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 1.Have you created a short presentation that can be shared with your colleagues? 2.Have you spoken with any of your senior management to present to them what the plan is? 3.Have you had conference calls or site visits with comparable health systems to gather data?

27. Staffing 4.Have you worked with your facilities staff to identify space, no matter how small, that can be altered for fit-to-use? 5.What budget constraints do you have given the economic climate? 6.Which department heads have you met with that are already interested in simulation?

28. Staffing 7.What research papers have you gathered to show the benefits and cost savings from simulation? 8.Have you identified the budget line items that will be affected? (meet with Finance!) 9.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