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Currents April 3 To Medical Center Employees: At the April 3 communications meeting Pat Cawley, M.D., Medical Center medical director, gave an overview of the new clinical service line organizational model. Service lines being implemented at this time include Children’s, Digestive Disease, Heart and Vascular and Transplant. A summary of Dr. Cawley’s presentation is highlighted below in this newsletter.   While all appointments have not been made, I want to congratulate the outstanding leaders appointed to date. An announcement is included in this week’s The Catalyst.   The service line model will align the objectives and working relationships of the clinical enterprise (Medical Center, College of Medicine and UMA) more effectively. It will empower service line physician and administrative leaders in decision making, improve patient care and enhance financial accountability. The service lines will support our MUSC Excellence goals. We will plan on additional service lines in the future as the needs dictate.   On another matter, Helena Bastian, Medical Center HR director, updated the management team on plans to provide MUSC Excellence training for new hires and to provide special training and assistance to areas with certain needs. We will continue to use the services of The McNair Group (TMG) to provide new hires training focusing on AIDET, rounding expectations, Standards of Behavior and Service Recovery. These key MUSC Excellence topics will be included in a single three hour session and will be available four times each month at various times (day, evening and night). The training will be offered immediately after general orientation or within the first 90 days of employment, depending on the specific needs of departments.   Some training by TMG will target areas of need. One half-day retreats will be made available to departments (one each month) that have special needs as indicated by patient satisfaction scores, employee satisfaction scores and other measures. The retreats will focus on development of action plans.   Also, two hour leader “refresher sessions” will be made available (one each month or as needed for up to 20 leaders) to provide assistance with AIDET assessments, Standards of Behavior modeling, Service Recovery and other needs.   Additional details will be disseminated concerning this training. Anyone with questions can contact Helena Bastian (bastianh@musc.edu).   Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center Upcoming Town Hall Meetings April 23: 3:30 p.m., IOP; April 24: 6:45 a.m., Room 100, BSB; April 25: 11:30 a.m. and 3 p.m., 2 West Amphitheater; April 25: 6 p.m., 2 West Amphitheater; April 26: 3 p.m.,SEI Auditorium; April 27: 7:30 and 11:30 a.m., 2 West Amphitheater; April 30: 11 a.m., SEI Auditorium; May 1: 10 a.m. and 1 p.m., SEI Auditorium; and May 2: 7:30 a.m.  and 2 p.m., IOP Service—Serving the public with compassion, respect and excellence Service lines Patrick Cawley, M.D., medical director, introduced the clinical service line model. The service lines are designed to meet both patients and providers’ needs for convenience, access, consistency and quality of care. Working with the Bard Group and Strategic Focus Associates, MUSC looks to bring physicians and hospitals together with the goal of MUSC recognized as a comprehensive center emphasizing its expertise in clinical practice, education and research. Service lines are important to MUSC because it aligns care to achieve the highest outcomes in quality, patient satisfaction, employee satisfaction and cost effectiveness. Service lines: achieve a patient-focused care experience; fosters interdependence among interdisciplinary providers; fosters pride of enterprise and sensed of shared destiny; brings research implications and applications directly to clinical care; aligns college and hospital objectives; generates clinical revenues to support the academic mission; and increase interdisciplinary research. Characteristics of service lines: aligns reporting and accountability for hospital and physicians; empowers service line leaders in decision making; improves patient experience; enhances accountability for financial success and simplifies reporting structures. The service line organizational model will feature both a physician leader and administrative leader in charge. Ultimately, both will have shared accountability for service line performance and report to the executive medical director of the hospital. Leaders will work closely with nursing and clinical chairs to manage the individual service lines. Clinically, service lines will co-locate programs of aligned care for specific patient populations; focus on specialized and sub-specialized clinical expertise; feature interdisciplinary clinical practice teams; support clinical pathways across services and functions; service agreements with participating disciplines; care managers to facilitate coordination of care; and provide continuous monitoring and improvement of clinical quality and outcomes. Financially, service lines feature operating budgets; contribution margin accountability; profit and loss accountability; consistent and reliable data reporting; patients will be counted and assigned to service lines according to their primary diagnosis. New service lines are being established in the Children’s Hospital, Digestive Disease Center, Heart & Vascular Center and Transplant Center. Service line leaders include: Children’s Hospital, Phil Saul, M.D., physician, John Sanders, administrator; Digestive Disease Center, Mark Delegge, M.D., physician; Vicki Marsi, administrator; Heart & Vascular Center, Eric Powers, M.D., physician; Bill Spring, administrator; Transplant Center, Prabakar Baliga, M.D., Ken Chavin, M.D., David Ploth, M.D., Mark Payne, M.D., interim team of physicians, and June Darby, administrator. The final Transplant Center leaders will be named in the future. The service lines in these four areas will be operational by July 1. Coincidentally, the service line model shadows the hospital’s MUSC Excellence pillar goals. Service lines are expected to be the pacesetters for the Medical Center. It is expected that service lines will contribute by improving the Medical Center’s market share. ACC update KSA, an operations consulting firm hired to assist with the new Courtney hospital facility’s operationalization plan, has completed its task and will release their plan results in April. Results will be available via Quickbase database and CDs. These results will be helpful to both the Heart & Vascular and DDC services as they prepare to move into the new facility. A key goal in this plan was to create a mid-level and process design, which was achieved by KSA. Dedication of the new facility will occur Oct. 12 followed by service to its first patients in late October. Finance-Providing the highest value to patients while ensuring financial stability Finance update Stephen Hargett, MUSC Medical Center controller, reviewed the Medical Center’s income statement ending in February. Hargett reported an increase in total operating revenue of almost $50 million from 2006. The increase reflects a $14 million in additional Medicaid disproportionate share income. Helping to drive this gross revenue increase are: patient census (4 percent increase); inpatient surgeries (8 percent increase); outpatient surgeries (8 percent increase); plus transplants, deliveries, and emergency room visits. Medicare length of stay increased slightly from January, while the overall length of stay decreased from 5.4 percent to 5.37 percent. Both length of stay indicators are below same period last year. Acuity of patients in February dropped (as indicated by the case mix index) from January, and that resulted in a drop in inpatient revenues. Operating expenses, which are volume and inflationary driven, increased by $44.7 million. FTEs per AOB dropped to 6.19 percent in February as well as supply costs from January on a volume-adjusted basis, which is expected with lower acuity levels. Operating income of $27.7 million results in an operating margin of 5.5 percent. Net income results in an actual net margin of 4.6 percent, which is just below the MUSC Excellence pillar goal of 5 percent. MUHA’s unrestricted month-end cash continues its up-and-down trend. The Medical Center reported $66 million cash-on-hand for February.   People-Fostering employee pride and loyalty Education roll-out update The March meetings summary reviewed revisions to test request cards featuring a new panel for BMP, Mg and Phos testing and introduction of new green lithium heparin tubes. As a reminder, staff should continue to use SST tubes before switching to the lithium tubes. Medication Administration Record (MAR) revisions featuring changes in type style on medications. Work continues on this effort. All forms rolled out are now grouped by category for easy access in collaboration with the Center for Clinical Effectiveness. Staff may access these forms by visiting http://www.musc.edu/clined/Ed%20Roll-Out/FormsUpdateJan-Feb07.pdf. Other topics discussed included the medication workflow workshops; GetWell Network updates; RN referral guidelines for organ, tissue and eye donations (using LifePoint); fecal management guidelines; revision to Policy C65 on patient and family education; revision to Policy C85 regarding the transfer of patients within the Medical Center, plus upcoming Network Educator lunch sessions for networking. Details were shared about the new graduate nurse residency program relating to new grads hired into the Medical Center from January to May 8. Education sessions for participants are scheduled from 7 to 11 a.m., the second Tuesday of every month. Staff nurses will serve as mentors or coaches to new grads. Expert nurses will be facilitators working with new BSN grads. The next mentor preceptor workshop will be May 2. Contact Linda Warren (transition coordinator) or Kimberly Harris-Eaton (BSN nurse residency coordinator) if you would like to be a mentor/resident facilitator working with new the graduate nurses. Finally, progress with the new wristband and label project was introduced as a pilot in the STICU since mid-March. STICU patients were issued a sheet of labels (including the new Patcom barcode) in their chart and blue plate for use in other areas. This project roll-out is similar to the AdminRX plan. Roll-out details will be forthcoming. HR update Helena Bastian, Medical Center Human Resources Director announced revisions to the following policies: HR Policy 4, Employment (revised) (Policy Section B) and Procedure Section A.3. Clarifies that all promotional opportunities should be posted, but may be posted for internal applicants only. (Section A.4) Clarifies that a change in status from “permanent” to temporary does not require posting. (Section D.6) Explains that the hiring official should inform candidates of drug testing requirements. (Section F.1) Specifies that the post-offer health screening includes drug testing. (Sections I-L) Includes new information on how retirees/TERI employees are treated including: reemployment is not guaranteed; may retire and return as employee with no grievance rights; departments are not required to positions if the retiree/TERI will be “returning”; and specifies time frame required for separations of retiree/TERI before retuning. HR Policy 15, Compensation (revised) We will be working with Mercer to overhaul our compensation policy this year. The following changes are minor adjustments needed in the meantime: (Section F.3) Specific reference to pay increases of “up to 10 percent” have been omitted and replaced with language saying the percentage of increase will depend on equity. (Section G.3.a) Language dealing with market equity adjustments across-the-board has been deleted. (Section G.4. and section H.1) The in-band increase form has been deleted and placed with language saying the in-band increases need to be well justified. (Section O.1) “Pilot Incentive Pay Plan” was deleted. Questions regarding the policy revisions may be referred to Helena Bastian at bastianh@musc.edu. Some hospital employees have requested that their home address not be distributed for thank you notes. If departments have such employees, managers or the employee should email Jane Scutt at scutt@musc.edu . Employees can still receive thank you note in their departments. MUSC Excellence ongoing training Plans are to continue MUSC Excellence training with new hires and departments with specific needs. Proposal for ongoing training programs are: New Hire Training Action Plan: Offer 4 sessions each month to provide the following: MUSC Excellence overview; understanding expectations of rounding; Standards of Behavior; AIDET/Key Words at Key Times; and Service Recovery. New employees will be scheduled for this training immediately following general orientation or within 90 days of hire. Department Specific Reinforcement (Half-Day Retreat) This training (1/2 day retreat) is designed for departments that need support with MUSC Excellence for a variety of reasons (see below). Action Plan: Assist areas with: low patient satisfaction scores; low employee satisfaction scores; HR input of complaints, vacancies, turnover, employee evaluations on time; Town Hall meeting input; and offer half-day planning retreats to develop action plans. Leader Development (Two-Hour Session) This training provides leadership coaching (no more than 15 to 20 participants per session) in specific areas: rounding; AIDET assessments not being performed; modeling Standards of Behavior; and Service Recovery Action Plan: Schedule a Leader Level II session monthly (or as need may determine by participants) for refresher on the following: how to conduct effective rounding; how to model Standards of Behavior; utilizing effective AIDET and monitoring for results Support with Roll out of Additional “Must Haves” Two additional “must haves” will be rolled out at future MUSC Excellence Leadership Development Institutes (LDI) will include high/middle/low performer (expected LDI roll out in June) and selection/peer interviewing/retention (expected LDI roll out in September). Further information and details will follow. Announcements Kimberly Croy is the new OR manager. Croy began in mid-March and comes to MUSC from West Virginia. Rhonda Flynn, R.N., was named the new nurse manager for 10 West. She has been in the interim role since November. Amanda Budak, R.N., was named nurse manager for 6 East, Bariatric and GI surgery unit on the Courtney Campus. She will also continue to manage will also continue managing the Bariatric Program and begin work in the new facility this July. The Department of Radiology has added a new Siemens MRI unit. Beginning in May, Radiology will replace the existing MRI, which may impact some departments. To help accommodate the Rutledge Tower outpatient clinic, a mobile MRI unit will be positioned in the Rutledge Tower parking lot.     Friday, April 6, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.