Administration Part 2 Sultana Qureshi, PGY-2. Outline Role of the Medical Director Role of the...
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Transcript of Administration Part 2 Sultana Qureshi, PGY-2. Outline Role of the Medical Director Role of the...
Administration Administration Part 2Part 2Sultana Qureshi, PGY-2Sultana Qureshi, PGY-2
OutlineOutline
Role of the Medical DirectorRole of the Medical Director Patient ComplaintsPatient Complaints Public RelationsPublic Relations Observation UnitsObservation Units
Executive Medical DirectorDr. Cam Waddell
Vice PresidentThelma Inkson
Regional Clinical Department Head
Dr. Gil Curry
Director, Emergency, Urgent Care and Health Link
Caroline Hatcher
Deputy RCDHDr. Wayne Sefcik
Undergraduate CoordinatorDr. L. Baker
Division Chief, Education
FRCP: Dr. B. YoungQI PhysicianDr. T. Rich
Site ChiefsFMC: Dr. G. Greenfield
PLC: Dr. P. DavidsRGH: Dr. C. Godfrey
Patient Care ManagersFMC: K. Howe
PLC: E. Shackleton RGH: T. Smith
Service Planning Coordinator
Judy Pedersen (interim for Maureen McNaul)
Research Coordinator
R. Vilneff
Data SpecialistD. Wang
Regional Clinical Nurse SpecialistA. Mageau
REDIS CoordinatorsK. JessenH. BattleD. Hone
AssistantPatient Care Managers
FMC: H. CrowePLC: B. JensenRGH: L. Walters
Division Chief, Research
Dr. M. Yarema
Associate ResearchDirectorVacant
Resident Research CoordinatorDr. C. Hall
Patient Care ManagerACH: T. Davidson
Regional Department of Emergency Medicine / Emergency Services Organizational ChartMay 2006
Director, Calgary Regional Sexual Assault Response Team
Dr. P. Head
Division Chief, EducationCCFP(EM):
Dr. N. Collins
Assistant Division Chief, Education
CCFP(EM): Dr. I. Walker
Assistant Resident Research CoordinatorDr. R. Morris
The Emergency The Emergency Department Department DirectorDirector
““80% of the job is 80% of the job is just showing up…”*just showing up…”*
*La Salle. Emerg Med Clin N Am. 2004;22:1-18.
“…“…the ED the ED administrative administrative and clinical and clinical leader must leader must learn how to learn how to acquire power of acquire power of all types…”*all types…”*
Emergency Department Emergency Department DirectorDirectorPurpose of the PositionPurpose of the Position((ACEP Guidelines 1998)ACEP Guidelines 1998) Provide leadership & management for the EDProvide leadership & management for the ED
Work cooperatively with ED staff to provide emergency Work cooperatively with ED staff to provide emergency services to patientsservices to patients
To work cooperatively with diagnostic and therapeutic To work cooperatively with diagnostic and therapeutic services to ensure availability, quality, and effective use services to ensure availability, quality, and effective use of servicesof services
To provide input into preparation of departmental To provide input into preparation of departmental budgetbudget
Monitor community needs and provide input into EMS Monitor community needs and provide input into EMS and disaster planningand disaster planning
Aric Storck. Administration 2005
QualificationsQualifications Career EP with proven clinical and Career EP with proven clinical and
administrative skillsadministrative skills Board certified in EMBoard certified in EM Demonstrated knowledge and ability in Demonstrated knowledge and ability in
financial, managerial, and marketing financial, managerial, and marketing aspects of EMaspects of EM
Participates in CMEParticipates in CME Demonstrated ability to speak effectively Demonstrated ability to speak effectively
on administrative and clinical matters on administrative and clinical matters related to EMrelated to EM
ACEP Guidelines 1998
ResponsibilitiesResponsibilities
Leadership, organization, staffing, coordination, and Leadership, organization, staffing, coordination, and evaluation for ED activitiesevaluation for ED activities
Ensure ethical practice of EM within deptEnsure ethical practice of EM within dept Supervises and has responsibility for EP’s in clinical Supervises and has responsibility for EP’s in clinical
and administrative dutiesand administrative duties Acts as liaison between hospital administration and ED Acts as liaison between hospital administration and ED
staffstaff Should be member of hospital executive committee Should be member of hospital executive committee
and and represent interests of EMrepresent interests of EM Should be concerned with physician schedulingShould be concerned with physician scheduling
ACEP Guidelines 1998
Other responsibilitiesOther responsibilities
Department Department managementmanagement
EducationEducation LiaisonLiaison Public relationsPublic relations Recruitment and Recruitment and
orientationorientation Department meetingsDepartment meetings Committees – hospital Committees – hospital
and departmentaland departmental
Quality assuranceQuality assurance Peer reviewPeer review
Physician evaluationPhysician evaluation
PlanningPlanning LegalLegal
Risk managementRisk management
Contracts and Contracts and financesfinances
ACEP Guidelines 1998
““The primary mission of the The primary mission of the Emergency Department leader is to Emergency Department leader is to ensure excellence of professional ensure excellence of professional performance at all levels so that performance at all levels so that safe patient care is delivered.”safe patient care is delivered.”
What qualities What qualities makes a good ED makes a good ED Leader?Leader?
How does one become a How does one become a good ED leader?good ED leader?
1. Leadership must develop incrementally based on trust 1. Leadership must develop incrementally based on trust and credibility.and credibility.
2. Must develop a reputation for honesty, take selfless risk, 2. Must develop a reputation for honesty, take selfless risk, and seek to inspire by example. Shoulder a greater burden and seek to inspire by example. Shoulder a greater burden without complaint.without complaint.
3. Achieve “street smarts” by developing an accurate & 3. Achieve “street smarts” by developing an accurate & predictive intuition of what motivates action. Careful predictive intuition of what motivates action. Careful listening, keen observing, understanding their own listening, keen observing, understanding their own strengths and weaknesses.strengths and weaknesses.
4. Good leaders are not selfish & understand that 4. Good leaders are not selfish & understand that recognition & monetary reward are secondary to the goal recognition & monetary reward are secondary to the goal of providing excellent patient care. Take care of their of providing excellent patient care. Take care of their troops.troops.
La Salle. Leadership in Emergency Medicine. Emerg Clin N Am. 2004;22:1-18.
How does one become a How does one become a good ED leader?good ED leader?
5. Understand the ED is not an island, and 5. Understand the ED is not an island, and proactively collaborate with outside departments, proactively collaborate with outside departments, organizations..organizations..
6. Understand and accept conflict.6. Understand and accept conflict.
7. Perseverance to overcome resistance to 7. Perseverance to overcome resistance to change.change.
8. Understands the importance of perception and 8. Understands the importance of perception and works industriously to fashion fair perception and works industriously to fashion fair perception and promote vision that is realistic and attainable.promote vision that is realistic and attainable.
La Salle. Leadership in Emergency Medicine. Emerg Clin N Am. 2004;22:1-18.
Education:Education:
ACEP – Emergency Department ACEP – Emergency Department Director’s AcademyDirector’s Academy
Four phase courseFour phase course
Patient ComplaintsPatient Complaints
What do patients What do patients complain about?complain about?
Patient complaint types Patient complaint types (CHR-EDs Apr-Oct 2005)(CHR-EDs Apr-Oct 2005)
Complaint Types
0
20
40
60
80
100
120
1
Types
Am
ou
nt
A1-1 A1-2 A1-3 A2 A3 A4 A5A6 A7 A8 B1 B2 B3 C1C2 C3 C4 C5 C6
Code Complaint Type
A1.1Access/Wait Times - Waiting
Room
A1.2 Access/Wait Times - Department
A1.3 Access/Wait Times - Other
A2 Financial
A3 Lost Belongings
A4 Physical Environment
A5 Communication Process
A6 Multiple Departments
A7 Triage
A8 Other
B1 Personal Interaction
B2 Care Provided
B3 Other
C1 Personal Interaction
C2 Physician Competence
C3 Discharge Issues
C4 Treatment Expectations
C5 Missed Diagnosis
C6 Other
Patient complaint types Patient complaint types (CHR-EDs Apr-Oct 2005)(CHR-EDs Apr-Oct 2005)
1. Treatment expectations1. Treatment expectations 2. Personal interaction 2. Personal interaction 3. Length of waiting room stay3. Length of waiting room stay 4. Care provided4. Care provided 5. Triage5. Triage
Goals of a complaint Goals of a complaint systemsystem Facilitate positive interaction with patients, public Facilitate positive interaction with patients, public
and staffand staff
Identify systemic problems – integrate with QI Identify systemic problems – integrate with QI systemsystem
Identify personnel deficiencies (eg: poor Identify personnel deficiencies (eg: poor communication skills, staff demeanor,etc.)communication skills, staff demeanor,etc.)
Integrate with overall risk management strategies Integrate with overall risk management strategies and reduce litigious dispute resolution (ie: lawyers) and reduce litigious dispute resolution (ie: lawyers)
Aric Storck. Admin. 2005
Patient Representative Patient Representative ServiceService(CHR Website- Patient Concerns)(CHR Website- Patient Concerns)
is a point of entry into the regional health system for is a point of entry into the regional health system for patients or their advocates to patients or their advocates to express concerns, express concerns, complaints or messages of thankscomplaints or messages of thanks regarding patient regarding patient care care
takes a lead role in facilitating the internal review takes a lead role in facilitating the internal review process with a focus on client relations, information process with a focus on client relations, information sharing, and conflict resolutionsharing, and conflict resolution
resolutions based on mutual interests, with the goal resolutions based on mutual interests, with the goal that this leads to increased that this leads to increased consumer satisfactionconsumer satisfaction and and continuous quality improvement continuous quality improvement
Patient Representative Patient Representative ServiceService(CHR Website- Patient Concerns)(CHR Website- Patient Concerns)
Process:Process:
Issues may be brought forward in writing, by phone, or online Issues may be brought forward in writing, by phone, or online formform
The Patient Representative will assess the issue and The Patient Representative will assess the issue and determine whether a formal review is necessary or whether determine whether a formal review is necessary or whether other, more immediate measures are required (ie. inpatient vs. other, more immediate measures are required (ie. inpatient vs. remote outpatient complaint)remote outpatient complaint)
Concerns received once pt has left hospital- the issues are Concerns received once pt has left hospital- the issues are forwarded to the Regional Clinical Department Head if a forwarded to the Regional Clinical Department Head if a medical review is required, or the Director of the service if the medical review is required, or the Director of the service if the issues involve staff from the care areaissues involve staff from the care area
When messages of thanks are received regarding care, the When messages of thanks are received regarding care, the appropriate senior member of the service or hospital site writes appropriate senior member of the service or hospital site writes to the staff to commend them and provides a copy of the to the staff to commend them and provides a copy of the commendation received. commendation received.
Patient Representative Patient Representative ServiceService(CHR Website- Patient Concerns)(CHR Website- Patient Concerns) Time frame:Time frame:
Many issues can be addressed or resolved by the Patient Many issues can be addressed or resolved by the Patient Representative. This is particularly true when queries are about Representative. This is particularly true when queries are about regional programs or services, policies, processes, etc. regional programs or services, policies, processes, etc.
When a concern is received that requires a formal investigation, When a concern is received that requires a formal investigation, the goal is to respond back to the patient within a 4 week the goal is to respond back to the patient within a 4 week timeframe. (May be longer is multiple areas involved, or staff timeframe. (May be longer is multiple areas involved, or staff interview required.)interview required.)
Patient contacted in writing or by telephone. (new policies may Patient contacted in writing or by telephone. (new policies may require only writing. Is this a good idea?)require only writing. Is this a good idea?)
Patients must provide consent to review recordsPatients must provide consent to review records
Once lawyers involved, becomes CMPA issueOnce lawyers involved, becomes CMPA issue
Patient RightsPatient Rights(CHR Website- Patient Concerns)(CHR Website- Patient Concerns)
Be treated with respect and Be treated with respect and without discriminationwithout discrimination; ;
Expect that information about you is Expect that information about you is confidentialconfidential, and that you will , and that you will be informed when a medical doctor is legally required to disclose be informed when a medical doctor is legally required to disclose information for your safety or the safety of others; information for your safety or the safety of others;
Expect a medical doctor or health care worker Expect a medical doctor or health care worker not to take not to take physical, emotional, sexual or financial advantagephysical, emotional, sexual or financial advantage of you; of you;
Receive Receive reasonable explanationsreasonable explanations about your care, examinations about your care, examinations and treatment so that you may give or withhold informed consent; and treatment so that you may give or withhold informed consent;
Personal privacyPersonal privacy while disrobing, or when parts of your body are while disrobing, or when parts of your body are being examined; being examined;
RefuseRefuse a particular type of examination or treatment or a particular type of examination or treatment or withdraw withdraw consentconsent without obligation or harassment; without obligation or harassment;
Be informed of major delaysBe informed of major delays in consultations/treatments, if at all in consultations/treatments, if at all possible; possible;
Know if there are supervisors, consultants, students, interns or Know if there are supervisors, consultants, students, interns or others with whom your medical doctor will discuss your case;others with whom your medical doctor will discuss your case;
Receive a timely referralReceive a timely referral or consultation with another health or consultation with another health professional whenever you and the medical doctor believe it professional whenever you and the medical doctor believe it appropriate; appropriate;
Receive a second opinionReceive a second opinion regarding your treatment or the medical regarding your treatment or the medical doctor's methods; doctor's methods;
Be Be listened tolistened to carefully and to carefully and to receive supportreceive support throughout your throughout your health care experience; health care experience;
Have Have another person presentanother person present during examinations. during examinations.
Patient RightsPatient Rights(CHR Website- Patient Concerns)(CHR Website- Patient Concerns)
Respect the privacyRespect the privacy of other patients, medical doctors and staff; of other patients, medical doctors and staff;
Ask your medical doctor or health care workers for Ask your medical doctor or health care workers for further further information if you do not understand; information if you do not understand;
Let your medical doctor or health care worker Let your medical doctor or health care worker know if you feel know if you feel uncomfortable; uncomfortable;
CooperateCooperate and follow the care prescribed as recommended for and follow the care prescribed as recommended for you as long as you are in agreement; you as long as you are in agreement;
Inform the medical doctor or staff if you are unable to keep your Inform the medical doctor or staff if you are unable to keep your appointment; appointment;
Allow the medical doctor to have a Allow the medical doctor to have a staff member presentstaff member present during an during an examination examination
Patient ResponsibilitiesPatient Responsibilities(CHR Website- Patient Concerns)(CHR Website- Patient Concerns)
Key to Avoiding Key to Avoiding Complaints…Complaints…
CommunicationCommunication CommunicationCommunication CommunicationCommunication
Expressive qualityExpressive quality Verbal techniquesVerbal techniques Introduce oneself by nameIntroduce oneself by name Explain one’s role in the EDExplain one’s role in the ED Use reflective listeningUse reflective listening (i.e., (i.e.,
summarizing what the patient summarizing what the patient has said to demonstrate has said to demonstrate understanding)understanding)
Use Use empathetic commentsempathetic comments such as “I understand” or “Isuch as “I understand” or “I
see”see” Apologize for waits and Apologize for waits and
delaysdelays Apologize for interruptionsApologize for interruptions Nonverbal techniquesNonverbal techniques Have good eye contactHave good eye contact Smile (when appropriate)Smile (when appropriate) Adopt a “concerned” and Adopt a “concerned” and
“interested” look that shows “interested” look that shows you are listeningyou are listening
Allow the patient to describe Allow the patient to describe their problems their problems without without interruptionsinterruptions
Information deliveryInformation delivery Use Use anticipatory guidanceanticipatory guidance Provide information about Provide information about
diagnoses and potential diagnoses and potential causes of the problemcauses of the problem
Explain results of tests and Explain results of tests and their implicationstheir implications
Provide Provide discharge instructionsdischarge instructions (in writing if possible)(in writing if possible)
Explain the purpose of Explain the purpose of procedures and the potential procedures and the potential for pain for pain
Tailor the content to the Tailor the content to the intellectual level, medical intellectual level, medical sophistication, and language sophistication, and language mastery of the patientmastery of the patient
Foreign language Foreign language communicationcommunication
Acquire proficiency in Acquire proficiency in languages most common to languages most common to the regionthe region
Use professional interpretersUse professional interpreters
Public RelationsPublic Relations
Observation UnitsObservation Units
The primary objective of observation units is to The primary objective of observation units is to provide an alternative to hospitalization for provide an alternative to hospitalization for patients requiring extended diagnostic patients requiring extended diagnostic assessment or treatment for up to 24 hoursassessment or treatment for up to 24 hours
Advantages include:Advantages include: Improved resource use Improved resource use (50% less cost than admission)(50% less cost than admission)
Increased diagnostic accuracyIncreased diagnostic accuracy Higher patient satisfactionHigher patient satisfaction Increased educational and research opportunitiesIncreased educational and research opportunities
3 models of OUs3 models of OUs The scatter bed model The scatter bed model
any bed in the hospital can become an observation bedany bed in the hospital can become an observation bed generally does not work very well, because of inefficiencies due to the generally does not work very well, because of inefficiencies due to the
varying needs of patients on the floor varying needs of patients on the floor
The in-house defined unit modelThe in-house defined unit model usually run by hospitalists within the institutionusually run by hospitalists within the institution predominant problem tends to be reimbursement issues (mainly US predominant problem tends to be reimbursement issues (mainly US
problem with insurance companies)problem with insurance companies)
The linked emergency department modelThe linked emergency department model a “virtual unit,” where any bed in the ED can become an observation a “virtual unit,” where any bed in the ED can become an observation
bedbed typically does not work well since the staff is too busy with the sickest typically does not work well since the staff is too busy with the sickest
patientspatients
Defined UnitDefined Unit Technically the ideal model, with unit attached to ED.Technically the ideal model, with unit attached to ED. Most likely to manage care efficientlyMost likely to manage care efficiently
What type of What type of patients would you patients would you select?select?
Conditions Appropriate Conditions Appropriate for Observationfor Observation
Evaluation: Critical Diagnostic SyndromesEvaluation: Critical Diagnostic Syndromes Abdominal painAbdominal pain Chest painChest pain DVTDVT Gastrointestinal bleedGastrointestinal bleed SyncopeSyncope Blunt abdominal traumaBlunt abdominal trauma Blunt chest traumaBlunt chest trauma Penetrating abdominal traumaPenetrating abdominal trauma Penetrating chest traumaPenetrating chest trauma Head injuryHead injury
Conditions Appropriate Conditions Appropriate for Observationfor Observation
Treatment: Emergency ConditionsTreatment: Emergency Conditions AsthmaAsthma Atrial fibrillationAtrial fibrillation Congestive heart failureCongestive heart failure DehydrationDehydration Infections Infections PneumoniaPneumonia PyelonephritisPyelonephritis