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: Brass Tax Tips To Partner For Success

As health systems work to create more affordable care, advanced practice providers (APPs) are an essential part of most ED teams. This presentation will focus on how best to develop, incorporate and train APPs into a busy ED setting.

  • Discuss personnel management strategies and scope of practice for PAs and NPs
  • Identify key components of onboarding an educational programs to help APPs understand clinical and process issues in your ED
  • Review practice guidelines that help APPs work at “top of license” to provide safe, high-quality patient care

An Intro to the Wild Wild West: Free Standing EDs

Freestanding emergency centers are a relatively new model for the delivery of emergency and unscheduled care. These centers provide the opportunity to develop efficient processes without the red tape of a hospital and have unique management challenges and opportunities.

  • Discuss the role of FSEDs in the changing healthcare landscape
  • Identify unique management skills and tools needed to direct a freestanding ED
  • List critical leadership skills required for success

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

Approaching Problem Providers

Effectively addressing problem performance can be a tremendous strength and a key to a high-performing ED. Conversely, ineffective approaches risk poor performance, disrupt teamwork, and can even derail a leader’s professional pathway.

  • Review the objectives of a healthy team and healthy providers in the ED
  • List the common presentations of the problem provider (attitude, speed, quality, impairment, etc.)
  • Demonstrate differences and distinctions in 3 common interventions (feedback, coaching, and counseling)
  • Demonstrate how to appropriately advance a counseling continuum (from definition to expectation to specific performance to separation)
  • Discuss the fundamentals and pitfalls of documenting your encounters

Billing Primer

Leading a great ED requires many skills, including an understanding of the basic forces that drive revenue.

  • Outline the systems that determine ED facility payment
  • Analyze the process of correct medication capture
  • Review appropriate charge capture for procedures

Billing/Coding/Observation

Billing and coding for observation services is a complex area fraught with regulatory intrigue and uncertainty. We will work to clarify the known and unknowns and go through the rules, regulations, best practices, and benchmarks to facilitate your observation unit’s financial success.

  • Outline the basic factors driving ED observation revenue
  • Analyze best practices for appropriate observation charge capture
  • Explore methods for applying simple solutions to your local ED observation program
  • Describe strategies for appropriate use of observation services

The Business Case for Patient Flow

The patient is and always will be at the center of our efforts. In service to those patients, multiple “gears” are leveraged in service of those patients, including service, clinical excellence, clinical effectiveness, and flow. The presenter will discuss how these aspects combine in a business fashion, leveraging how best to deploy resources in a capacity-constrained environment, where value trumps volume.

  • Define and describe the principle of flow and how it adds value and eliminates waste
  • Delineate the financial impact of applying the principles of hard-wiring flow, both in the ED and hospital-wide
  • Describe how best to leverage resources to produce the maximum results across boundaries
  • Describe change management strategies to produce effective flow
  • Crosswalk the impact of these strategies for the hospital and physician group

Care Coordination/Transitions

After healthcare reform, it is necessary for the Emergency physician to know more of the “long view” of patient care and look for alternatives to hospitalization. This course will describe alternative options in the community and the ED resources to make placement possible.

  • Discuss the ED resources to improve community transitions
  • Describe possible community options
  • Review the tools available to expedite these processes

Checklists Work! Improving STEMI Processes Across Your Health System

During this interactive session you will learn how a quality improvement project profoundly impacted STEMI care – bringing outcomes into the 90th percentile. Using a case study approach, learn valuable lessons that were then transposed across fourteen EDs.

  • Describe how a quality improvement project improved mortality for STEMI patients
  • Review key components of a process improvement project utilizing a case study approach

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 physicians on arrival, admitting an increasing percentage 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 (emergency physician, RN, Patient, Admin, PCP, etc.)
  • Describe the interrelationship between clinical quality and service excellence
  • Describe simple strategies to improve both clinical quality and the patient experience, including specific actionable behaviors.
  • Explain the value of creating systems which the support the actionable behaviors noted above
  • List methods to make your ED a more consistent highly reliable organization

Collaborative Leadership

Successfully leading an emergency department is a challenging task. Made even more difficult by a mediorcre or poor relationship between the medical director and nurse director. During this session, we will discuss the importance of a collaborative leadership model and how it can help improve the ED team’s interactions.

  • Define the Collaborative Leadership Model
  • Discuss why collaboration is beneficial
  • Review practical starting points in implementing a collaborative model

Complaint Management

“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, and 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

Complaint Management Cases

To effectively address complaints, we must get beyond the theoretical to the actual. This intensive workshop will provide the opportunity to address genuine complaints from the beginning, through the investigative process, and on to resolution. The presenter will provide worksheets and cases that will allow participants to assess, address, and document a variety of complaints.

  • Review and address patient and staff complaints
  • Communicate findings to complainant
  • Document reviews
  • Assign quality scores

Creating a No Wait ED

Minimal to no ED wait times are a current advertisement ploy. How do we meaningfully meet this goal? This presentation will discuss give practical strategies to create an ED with minimal wait times.

  • Discuss setting a team vision and culture of continuous ED improvement
  • Describe a flow team and flow improvement process improvement methodologies to improve flow
  • Explain how intake and acuity based patient streams will decrease wait times
  • Review how patient care teams even physician and nursing workloads and improve communication
  • Discuss how metrics can drive performance

Crisis Communications

When communicating in a crisis, you need more than ordinary performance skills. Allaying fears and encouraging appropriate actions require specific communication competencies. This presentation will explore both basic and advanced presentation proficiencies.

  • Discuss how to confidently engage your audience and build relationships
  • Discuss how to organize your thoughts, handle tough questions and avoid awkward situations

Crowd Control: Reducing Boarding in the ED

Reducing ED boarding will require new strategies. The new era of healthcare reform gives a unique opportunity to evaluate and improve past practices. This course will describe an overcrowding scoring tool and will touch on developing a partnership with the hospital and inpatient physicians thus reducing length of stay and creating ownership for boarded patients.

  • Describe an overcrowding scoring tool
  • Discuss developing a partnership with the hospital and inpatient physicians
  • Review strategies to reduce length of stay and creating ownership for boarded patients

Dealing With the Dysfunctional and Marginal Providers: Improving Performance

The problem provider comes in many forms, among them: bad attitude, poor clinician, too slow, too fast, and even impaired.  This presentation will focus on early recognition and rapid response, and will articulate two fundamental approaches for dealing with almost any problem performance issue.

  • List the common forms of the problem provider
  • Describe typical strengths and weaknesses that leaders exhibit when dealing with problem performance
  • Articulate two basic methods for initially approaching a problem provider
  • Identify appropriate preparation and delivery using these methods

Difficult Conversations: A Leader’s Duty

Leaders have so many day-to-day responsibilities for which most must be carried out through others. Leaders have an obligation to provide feedback to the very people they lead. Confrontation is not easy. This is the single hardest and most uncomfortable action for leaders. This presentation will explore why confrontation is so uncomfortable for many leaders and review approaches and tactics that a leader can apply to carry out this important duty.

  • Review the key tenets of crucial / difficult conversations
  • Explore our personal communication style propensity under stress
  • Apply and practice conducting a difficult conversation

DISC Profiling and Application for Leaders

One of the most fundamental skills for any leader is to successfully manage relationships. The secret sauce to leading people is being aware and understanding the tendencies and preferences of one’s self and others so that one can adapt approaches to achieve a successful outcome. This presentation will help leaders to quickly identify the 4 personality profile types and adaptation tactics to optimize interactions with the different types of people with whom leaders work.

  • Explain what DISC is and the four basic DISC profiles
  • Discuss the importance of recognizing DISC profiles in communicating and relating with people
  • Identify adaptive strategies to best relate with each DISC profile and optimize relationships
  • Apply and practice identifying DISC profiles and how to utilize this tool as leaders

ED Crowding Strategies

This workshop is an expanded discussion of techniques to reduce ED crowding. This will include a discussion of surgical smoothing role in reducing boarding and the necessary community resources.

  • Describe strategies to engage the inpatient team to reduce boarding
  • Describe ways to decrease inpatient length of stay to create inpatient capacity
  • Discuss OR smoothing and the impact on overcrowding
  • Discuss a tool to standardize discussion around overcrowding and assist with daily operations

ED Strategies to Manage Psychiatric Patients

The current ED management of psychiatric patients is a negative experience for both staff and patients. This interactive discussion will discuss strategies to best handle ED psychiatric patients.

  • Describe the current state of emergency psychiatry
  • Discuss a new model of ED care involving active treatment of patients
  • Describe the use of standard service operations principles to improve care and decrease ED length of stay
  • Describe innovative models around the country improving ED psychiatric care

ED Violence Mitigation

Workplace violence is a concern we can't ignore. How we respond greatly determines the safety of everyone involved. We will look at the escalation of violence in the health care environment and discuss regulation and mitigation.

  • Discuss strategies to promote safety, security and dignity for all involved
  • Describe how we influence whether a crisis is prevented or escalates

EDIS: Getting the Most Out of Your Information System

The ideal computerized ED is the elusive holy grail. The EMR promise to transform the inefficient ED to the modern information age has only been partially realized , and at the cost of “digital overhead” due to data entry, search for data, and lack of interoperability. This situation has been further complicated by little choice in which system you must use. Surveys have shown a major factor for graduating residents job search is which EDIS they will have to use. Despite these challenges, many benefits of EDIS go unrealized due to a lack of leadership, knowledge, and initiative. This presentation will address common EDIS challenges and solutions.

  • Discuss current ED information systems (generically), addressing common challenges
  • List opportunities for improvement, utilization of data, & functionality
  • Discuss operational changes necessary to achieve successful use of EDIS
  • Review future technology and enhancements on the horizon

EMTALA Advanced Cases

Even with a good working knowledge of EMTALA, common and more rare EMTALA situations can be challenging. This workshop will entertain various EMTALA situations and allow the group to work through solutions guided by the moderator. Advanced EMTALA cases will be presented & solutions determined by the group. EMTALA questions will be elicited and answers determined by the group as guided by the moderator.

  • Discuss options for managing EMTALA issues with administration & medical staff
  • Discuss how to prepare for the hiring process, including that retention begins with the leadership
  • Identify practical and best practice strategies for building a positive culture and department 

EMTALA Primer

No law enacted before, or since, has had a bigger impact on the way hospital EDs must manage patients. Yet, these regulations are often misunderstood and interpreted inconsistently. The presenter will provide a foundation for understanding and implementing EMTALA in the current emergency care environment. These principles will be used in working through cases in the Advanced EMTALA Cases workshop.

  • Discuss basic EMTALA principles
  • Outline recent changes to EMTALA
  • Define obligations related to medical staff, on-call physician, and transfer
  • Recommend methods to enhance compliance
  • Identify resources for further study

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

How to Lead and Inspire Teams

Effective leadership and management of emergency departments requires a working knowledge of how to recruit talented professionals, assemble them into an effective team, and build skills and abilities among those team members. In many cases, we can assure our patients that they will be taken care of by a team of experts-but will they be taken care of by an expert team? This session will explore the importance of teams and teamwork in the context of effective ED operations across patient experience, patient safety, clinical effectiveness and hard-wiring flow.

  • Define teams and teamwork in healthcare and in the emergency department
  • Define and describe the tools of teamwork
  • Describe a framework for holding professionals accountable for teamwork and team results
  • Describe how to assure teamwork on a daily basis
  • What to do when the team breaks down

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

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 the role of leadership and the importance of accountability in change management
  • Review the tactics to build collaborative dyad leadership of the medical director and nursing director
  • List models and tools for engaging and aligning your teams
  • Describe the different approaches of physicians, nurses, and administrators so that effective communication can be developed and maintained

Patient Experience: Beyond the Ordinary

Patient experience is in the process of replacing and expanding simple customer service in healthcare and in the emergency department. It requires an understanding of the entire experience versus simply what the patient’s opinion of those who provide the care, and includes the sum of all interactions in the entirety of patient care. What are the tools and techniques which improve patient experience while making the job easier for those who provide the care? The presenter will build on the previous EDDA 1 talk with a suite of solutions to this increasingly-important issue.

  • Define and describe patient experience, summarizing the material presented in EDDA for those who were not there
  • Define A-Team Toolkit solutions to improve patient experience
  • Describe how successful organizations have created team-based solutions to patient experience
  • Use case studies to show how these solutions improve patients’ experience while making the job easier for those who provide their care

Performance Dashboards

What you can’t measure, you can’t manage. And what you can measure you have to treasure. Sometimes what you can measure doesn’t matter, and what you really need to measure you can’t. This session will outline the importance of having performance dashboards for both the department as a whole and for your individual providers.

  • Define the importance of choosing key metrics and creating a specific executive scorecard tracking those metrics
  • Explain the importance of both group measurement and individual measurement
  • Describe how to create an action plan with the important components to move the emergency department from baseline to target
  • Describe the importance of defining metrics outside of the ED and engaging hospital inpatient leadership to create a throughput effort similar to the ED

Recruitment and Retention of Emergency Nurses

Nursing is near the top of the employment growth list, but combined with an increasing aging workforce, an aging patient population, and increased access to healthcare, the critical need for nurses remains a priority in our healthcare systems. Finding, and more importantly, retaining emergency nurses is an imperative for ED leaders in order to deliver quality and service goals.

  • Review the current statistics of nursing workforce
  • Identify the negative effects a nursing shortage
  • List the characteristics of a healthy work environment

Recruitment and Retention of Emergency Physicians

Physician shortages are a constant challenge. It has the potential to become worse with increasing demands and record number of staff retiring. In this interactive session, participants will learn how to build a foundation that attracts and retains good physicians.

  • Identify some of the barriers to attracting and retaining physicians
  • Discuss how to prepare for the hiring process, including that retention begins with the leadership
  • Identify practical and best practice strategies for building a positive culture and department

Reducing Practice Variation

This workshop will develop concepts discussed in the earlier rapid-fire lecture “Reducing Practice Variation: Creating System-Wide Clinical Care Paths".

  • Explore existing and future clinical care paths/guidelines to improve clinical processes and patient outcomes
  • Discuss assets of technology that can support clinical decision making, as well as potential barriers
  • Share process improvement best practices and projects that reduce practice variation

Reducing Practice Variation: Creating System-Wide Clinical Care Paths

In a value-based world, it will be increasingly important to practice evidence-based medicine to appropriately manage patient populations. This session will describe the use of clinical care paths (AKA: guidelines) to improve patient outcomes and improves clinical process – for both the patient and the provider.

  • Describe how clinical care paths/guidelines can improve patient outcomes
  • Discuss how technology can play a role in clinical decision support tools
  • Review shared-decision making models to incorporate patient and family preferences into clinical processes

Regional ED Integration: A Practical Guide For Leaders

Health systems are undergoing continued consolidation and mergers – similar to the airline industry decades ago. This affords great opportunity for both clinical and business efficiencies. As your system expands from a solo ED to many, learn valuable lessons to help guide your strategy and approach.

  • Identify the pros/cons of different employee models
  • Discuss how standardized process can enhance clinical workflows and patient outcomes
  • Describe oversight and governance committees to help with integration across multiple EDs
  • Share best practices with other ED leaders as they work to improve health system integration

Reimbursement

Without adequate revenue your ED will be starved of resources. No margin no mission is a basic tenet of being a modern ED leader. Appropriate billing and coding creates the revenue required to obtain the resources necessary to run our EDs well and deliver top-notch clinical care. The ED does not have to be viewed as a financial drag on hospital finances but rather through appropriate basic steps can be a profitable revenue center.

  • Analyze best practices for appropriate revenue generation and charge capture
  • Outline metrics and benchmarks to apply to your ED revenue generation and appropriate charge capture process
  • Explore methods for applying simple solutions to your local ED coding process

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

Service Champions

As patient perception of care begins to have a greater impact on revenue and reimbursement becomes tied to quality of care metrics, optimizing service operations will be essential to the success of your department. This interactive session will provide tools for optimizing service operations in your department by focusing on patient and provider perception of care.

  • Identify valuable techniques for setting, meeting, and exceeding patient expectations
  • Create a plan for developing a “Culture of Service” 
  • Identify valuable techniques for maximizing the “return on investment” to physicians and other providers and services

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 a great opportunity for enhancing your role, advancing your department, and positively impacting patient care. Through active discussion and real-time case studies, we will explore effective approaches, new suggestions, 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 defining and categorizing problems that promote successful approaches
  • Identify opportunities to re-frame issues and build relationships in order to produce desired results

Strategies to Improve Front End Flow

The patient experience in the ED starts from the moment they walk through the front door. Patients want their time spent in the ED to be meaningful. The faster they are evaluated, the more likely they are to be satisfied with their care.

  • Discuss tricks of the trade to decrease times from door to provider and keep your patients out of the waiting room
  • Outline key processes that can help make the patient experience valuable and every minute count
  • Identify tools to help develop processes unique to your ED and patient population

Team Building

This workshop will build on earlier talks on Nurses are from Saturn, Physicians are from Jupiter, and the Performance Metrics course. It will be an interactive planning workshop on how to run an ED management team meeting, how to build an executive scorecard, and how to create and track an action plan. Attendees should be encouraged to bring their own current scorecards/dashboards and action plans and teams will be given the opportunity to modify those items.

  • Describe how to work on current scorecards and action plans to make them more effective
  • Utilize specific tools to define leadership styles and how to build strong collaborative working relationships between physician, nurse and administrative leaders
  • Review specific examples of how to create great teamwork and improve morale among the ED team

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

Value-Based Decision Making

Historically, decision-making has been made been characterized by an "either/or" mindset with constraints that keep us from thinking outside the box. Value-based decision-making begins with a desired goal. Performance measures are applied to each possible strategy in order to assess alternatives and achieve the goal. An interactive case study will illustrate how to use this model in ED leadership situations.

  • Differentiate the attributes of alternative and value-based decision-making
  • Identify the steps in value-based decision-making
  • Discuss the use of performance measures to support your decision

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!