A Partnership Between the University of Utah College of Nursing and Sutter Health. Leissa Roberts, DNP, CNM Assistant Dean of Faculty Practice

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1 A Partnership Between the University of Utah College of Nursing and Sutter Health Leissa Roberts, DNP, CNM Assistant Dean of Faculty Practice

2 Purpose Background Methods History of Partnership SHGA requirements Management Roles and Guidelines Books of Business (Existing and New) Metric Review Accountability & Improvement SHGA Satisfaction

3 Provide graduate nursing students with graduate assistantships (GA) that would pay a wage plus tuition Facilitate the skills development of doctor of nursing practice (DNP) students CON The major aim for the Sutter Health was to increase organizational and patient satisfaction with their telephone triage services. Sutter

4 Adding telephone triage to DNP student education enhances the diversity of clinical experiences. The cost of graduate education poses a barrier for some students. Supervised advanced practice nursing skill development promotes several aspects of students academic success. Handled appropriately, telephone triage can assist a health system to respond to patient needs, aligning the patient with the right level of care, the right provider, in the right place, at the right time. Cost savings CON Sutter

5 CON contracted with Sutter to set up a virtual nursing service Graduate Assistants hired by the CON Best practices are employed Accountability and Quality

6 Sutter Health s vision to have a call center staffed with skilled and professional nurses + University of Utah College of Nursing s expertise and creativity in providing health services = Contract formed between Sutter Health and the University of Utah- August 2011 Hospice Care Call Center Launch date: October 2011 Primary Care Triage Call Center Launch date: November 2011 ED Discharge Call Back Center Launch date: June 2012 Daytime Primary Care Triage Center Launch date: September 2012 OB/Gyn. Care Triage Center Launch date: December 2013

7 Serving more than 100 cities and towns in CA: 26 acute care hospitals 3,400 physicians (8 physician medical foundations) Approximately 48,000 employees $7.7 billion in revenues (2007) $8.7 billion in assets (2007) Home health & hospice, and long-term care services Medical research and medical education/training 24 fundraising organizations; tens of millions raised each year

8 College of Nursing hires the RNs SPS with CON has responsibility for coaching and management SPS offers employed positions SPS provides information to the College of Nursing on the performance of the RNs College of Nursing collaboratively works with SPS on improvements to patient care

9 A Learning Culture Focus on proactive management of system design and management of behavioral choices System Design Adverse Events Human Errors Managerial and Staff Choices Learning Culture Just Culture Copyright 2007, Outcome Engineering, LLC. All rights reserved.

10 Full time (100% GA) 300 hours per semester (16-20 hours/wk) Eligible students qualify for Graduate Tuition Benefit Program in fall & spring semesters Full-time participants in GTBP receive a 100% reduction in tuition & fees; does not include nursing tuition differential fee (estimated $ $2100/semester) Tuition reimbursement for summer semester (not including nursing tuition differential) Part time (50% or 75% GA) 150 hours or 225 per semester (8-10 hours/wk or hours/wk) Eligible students qualify for Graduate Tuition Benefit Program in fall & spring semesters Part-time participants in GTBP receive a 50% or 75% reduction in tuition & fees; does not include nursing tuition differential fee Tuition reimbursement for summer semester (not including nursing tuition differential) Non- Benefitted GA Competitive hourly rate No tuition benefit or reimbursement **Minimum 1 year clinical RN experience for all positions

11 Opportunity to receive a tuition benefit or tuition reimbursement when you carry at least 9 credits/semester Monetary compensation of $ /hr while going to school Training and experience gained while working at a Primary Care Triage and Discharge Call Center Ability to obtain a California RN license

12 Interview skills Problem based history Tell the story Use of didactic information in the work setting Critical thinking skills Hone diagnostic reasoning Use of Pharmacology

13 College of Nursing - Sutter Health Graduate Assistants Grad Date # of students Program of Study 2015 grad date 2016 grad date 2017 grad date 6 Primary Care 1 Acute Care 1 Informatics 8 Primary Care 4 WHNP/CNM 1 Informatics 12 Primary Care 3 WHNP/CNM 2 Informatics Grand Total = 38

14 Bruce Wickersham, Director of Clinical Services (DON) (SPS) Lurie Dimalanta Responsible for the CA Relationships Sarah Luck, Scheduling Coordinator (SPS) Leissa Roberts, SHGA Program Director (CON) Recruitment, Communication, Overall Direction Jennie Noren, Director of Faculty Practice Operations (CON) HR, Policies, Communication and Scheduling Susan Hall, Assigned Faculty (CON) Education, Quality and Scheduling Trista Long, Program Manager (CON) Recruitment, Training, Communication, Timekeeping and Scheduling CA Licensure for SHGA Stephanie Wallace, Onsite Supervisor (CON) Collaborates with Trista on schedule and RN communication Training, EPIC Systems Access, Orientation Remote Work liaison 14

15 Clinical Lead assigned for PMs and Weekends Work either 1 wkend day or every other wkend 2 days Expectation to help each other out If picking up additional shifts, RN s need to make sure they are trained for that business line For Daytime triage and ED discharge shifts - need to commit to working these on a consistent basis every week or every other week. Responsible for finding coverage for any shifts they need to trade once monthly schedule is published. Must follow attendance guidelines for sick call the day of a shift or within 48 hours off a non-emergency conflict with scheduled shifts 15

16 Triage Adult - Thompson Pediatrics Barton and Schmitt reference the protocol in the documentation. OB/ Gyn Long& McMullen plus Escalation Matrix Use clinical guidelines where they exist within the SMF epic links. Up-To-Date 16

17 Primary Care Triage = Sutter Medical Foundation (SMF) ED Discharge = Mills Peninsula Health Services (MPHS) Day Time Triage = Sutter East Bay Medical Foundation (SEBMF) Re- Admission Management Day Time Triage = Sutter Medical Foundation (SMF) OB/Gyn. After Hours Triage - Sutter Medical Foundation (SEBMF now & SMF soon) TAMS Anti-coagulation line RX Renewal Sutter Health Plus Memorial Care

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19 Daytime SEBMF 1000 Daytime SMF 500 0

20 Key Performance Indicators Metric Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Calls Forecasted ,118 1,113 Calls Transferred ,087 Calls Transferred per Business Day Encounters Handled 674 1,127 1,342 1,369 1,941 2,295 % Handled to Forecast 77.0% 78.9% 65.2% 101.5% 87.3% 187.5% Service Level - % of Calls Transferred in 45 Seconds 83% 74% 79% 72% 75% 67% Unable to connect to Nurse % (Goal 5.0%) 13.5% 24.5% 57.4% 15.5% 13.3% 18.7% Nurse wait time (seconds) (Goal 45.0) AHT (minutes) AHT Forecast Turn Around Time (minutes) n/a Disposition Codes Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 See Physician Within 3 Days 20.0% 6.0% 14.3% 18.9% 13.2% 9.3% Home Care Instruction 20.0% 6.2% 4.6% 4.7% 4.3% 8.0% See Physician Within Hours 40.0% 26.4% 11.2% 1.6% 5.5% 7.8% Emergency Department n/a 5.3% 5.2% 2.6% 5.7% 3.6% Urgent Care n/a 5.5% 1.6% 1.9% 2.0% 2.7% Technical issues result in nurses being unable consistently to select dispositioncodes following their calls. The data shown are based on a subset of outbound calls. 20

21 Key Performance Indicators Metric Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Calls Forecasted ,370 1,367 Calls Transferred Calls Transferred per Business Day Encounters Handled ,262 1,600 Encounters Handled per Business Day % Handled to Forecast 101% 94% 75% 75% 59% 61% Service Level - % of Calls Transferred in 45 Seconds 94% 81% 72% 67% 69% 54% Unable to connect to Nurse % (Goal 5.0%) 3% 18% 21% 25% 25% 35% Nurse wait time (seconds) (Goal 30.0) ATT (minutes) ATT Forecast (minutes) Turn Around Time (minutes) Disposition Codes Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 No Answer 31.0% 30.4% 30.1% 32.8% 33.0% 34.5% Home Care Instructions 12.9% 15.2% 16.8% 21.3% 19.5% 16.6% See Physician Within Hours 12.5% 9.4% 14.7% 11.9% 14.6% 15.9% PCP or Care Center Contacted 12.9% 12.2% 7.6% 12.8% 11.2% 13.1% Same Day Appt. Scheduled 6.6% 11.1% 9.4% 6.8% 9.7% 6.2% Technical issues result in nurses being unable consistently to select dispositioncodes following their calls. The data shown are based on a subset of outbound calls. 21

22 Encounters Handled Encounters Handled 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, Encounters Handled 3,523 3,076 3,149 2,718 2,827 2,510 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan Encounters Handled Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 SMF AH RN SEBMF AH RN

23 Top Contact Drivers Reasons for calling the Answering Service (April-September 2012) 35.0% 22, % 25.0% 20,213 15,033 General Information/Question Nurse Advice 20.0% 15.0% Page/Call Physician (Outbound) 10.0% 5.0% 4,366 2,683 Physician/Hospital Calling (Inbound) Message For Care Center 0.0% % of calls taken using contact driver 64,509 Calls

24 Sutter Medical Foundation (Nurse Triage) 60.0% 50.0% 40.0% 5,825 11,515 Total Calls 30.0% 2, % 10.0% 1,467 1, % *SMFRN - Home Care *SMFRN - PCP Paged For Triage *SMFRN - See Physician Within Hours *SMFRN - Urgent Care *SMFRN - Emergency Department *SMFRN - See Physician Within 3 Days

25 Talk Time in Minutes Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 SMF SCAH

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28 All phone calls are recorded, 1% are monitored Chart Reviews completed by clinical teams to investigate patient complaints, physician feedback and improvement opportunities Error reporting and feedback to RNs Establish common workflows Measure defects mitigate impact of defects Redesign the process to improve reliability

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31 1. Improvement Required Demonstrated communication that does not meet the expectations on the checklist. Significant improvement required immediately. 2. Growth Needed in Some Areas Demonstrated communications that generally met expectations in most areas on the checklist. Development needed in some areas. 3. Strong Performer Demonstrated communication that met expectations as outlined in the checklist. May exceed expectations in focused areas. 4. Exceeds Expectations Demonstrated communication that exceeded a majority of expectations outlined in the checklist. May be a role Model in several areas. 5. Role Model Demonstrated communication that exceeded all expectations outlined in the checklist. Exemplary call handling.

32 Do you feel the SHGA program has helped you apply didactic information in the clinical setting? N Yes No Prefer not to Answer 15 80% (12) 13% (2) 6% (1) I've learned how to refocus conversation, interject teaching and ask pertinent questions. Do you feel the SHGA program has helped you hone your diagnostic reasoning ability? N Yes No Prefer not to Answer 15 60% (9) 40% (6) The patients who call in are basically asking you to diagnose over the phone. Using the written protocols had helped me learn a lot about conditions that I don't deal with regularly at the hospital I work at, so becoming familiar with these protocols had helped me with my diagnostic abilities.

33 Do you feel the SHGA program has helped integrate pharmacologic treatment measures into your knowledge base? N Yes No Prefer not to Answer 15 66% (10) 33% (5) Meds are being reinforced. I am remembering generic and brand names, can quickly look up mechanism of action, possible uses, side effects and interactions, and appropriate population for use. When patients call needing a new or renewed prescription, I am building the knowledge to know the appropriate medication and dosage and am learning new things every day.

34 Do you derive satisfaction from your work as a Graduate Assistant with Sutter and the CON? N Yes No Prefer not to Answer 29 83% (24) 10% (3) 7% (2) Is your satisfaction intrinsic meaning you enjoy the challenge, responsibility, recognition and personal growth? N Yes No Prefer not to Answer 29 62% (18) 24% (7) 14% (4)

35 I enjoy the type of work I perform at Sutter. I feel like it requires a lot of critical thinking skills and it's a rewarding challenge. Also, I feel like it's refining my assessment skills which will hopefully help me in my future career as a nurse practitioner. I believe I have been challenged in every shift. I learn a lot and I enjoy all of the staff (they are so helpful). The environment is excellent.

36 Is your satisfaction extrinsic meaning you enjoy the wage and tuition benefit? N Yes No Prefer not to Answer 29 86% (25) 10% (3) 3% (1) I probably could not afford to go to graduate school if it were not for this program. It has been so nice to have work coincide so nicely with school and not have scheduling problems. I am really grateful for the tuition benefit - it has significantly reduced my student loans. Yes, I am beyond excited to get the tuition benefit in addition to getting paid for my time there. I am really looking forward for the OB triage program to begin and think i will enjoy my job at Sutter much more once that happens since that is where my true interest lies.

37 Opportunity to receive a tuition benefit or tuition reimbursement when you carry at least 9 credits/semester Monetary compensation of $22.50-$24.50/hr while going to school Training and experience gained while working at a Primary Care Triage and Hospice Care Call Center Ability to obtain a California RN license For more information, please visit: Or contact Trista Long at trista.long@nurs.utah.edu (801)

38 Is the Sutter Health GA Program right for you?