State of the department OB-GYN 5-21-15 This has been a transition year for the department and its leadership with both progress and challenges. Please see 2014 goals for the department and color-coded progress (below). Despite a bleak fiscal year and the spending down of the last of our departmental reserves, we thought we were likely to finish the year only about $150,000 in deficit; but this figure has jumped to around $520K. Our main source of departmental support remains clinical revenue we are projected to end FY15 ahead of last year, but under budget, largely due to lower clinical volume than anticipated. We are down year over year in clinic visits and births, but have benefited from a higher percentage of women covered by Medicaid and by improved billing/collections. Our previously relatively small projected deficit is largely due to a favorable chair package negotiation, which shifted some large recurring fixed costs to the hospital, the Cancer Center and the SOM. Additionally, the chair package included some hospital funding for 24-7 L&D coverage, funding that will be fully realized over the next 2 years. We are currently reviewing reasons for the larger deficit than projected. Positives: - Recruitment of faculty and staff o Faculty Recruits: Dr. Cichowski, Murata, Swanson, and Andrews Recruiting: MFM Division chief, MFM VA-GYN position o Staff Recruits: Operations manager (Sarah), Accountant 3 (Zach), Faculty Services Rep (Samantha), Residency program coordinator (Susan ), Grants manger (Elizabeth), Master scheduler (Patricia Esquibel), Practice Manager (Johnnie Jones) Recruiting Master scheduler - Consolidating leadership infrastructure o Executive Committee with regularly scheduled meetings/division Chiefs with individual and Division metrics o Ambulatory task force with regularly scheduled meetings/charge to committee/metrics o Quality/Safety Vice Chair job description and metrics M&M conference leaders integrating into quality/safety program OB and Gyn metrics for quality/safety o Developing pathways for junior faculty to attain leadership experience Quality and safety M&M directorship Resident research directorship Ambulatory clinic directorship
- Eubank planning obtained entire space (22,000 sq feet) for a comprehensive Women s Health clinic - Significantly increased revenue capture practice management, accountability - Initiated payment for 24-7 L&D coverage - Developed new webpage and Wiki page - Development of MOU with Cancer Center to move administrative center - Administrative reorganization reduced costs/streamline processes - Initiated faculty MFM services a start on strengthening our internal MFM services - Addressed areas of intra-departmental conflict related to consulting faculty in other Divisions for a higher level of care - Admitting privileges for midwives - Initiated Ambulatory Task Force to improve access, quality, safety and flow in the ambulatory setting. - Full day faculty retreat, junior faculty mini-retreat to determine faculty priorities strategic planning - Developing more inter-departmental collaborations o Breast clinic (General Surgery-Gyn) o Journeys clinic (Psych) o Mother-baby postpartum rounds (OB-Peds) - Hiring and developing additional research infrastructure - Incorporated some LEAN management principles including a Rapid Improvement Event (RIE) to improve processes. - Education strong programs in residency and medical student education: partnering with General Surgery Surgical boot camp, initiated quality activities/curriculum for medical students. Residents: Simulation/surgical skills curriculum, REI hybrid curriculum partnering with private community doctors, overhaul of resident retreat/goal setting feedback to residency - Research Maintained and slightly increased current research funding in the department - Retained Dr. Wager and Dr. Muller Changes - Dr. Byrn is retiring, partnership planned with private REI in town, scaling down REI - Uncertainty with NM Sonographics, our external ultrasound partner - No major changes at SRMC - Lower clinic and delivery volumes (see challenges) Challenges - Loss of key faculty: Family planning, MFM, difficulty recruiting certain specialties (MFM, Gyn Onc), genetic counseling, diabetic educators, etc. - Loss of market share in OB requires work on marketing/website, appointment access, feedback to referring providers, patient-centeredness, outreach under threat - Lack of adequate data analytics and practice management: Data and interpretation lacking to make clinical decisions and understand financial impact on department - Lack of a true incentive plan
- Interdivisional conflicts affecting morale and potential impact on quality patient care - Lack of administrative processes for important departmental functions like Promotion and Tenure, FIBCI, volunteer clinical faculty, OPPE/FPPE - Need for departmental administrative unit with competence in financial management and clinical practice support - Need for training, alignment and ongoing competence and accountability of administrative staff - Need for alignment and engagement of hospital/hsc leadership in supporting department level initiatives Self-evaluation - My major focus this year has been on orienting to the Chair responsibilities in the department and in the School of Medicine. The focus has been more on process than on outcomes given the need to create infrastructure and processes within the department for faculty participation in leadership, assessment of department financial status including opportunities for growth and reduction in expenses, critical faculty processes such as P&T, hiring, etc. and. I have attempted to be inclusive in hearing the concerns and ideas of the faculty in planning the future of the department. Slowly, I believe we are moving to a more efficient administrative structure, toward more defined leadership responsibilities and accountability, and towards a more robust departmental infrastructure to support faculty development. In the School of Medicine and hospital, I strive to be collaborative and a team player and believe I have the confidence of the chairs and the leadership. - 360 eval critiques o Have patience o Set goals and stick to them stay focused on 2-4 and complete them before moving on to next step o Seems afraid of allowing faculty members/leaders to make decisions, micromanages o Delegate responsibility and enable those to follow through o Foster a culture of service in the administrative staff o Listen a little longer before replying - I am taking the feedback seriously and working on plans to improve in these areas - Goals for the department for next year o Increase obstetric volume improve appointment availability and access, improve ambulatory clinic processes, standardize prenatal care content o Create standardized financial reports to share with all faculty monthly o Move to apprenticeship model for general obstetrics and gynecology services o Create a true incentive plan for faculty compensation o Improve departmental integrated program on Quality and Safety o Initiate a formalized faculty mentoring program o Creation/continued development of specialized services Special delivery service Centering pregnancy (Eubank)
Minimally invasive gynecology (Taylor) Faculty OB-GYN group (Eubank) Collaborative clinics: Breast, Journeys o Education and research goals Dr. Kennedy/Zsemlye/Rogers o Administrative staff goals promoting and nurturing a culture of service, reward system for staff. Goals for the OB-GYN Department 2014-15 Accomplished: Green Good progress: Blue Not yet: Orange Not at all: Red Governance - Create shared governance with a strong executive team with a shared vision to expand clinical, education and research opportunities o Assemble key departmental clinical, education and research leaders as well as representation from a junior faculty member into an executive committee, meet regularly (following guidelines of effective meetings) o Create/define the roles of Vice Chairs - Expand and develop a comprehensive OB-GYN quality and safety program with initiatives to improve quality of care, patient satisfaction and safety o Initiation of Standard Operating Procedures (SOPs) to increase standardization of practices. Clinical/Financial - Increase accountability and transparency in Division and Department finances; determine productivity goals for each faculty member/division and adjust service provision accordingly. - Improve the quality of financial information available to the Department and to Division chiefs. Working with a highly qualified financial manager, create standardized financial dashboards across Divisions as well as existing individual faculty productivity reports - Develop productivity expectations across Divisions, including making up or covering canceled clinics, reviewing templates for number of patients seen, ensure coverage of clinics from beginning to end, review billing regularly with Practice Manager, create policies for timely dictation/chart completion. - Improve patient satisfaction (inpatient and outpatient) by at least 5% - Increase obstetric clinical activity and increase number of deliveries: Create expectations for increased practice of obstetrics among generalists and family planning faculty, review midwifery expectations.
- Review faculty salary for equity and for incentives based on clinical productivity. - Initiate steps to create an integrated UNM high-risk obstetrical service in an off-site location to serve the UNM community (midwifery, general obstetrics/gynecology, family medicine) as well as private providers in Albuquerque and throughout the state. o Create quality services that attract use by all UNM constituents and outside providers o Ensure continuum of outpatient to inpatient care (L&D, OR service such as cerclage, fetal testing) - Consider the hire of sonographers vs. ultrasound contract for outreach in order to capture technical fee for MFM outreach ultrasound services. Increase UNM s market share for all women s health services by increasing patient and referring provider satisfaction, promoting UNM s unique aspects Expand partnerships with other services (Peds, Family Medicine) - Improve service to referring providers across Divisions o Create templates for timely feedback to referring providers o Identify ways to improve ease of accessing clinical services both for referring providers and for patients - Expand clinical partnerships with other Departments (Pediatrics, Family Medicine) and with SRMC. - Meet with and work with Development in cultivating donors for fundraising activities for the Department create fund for global health for residents/faculty to participate in assisting a sister-school in Africa, create a resident research/education fund. - Expand signature clinical programs o Determine areas of expansion, such as REI, minimally invasive surgery, ultrasound, obstetrics (prenatal care through delivery) o Determine investment in new faculty members in order to deliver services and to increase obstetric and gynecologic volume o Create business model for any expanded services consistent with financial self-sufficiency o Increase surgical volume at UNM, SRMC and OSIS by 5% and increase overall revenue by 2% o Longer-term goal is to create a comprehensive women s health with integrated women s health services. - Create a comprehensive marketing plan for UNM signature Women s Health services to expand market share - Achieve AAAHC accreditation for the UNM Center for Reproductive Health and Young Women s Clinic. - Apply LEAN principles and quality improvement to all clinical endeavors in the department. Research
- Expand research partnerships with other Departments (Pediatrics, Family Medicine) - Improve departmental infrastructure by creating a centralized, departmental wide research committee that supports the research of faculty, fellows and residents and identifies and encourages pursuit of funding opportunities. - Through expanded research infrastructure on a departmental basis, explore a focus in Community Based Participatory Research, a type of research particularly responsive to community needs and in which we have a nationally recognized Institute in New Mexico. - Improve our support for research for our residents with set timelines, didactics and expectations both for residents and their mentors. - Increase expectations for resident involvement in recruitment in all research - Longer-term goal is to expand fellowships (Gyn Oncology/Minimally invasive surgery, Pediatric Gynecology), which will help fuel an increase in scholarly activity. - Increase faculty involvement in research, as evidenced by grant funding (internal and external) and publications. Education/Mentoring - Medical students o Increase venues for medical student participation including SRMC and graduated residents o Work with the clerkship director to incorporate quality/safety programs/projects into the curriculum - Residents o Support the residency program director in the transition to educational milestones in the accreditation process o Increase clinical volume Increase gynecologic surgery volume by partnering with SRMC, a prime opportunity for expanded education for residents. Create another OB service (SRMC in the future) o Longer-term goal: With expanded resident gynecologic and obstetric volume, expand the residency o Identify areas of service over education work to hire and retain APCs o Create experiences to incentivize residents to practice in rural locations encourage rural rotations (GME funding an obstacle). o Work with institutional leadership for other incentives for rural practice e.g., loan repayment. o Improve research support for residents o Develop more structure and expectations of mentors and mentees building on the current mentor model for residents within the Department. o Explore educational opportunities for residents in Public Health, Clinical Research for those interested o Work with the residency program director to increase the incorporation of quality/safety programs/projects into the curriculum
- Fellows/fellowships o Explore feasibility of expansion to new fellowships within the department including Gyn Oncology and Minimally Invasive Surgery. o Improve research support for fellows o Partner with the Masters programs (Public Health, Clinical Research) to encourage fellow participation - Faculty o Create a program of mentors within and outside the department to successfully launch new faculty members, support them and help them achieve clinical and academic success. (See University of Arkansas model). o Partner with the Office of Diversity to improve mentoring for minority faculty, residents, fellows