Maximizing Resources- Minimizing Cost:

Transcription

1 Maximizing Resources- Minimizing Cost: How to get the most of what little you ve got Bruce E. Herman, MD Professor of Pediatrics Associate Program Director, Pediatric Residency Program Director, Pediatric Emergency Medicine and Child Abuse Fellowships Pamela Carpenter Manager, Pediatric Education

2 Objectives Maximizing Resources/Minimizing Costs Problem, analysis, solutions PDs and PCs working together to increase efficiency Small group exercise

3 Our Problem Future of academic children s hospitals Pediatrics special article by our Chair Funding it s all about the money New and changing requirements unfunded mandates Tradition trumps innovation this is the way we ve done it

4 Assessing the Problem SWOT analysis Identify all programmatic processes Identify cost of all processes Assess program needs Prioritize Maximize resources

5 SWOT Analysis Analytical tool to help an organization develop a preferred future Identifies Strengths, Weaknesses, Opportunities, and Threats

6 SWOT ANALYSIS: Fellowship Training Primary factors I N T E R N A L Strengths Clinical Experience/reputation* Structured fellowship education (PFCC)* University and IHC Quality and Health Services Research Training * Strong faculty educators Functional administrative structure in Department, with many resources, and leadership that recognizes value of education Retention of future faculty from fellowships Geographical location (large referral base) Weaknesses Reduced funding* Tradition trumps innovation* NAS: evolving requirements = increased time/resources required* Ever growing faculty time commitment Overcoming possible negatives in recruiting (re: geographical location) ABP SCTC recommendations Intermountain IT resources Difficulties recruiting and retaining foreign trained physicians Service vs education concerns of trainees E X T E R N A L Opportunities Forward thinking (re: faculty succession & cost effective programs)* Marketing & recruiting* NAS gives opportunity for innovation* Collaboration/training between fellowships: directors/coordinators* Increases national recognition/exposure for fellowship & leaders Program development Locating new revenue sources for training Innovative ideas for increasing fellow education (clinical experiences) to increase revenue Increase Intermountain branding of Pediatric Care Threats Limited funds* Change in Intermountain/University policies* Internal resistance threat of change or elimination of programs* Recruiting difficulty with academics (lack of alignment of incentives with needs) Lack of employment opportunities in certain subspecialties Educational debt

7 SWOT ANALYSIS: Fellowship Training Primary factors I N T E R N A L Strengths Clinical Experience/reputation* Structured fellowship education (PFCC)* University and IHC Quality and Health Services Research Training * Strong faculty educators Functional administrative structure in Department, with many resources, and leadership that recognizes value of education Retention of future faculty from fellowships Geographical location (large referral base)

8 SWOT ANALYSIS: Fellowship Training Primary factors I N T E R N A L Weaknesses Reduced funding* Tradition trumps innovation* NAS: evolving requirements = increased time/resources required* Ever growing faculty time commitment Overcoming possible negatives in recruiting (re: geographical location) ABP SCTC recommendations Intermountain IT resources Difficulties recruiting and retaining foreign trained physicians Service vs education concerns of trainees

9 SWOT ANALYSIS: Fellowship Training Primary factors E X T E R N A L Opportunities Forward thinking (re: faculty succession & cost effective programs)* Marketing & recruiting* NAS gives opportunity for innovation* Collaboration/training between fellowships: directors/coordinators* Increases national recognition/exposure for fellowship & leaders Program development Locating new revenue sources for training Innovative ideas for increasing fellow education (clinical experiences) to increase revenue

10 SWOT ANALYSIS: Fellowship Training Primary factors E X T E R N A L Threats Limited funds* Change in Intermountain/University policies* Internal resistance threat of change or elimination of programs* Recruiting difficulty with academics (lack of alignment of incentives with needs) Lack of employment opportunities in certain subspecialties Educational debt

11 Identify Processes Use academic calendar Use line items from budget Will require help from coordinators

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13 Identify Costs FTE breakdown for each process Using salary information, assign costs to FTE expenditures for each process Use budget data to identify non-personnel costs of each process

14 Orientation.5 FTE

15 Identify Costs Identify cost of total fellowship per trainee

16 Costs Per Fellow Financial Sources Per Fellow

17 Costs Per Fellow ~ $100K Financial Sources Per Fellow

18 Assess Program Needs Determine workforce needs Strategic planning for internal faculty replacement Physician needs in the region Physician needs nationally Graduation statistics who are you training?

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24 Assess Program Needs Distinguish needs versus wants (requirements, logistic necessities, morale building, tradition, faculty or PD preferences) Create a value assessment by staff, trainees, and faculty of each process, event, and expense Allows you to objectively uncouple tradition from the equation

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26 Prioritize Perform a stress test If you had to cut 10% from your program expenses, what would you cut? 20%? 30%?

27 Maximize Your Resources Redistribute resources to match program priorities and requirements Look for innovative solutions for efficiency Don t recreate the wheel See what others are doing Seek out creative minds

28 Solutions to Our Problem Justify fellow need to Department with data collected PEM fellows cost effectiveness

29 Solutions to Our Problem Justify fellow need to Department with data collected PICU fellow value

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31 Solutions to Our Problem Centralized leadership Associate Program Director in core program over fellowships Trains PDs Creates shared resources A super coordinator in core program Trains PDs and PCs Can share resources easily Common coordinator job description

32 Solutions to Our Problem Centralized fellowship coordinators Most coordinators doing other jobs for the divisions (highly variable: 10%-80% of workload dedicated to fellowship) Supervised by managers without perspective of program requirements Our 8 fellowships can be managed with 2 full time fellowship coordinators in core program Develop highly trained, specialized staff with advocates in management structure (super coordinator)

33 Solutions to Our Problem Centralized fellow education for all first year fellows Combined fellow orientation

34 Future Innovation Fellowship Farm Club Shared departmental resources Research QI Piggyback on the core program Advocacy Career planning resources Global health

35 Small Group Exercise