1. Penn Presbyterian & Trauma Transitions September 2014 Special All Employee Meetings

2. 2 Today’s Session Highlights  Penn Medicine University City  Campus Security & Parking  Human Resources plans  Patient care unit changes timelines  Service and support changes  Preparations and orientation to transition  New trauma process operations in development  …Ask the audience

3. 3 Penn Medicine University City  Now Open – Penn Medicine’s Newest Outpatient Center  HUB site for the Penn Musculoskeletal Center  PMUC intranet page with details of operations of building  Average Daily Impact of Activity Shifting from PPMC to 3737 Market: 360 staff and faculty 140 Therapy Visits 300 Clinic Visits 122 Medical Imaging Visits 19 Surgery Cases

4. 4 Penn Medicine University City Occupants FloorDepartment 8Penn Neurosciences Clinic (Neurology & Neurosurgery) Penn Musculoskeletal Center (Orthopaedics & Rheumatology) 7Medical Imaging, Outpatient Lab & EKG, Neurodiagnostic Lab & Non-Invasive Vascular Lab) Penn Musculoskeletal Center ( Orthopaedics, Pain Medicine; Sports Medicine ) 6Administrative Offices & Faculty Offices 5The Surgery Center at Penn Medicine University City 4Surgery & Urology Penn Mesothelioma & Pleural Program 3Allergy & Immunology Endocrinology, Diabetes & Metabolism Otorhinolaryngology 2Penn Therapy & Fitness Physical Therapy 1Retail Pharmacy Note: Floors 9 and 10 will be occupied in the spring of 2015

5. 5 First Renovations at PPMC opening 2 (1.5T MRI) & control room Inpatient holding Prep consult space Radiologist reading room Male & Female changing (4) Test & Evaluation Rooms Bereavement Room Reopen side entrance to the ED (former ambulance entrance) for all traffic Half of the Emergency Department Renovations for the new Reception and Triage area have opened along with the new MRI suite

6. 6 Safety Enhancement - Crosswalk 38 th Street  The opening of Penn Medicine University City has increased pedestrian traffic crossing midblock between the main campus and Filbert Street  City Traffic Engineering has approved the crosswalk plan which will be constructed this fall

7. 7 Security Enhancements Penn Police officer stationed outside the emergency department day and evening shift 12 additional full time staff joining the PPMC security team Additional officer posts positions Team Handcuff and baton carrying Aggression management Act 235 certification for enhanced control of situations Crowd control methods Skills Metal detector at emergency room Panic buttons at reception desks/nursing station 4 PAC and 4 Cupp secured access unit with video monitoring Video monitoring throughout Facility Additional staff will allow for increase incident response time Enhanced rounding and expanded coverage hours Security coverage is consistent with HUP and other Level 1 Trauma Centers coverage Response

8. 8 Staff Parking at PPMC 1 4 5 2 Penn Presbyterian Campus Parking is located currently in five locations: 1.Powelton Lot 2.Scheie/3910 Lot 3.Rudolphy Lot 4.Main Parking Deck 5.Fresh Grocer Parking Free Employee Parking: -In after 2 PM & out by 9AM -All Weekend -Main Parking Deck Must have PPMC ID badge 3

9. 9 Staff Parking at PPMC  Patient parking for Penn Medicine University City is now available at the connected garage servicing the 3737 location  No additional parking structures have been built  Rudolphy lot will be converted to a patient lot and staff parkers in that lot will be accommodated in other campus lots (Fall 2014)  Staff requests for parking are being accommodated currently in the Fresh Grocer garage located at 40 th & Walnut  Currently parking rate for the 40 th & Walnut location is $169.08/month rate which is the standard University rate  Shuttles are provided to the campus between 5 AM to 9:30 AM; and resuming from 3:30 PM to 9:00 PM on continuous loop

10. 10 Ensure Trauma competency transfer to meet the patient needs and ensure Trauma Foundation compliance Ensure a smooth integration of combined PPMC teams and new job roles. Retain and expand PMC staff as well as increase skills and competencies as needed to support the trauma patient and new care requirements Mitigate any Human Resources differences between entities as barriers to transfer and retention. Develop an easy process for job role transfer Trauma Transition Guiding Principles

11. 11 Hospital Staff Impact FY15 Well resourced to support the care of the trauma patient as well as increase PPMC capacity to 24/7 operations and the new Pavilion occupancy expansion * Includes 20 advanced practice providers

12. 12 CPUP Incremental Expansions for FY15 14.1 FTE Faculty 7.0 Residents/Fellows TOTALS 5.1 Faculty 1.0 Critical Care Fellow Anesthesia Critical Care 3.0 Faculty 1.0 Resident Emergency Medicine 1.0 Fellow Medicine – Infectious Disease Additional call Neonatology 0.5 Faculty Neurosurgery 1.0 Faculty 1.0 Fellow Neurology-Neurocritical Care Additional call 1.0 Resident Obstetrics 1.0 Resident Otorhinolaryngology 1.0 Faculty PM&R 1.0 Faculty & additional call Radiology – Interventional Rad. 2.5 Faculty 1.0 Critical Care Fellow Surgery DepartmentFaculty/Residents/Fellows In addition to the existing faculty and staff at PPMC several departments expanded staff to ensure 24/7 provider depth coverage and to facilitate new program growth

13. 13 Human Resources Programs Base Pay Compensation program will be the same Benefits program is the same including Tuition and Paid Time Off programsCertification and Preceptor bonus pay will be standardizedAllied Health job requirements will be standardizedAlignment of Shift Differential policy and rates Registered Nurses will transition to Exempt/Professional model

14. 14 Transition to RN Professional Exempt Model Professional Nurse: Pay Program  UPHS supports the professionalism of RNs while remaining market competitive in pay and practices.  Penn Medicine Nurses are full partners with Physicians and other health care professionals. HUP RN’s have been classified as exempt under the Fair Labor Standards Act for over 20 years, setting the model for the rest of the country.  Nurses will be scheduled over a two week (80 hour) period allowing flexibility in scheduling to fulfill their guaranteed FTE. To recognize Nurses who work beyond 80 hours in a pay period, a premium pay will be paid for time worked in excess of 80 hours. This premium pay is equal to 1.5 times the Nurse’s base rate of pay.  To give the professional Nurse flexibility and discretion during their time at work, time worked that is less than 30 minutes before or after the nurse’s scheduled shift does not qualify for premium pay. When time worked exceeds 30 minutes before and/or after the scheduled shift, then all the time worked before and/or after the shift may qualify for premium pay. Qualifying minutes are not cumulative in the same day, or from day-to-day.

15. 15 Alignment of Shift Differential Practices  Scope: all shift differential eligible positions at PPMC to adopt UPHS shift differential practices (same as HUP’s current practices)  Summary of current and proposed shift differential practices  Most significant changes:  All shift differential pay changes from a flat dollar amount to percent of pay  Those positions that move to a 12-hour pay rule will no longer receive any differential on 12-hour day shifts (7A to 7:30P) & will receive all night differential on 12-hour night shifts (7P to 7:30A)

16. 16 2014 Campus Transition Timelines Penn Medicine University City opened; HUP based MSK Radiologists & HUP Orthopaedic faculty and staff transition to campus with this move 2 new 1.5 T MRI suite at PPMC - Temporary MRI trailer closes Cupp 3 East and 3 South service line shifts Rapid Assessment and Treatment opens in the Emergency Department – 1 Myrin New recruits for PAC opening begin Trauma Program Staff and Faculty Offices move from HUP Eye Emergency Suite open 24/7 in Emergency Department Aug Fall Dec

17. 17 2015 Campus Transition Timelines SICU moves to new home in 4 PAC Trauma Surgical Critical Care Unit PACU/SPU move to new 2 PAC home ED expansion opens and the MICU moves to 2 Myrin and Neurocritical Care service begins in 4 PAC unit CCU moves to new 3 PAC home New complete Heart and Vascular Unit begins with move of CT patients to new 3 PAC unit Observation patients move to 3 Wright Saunders (former CCU space) Trauma service begins, PAC Helipad opens, and HUP staff transition 01/05/15 01/10/15 01/12/15 01/19/15 4 01/26/15 5 01/29/15 02/04/15

18. 18 PPMC Service Enhancements New welcoming Cupp lobby and Concourse Medical Imaging and Lab waiting in new Concourse All radiology modalities in new consolidated facilities Neurosurgical and neurocritical care services Expanded food service options with addition of new café Dedicated Observation unit New Inpatient therapy gym Emergent 24/7 Eye Injury treatment in Emergency Department Enhanced Surgical Patient & family experience Rapid Assessment and Treatment pathway for Emergency department patients Expansion of Critical Care capacity at PPMC Expanded consult services Many of the service and facility enhancements on the horizon enhance the patient care experience for ALL of the PPMC patients and providers

19. 19 Preparing Teams for Transition  Learning the process of Trauma Care is being facilitated via multiple skill sessions including : HUP Onsite Observation/Preempting; Skills sessions & formal didactic course; Scenario based simulation at SIM Center;  New Pavilion Orientation Unit and ancillary staff in new PAC Life safety and unit orientation/process flow  PPMC Need To Know Orientation for All Staff Pavilion Navigation and Orientation New campus service expansion Trauma and Injured Patient Awareness 101  Simulation will be conducted following the path of the patient in the new PAC facility

20. 20 Team Structure and Integration  Staff transitioning from HUP will retain their seniority and tenure from date of hire to the health system  New team members will integrate with the PPMC teams  Some departments may have changes to shifts and team assignments as the new team structures are identified

21. 21 “Hidden” Transition Challenges  Replication and expansion of services to support the trauma patient outside of HUP has been the focus and measure of success in our transition readiness.  Areas where HUP has had historically limited patient demand have required us to think more creatively about how to serve these patients in the new trauma environment at PPMC: Pregnant Patients Neonatal and Pediatric Patients Inter-facility Transport

22. 22 Rapid Intercampus Staff Transport Plan  The Rapid Intercampus Staff Transport (RIST) protocol was established for emergency staff mobilization  Facilitated by the PPMC and HUP security offices  Staff member place call to campus dispatch number  Transport pickup within 15 minutes of call  Designated pickup location at each campus  Activated 24/7  Transport vehicle fleet expanded to accommodate demand

23. 23 Scenario Simulations Patient simulation scenarios will assist teams to practice many of the new clinical situations that the PPMC campus will encounter. Security Scenarios Patient transport & Bed Flow Pediatric trauma patient/ neonate pediatric patient Family management in Trauma Bay Blood transport and order Trauma impact to OR cases

24. 24 Ask the Audience…  Please get out your phone  Open your messaging app  Create a new text to: 22333 https://www.polleverywhere.com/my/polls#!/my/polls

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