1. MARYLOU HAGEN, PA-C UNIVERSITY OF WISCONSIN HOSPITAL DEPARTMENT OF SURGERY APP SUPERVISOR Improving APP Workforce at a Department level at a Department Level

2. University of Wisconsin Department of Surgery The Department consists of 7 divisions. A total of 67 Advanced Practice Providers.

4. Prior to 2015 APP Leadership structure was at a division level APP’s were self-governed Led to inequities and inconsistency across the department  Role utilization  Time off  Holiday coverage  Call  Practice concerns

5. 2015 - Supervisor role initiated UW Health Director of Advanced Practice Providers Leads over 380 APPs in 17 clinical departments Recognition that structure needed to be imposed to create meaningful change Supervisor role initiated for large departments.

6. Supervisor requirements 1) Clinically active 2) In the Department for at least 3 years 3) Consistently meeting performance expectations of Department and UW Health.

7. Department of Surgery APP Supervisor Position Description written 50% FTE assigned Hospitals funds:  Annual stipend of $7500  50% of the current APP’s salary. Clinical work decreased by 50%

8. APP Supervisor Reporting Structure Reports to the Department Chair Reports to the Department Administrator Reports indirectly to UW Health Director of Advanced Practice Providers.

9. 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 metrics Hold monthly team lead meetings Hold quarterly Department meetings Leave and payroll approval for team leads Attend monthly APP Supervisor meeting

10. APP Supervisor Selection Process Recruitment process initiated Open to all practicing APP’s in the Department of Surgery. 10 applicants – all interviewed The interview process led to additional applicants. 3 finalists were identified and supervisor was chosen.

11. Immediately recognized that this was too much for one person to do.

12. 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)

13. 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

14. Team Lead Roles and Responsibilities APP role optimization in the division Orientation of new team members Advocacy for APP’s in the division Staffing Call schedule Time card and leave approval for division APP’s Liaison to Department of Surgery APP

15. APP Team Lead Roles and Responsibilities Administrative time  0.1 FTE – this is not protected time  $2000/ year stipend. Paid by the division. Is $2000 enough?

16. Communications and meetings – Team Leads Monthly meeting with APP supervisor  2 nd Tuesday of the month at 7 am  Review staffing and recruitment  Discuss current issues, changes, upcoming events, and current initiatives.

17. Communications and meetings All 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

18. Communications and meetings All APP’s- “get to know” Email sent bi-weekly to all APP’s Fun questions asked Photo 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?

19. “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.”

20. 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.

24. 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.

25. Initiatives and Projects Reviewing appropriate placement of APP positions.  Medicine versus Surgery

26. Initiatives and Projects Investigated areas of job dissatisfaction – retreat

27. 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.

28. 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

29. Department Value Recognized go-to person with APP questions. APP’s have an advocate Consistent rules are created and applied Credibility to understand and change clinical work flows APP’s working at the top of their license

30. Lessons learned in the 1 st 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!!

31. THANK YOU QUESTIONS? hagenm@surgery.wisc.edu