contract.

10. With a Dedicated Space? WOW! • Support staff, FT / PT. • IT Support for equipment. • Media Services support. • Internal education staff and materials that provide the scenarios. • Budget guidelines for OH allocation.

11. Develop the Operational Budget • Use current budgets as a baseline. • Colleagues with SIM centers, large and small, will share budget data with you and can be tailored to your organization. • Then, share with your senior leader colleagues for feedback and approach method.

12. Issues at Hand? Utilization! • Last year’s survey: • Competition for space is an important on-going issue – 79% agreed or strongly agreed!

13. Issues at Hand? Utilization! • Space is always a premium asset, look for space that is underutilized. • Develop a SWOT analysis on the space needs and where you have options for space. • BE FLEXIBLE when you are starting out – the point is to get something, not your ideal space.

14. Strengths • Philosophy of BHSF is to care for patients, and be the best. • Allows a competitive advantage over other health systems. • Several SIM’s already purchased. • Metrics allow for proof of gains. • Knowledge base to perform this is within BHSF. • Small Simulation Lab start-up already occurring. • BHSF has the culture to innovate. • BHSF is able to do this financially. • Media Services already adept at the technology to support this. • Strong support from areas that have a greater need to train in an environment as close to real as possible.

15. Weaknesses • Location of space for new Center. • Requires a Champion of the cause for each clinical area. • MD /RN teaching requirements. • Funding – start-up. • Funding – annual operational. • Staffing allocation. • Training not required by departments. • Will require new supplies and equipment. • Reliability of metrics collected. • Each Simulation scenario takes time - from setup, to scheduling, to performing it, to debrief, to cleanup, to final documentation.

16. Opportunities • Ability to have one Simulation Center for all. • Simulation scenarios can be based upon need, criticality, error rates, according to departmental need and justification. • Every area can identify scenarios that are needed to jump from classroom training to real-life training. • Metrics can be established and then monitored – (possibly never been done before). • Can create policies to cover high profile areas SIM scenarios, thus satisfying educational / present and future regulatory needs. • Can market this to International Services physicians and staff. • Computer simulation/ modelling is growing and the tools are mature, allowing interactive experiences.

17. Threats • Regulatory compliance. • Perception of ‘time away from work’. • Legal issues from recording. • Competing resources. • Having different SIM platforms – one centralized, other small labs in the hospitals. • Under-utilized space after Center opening. • Cancellation of a scheduled SIM scenario due to absenteeism, emergency, creates poor perception of commitment.

18. Issue at Hand? Space! • There is an unwritten rule in health care: Unused space becomes reallocated space.

19. Issue at Hand? Space! • Last year’s survey: • Underutilized center: 45% • Maximum utilization: 26% • Process to maintain utilization: 19%

20. Space Determination • Spending resources to develop a feasibility plan to justify a certain amount of space that is required for training can be fruitless. • Instead, use your collegial contacts to discover unused space. • If not, then space will have to be rented / leased.

21. Issues at Hand? Staffing! • From the survey – • “Difficulty in maintaining the commitment to training time” - 44% strongly agreed. • “No standards for SIM training: - 44% strongly agreed. • “Standards created” - 9% strongly agreed.

22. Staffing • From the survey – • “Competition for faculty time is a major consideration” - Score: 4.4 of 5 94% agreed or strongly agreed!

23. Staffing • From the survey – • “Competition for staff time is a major consideration” - Score: 4.32 of 5 97% agreed or strongly agreed!

24. Staffing • Politics comes into play to insure that staff time is a part of the culture – that SIM training is ongoing and required. • This directly affects space utilization. • Without this, you are at risk of losing the space anyway.

25. Staffing • Proper thought needs to determine what resources are needed, how often, and in what roles. • Required education will be the main driver. • These factors can then be quantified – and the numbers can be revealing.

26. Staffing • Have you created a short presentation that can be shared with your colleagues? • Have you spoken with any of your senior management to present to them what the plan is? • Have you had conference calls or site visits with comparable health systems to gather data?

27. Staffing • Have you worked with your facilities staff to identify space, no matter how small, that can be altered for fit-to-use? • What budget constraints do you have given the economic climate? • Which department heads have you met with that are already interested in simulation?

28. Staffing • What research papers have you gathered to show the benefits and cost savings from simulation? • Have you identified the budget line items that will be affected? (meet with Finance!) • Do you have any videos or news clips showing what the goal would be like? People love visuals!

29. Issue at Hand? Commitment! • How do you build commitment? • Paint the picture of what needs to be and then show how others are doing it; show what is not being done; and then prepare the plan on how to bridge the gaps.

30. Commitment: One at a Time

31. Commitment • Sometimes, you get top down drivers. Great! • Sometimes, you get regulatory compliance. This works! • Sometimes, you have to build the support block by block.

32. Finally….the Big Picture • If you are the driver behind this, then you are building something that has not existed. • Other managers may not be able to relate, as they typically inherit something that has always been. • There are two ways to do this: as an opportunity, or as a crisis.

33. Finally….the Big Picture