Phase II Course Descriptions

PLEASE NOTE: These courses are for example purposes and subject to change as the course nears.

Administrative Challenges: Case Based

“So much to do, so little time…” As the new or established medical or nursing director of the emergency department, you are expected to create and share vision, answer complaints, run meetings, keep everyone happy, do shifts, be the expert, mentor your group, remove “bad apples,” grow volume, and if you’re lucky eat sleep and have a family. The presenters, through this interactive case based review, will identify, discuss and address multiple real world administrative challenges.

  • Define common challenges encountered by ED leaders.
  • Describe conflict and problem resolution with real world examples.
  • List critical leadership skills required for success.
  • Identify the resources necessary to be a successful leader.

Advanced Practice Providers

Health care reform initiatives have created a need for both innovative and cost effective approaches to care delivery. ED volume, flow and throughput are daily director issues. This presentation will discuss the utilization of advanced practice providers and their impact on the current and future ED workforce issues.

  • Discuss the market forces leading to increased use of NPs and PAs
  • Review PAs and NPs training and their scope of practice
  • Review some current controversies in the use of APP’s in the ED
  • Discuss strategies on approaching the EM physician /APP relationship: supervision, oversight, reimbursement, scope of practice and remote providers

Applying Lessons Learned: Workshop

Hearing or having a great idea is a good beginning, but it should not be the end. Leave this conference with a concept and a plan for achieving it. This critical session will give you the opportunity to plan an actual implementation strategy. You will be matched up with others who have an interest in putting the same concept into practice. After a brief strategy discussion, you will begin working on the specific steps necessary to successfully execute a new process / program to improve your practice. Several faculty will be available to consult on your plan.

  • Define a specific practice improvement.
  • Describe the intended outcome.
  • List the critical stakeholders and barriers to success.
  • Design an implementation strategy.

Billing/Coding/Observation

A detailed analysis of the major driver of ED revenue, Facility EM leveling, including a review of the common coding systems and problems will be explored. Additionally, the charges for medication administration will be reviewed along with strategies to optimize correct charge capture of these key services. Facility quality programs will be reviewed along with their direct reimbursement impact. With an eye towards the future a review of CMS sentiment and new bundling edits will provide clarity regarding the CMS vision for future payment methodologies.

  • Describe the methodology for facility reimbursement and areas for potential improvement.
  • Analyze the different models for assigning facility E/M levels.
  • Identify opportunities for correcting Medication Administration charge capture deficiencies.
  • Review the impact of increased ED service packaging.

The Business Model for Patient Flow, Service and Safety

Emergency physicians work in a variety of practice environments and participate in various compensation packages. Does it really matter if you're an employee or an independent contractor? It might! In a productivity model, you should get credit for the work you do, but what happens if you're stuck on a few slow night shifts? And since generally we get what we incentivize, should we pay for patient satisfaction, showing up for meetings, etc.? The presenter will discuss advantages and disadvantages of several compensation plans and focus on how to take full advantage of each arrangement.

  • List the differences and relative advantages of employees v. independent contractors.
  • Identify the components of compensation arrangements.
  • Describe methods of connecting work performed to compensation.
  • Discuss various incentive plans and compensation structures.

Care Coordination/Transitions

Emergency physicians are experiencing increasing options for the disposition of patients from the Emergency Department. The introduction of other options has created the need for additional resources in the form of people and tools as well.

  • Discuss the community options to facilitate the disposition
  • Review available tools to streamline the process

Clinical Quality and Service Excellence

As our grandmothers used to say, “Beauty is in the eyes of the beholder.” So is quality. Is it getting a blood culture before antibiotics, keeping patients informed, greeting private attending on arrival, admitting an increasing % of the ED patients…? The presenter will describe how quality and service excellence intersect, by presenting the different perspectives and ways to address them all.

  • Define quality from the various perspectives (Emerg. Phys, RN, Patient, Admin, PCP, etc.).
  • Describe the ways that we do (don’t) meet quality expectations.
  • Describe the A-Team, B-Team behavior and its influence on quality.
  • Explain the value of goal setting, measurement and feedback.
  • List tools to improve quality and service excellence.

Complaint Management: Deep Dive

“Not another complaint!” People complain when they are dissatisfied. Add the anxiety, confusion and potential peril of an emergency and the number and seriousness of complaints increase. Complaint recognition and management are critical components of the successful ED leader. When handled properly, a dissatisfied and angry person can achieve satisfaction. Alternatively, the improper management of a complaint can lead to a disgruntled person who seeks retribution. The presenter will briefly review complaint causes, methods of prevention and a successful management methodology. The majority of the presentation will delve into several classic emergency department complaints. Underlying issues and methods of resolution will be discussed.

  • List the primary reasons that patients, families, staff, etc. become dissatisfied.
  • Describe several techniques to prevent complaints, including
  • The “Theory of Yes”
  • Realistic Triage
  • Resetting expectations
  • Describe methods to seek, investigate, and complaints from patients, staff, administration, etc.
  • Use interactive case studies to describe classic complaints, the underlying issues, and prospective and retrospective solutions.

Crisis Communications

We currently live, work and express ourselves in a “Knowledge Industry.” To thrive today, you need more than ordinary communication and presentation skills. Effectiveness and image are driven by our communication skills and are key ingredients of success and allaying fears in a time of crisis. Building your oral communications skills is a vital part of every professional's development and will have a significant impact on your organization's image. This presentation will explore communication-driven success including basic and advanced presentation skills.

  • Discuss how to organize your thoughts, handle tough questions and awkward situations.
  • Discuss how to confidently engage your audience and build relationships.
  • Discuss the basics for crisis communications.

Customer Satisfaction: Beyond the Ordinary

Service excellence requires understanding and meeting or surpassing the perceived needs of the patients, staff, administration and other critical stakeholders. What really matters to our patients and co-workers? Do you understand the measurement tool and has the staff been trained to direct their approach to the issues addressed in the survey tools? Do you effectively use scripts? The presenter will describe effective leadership approaches to improve the satisfaction of those who use your services.

  • Describe the importance of patient/customer satisfaction
  • Define the customers and their expectations.
  • Explain how successful organizations / leaders create satisfaction by focusing on systems and people.
  • Provide tools for staff, such as scripts, effective listening techniques, linguistic training, etc.
  • Describe service recovery and cases.

Dealing With the Dysfunctional and Marginal Providers: Improving Performance

The problem provider comes in many forms, among them: bad attitude, poor clinician, slow as molasses, too fast, and impaired. This presentation will focus on the development of early recognition and rapid response. Counseling methods will be described including appropriate documenting of the process.

  • List the common forms of the problem provider, attitude, speed, quality, impairment, etc.
  • How disruptive behavior can create a hostile and undermining environment.
  • Avoid hiring (recognize in advance) problem providers.
  • Describe counseling, assistance, rehabilitation and corrective action.
  • Define documentation procedures and end points.

EMTALA: Advanced Cases

No law enacted before, or since, EMTALA has had a bigger impact on the way we must examine and treat ED patients. While the new rules maintain basic patient protections and clarify certain obligations, they also limit the responsibilities of medical staff to provide ED on-call services. As for HIPAA, the legislation has led to dramatic changes in our procedures, and some are improvements. These regulations are often misunderstood and interpreted inconsistently. The presenter will provide the latest information and cases. Plenty of time will be left for questions.

  • Analyze the current CMS interpretive guidelines and the associated ED obligations.
  • Explain medical screening and stabilization, including by whom it can be performed.
  • Define obligations related to medical staff, on-call physician, and transfer.
  • Describe HIPAA guidelines and the various local interpretations.
  • Cite cases that clarify these regulatory mandates.
  • Recommend methods to enhance compliance.

The Front End: Strategies to Improve Door-to-Provider Time

Door to provider is a critical component of patient satisfaction. “After all, it is an EMERGENCY department!” The typical silo approach meets the needs of the various staff members, but ignores the benefits of a more patient centered approach. This presentation will review the many methods to improve “Door to Doc” time, while enhancing the patient and staff satisfaction. Typical barriers to implementation will be described.

  • Describe role of Door to Provider as a critical aspect of patient satisfaction.
  • List specific components of Door to Provider.
  • Describe concepts and implementation of: Rapid Triage/Rapid Registration, Advanced Nurse Interventions/Protocols, Bedside Registration, Bed to Doc Strategies.
  • Define operational improvements and staff satisfaction with implementation.
  • List barriers to implementation and methods to achieve buy-in.

Generations at Work

Our ED's currently employ five generations of workers, each with their unique developmental history and view of the future. The characteristics of each group greatly affect not only the current work environment but will likely play an even larger role in the future. The speaker will address the various generations encountered in the workplace, the complex issues you may encounter, and the best methods for recruiting and retaining these varied practitioners.

  • Discuss the 5 generations encountered in the workplace and their characteristics.
  • Discuss the expectations of and how to best recruit, engage and retain these varied practitioners.
  • Discuss complex issues such as loyalty, feedback/evaluation, career plans and work patterns.
  • Describe the interactions between generations and its effect on the workplace environment.

Getting the Most Out of Your ED Information System

The ideal computerized ED is the Holy Grail. It could allow a radical transformation from the typical inefficient ED (looking for patients, records, staff; Handwriting – multiple times in multiple places; misplaced charts, orders, discharge instructions and prescriptions) to a system that hums (bedside registration, bedside documentation and ordering, immediate access to EMR (EHR), rapid discharge / prescriptions / instructions, and autofax to PCP). The presenter will describe the components of a perfect system.

  • Describe routine inefficiencies, seeking information, looking for patients and staff.
  • List advantages and disadvantages of computerized triage, tracking, documentation and discharge.
  • Describe components of a perfect system.
  • Discuss current systems (generically).
  • Describe the advantages of immediate access to the EMR (EHR).

Hiring and Retention - Transforming the Workforce

Physician and nursing shortages are a constant challenge which only looks to get worse as we face increasing demands and record number of staff retiring. We must take an active role in solving these problems. In this interactive session, participants will hear about having the proper mindset and help learn about building a foundation to attract and retain good providers.

  • Learn what some of the barriers are to attracting and retaining providers
  • Help prepare oneself for the hiring process
  • Talk about building a culture and department where people want to work at
  • Learn that retention starts from the top 

How to Lead and Inspire a Team

Excellent leaders have the ability to inspire by creating vision, share power by collaborating and generate progress by creating change. Unfortunately, being an effective clinician does not translate into being an exceptional leader. This session will dissect and explore the differences between leading and managing in the context of change. It will focus on the pearls and perils of leadership, and methods to bring about cultural change.

  • Describe critical leadership concepts (spread, change management, adoption, and levers).
  • Discuss models of leadership, management and collaboration.
  • Describe typical barriers to change, negotiation and conflict management.
  • Explain active and inclusive feedback methods to determine what others want.

Improving Service Operations: Driving From the Back of the Bus and Other Strategies for Change

Improvement ideas abound, but the execution and implementation of these ideas often fails. This lecture will spotlight how to lead change and improvement from the "Back of the Bus" and other strategies for change.

  • Outline the essential elements for change management.
  • Explain how and why physicians can be particularly challenging to manage in change.
  • Describe strategies for change that are proven to be effective.
  • Illustrate the case for leading from the rear.
  • Describe real cases of performance driven change.

Influence Strategies: Rethinking How To Get Our Staff To Do What We Need Them To Do

There are many great best-practice strategies that promise to improve operations and move the metrics. E.D. Leaders across the country conscientiously try to apply and implement these strategies and frequently fail. The reason? Staff does not comply or they resist change. This session provides insight on the reasons why traditional approach in implementing change fails. It will focus on the most critical influence strategies that will yield the most impact in changing behaviors in staff.

  • Explain critical principles related to influence that have the most impact in changing behaviors.
  • Share case study of how influence strategies were applied to improve patient experience/satisfaction.

Medical Staff Relations

To achieve success, the ED providers must articulate and share a philosophy of partnership – among themselves and with the medical staff. We must deliver and be recognized as delivering high quality patient care while effectively and consistently addressing the needs of those with whom we work. This session will define the importance of and methods to effectively integrate with the medical staff organizational structure, particularly hospital related committees, etc.

  • Define model for group success.
  • Describe the components of strong relationships and effective integration.
  • List clinical services to provide/avoid.
  • Define critical administrative processes.
  • Utilize cases to demonstrate solutions.

Nurses are From Saturn, Physicians from Jupiter, Administrators from Mars

More than anywhere else in the Hospital, effective collaboration in the ED is a matter of absolute necessity. Patient and staff safety and satisfaction depend on successful team work. In fact, competent teams find that work is easier and more enjoyable. Learning to “play well in the sandbox” is simply a matter of enlightened self-interest. This session will focus on the importance of and methods to build and maintain teams during change.

  • Describe human motivational theory, leadership and change management.
  • Explain what’s in it for them and what’s in it for you.
  • List models and tools for leading and leveraging your teams.
  • Describe development of rules of engagement.

Performance Dashboards and Key Metrics Analytics

What you can’t measure, you can’t manage. What you can measure, you have to treasure. Quality improvement requires defining what your key metrics are, identifying your baselines, setting your target goals, and then creating action plans with specific action steps, timelines and accountable people. Your metrics need to be placed in a single performance dashboard to which your action plan is tied. Passive tracking of results will no longer be accepted. This session focuses on your key metrics, both ED and inpatient (as it affects the ED throughput), and then how to organize and follow through in order to create outstanding ED outcomes.

  • Describe the importance of key metrics in improving clinical and service outcomes.
  • Define the key metrics in the emergency department (ED) and for inpatient throughput as it affects ED throughput.
  • Demonstrate the development of an action plan tied to a performance dashboard that will move an ED from its baseline performance to target goal.
  • Discuss the utilization of an electronic data warehouse to facilitate reporting of outcomes.

Reimbursement

Facility resources are dependent on adequate revenue to support the mission of providing excellent care to our patients. Hospital quality programs are expanding with increasing financial consequences. Observation services have become a key determinant of facility viability.

  • Identify the key components of ED Facility appropriate charge capture
  • Review reimbursement changes impacting facility revenue for 2016
  • Analyze the impact of Quality programs on the ED bottom line
  • Discuss the role of Observation status and the 2 midnight rule

Risk Management

An emergency department is the vortex of conflict between the high expectations of our patients (society) and the inexact science of medicine. This battle ground is governed by well established case and statutory law, which determine how we should ideally respond. This highly interactive session will train the participants to analyze and manage particular complaints and medical legal problems. In small groups, cases will be presented, broken down, analyzed and then presented to the larger group for discussion.

  • Identify methods of diffusing potential medical legal situations.
  • Describe the obligations inherent in the doctor-patient relationship, particularly in a situation of refusal of care (AMA).
  • List the factors allowing restraint, i.e. suspension of civil liberties.
  • Formulate rules and regulations to safely discharge patients.

Solving the Unsolvable: Effective Approaches to the Most Common Medical Director Quandaries

The Medical Director’s Role is fraught with problems, issues, and quandaries. Some have clear solutions, and some seem almost unsolvable. This interactive session discusses real problems and common issues that make ED Directors feel “stuck”. Approached correctly, however, even the thorniest problem offers great opportunity for enhancing your role, advancing your department, and positively impacting patient care. Through discussion and case studies, we will explore suggestions, new ideas, and solutions.

  • Identify the most common “unsolvable” or recurring issues for ED medical directors
  • Explain dysfunctional approaches that fail to solve problems, and may even perpetuate issues
  • Describe critical skills for clearly and succinctly defining problems that promote successful resolution
  • Identify opportunities for reframing and paradigm-shifting, in order to produce desired results

Telemedicine: Where We Are, Where We’re Going

Telemedicine provides health care via telecommunication and information technologies. It can eliminate distance and cost barriers, improving access to medical services that would otherwise not be consistently available or affordable. This presentation will discuss the current status of telemedicine and its impact on the ED and our patients.

  • Review current reimbursement and liability environment for telemedicine providers
  • Review the ED’s role as the telemedicine expert, to include referrals, and oversight or other ED’s and specialties
  • Discuss telemedicine specific concerns related to the patient-physician relationship, documentation, and standards of care
  • Discuss the potential future impact of telemedicine on the ED and its patients

Work Life Balance

Work life balance has never been more important to talk about than now. With ever increasing workloads and expectations, many of us lose sight of what truly may be important. This presentation will help start the path towards balance.

  • Define what work life balance is and how to utilize a life balance assessment
  • Discuss the stress and conflict of lack of balance and its impact on personal and work life
  • Review the steps towards initiating a work/personal life change
Knowledage You Can Use
My thanks to everyone involved - probably the most useful conference I have attended in 39 years as RN!