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Department of Medicine Sub-Specialty Support Staff Restructuring Confidential: Quality Improvement Material Collaborative Team David Katz, Donna Epley, Jacqueline Foulk, Juanita Kizior, Jane LaMarre, Jacqueline Pikes, Katina Shehie, and Rosetta Sramek

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Department of

Medicine

Sub-Specialty

Support Staff

Restructuring

Confidential: Quality Improvement Material


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Collaborative Team

David Katz, Donna Epley, Jacqueline Foulk, Juanita Kizior,

Jane LaMarre, Jacqueline Pikes, Katina Shehie, and Rosetta Sramek

Richard Novotny, Sue Plancon, and Marilyn Hauser

Fahey Team Picture

Confidential: Quality Improvement Material


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BACKGROUND

The Department of Medicine conducted an operational assessment in an effort to proactively identify opportunities for cost savings and service improvement.

Because 6 Sub-Specialty Divisions within the Department of Medicine (Allergy-Rheumatology-Immunology, Dermatology, Endocrinology, General Internal Medicine, Infectious Disease, and Pulmonary and Critical Care Medicine) were situated together in the Fahey Building (1st Floor), these areas became the focus of discussion to consider how positive change might result if creative consolidation, integration, and collaboration efforts were implemented.

The planning process completed, and implementation shortly followed. Understanding that Loyola staff members would be critical for success, a priority was established to ensure that the resulting environment would be one that strives to promote teamwork, professional development and employee satisfaction.

Confidential: Quality Improvement Material


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PURPOSE/GOALS-OBJECTIVES:

Create an organizational structure within the Department of Medicine (1st Floor Fahey Divisions) that would allow for cost savings and improved service with specific focus on the following goals-objectives:

  • Match expense to revenue (Cost Savings)

  • Improved operational performance and service though consolidation and integration

  • Graduate Medical Education (GME) program improvements

  • Create a work environment that emphasizes teamwork, promotes integration and collaboration, and offers challenge and opportunity

Confidential: Quality Improvement Material


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Organizational Characteristics

After Restructuring

Organizational Characteristics

Before Restructuring

  • 7 Support Staff FTEs

  • 6 Divisions operating in a more

  • integrated, collaborative manner

  • 5 Educational (GME) Programs

  • operating under the coordination of 1 individual

  • 1 designated Administrator responsible for coordination of support staff

  • Systems to allocate shared resources to areas of need

  • Shared systems and protocols

  • between divisions

  • 10 Support Staff FTEs

  • 6 Divisions operating independently

  • 5 Educational (GME) Programs

  • operating independently

  • Minimal integration between Divisions

  • Varied workloads within Divisional

  • and individual responsibilities

  • Minimal coordination/consistency with Divisional policies/protocols

Confidential: Quality Improvement Material


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Before

Director of Administration

Division

Administrator

Division

Administrator

Division

Administrator

Allergy

Rheumatology

Immunology

General Internal Medicine

Pulmonary & Critical Care

Infectious Disease

Dermatology

Endocrinology

Admin

Secretary

Admin

Secretary

Admin

Secretary

Senior

Secretary

Senior

Secretary

Senior

Secretary

Senior

Secretary

Admin

Secretary

Admin

Secretary

Senior

Secretary

Fellowship

Program

Fellowship

Program

Fellowship

Program

Fellowship

Program

Residency

Program

Confidential: Quality Improvement Material


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After

Director of Administration

Division

Administrator

Division

Administrator

Division

Administrator

Education

Coordinator

4

Fellowship

Programs

1

Residency Program

Admin

Secretary

Admin

Secretary

Admin

Secretary

Admin

Secretary

Admin

Secretary

Admin

Secretary

Allergy

Rheumatology

Immunology

& Pulm &

Back up to

Infec Dis

Dermatology

& Back up to

Endocrinology

& General Internal

Medicine

Pulmonary & Critical Care

& Back up to

Rheumatology

& Infec Dis

Endocrinology

& Back up to Dermatology

& General Internal Medicine

Infectious Disease

& Back up to Pulmonary

General Internal Medicine,

Dermatology &

Endocrinology

Confidential: Quality Improvement Material


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SOLUTIONS IMPLEMENTED

New Organizational Structure

  • Allowed for reduction of 3 FTE positions

  • Created cross-coverage and defined back-up systems between individuals and Divisions

  • All support staff positions standardized at

  • Administrative Secretary level of responsibility

  • Established designated Administrator

  • responsible for coordination of Support staff

  • Established “Education Coordinator” position

  • responsible for coordination of all GME programs

Confidential: Quality Improvement Material


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SOLUTIONS IMPLEMENTED

Integration and Collaboration Protocols

  • Implemented “shared” protocols/ procedures including establishing a Shared network drive, creating shared EPIC In-Baskets, and developing shared calendars in Groupwise

  • Expanded electronic access for all staff to ensure efficient use of EPIC, Lawson, Corporate Express, Web-on Call and all Loyola systems

  • Implemented improved Phone coverage standards and protocols

  • Standardized signage, phone listings, voice-mails, and employee ID’s in an effort to promote consistency,

  • teamwork and service

  • Established regular “Team” meetings

Confidential: Quality Improvement Material


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SOLUTIONS IMPLEMENTED

Consolidation of Educational (GME) Programs

  • Established 1 primary contact with GME office to

  • represent all 5 GME programs

  • Centralized systems/policies for Internal reviews,

  • RRC site visits, interview/ranking systems,

  • in-service examinations, orientations, and

  • special projects

  • Protocols implemented to foster consistency and

  • collaboration among the 5 GME programs

  • Reviewed/improved day to day support consistent with new organizational structure

Confidential: Quality Improvement Material


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After

Restructuring

Before

Restructuring

RESULTS

  • Cost Savings

  • $132,000.00

  • (28% Reduction)

  • 100% Live Phone Coverage

  • Increased integration and teamwork creating a

  • friendlier, more cooperative and more

  • supportive work environment

  • Improved Educational (GME) Programs and support

Salary and Benefit Costs

Confidential: Quality Improvement Material


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Testimonials to Results

“I have seen a significant improvement in support to me and the Division as well as a clear presence of a cooperative spirit within the Fahey group.”

Edward Gurza, M.D., Director, Division of General Internal Medicine

“The Fahey staff has done a remarkable job with working together as a team to share ideas and implement improvements in all areas. The project’s success, thus far, has clearly hinged on their collaborative efforts.”

David Katz, Division Administrator

“The staff was outstanding in their efforts to expand Dermatology’s resident complement for next year and coordinate our recent internal review of the program.”

James Swan, M.D., Dermatology Residency Program Director

“Although skeptical, at first, with the new structure, I was very pleased with how Rheumatology’s first round of interviews were planned and conducted under the new structure.”

Elaine Adams, M.D., Director, Division of Rheumatology

“The Department of Medicine's recent initiative to centralize programs, thought a significant break with traditional academic medical centers, provides the essential underpinnings to true program administration and development. Allowing an individual to focus exclusively on the educational mission, to perform accreditation tasks more frequently , and to be able to identify and adopt best practices across programs will undoubtably improve our accreditation periods. Similarly in the current fiscal crisis, such a transition makes complete fiscal sense.”

Dorothy Jambrosek, Admin Dir, Med Staff Affairs and GME

Confidential: Quality Improvement Material


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ANALYSIS

Although only several months post implementation, initial review of the restructuring indicates substantial achievement of stated goals of cost savings, improved performance and service, Educational Program (GME) improvements and an enhanced work environment.

NEXT STEPS

  • Solicit ongoing input from Faculty, Residents, Fellows, Staff, and other stakeholders to identify areas for further

  • improvement

  • Continue communications/reviews to ensure optimal

  • organizational structure is maintained

  • Attempt to identify additional Service Improvement

  • opportunities

  • Attempt to identify additional work environment

  • improvement opportunities


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