Department of MedicineSub-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 Richard Novotny, Sue Plancon, and Marilyn Hauser Fahey Team Picture Confidential: Quality Improvement Material

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

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: PURPOSE/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

Organizational Characteristics Before Restructuring 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 Organizational Characteristics After 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

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

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

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

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, voic s, and employee ID’s in an effort to promote consistency, teamwork and service Established regular “Team” meetings Confidential: Quality Improvement Material

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

RESULTS Cost Savings $132, (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 Confidential: Quality Improvement Material Before Restructuring After Restructuring Salary and Benefit Costs

Testimonials to Results “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 Confidential: Quality Improvement Material “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 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

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. 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 ANALYSIS NEXT STEPS