Provider Orientation

1. Provider Orientation

2. PPR Physician and Provider Relations

3. Facility Information • Service Lines available at the facility • Sister facilities’ service lines • Grand Rounds • Awards • Committee and Medical Staff Involvement • Physician Lounge • Credentialing Portal access and how to get help • Physician Events

4. Provider Relations Role in Orientation • PPR- Physician and Provider Relations • Providing all of the tools/resources needed to provide patient care • Issue Resolution • Equipment needs • Medical Staff Connections • Physician Orientation Folder Review

5. Introduction Pull out your phones… Colby Fosmark Lakeview Physician Liaison 801-589-4836

6. Provider Role in Orientation • Providers • Attend orientation and CPOE Training prior to first shift • CPOE Training will be scheduled after orientation completion. • Attend a minimum of one shadow shift with on-shift providers • This can be scheduled in conjunction with badge and tour appointment • Contact Information • Change of location: clinic, home, email or phone. • Please let myself or Medical Staff Office know of any changes in contact information or health changes.

7. Provider Relations Facility Contact Information EIRMC Mindy Hall 208-484-0171 Cody Arave 208-390-5412 WVMC Fred Webster 208-921-2431 CVH Lisa McDermott 801-989-6323 BCCH Lisa McDermott 801-989-6323 ORMC Lisa McDermott 801-989-6323 ARH Christi Stephens 907-354-5977 LVH Colby Fosmark 801-589-4836 SMH Janna Williamson 801-718-9188 LPH Janna Williamson 801-718-9188 TRH Rob McFarlane 385-225-0485 MVH Rob McFarland 385-225-0485

8. Resources/Appendix Physician Orientation Folder Medical Staff Bylaws/Rules and Regulations Policies Medical Staff Directory

9. Patient Experience

10. Patient Experience

11. What We Think…What Patients Think Access and scheduling: I’m worried NOW Fewer delays: don’t waste my time Integrated care: make it easy for me Quality outcomes: keep me safe Do no harm: don’t give me more to worry about Clear communication: don’t confuse me Empathy: be kind to me

12. Patient Experience “When patients are in the presence of observant, authentic, connected clinicians, they are more likely to move past the distrust that so often accompanies the perception of clinicians’ “otherness” and collaborate in addressing next steps that are scary, unknown, or unknowable.” • Daniel R. Wolpaw, M.D., and Dan Shapiro, Ph.D. The Virtues of Irrelevance

13. FRIST FIRST • Dignity • Suffering • Dependence • Independence

14. Emergency Department Staff Worked Together 97% Likelihood of Recommending Dr. Kept You Informed Information About Delays Press Ganey Drivers of Emergency Likelihood of Recommending

15. Inpatient Staff Worked Together 94% HCAHPS Rate Hospital 9-10 Room Clean RN Listens Press Ganey Drivers of HCAHPS Rate Hospital 9-10 n=937,000 patients

17. Inpatient HCAHPS Provider Questions: ED Provider Questions:

18. Jami Momberger VP Patient Experience HCA Mountain Division Jami.Momberger@hcahealthcare.com 385-246-5347

19. CLINICAL EXCELLENCE Quality, Safety, and Risk Management

20. Introduction • What is Clinical Excellence • Recognize the measures and goals related to Clinical Excellence • Current Focus Areas: mortality, sepsis, blood, stroke, pre 39-week delivery (PC-01), hospital acquired infections (HAI) • What is Quality Management • Understand the basic principles of QM • Clinical Documentation • Sedation • What is Risk Management • Understand the basic principles of RM • Observer Policy • What is a Regulatory Program • Understand your role in continuous readiness • Appreciate your role in participating and improving these programs • Know the Division structures, contacts, and 2019 goals related to Clinical Excellence

21. Quality, Safety, Risk Management Division Contact Information Michael H. Baumann, MD, MS Division Chief Medical Officer (801) 568-5941 Stephany L. Seuell, PhD Candidate, MSM, RN Division Vice President of Quality and Risk Management (801) 568-5935 Yvonne M. Stephens MPH Mountain Division Clinical Quality Data Manager (801) 631-1268

22. Quality, Safety, Risk Management Facility Contact Information HCA – Mountain Division Julie Hogue QM director (208)-529-7394 Sara Hawkins PSD / RM (208) 529-6312 Renee DeHaas QM / PS director (208)-455-6505 Natalie Oliverson QM / PS director (435) 713-9728 John Nelson QM / PS director (435) 734-9471 x4162 MaryAnn Green QM director (907)-264-2360 Georgi Yonuschot PSD/RM (907)276-1131 Brett Powell QM director (801) 479-2445 Jodi Waddoups PSD / RM (801) 479-2446 Brianna Barton QM director (801)-299-2397 Jeremy Plumb PSD / RM (801)299-2586 Deb Widmer QM director (801)268-7184 Eddie Decker PSD / RM (801) 268-7199 Troy Carlton QM / PS director (801) 545-8012 Robin Phillips QM / PS director 801-714-6047 Elaine Hoagland QM / PS director (801) 465-7051

23. HCA at a Glance

24. The Clinical Excellence Agenda Every HCA Division and hospital is ranked Clinical Excellence is determined by 12-month rolling performance in 30 measures More consequential measures have higher weighting (e.g., mortality) Senior Leaders at each hospital get their CE scorecard each month Scorecard is used to set priorities and evaluate the effectiveness of improvement efforts

29. Mountain Division2019 Clinical Excellence Focus • Overall mortality reduction • Clinical documentation to get credit for the work you do and the acuity of your patients • Billed vent days • Reduction in Hospital-Acquired Infections (CAUTI, CLABSI, CDI, MRSA, SSI) • 4. Blood transfusions Hgb <= 7 • Sepsis Bundle Compliance particularly antibiotics within 1 hour • Evolving patient safety and transparency communication • Stroke

30. Quality Management Monthly Service Line Meetings Monthly Facility QMOR Monthly CMO Meeting Monthly CNO Council Monthly Division Quality Quality Collaboration Meeting Our Organizational Framework for Clinical Excellence

31. Core Measures

32. Clinical Documentation • Documentation • Specific • Timely • Accurate • Complete • Reasons: • Credit for the work you do – how sick are your patients? • Physician Compare • Other • Observed/Expected (O/E) • Ratio impacted by: • Quality of care provided (Observed) • And/or.... • Quality of documentation (Expected)

33. Sepsis Documentation Case

34. Observer Policy • Each facility has a template policy • Key components • At least 18 years old • Observer medical (physician, APRN, PA), and Allied Health Staff members (dietary, respiratory, physician tx) in the hospital for educational and/or professional purposes • NOT an employee, privileged physician, contracted student, resident or fellow or an approved vendor (footnote here).

35. Observer Policy • Check list to cover (partial list) • Observer orientation booklet and quiz • Dress code • Confidentiality and security agreement • Signs “application and agreement for observing at the hospital” • Hospital administrator (CEO, COO, CNO, CMO) must sign off • HR must provide a badge (observer must have badge) • Negative PPD; and, flu vaccine “in season” • Patients MUST sign an authorization that includes language for an observer being present • Observer may NOT touch patient or participate in care

37. Risk Management What is Health Care Risk Management? • a function of administration of a hospital or other health facility directed toward identification, evaluation, and correction of potential risks that could lead to injury to patients, staff members, or visitors and result in property loss or damage. • Risk Assessment • Risk Factors • Risk Finding • Risk Appetite • Risk Retention vs. Risk Transfer

38. Risk Management? What is Health Care Risk Management? • To understand and deal with risk, whether potential losses or benefits. • Unmanaged risk prevents achievement of objectives. • Well managed risk promote achievement of organizational objectives and support positive patient outcomes • Ongoing series of interrelated activities designed to identify, assess, manage and monitor risks the organization faces. • The Key is to mitigate risk prior to experiencing a risk event. • Disclosures – Clinical and Institutional. • Medical Malpractice Claims Specific Goals for Providers • Develop partnership with Physician • Assist with patient complaints • Assist with malpractice risk mitigation • Occurrence data review • Regulatory knowledge

39. Risk Management Risk Management is a proactive and responsive profession that works to deliver safe and trusted healthcare by: • Saving lives, preventing errors and conserving financial resources • Reducing organization costs through optimal patient outcomes • Managing enterprise risk and increasing success in risk prevention

40. Adverse Events • Adverse events are untoward incidents, therapeutic misadventures, iatrogenic injuries, or other adverse occurrences directly associated with care. • Adverse events that necessitate a change in the patient’s care • Communicate the situation as soon as you are aware. • Clinical Disclosure or Institutional Disclosure Performed? Communications –involved in 90% of all events. Communicate properly = positive outcomes! Adverse Events- discuss the situation with your Risk Manager, help identify triggers for the situation, join the team.

41. Clinical Disclosure What is Clinical Disclosure • An informal process for informing patients or their personal representatives of harmful adverse events related to the patient’s care. • The clinical disclosure of adverse events is considered a routine part of clinical care, and needs to be made by the attending or senior practitioner or designee. Do you have the right tools and parts for the job?

42. Adverse Events • Clinical disclosure of an adverse event must occur within 24 hours of a practitioner’s discovery of the adverse event if adequate information is available. • Institutional disclosure of an adverse event must take place as soon as possible (generally within 24 hours, but no more than 72 hours if adequate information is available) after a practitioner’s discovery of the adverse event. ALSO Bridge out ahead….

43. Adverse Events

44. Variation • Variation is a fact of life – there is variation in everything • Some variation is good and may even be considered a facet of quality • Some variation is the enemy of quality/safety • When evidence indicates there is a RIGHT or BEST way • Most quality or safety improvements seek to eliminate unnecessary variation

45. Regulatory / Compliance • Healthcare is one of the most highly regulated industries • Regulations and accreditation standards are the foundation of quality, safety and high reliability • They define the basic “must haves” in virtually every aspect of the care and services we deliver • Compliance with regulations or standards is not the Quality Department’s job – it’s your job • Know what the regulations and standards are in your area of responsibility and establish methods to assure continuous compliance

46. Regulatory / Compliance Be Involved, Be a part of the Team, Contribute your knowledge What does Regulatory Compliance look like?

47. Your Role in Regulatory / Compliance

48. How Can You Help? If we have all the puzzle pieces in place at our facilities and division then……. We can prevent patient safety events, improve communication if one occurs AND we will never hear the below words from any regulatory agency.

49. Provider Role in Clinical Excellence, Quality and Risk Management Commit to our mission, vision and zero-harm Take ownership for continuous compliance with all safety, regulatory and accrediting standards related to practice area(s) Speak up and Identify critical processes to assure robust methods for monitoring and improving them Be diligent in with communication and eliminating unwarranted variation in practices that compromise patient quality/safety Insist that your team be engaged in your quality, safety and high reliability efforts Remember you’re not alone - use the skill and scale of HCA

50. Pharmacy