Hi, welcome to our essential skills for CV program management. My name is Jenny Kennedy. I'm the vice president of care transformation and today we're going to talk about clinical operations for your clinic. These are my disclosures. And we have several learning objectives today. And I really want to focus on how you can optimize your clinical team members within your clinics to really run your practice efficiently and help guide your workflows and how to optimize each team members role to be part of the care team. So let's talk about your overall objectives of clinical care because there's a lot of things that have to come together. There's a lot of things that we need to establish to make sure that you're operating efficiently and your team members are productive but also satisfied in their roles. So as you can see there's really four buckets that we have to hit and there's within each bucket several things that we can do to make sure that all of these align. The first one that we want to focus on is delivering high quality patient centered care. And all of that is going to help drive improved patient outcomes enhancing their satisfaction while we're doing this in a really efficient manner. So when we talk about high quality patient care, we aren't reinventing the wheels. There's a lot of evidence and guidelines that will drive our clinical practice. These are proven to be effective and we have roadmaps so we need to tap into those evidence based practices and guidelines to help drive those decisions. It's also important that we're using interdisciplinary teams so it doesn't just take the physician, it doesn't take just the nurse, it's the entire care team and making sure that they're all working together for the betterment of that patient. It also makes sure that we're doing shared decision making with our patients. Patients have a lot of resources, they can get a lot of information. So really making sure that they are aware of all their options and that they have a part in understanding and making the decisions that they feel are best for them. So we're not telling them necessarily what to do, we're guiding them and making the choice that's best for them. And all of this is going to rely on very clear communication channels which we're going to talk about in a little bit more detail later. And when we do this, it can help and drive improve patient outcomes. So there's things we can also implement to support that better such as clinical decision support, quality improvement or process improvement, understanding where your opportunities are and working together as a team to improve them in a meaningful way that will sustain change. And we do this by measuring key performance indicators. So what are you tracking to make sure that your changes are affecting things in the right direction and then maintaining those. And then another piece that we don't always think about as much on the outpatient side is care coordination. So it's no longer the days of the patient coming and going to the office, we have to do a lot of support of these patients from the office. So it's really about coordinating their care and do you have the team and the resources to do so. And all of that will help increase their patient satisfaction. They want to have communication and that communication can come in various ways, whether it's on the phone, whether it's through a portal, text messaging, you have to have options for your patients. We also need to have multiple formats for education and delivering information because people learn differently. And we do need to make sure that we are incorporating customer service into our care. It's important that they feel like they're being heard. They are cared about. And that's really what we want them. We want them to feel that that they can trust us and that improves communication and care overall. And to do this, there's ways to put pieces together so that you can work efficiently. So there's ways to streamline clinical workflows. We want to use data to drive these workflows. You want to use that to identify what your opportunities are. And we really want to be intentional about establishing very clear roles and responsibilities for each team member. And when we do that or implement changes and define things, we want to make sure that we're regularly assessing those and making sure that the team members are working within scope, doing what they're supposed to be doing. But also understanding if we need more resources. We're really good about saying we're going to add resources at a certain time, but then we don't really assess it. So making sure that as we're implementing changes, as we're adding volumes and responsibilities, that we're assessing that with our ratio of team members. So being a leader within health care is a really important job, especially within cardiology. Cardiology has gone through a whole lot of changes. There's been a lot of advances in life-saving therapies over a pretty short period of time, and it's constantly evolving. And the emphasis on the outpatient side is only continuing to increase as we need to keep patients out of the hospital, we need to deliver care to where they are, incorporate technology. So the transition or the paradigm has shifted. So things used to be very physician-centered, really focused on inpatient care. There were a lot of silos, very driven on productivity, so volumes, things of that nature. So I want you to notice we are moving from that paradigm into this newer paradigm where things are patient-centered. We're focused more on prevention instead of intervention. And we have a long way to go, but the reality is we know that this needs to happen. So things aren't really episodic. It's really about the whole continuum of care. It's about collaborating with different specialties. It's about making sure things are standardized, not cookie cutter, but intentionally standardized so that we can be more efficient and make sure we're hitting those guidelines that the evidence shows us are effective. The one thing you will say is that quality of life is the same. And as we've evolved within cardiology, we know that there's a lot of things that take place to impact quality of life, so that's not ever going to change. But you'll see our focus is different. We really want to leverage our teams, improve team collaboration, and make it effective for the patient to support them in the setting where they are. So this is where it's very important to understand the team members that you have and understand the roles and responsibilities each one has. Each one is just as important as the other. They cannot function independently. And so defining these roles can sometimes feel a little bit uncomfortable, especially if they've been operating without specific roles and responsibilities. This can commonly occur if you're more of a smaller practice and you start experiencing growth and hiring. I will say that people have been within a clinic for a long time, maybe doing things out of scope because they can and they have the knowledge because they've been there long enough. But is it within their license or their role? So it's important that we do work our team members to top of license or top of scope. We hear that a lot. But how do you do that? And that's a really important thing we're going to talk about. You also want to make sure that you're minimizing variation. Not everything's cookie cutter, but you do want to be about 80% standardized so that you have guidelines that people are not varying in how they're working. And that also allows for cross coverage. You know there has to be the ability of the team to be flexible and nimble for things because things pivot very quickly. So you do need to minimize that variation. You also need to make sure that your team members are competent. You need a process in place to make sure that they can do what is expected of them and that that's reassessed on a regular basis. And then you want to make sure that you're rolling things out in a very strategic way. We are very good about putting new initiatives in or implementing new things, but make sure that you're very strategic about it, planning it and rolling it out in an effective way so that you're not overwhelming your staff. And if it's something that's big, are we taking into account? Do we need new resources or additional resources? So be realistic in that. Understand that your teams are doing a lot of work and we really want to try to support them as best as possible. So top of licensure training, what does that mean? So for nursing and APPs, a lot of times there can be some overlap there. So when we're talking about provider level versus nursing level, there are some areas we can improve this where we can implement protocols that will actually optimize time and nursing autonomy, which improves job satisfaction and decreases a lot of unnecessary phone calls and communications, which is important when our providers are getting a lot of phone calls, text messages and basket messaging that they have to deal with. So it really streamlines things in an appropriate manner that is safe for your staff and your patients. You want to make sure that you're also providing ongoing education and support. Guidelines are constantly being updated. New information is coming out. So how are you keeping your clinicians aware and involved in the education so that they are kept aware of these changes? And again, I can't emphasize it enough, a clear scope of what their responsibilities are. So I want to pause and talk a little bit more about our nursing and our nursing, our clinical support staff, because there are differences in their backgrounds, their education and their training. Again, they're all extremely important in what they do, but there is a difference in what they can and cannot do. So when you look at your nurse or your RN, that is generally a two or four year program. They are licensed by the state. So each state has its own licensing requirements. And that generally has to be renewed every few years, generally requires a certain amount of CEUs. But again, look at your state requirements for that. They do have to have approved training and a licensing exam. And the thing about RNs that is so great is they can do clinical decision making through algorithms and protocols. So they can assess, they can do certain clinical decision making. And when we align that with implemented algorithms or protocols that are approved, it can be really beneficial for your patients and your operational workflows. An LPN is also a nurse, that is a one or two year program that is also a state licensed position. I recommend you look at your requirements for that. They too can do clinical decision making through algorithms and protocols. These positions sometimes can be hard to come by, but they can be really instrumental in your ambulatory setting, especially with triaging, rooming, very flexible positions. And when we talk about your CMAs and CNAs, sometimes those can be seen as interchangeable. They can do the same jobs, but there is a difference. I want to make sure you're aware. A CMA is usually a three to six month program. It's not typically licensed and they don't really have a defined scope of practice. So often when I'm asked about what's the difference, you want to think about it is, is there clinical decision making involved? If the answer is yes, it is out of a scope of a CMA or a CNA. Clinical decision making is a nursing position, a nurse practitioner, a physician's assistant, or a physician. So if there's clinical decision making, your CMAs or CNAs cannot be involved in that. They can be delegated, they can follow tasks. So they're very good at rooming, charting, all of those things. They're really important to your workflows, but that's the decision point is, are there any clinical decisions? A CNA, on the other hand, doesn't have quite as the extensive training. They do have 120 clock hours. Licensing is really dependent on states. So some states do require an exam and license, some do not. They do have to go through an approved training program, usually a certificate program. And they're really focusing on basic patient support. So generally, CNAs are seen more on the inpatient side, doing vital signs, bathing, mobility, things of that nature. So they are also very helpful in the ambulatory space. They can do vital signs and things of that nature. So I wanted to educate you a little bit more on the background of each role, because sometimes that's not always clear amongst your team members and making sure that they're working within the appropriate level of what their role and perhaps license is. And again, making sure you're checking with your state requirements is important because they do vary. So when you think about all of your team members from a clinical team member perspective, it's important that you're outlining whose responsibility is what. Some of these, yes, there is some overlap. But generally, you want to establish workflows so everybody knows what's expected of them and their teammates. So you can see the higher level of degree and training, the more responsibilities, obviously. Physicians are seeing patients. A lot of practices are having them do their new patient visits. Of course, they're going in and out of the hospital, managing their in-basket portal messages, developing plans of care, responsible for documentation and all of that. They're really the leaders of the office and really important that they're promoting team-based care, that they're helping educate and support their team members. APPs, too, have a lot of responsibility, a lot of similarities with the physicians. So you may note some are working independently, some may go in with a physician or be followed by the physician. It's really dependent on what your state regulations are and then the relationship between your providers there. But they, too, are seen as leaders and need to be able to support their nurses and MA staff, help with education and things of that nature. Nurses, these roles can look different based on what your needs are. We're going to talk a little bit more about those roles and what they could be. But things like triaging, so a lot of answering phones and in-basket messages and understanding, is this something that's critical, urgent or non-urgent, and what to do with that information. What's the best way to communicate and get assistance? They may be calling results on patients. They may be providing support to patients who walk in with emergencies or non-emergencies. They may be adjusting Coumadin or other medications based on protocols. So there's a variety of tasks that they may be doing and all very important. Your MA or CNAs, they're usually rooming your patients, pulling them into the room, doing vital signs, preparing them for their visit with the provider. So it's very important that they're organized and efficient in that. A lot of them do a lot of work with prescription refills, prior authorizations, and then record collection and chart prep and abstraction. And then we do have medical records on here. Those don't always exist now with EHRs. However, it is very important that we're prepared for our visits, So they can be very important in this in our workflows as well. So how do we work our teams to top of their license. One of the ways we can do that is through protocol based care. And again, that doesn't mean it's the exact same, but it means that we're organized in a way that people can understand what expectations are is very clear what the nurse can do, what they can't do, when they need to escalate versus when they can maybe send an in basket message. And when we do create protocols, we want the teams to come together. We want them to communicate with each other, develop a plan with each other and implement together so that there's no sense that it's not a team effort. There are opportunities as well to update provider order sets and nursing protocols together. How are you identifying your patients per protocol? What does it look like to enroll a patient in a protocol? So these are all discussions that need to take care within the multidisciplinary team. So you need to make sure that you have an avenue for those team members to meet and communicate because communication is really important. It's the most effective way to bring your team members together and deliver high quality patient care. So I would recommend a couple of best practices. You want to make sure that, again, you have some sort of avenue. So by holding regular team meetings, you really get an opportunity for you as the clinic or practice leader to communicate information to them. But they can also tell you any positive or negative things that are going on and opportunities that need to be addressed. So by having this avenue, we can allow our teams to problem solve together. So it's through this interdisciplinary collaboration where they can also understand the differences in their roles and work together so it can really improve their teamwork and, again, help them to understand the roles and responsibilities. You want to leverage technology where you can. So use your EHRs, look at communication methods and styles through EHRs and other technology platforms, sometimes even like a Teams chat, group chat, things of that nature to keep people connected in an easy way. So communication is really important from a team member standpoint, but we also have to remember the communication style with our patients. And again, with all the variations in technology and preferences with patients, we really need to adjust to what that patient wants. So it does provide an opportunity to be a little bit overwhelmed by these multiple communication pathways, but we really need to accommodate our patients while ensuring that their privacy is intact. You can do that through establishing specific workflows and establishing clear handoff is really important. So as we're consuming this information, whether it's through a patient portal, maybe a text message or a standard phone call, what is the process to hand off the information so that we're making sure that a patient calls or reaches out, we're closing that loop. A lot of times we may take that information in and send it on, and then we're not really closing that loop, and that's where things fall through the cracks. And that's what we can't have. So making sure that the processes have minimal steps and that we're minimizing those opportunities for errors and closing the loop on that communication, meaning we're following back up and making sure that patient answer or issue is resolved. Next, it's also important as your patients are in the clinic, you have established processes for the different types. So obviously things are going to look a little bit different if it's a new patient versus your follow-up patient. Maybe you've got a routine follow-up versus a hospital follow-up, someone who was admitted for PCI or heart failure that needs to be seen quickly. What are some of those admission or subspecialty considerations? How is it set up for EP follow-up, structural heart, new onset AFibs? All of that really is important that we're outlining so that, again, there's clear expectations on the amount of time and what's expected or needed for that patient visit. So let's look at this sample office visit model. So this is a pretty detailed one, but it really outlines kind of an algorithm, if you will, for each patient. So if you look at a new patient referral, what is your process? Does it get assigned to specific physicians or is it the first available? A lot of times it's the wait list, again, and with a physician or an APP can be lengthy. So what is that process within your organization? And especially with team-based care where we're implementing or utilizing our physicians and our APPs, are you having a new patient see a physician and then following up with the APP and they see the physician every year? That's a pretty common practice that we're seeing, especially in the face of physician shortages, and it's completely acceptable. Communicating that with your patient, the messaging on that is very, very important. So especially with concerns of transitioning from a physician to an APP, the physician messaging that I work with this APP, I trust them. If there's any issues, they're going to escalate it to me. Those are some talking points that can help our patients receive this message a lot better and trust the APPs. So you want to outline this and also consider the amount of time each position or each time slot needs. So it's not uncommon for new patients or hospital follow-ups to be 30 minutes or 20 minutes versus a follow-up appointment to be about 15 minutes. So I just encourage you to take this and compare it to what your practices are. Is there room to revisit it? Is it outlined or does it need to just be initiated and outlined? So I encourage you to do that to make sure that your team understands the expectations for each patient type. This will also drive the appropriate patient visit preparation. So you want to have as much information as possible prior to each visit, and especially when these visits are a short period of time, you need to do that in advance so that the patient is there, you got your clinicians have the information they need to make the best decisions and develop the best care plan in that short period of time. So with our new patients, you really want to understand why they're coming, understanding their symptoms, their diagnoses, what's the reason they're coming, and gather any information you can. Follow-ups, it's really beneficial to review their lost office note or if they were in the hospital, understanding that hospitalization, what occurred during that, why were they admitted, things of that nature. And we do that by pulling admission H&Ps, looking at specialty notes, diagnostic testing labs, anything like that. We also want to see if there's any diagnostic testing. So whether that's electrocardiograms or ECGs, is there echoes, are there telemetry readings, anything that will give the provider more information. If they have a device, has there been any interrogations or any issues with that. And then also want to check to see did the patient have orders that they didn't complete, or is there something outstanding that needs to be discussed with them while they're in the office. So it's really important that you're using your clinical teams, especially your MAs or your CNAs, to have a very solid chart prep process so that if there's any records that need to be obtained, anything needs to be followed up that's done in advance of the visit. And in fact, it's best to do that at least 24 hours before their appointment so you're not scrambling the day of the visit. So again, this is just a sample process and another for rooming. So this is another opportunity for the interdisciplinary team to create this together and be approved. Understanding there are nuances based on provider, you want to minimize those. So a lot of times if there's paper for this doctor and electronic for this one, and that you really need to kind of standardize these as best as possible. So you're not duplicating work, you're decreasing risk of errors, and you are improving efficiency. So intake, obviously, this is where you're creating your patient, you're pulling them back, verifying them with two patient identifiers, and getting them situated in the room. This is generally done by your CMA. You may use a nurse on some occasions, it really just depends on your model and your staffing for that day. You're going to work them up and generally these processes for this or things covered are weights, vitals, an EKG is pretty routine, confirming the pharmacy, checking the medications, and verifying any allergies. Clinical documentation is really, really important. I can't stress that enough. Again, these workflows are pretty common that you'll see in terms of family and social history, risk factors, past procedures, confirming medical history, things of that nature. Cleaning it up and preparing for the provider as much as possible. And then you need to have a good process of flagging when the patient is ready to be seen by the provider. You know, some offices still use a good old flag system at the door or are using it within your EHR where you can click the button, change the color, so they know that the patient is ready for them. That can eliminate a lot of unnecessary delays and miscommunications by using those, having those sorts of processes in place. Your provider, I think it's really important from a documentation and billing perspective that they are covering all of these components in their note. So, you want to make sure they're documenting that they've reviewed the patient history and any previous records. Documenting the physical examination, of course. Generally, these are in a templated format, but of course want to make sure any changes are noticeable. If there's any differences in patient condition, that that is well documented. Treatment planning, ensuring that that's discussed with the patients, the options are reviewed, and there's shared decision making between the patient and the provider. We really need to be diligent about documenting that. We're seeing more and more of that as a requirement as it should be to empower that patient to make, to be involved in their own decision making. You want to document any diagnostic procedures and testing, and of course your billing codes, and then any patient education and follow-up instructions. Some could argue this is the most important, so if they do see another provider or end up in the hospital, it's very clear what the patient was seen for, what they were educated on, and what the next steps were to be for that patient. It does help with the care continuum and improving communication for all providers and clinicians that are seeing the patient. I do want to talk a little bit in more detail about the different roles for your team nurses. There's different models and different roles based on what the needs of your clinic are. A lot of nurses in the clinic may start with standard phone calls, documentation. What does that look like? Are you triaging patients from an emergency standpoint? Do you have a dedicated triage, or do you have a nurse that is really manning all the phones? You really want to outline a standard work for callbacks and documenting that process that the patient was made aware, especially for abnormal results. Look at that and make sure that you are establishing those workflows for your nurses. Basket management is a big, big topic. There's different ways you can manage these, and a lot of nurses are responsible for managing provider inboxes. What does that look like within your organization? There's different strategies, again, where you can divide up the work, so it takes that burden off a little bit of each individual, but look at what your current processes are. I also want to understand what the communication between physician and APP and nurses are, and what are the expectations, and how are you holding them accountable? You don't want your nurses communicating issues to your providers and them being delayed in responding, because that can ultimately cause patients to go to the ED. So just really be clear and intentional about what those expectations are, and then make sure you're following up on those and holding them accountable. Understanding what the chain of command is, so not only from a clinical perspective, but if your clinical team is having issues, what is the escalation policy if they're needing assistance? Just making sure that they understand what that is, what that looks like, and that it's well known for the whole team. And then you do want to minimize kind of those non-nurse functions, if you will, so scheduling, prescription refills. Again, you really want them focusing on the clinical decision-making responsibilities that the CMAs and CNAs cannot do. And it's really important that your nurses are allowed to do this, because they're really supporting care between the visits. There's a couple different roles, as I mentioned, including the lead nurse, team nursing, some locations use a nurse closer, some use a triage nurse, and then there's also nurse navigators. And there can be overlaps, so you can cross-train your nurses to do these roles, but there needs to be very clear expectations so that everybody in the clinic and office knows what is expected and what each person is doing. So a lead nurse is really, again, more of a supervisory role. They're going to can do clinical responsibilities, but they also have additional administrative responsibilities. A lot of time they're involved with the staffing and the patient scheduling. They are a leader, so they may help guide decisions or troubleshoot during the day, thinking about day-to-day operations and addressing any things that may pop up. So again, this may not be a full-time position. They may be a lead nurse while doing clinical responsibilities as a team nurse. Again, that team nurse is probably the most common at this point, where they're doing routine phone calls, answering questions, reviewing results, and communicating that back to the patients and doing a lot of patient education. Some of the more recent kind of roles that we've been hearing about is a nurse closer. This role is where the nurse goes in and closes the visit after a provider sees the patient. So they're going to go face-to-face with that patient. They're going to provide very specific education, help them with the next steps, outline you're going to go for a cath, an XYZ is going to happen, or we're going to start you on this new medication. So they may be entering orders and following up and really outlining the plan for the patient and answering any questions. This has been beneficial in reducing a lot of phone calls and messages after appointments where patients may have questions because they didn't understand clearly the plan, or maybe the education was not done just because the providers were busy wrapping up their session and getting ready for the next visit. So this is something that we're seeing more of and it's a very beneficial position. Triage nurse, this nurse is generally catching those triage complaints, of course, common short of breath, chest pain, and trying to work through if it's a true emergency versus is it somebody that needs to go to the ED or is it someone with low risk chest pain that I can check on tomorrow and they can be seen in the office in two days. So it's really important that you have protocols in place for common complaints that you're seeing in triage. They can also be available for patients that may walk in and do an assessment and then communicate to the providers. And then our nurse navigator coordinators, these are the ones we see generally in specialty programs such as heart failure, EP, structural heart. Some are being used for kind of referral management, if you will. They're really looking on long-term care coordination along the continuum. They do a lot of procedure planning, a lot of education, so it's a little bit different mindset of the other roles that you see that are more patient-facing, immediate, while the patient's in the clinic versus I'm helping to manage this patient routinely and over a longer period of time. So nurse visits are things that we commonly hear about. These are those patients that may come in and need a blood pressure check or a weight check or there could be other low-risk complaints. And it's important that you know that these nurse visits are not substitutes for poor access. Sometimes patients get split into nurse visits and then they actually end up, because of the nature of the patient and their complaint, the nurse is communicating with the physician and they have to be seen. So it really can sometimes hinder things, so you want to be very clear in who can be seen in a nurse visit. So think about your blood pressure checks. Is it an EKG, maybe a wound check after device? You want to make sure it's pretty low risk. You've got to be clear in what documentation is in the chart and set those expectations. Is there a template or a way to make it easy for those, because that will drive your billing and, again, any ongoing care, especially if a provider is not seeing this patient. That communication needs to be very, very clear in the documentation. Now it's important to note a lot of these nurse visits are not billable, which is why you may be using them for blood pressure checks and EKGs. But there are some things we can bill for. They are getting better about having codes on education and such, so do make sure that you're checking that and see if there's any opportunities that you may be missing. Order entry for nursing is something that can be a little touchy. So if you are allowed to do orders, your physicians, there needs to be a verbal order from a physician or a written order, if you will, or protocol based on protocol. Nurses can enter orders in those three ways, and they can go ahead and execute the order and the physician will sign off or finalize it. Again, it's very important you're checking not only your organization, but your state licensing to make sure that they can execute on verbal or protocol orders. So just make sure that if you are discussing that, that you're doing some homework and research before implementing that. Now I want to back up a little bit, because we've talked about the nurse navigator, and I want to take a moment and say how we're managing care in between visits is changing. As we know, patients are hard. There's a lot that they're dealing with, and we have to help them to coordinate their care. We're spending a lot of time communicating. We're spending a lot of time on medication management, with refills, with specialty medications. There's a lot of time spent on prior auths, so looking at medication management and what that process is. Then with the introduction of technology, we also have remote patient monitoring and telehealth services on top of our other responsibilities. So how do we manage all of that? It's acute, chronic, all-in-one, in-person, out-of-person technology. How do we manage all of that? A starting point, and you've heard me say it already in this training, is standardizing your work. So when you're doing this, I really encourage you to bring the team together, and every level of the team. So your medical director or physician leader is really important to have. These are the types of things. You want to identify your protocol that you're going to work on, and then align the pieces of that protocol to meet the guidelines, the evidence that supports that. So when you're looking at this, you want to... So let's just think heart failure. Thinking about your medications. What medications do heart failure patients need to be on? What are common medications? So obviously, we're thinking diuretics and guideline-directed medical therapy. You want to make it easy for your teams to do the work that they need to do. So thinking about what medications they need to be on. What labs are commonly ordered with the specific diagnosis or issue that you're addressing through this protocol? Are there lifestyle modifications or interventions, such as smoking cessation? Do they need a sleep study? Thinking about your non-cardiac services, like palliative medicine, hospice, pulmonary. Are any of those opportunities to plug into protocols to refer directly, as opposed to going and ordering each of those individually? Within the protocols, you want to make sure you're accounting for parameters when to escalate. So we're talking about, if we were doing a heart failure, using heart failure today, if we're using a protocol to say, patient has gained five pounds, give X amount of diuretic, and call in 24 hours. Another option of when to escalate would be if patient has gained greater than 10 pounds overnight, contact provider immediately. You want to be very clear in those parameters, and this is why you need that entire team at the table making these decisions. So making sure that they're very clear, it's documented, and you have an escalation process in place is going to be important when you're developing your standard work and protocols. Something else we really want to talk about is, how do you monitor performance in the clinic setting? So there are several metrics that are very common, and this is going to help tell you how well your teams are working in terms of productivity and efficiency. And it's not, again, to micromanage, but it's to tell you, one, how much is their workload? Is it too much, too little? How efficient are we in our processes? Or do we have redundancies and duplications in our workflows? So it's really driving how you're operating your clinic. All of your performance improvement and changes should be based on what data you're seeing. So these are some common metrics that you may want to monitor to see how your team is performing. So things like the number of live patient calls to nurse triage, how many calls are your nurses getting? And do your nurses perform at different levels? So if I have a nurse that's doing 10 calls a day versus someone who can manage 20 or 25, why is that so variable? Is there something that I need to do to support the nurse that's doing 10 a day to get her up more? Or is the 25 a day too many? And what is she doing? So looking for variances and understanding what your target is. What are the total number of patient messages that are taking off of voicemail every night? Again, looking for variances and patterns that may help you find opportunities to improve. How many unresolved patient calls are there every day? How many refills are you guys getting in a day? This can be a really big spot of time consumption. You're getting multiple refill requests, maybe from patient portal and pharmacy all on the same patient. So you're constantly sometimes double, triple working. So looking at your refill process, looking at your policies, do you require your patients to be seen every three months, six months, things of that nature. So you can rethink how your policy is, and that can also help offset the time burden that your staff may be taking. And then documents like return to work, handicap, paperwork, all of those, sometimes that can also be a big time crunch in terms of resourcing. So those are just some opportunities to look at and understand if there's ways to reduce redundancies in the work. It's also really important that we're doing all of this to recruit and retain top quality team members. Nurses are learners by nature. So we like to be developed, and typically we want ongoing education, and that's going to keep us happy. We need to feel like we have a sense of purpose. So being involved in team member discussions, collaboration process improvement really means a lot to the nurse, as it does to most team members. They want to feel like they're there for a purpose, that they're being seen and heard. A lot are looking for personal and professional growth. Now that's going to look different for each individual, so make sure you're connecting with your team members and understand what they're looking for from a professional or personal standpoint. Maybe they aren't looking for growth now, but that could change over time. So be connected and be visible with your team members. And then culture, we're looking for a good solid team culture. So when you have good team-based care, your team is generally going to perform better, be happier, and you're going to retain people and see a decrease in that turnover. And it's important as nurses that we are setting them up for success. It's really important that the foundation when they come in is based off of a framework. A lot of nurses that come to the outpatient side are generally coming from the inpatient side, which is great because they have a lot of knowledge, but it's very hard and it's a difficult transition from having a patient and perhaps your providers all there at your disposal to going to answering phones and trying to make decisions based on information you're receiving without seeing a patient. So there are differences, and it's really important that you've got a strategic and well-thought-out plan for how you're going to orient and onboard them. We can help with this. If you're interested, please feel free to reach out. But you do need to make sure that there's a specific preceptor that your new employee is working with. Obviously, ideally, this is someone who has been there for a while, who is positive and really going to be engaged with their preceptee. So you do want to be intentional about who you're setting that person up with. You want to make sure that they are seeing all the different aspects of cardiology. So regardless of what their role is, they need to understand the full breadth of cardiology services, whether that's in clinics or in the hospital. So getting them to go and observe and shadow, shadow the providers in the clinic, send them to the heart failure clinic, send them to the structural heart clinic, send them to the cath lab, let them see the whole depth of the program so they also understand. And then they also know what's available to the patients. Make sure as the leader that you are open and available and that you are intentionally touching point with them on a regular basis. You want to make sure they have what they need and allow them to tell you if things are not going as planned. Allow them to be open with you. Build that trust and rapport and help them to get situated. This first kind of six months of their journey is going to be really important. We don't want to see them. We don't want to invest that time and just to see them leave. So this onboarding and orientation is not just to check the box, it's to be very intentional for the long haul and making sure you're retaining that top talent that you've recruited. This is an example of a competency or assessment. So making sure again that the level of care they're delivering meets the minimum requirements. This is something you need to do a very detailed one at the beginning of their onboarding and then you need an ongoing annual competency assessment as well. Again, feel free to reach out if you need help with that. And I've mentioned this earlier, but I do want to take a moment because your nurses are really going to be champions for evidence-based practice. Evidence-based practice drives your clinical care. Again, there's research and studies that have been done and we have a really hard time translating it into reality. It takes about 17 years for us to implement research. So when we're talking about change, I'm saying this from a perspective of your nurses, your clinicians, a lot of them know the evidence-based practices or they can go find them. They can go to the library, there's journals, reach out to us. We can help share these because you don't have to reinvent the wheel. And it's intended to integrate evidence-based practice into your clinical practice. That's how it all comes together to improve patient care. So we really want to blend the clinical knowledge and expertise with your team to deliver that. So I want to make sure that you are exposing your teams to evidence-based practice and that you're supporting their growth and development. The way they get acclimated to all of that is through continuing education, through networking opportunities, getting involved, making sure they're at the table on maybe some quality improvement committees or work groups. How are they being engaged and understanding, again, their goals. Are they interested in leadership training and where can you plug them in there? So again, when you're thinking about your clinical teams, you really want to understand the importance of giving them that solid foundation up front and then continuing to support them will only benefit not only them, but your practice, your organization, and your patients and community by improving their education and skillset. There's a lot of nursing organizations, so I encourage you to support your nurses to join these organizations, these American Association of Critical Care Nurses, there's Heart Failure Association, there's the American Nurses Association. They are also aligned with, there's also certifications for cardiac nursing. So I encourage you to look into this and if you have opportunities for them to improve, maybe on a ladders program or study and cover their certification, this can be a really big satisfier for your nurses. I want to thank you for your time. I know we've gone over a lot of information, so just to summarize, I want to make sure that we cover and understand that there are ways to really improve operational efficiency and bring satisfaction to your care teams and deliver high quality patient care that will improve their satisfaction and their well-being. We do this through standard work and protocols using, again, what we know works. Sometimes it's just doing a little bit of research and putting the pieces together. Making sure that you are communicating within your teams and within your patient populations. What are the processes? What are those communication channels? And we're practicing closed loop communication. Maybe that's through implementing standardized communication tools. Think about your SBAR. What does that look like? That's a very good tool to help drive effective communication. And all of this hinges on the well-developed roles and responsibilities that you outline and hold your team members accountable to. If you can do this, you will have a very well-running clinic that's going to improve patient lives and employee satisfaction to deliver the best care to your cardiac community. And with that, if you have any questions, please don't hesitate to reach out to academy at medaxium.com. Thank you for joining us today.

clinical operations

team efficiency

patient-centered care

interdisciplinary teams

evidence-based practices

care coordination

team management

training and education

patient satisfaction