Memorial Hospital of Gardena, a Subsidiary of Avanti Health System, LLC Agreement Number: ET13-0203

Training Proposal for: Memorial Hospital of Gardena, a Subsidiary of Avanti Health System, LLC Agreement Number: ET13-0203 Panel Meeting of: November 16, 2012 ETP Regional Office: North Hollywood Analyst: M. Webb PROJECT PROFILE Contract Attributes: Counties Served: Job Creation Initiative Medical Skills Training Priority Rate Retrainee SET Los Angeles Industry Sector(s): Healthcare Services Priority Industry: Yes No Repeat Contractor: Yes No Union(s): Yes No Number of Employees in: CA: 1,400 U.S.: 1,400 Worldwide: 1,400 Turnover Rate: 14% Managers/Supervisors: (% of total trainees) FUNDING DETAIL 5% Program Costs - (Substantial Contribution) (High Earner Reduction) = Total ETP Funding $304,496 $0 $0 $304,496 In-Kind Contribution: 100% of Total ETP Funding Required $451,477 ETP 130 - Single (08/16/12) 1 of 5

Memorial Hospital of Gardena November 16, 2012 ET13-0203 TRAINING PLAN TABLE Job No. Job Description 1 Retrainee Medical Skills Training SET Priority Rate 2 Retrainee Job Creation Initiative Medical Skills Training SET Type of Training Continuous Impr., Computer Skills, MS Didactic, MS Clincal with Preceptor Continuous Impr., Computer Skills, MS Didactic, MS Clincal with Preceptor Estimated Range of No. of Hours Trainees Class / CBT Lab 24-200 0 110 24-200 0 Weighted Avg: 74 Average Cost per Trainee Post- Retention Wage 192 $738 $19.63 Weighted Avg: 41 $1,480 $13.09 Minimum Wage by County: Job Number 1: $19.63 per hour for SET Priority Industry; Job Number 2: $13.09 per hour for newly hired Job Creation trainees in Los Angeles County. Health Benefits: Yes No This is employer share of cost for healthcare premiums medical, dental, vision. Used to meet the Post-Retention Wage?: Yes No Maybe $4.00 per hour may be used to meet the Post-Retention Wage for Job Number 1 trainees. Wage Range by Occupation Occupation Titles Wage Range Estimated # of Trainees Laboratory Assistant (Job Number 1) Laboratory Assistant (Job Number 2) 9 Licensed Vocational Nurse 30 Social Worker 5 Respiratory Therapist 22 Radiology Technician 14 CT Technician 6 Clinical Lab Scientist 9 Occupational Therapist 4 Ultrasound Technician 6 Registered Nurse 155 New Graduate Registered Nurse 30 Physical Therapist 5 Speech Therapist 2 Case Manager 5 ETP 130 - Single (08/16/12) 2 of 5

Memorial Hospital of Gardena November 16, 2012 ET13-0203 INTRODUCTION Memorial Hospital of Gardena, a Subsidiary of Avanti Health System, LLC (MHG) is a for-profit hospital licensed by the Joint Commission on Accreditation of Hospital Organizations. Established in 1953, MHG provides medical services to an estimated population of 60,000 residents. The hospital specializes in Comprehensive Perinatal Services and Level II Emergency Services, and offers general medical/surgical services such as coronary care, intensive care, outpatient services, and respiratory care. MHG is eligible for ETP funding under Special Employment Training provisions for frontline workers. (Title 22, California Code of Regulations, Section 4409.) The hospital qualifies for ETP s priority industry reimbursement as a healthcare employer. PROJECT DETAILS In the past, MHG relied on registry nurses as contract labor to meet staffing requirements. The hospital is in the process of hiring nurses to retain full-time nursing help. As a result, an extensive amount of training will take place to educate and provide hands-on experience for recent graduates of the nursing field. Novice nurses are not typically prepared to assume responsibility for patient care; therefore, they must receive extensive theory and gain knowledge through preceptors in Medical Skills (MS) training in topics such as Hemodynamic monitoring, care for stroke patients, and EKG & Cardiac monitoring. MHG is implementing a multi-million dollar electronic medical records (EMR) system from McKesson Paragon. This system will assist in meeting the Meaningful Use requirement enforced by the Centers for Medicare & Medicaid Services to conduct the following: Perform drug-formulary checks; Incorporate clinical laboratory results into the electronic health record; Provide reminders to patients for needed care; Identify and provide patient-specific health education resources; and Employ the EMR system to support the patient s transitions from care settings or personnel. Physicians will now have the ability to review all patient information electronically. Staff will be able to read patients charts (labs, x-rays and other clinical aspects) from anywhere in the hospital. Another component of training will target patient satisfaction. The management team at MHG relies on surveys conducted by the Hospital Consumer Assessment of Healthcare Providers Systems to ensure patients are satisfied with services delivered by medical staff. These surveys are public and viewed by potential customers, physicians, and insurance companies. Training in customer service and continuous improvement will enable MHG staff to provide better patient care and improve patients experiences. MS Clinical with Preceptor training will also ensure new nurses are provided the hands-on experience needed to execute proper nursing skills. MHG has also made a commitment to become a baby friendly hospital, taking on the criteria established by the Baby Friendly Hospital Initiative (BFHI). BFHI aims to improve the care of mothers and newborns at health facilities that provide services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing Breastmilk Substitutes. To gain designation from BFHI as one of the few baby friendly hospitals in the area, MHG has committed to focusing on courses in areas of Pediatric and Obstetrics training. ETP 130 - Single (08/16/12) 3 of 5

Memorial Hospital of Gardena November 16, 2012 ET13-0203 Commitment to Training MHG currently has an annual training budget of $97,000. The hospital recently completed the first step of their EMR training to hospital staff. The training provided to staff is hospital wide; however, the training employees receive is job-specific according to their occupational functions within the EMR program. In addition, MHG continues to provide annual skills training. MHG represents that ETP funds will not displace the existing financial commitment to training. Hospital representatives report that safety training is, and will continue to be, provided in accordance with all pertinent requirements under state and federal law. Training Infrastructure MHG adapted a structured residency pilot program with their prior ETP project (ET11-0500). This extended residency program increases the number of hours of training a new nurse receives. Each new nurse will receive up to 400 hours of training led by clinical preceptors, with ETP providing up to 200 hours. All administrative staff responsible for implementation of the previous ETP Agreement will administer the new Agreement to ensure another successful training plan. Retrainee - Job Creation In support of job creation, the Panel is offering incentives to companies that commit to hiring new employees. Under the Retrainee-Job Creation program, training for newly hired employees will be reimbursed at a higher rate and trainees will be subject to a lower post-retention wage. MHG has committed to hiring 110 new employees (Job Number 2). To be eligible for reimbursement, trainees must be hired within the three-month period prior to Panel approval or during the term of contract. Substantial Contribution requirement will be waived for these trainees. The 110 new employees will include 30 New Graduate Registered Nurses (RNs), 40 RNs and 10 Licensed Vocational Nurses (LVNs). The remaining 30 new employees will be in the various other occupations as listed in Wage Range by Occupation table. Training Plan Training at the hospital will begin on December 1, 2012. The percentage of overall training is as follows: 10% Continuous Improvement, 10% Computer Skills, 40% MS Didactic, and 40% MS Clinical with Preceptor. Computer Skills: Training will be offered to all occupations and focus on the EMR system. The hospital will continue the implementation process, which entails additional training to review upgrades to the current EMR system. Continuous Improvement: Training will be offered to all occupations and will cover topics such as Customer Service, Crisis Prevention Intervention, and Frontline Leadership Skills. Medical Skills Training The Panel has established a higher reimbursement rate for nurse upgrade training, recognizing the higher cost of delivery for the Clinical Preceptor model. Approximately 155 RNs, 30 New Graduate RNs, and 30 LVNs will participate in MS Clinical with Preceptor training. Trainees in allied healthcare occupations (Technicians and Therapists) will participate in select MS Clinical with Preceptor and MS Didactic training classes, based on their patient care responsibilities. ETP 130 - Single (08/16/12) 4 of 5

Memorial Hospital of Gardena November 16, 2012 ET13-0203 The higher reimbursement rate, $22 per hour, recognizes the higher cost of delivery for clinical training. It will apply to both MS Didactic and Preceptor modes of delivery. The standard class/lab rate for priority industries ($18 per hour for Job Number 1 trainees) or Job Creation projects ($20 per hour for Job Number 2 trainees) will apply to Computer Skills and Continuous Improvement training. MS training will be offered to all occupations in a classroom and preceptor setting within their specific units. All new hires, regardless of occupation, will be required to train with a preceptor for a period of between two to ten shifts in order to validate skills, and become familiar with the patient acuity level and level of care that the hospital requires of all patient care staff. Prior Performance MHG s last ETP training project (ET11-0500) was funded under the federal Workforce Investment Act. The Education Department established a training program for medical staff to maintain education as the forefront of the hospital s agenda. The hospital is expected to earn the full amount of $168,912. RECOMMENDATION For the reasons set forth above, staff recommends approval of this proposal. PRIOR PROJECTS The following table summarizes performance by MHG under an ETP Agreement that was completed within the last five years: Agreement No. Location (City) Term ET07-0394* Gardena 6/30/07-6/29/09 Approved Amount Payment Earned $ % $295,650 $98,533 (33%) *Training was unable to gain momentum due to financial difficulties and turnover in the Education Department. New Education Staff were unfamiliar with ETP, thus training under this Agreement was not a focus until the final six to nine months of the term. DEVELOPMENT SERVICES MHG retained National Training Systems, Inc. in Ladera Ranch to assist with development of this proposal for a flat fee of $14,939. ADMINISTRATIVE SERVICES National Training Systems, Inc. will also perform administrative services in connection with this proposal for a fee not to exceed 10% of payment earned. TRAINING VENDORS To Be Determined ETP 130 - Single (08/16/12) 5 of 5

Memorial Hospital of Gardena ET13-0203 Exhibit B: Menu Curriculum Class/Lab Hours 24-200 Trainees may receive any of the following: CONTINUOUS IMPROVEMENT Case Management/Discharge Planning Charge Nurse Training Communications Skills Conflict Resolution CORE Measures Crisis Prevention Intervention (CPI) Critical Thinking Skills Culturally Appropriate Care Customer Service Documentation Skills Frontline Leadership Skills Organization and Time Management Skills Preceptor Skills (train-the-trainer) Performance and Quality Improvement Team Building COMPUTER SKILLS Microsoft Office/Excel Skills (Intermediate and Advanced) Electronic Medical Records Application Skills MEDICAL SKILLS TRAINING DIDACTIC Acute Myocardial Infarction Advanced Cardiac Life Support (ACLS) Arterial Blood Gas (ABG) Interpretation Basic Life Support (BLS) Body Mechanics Breast Feeding & Lactation Care of the Cardiac Patient Care of Pediatric Patients (Acute Care, Intensive Care) Care of the Stroke Patient Central Lines Management Chest Tube Care & Management Code Blue Response & Procedures Critical Care Nursing Skills Decontamination Procedures Diabetes Care & Management Dysrhythmia Recognition & Interpretation Educating the Patient & Family EKG & Cardiac Monitoring Electronic Fetal Monitoring (Beginning & Advanced) Emergency Care of the Burn Patient Emergency Room Nursing Skills Equipment Skills (IV pumps, cardiac telemetry, vital signs, pulseoximeter, ventilators, specialty beds and mattresses, etc.) Evidence Based Practices Gastrointestinal Assessment and Management Hemodynamic Monitoring Infection Control Intravenous (IV) Insertion & Therapy ETP 100 Exhibit B Menu Curriculum (02/13/12) 1 of 4

Memorial Hospital of Gardena ET13-0203 Kinetic Therapy Labor, Delivery and Postpartum Nursing Skills Laboratory Skills Medical/Surgical Nursing Skills Medication Administration & Management Moderate Sedation Neonatal Advanced Life Support (NALS) Neonatal Infant Pain Scale (NIPS) Neonatal Nursing Skills Neonatal Resuscitation Provider (NRP) New Graduate Nursing Skills Occupational Therapy Skills Orthopedic Nursing Skills Ostomy & Continence Care Pain Management (Acute & Chronic) Patient Assessment & Care Patient Fall Prevention Pediatric Advanced Life Support (PALS) Perioperative Nursing Skills Physical Therapy Skills PICC Line Insertion Pre and Post Operative Care Radiology Skills Rapid Response Skills Renal Assessment & Management Respiratory Assessment & Care Restraints Speech Therapy Skills S.T.A.B.L.E. Telemetry Nursing Skills Total Parenteral Nutrition (TPN) Transfer Techniques Triage Nursing Skills Trauma Nursing Skills Ventilator and Tracheotomy Care Wound & Skin Care MEDICAL SKILLS TRAINING CLINICAL PRECEPTOR Emergency Department Training o Emergency Room Nursing Skills o OB Trauma o Triage Nursing Skills o Care of Pediatric Patients Intensive Care Unit/Critical Care Unit Training o Critical Care Nursing Skills o Intra-Aortic Balloon Pump (IABP)Therapy o Ventilator & Tracheotomy Care o Hemodynamic Monitoring ETP 100 Exhibit B Menu Curriculum (02/13/12) 2 of 4

Memorial Hospital of Gardena ET13-0203 Laboratory Services Unit o Laboratory Skills o Bloodborne Pathogens o Venipuncture o Laboratory Testing Procedures Long Term Care Unit (Subacute, Skilled Nursing, Transitional Care, and Hospice) o Medical/Surgical Nursing Skills o Total Parenteral Nutrition (TPN) o Ventilator & Tracheotomy Care o Orthopedic Nursing Skills Medical/Surgical Unit Training o Medical/Surgical Nursing Skills o Orthopedic Nursing Skills o Medication Administration & Management Operating Room & Post-Anesthesia Care Unit (PACU) Training o Trauma Nursing Skills o Perioperative Nursing Skills o Malignant Hyperthermia o Medication Administration & Management Pediatric Services Unit o Care of Pediatric Patients (Acute Care, Intensive Care) o Pediatric Advanced Life Support (PALS) o Medication Administration & Management o Respiratory Assessment & Care Obstetrics Unit Training o Labor, Delivery and Postpartum Skills o Neonatal Nursing Skills o S.T.A.B.L.E. o Electronic Fetal Monitoring ETP 100 Exhibit B Menu Curriculum (02/13/12) 3 of 4

Memorial Hospital of Gardena ET13-0203 o o o o Neonatal Resuscitation Provider (NRP) Neonatal Advanced Life Support (NALS) Respiratory Assessment & Care Infection Control Radiology Services Unit o Radiology Skills o CT Skills o Ultrasound Skills o Patient Fall Prevention Rehabilitation Services Unit o Physical Therapy Skills o Occupational Therapy Skills o Speech Therapy Skills o Kinetic Therapy o Post Operative Care o Care of the Stroke Patient o Care of Cardiac Patients o Patient Fall Prevention Respiratory Services Unit o Respiratory Assessment & Care o Code Blue Response & Procedures o Advanced Cardiac Life Support (ACLS) o Basic Life Support (BLS) o Care of Pediatric Patients o Care of the Cardiac Patient o Ventilator & Tracheotomy Care o Neonatal Resuscitation Provider (NRP) Telemetry Unit Training o Care of the Cardiac Patient o EKG & Cardiac Monitoring o Dysrhythmia Interpretation o Telemetry Nursing Skills o Intravenous (IV) Therapy Note: Reimbursement for retraining is capped at 200 total training hours per trainee, regardless of the method of delivery. ETP 100 Exhibit B Menu Curriculum (02/13/12) 4 of 4