A Primer for The Nurse

Joan Bachman, RN, NHA, RHIT, BSBA, FCN Julie Traynor, MS, RN Eric Christofferson, BSN Jeanine (Jenny) Senti, APRN-BC, MS, CNS, IBCLC

Amanda Holland, RN Kelly Hagen, RN

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To increase your understanding of how knowledge of the health system will help you, the nurse, provide patient-centered care to guide each patient toward desired health outcomes.

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A complex system is a system composed of interconnected parts that as a whole exhibit one or more properties (behavior among the possible properties) not obvious from the properties of the individual parts

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The American healthcare system … isn’t. It isn’t a “system.” Patients have multiple providers. These providers rarely interact. The payment system operates in silos. And patient care isn’t coordinated.

http://blogs.ajc.com/health-flock/2012/12/05/breaking-down-healthcare-silos-the-need-of-healthcare-integration/

SILOS SYSTEM

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Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families,

communities, and populations. ANA http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing

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Life-style

Physical abilities

Diagnoses

Treatment options

Income

Family Obligations

Hopes/dreams

Culture

Education

Support systems

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THE PROBLEM “it is in inadequate handoffs that safety often fails first” “nurses are the health care professionals most likely to

intercept errors and prevent harm to patients”

http://www.ahrq.gov/professionals/clinicians- providers/resources/nursing/resources/nurseshdbk/index.html

THE SOLUTION Be aware of the many facets of the System Recognize “how things work” – and why Know who is responsible Realize complexity/barriers – seen by you seen by patient Know that patients may need help to identify sources of

service & make decisions

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1. Review the health care system’s provider types and levels of service, regulation, and reimbursement mechanisms;

2. Investigate your organization’s structure and processes;

3. Describe your position/role within the organizational structure; and

4. Demonstrate your knowledge of the health care system to help a patient (and family) consider and access viable options for achieving personally desired health outcomes.

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COMMUNITY

OUTPATIENT

INPATIENT IN-HOME

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“GENERAL PROVIDERS” – Available to qualified general population

SPECIAL POPULATION PROVIDERS

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Public Health http://www.ndhealth.gov/phsp/

Rural Health Clinics , FQHC

http://www.ndhealth.gov/hf/North_Dakota_Rural_Health_Clinics.htm

WIC http://www.ndhealth.gov/wic/

Home Health Care School Nurses Faith Community

Nurses Foot Clinics

Vaccination Clinics Wellness/Fitness

Centers Social Service/Mental

Health Agencies http://www.nd.gov/dhs/service

s/mentalhealth/

Durable Medical Equipment Suppliers

Pharmacies http://www.legis.nd.gov/events

/2014/04/05/state-board-pharmacy

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Industrial Health – may be limited to certain employees

Shelters/Halfway Houses

Foster Care

Adult Day Care – Respite Care Providers

Group Homes for Physical and Social issues

Community Action Agencies

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Medical Clinics – 305 est (52 RHC, 7 FQHC) (3,679,739 est. visits in only hospital-based clinics in

2012)

Ambulatory Surgery Centers – 12◦ http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downlo

ads/som107ap_l_ambulatory.pdf

Hospitals – (1,702,820 OP visits in 2012)

Physical and Occupational Therapy◦ https://www.ndbpt.org/◦ http://www.ndotboard.com/◦ https://www.ndsbrc.com/◦ http://www.ndsbe.com/

◦

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Audiology and Speech-Language Pathologists http://www.legis.nd.gov/cencode/t43c37.pdf?20140524165810

Dietitian/Nutritionist◦ http://www.legis.nd.gov/cencode/t43c44.pdf?20140605102603

Comprehensive Outpatient Rehabilitation Facility (CORF)

http://cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_k_corf.pdf

Addiction/Mental Health Therapy – 54◦ http://www.nd.gov/dhs/info/pubs/docs/mhsa/nd-licensed-addiction-treatment-programs.pdf◦ http://www.ndbce.org/

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Renal Dialysis Centers (ERSD) – 16◦ http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Surv

eyCertificationGenInfo/downloads/SCletter09-01.pdf

Diagnostic Services◦ Laboratory

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c06.pdf

http://www.ndclinlab.com/

◦ Radiology http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/dow

nloads/som107ap_d_xray.pdf

◦ Screening – Providers, Practitioners, Pharmacies, Health Fairs

◦ Telehealth – From Providers, Practitioners

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Adult Day Care – Respite Care and In-Home Aging Services◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html

Reflexologists

http://www.legis.nd.gov/cencode/t43c49.pdf?20140524160717

Massage Therapists http://www.legis.nd.gov/cencode/t43c25.pdf?20140524165633

Hearing Aid Dealers http://www.legis.nd.gov/cencode/t43c33.pdf?20140524165924

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Cardiac and Wellness Centers

Chiropractic Clinics

Pharmacies

Telehealth

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Hospital – 51 (97,028 inpatient admissions; 337,451 ER visits - 2012)

◦ Acute General Critical Access – 37 Swing Bed (LTC) - 37 Prospective Payment – 6

◦ Rehabilitation - 1◦ Long Term Acute Care - 2◦ Acute Psychiatric - 3◦ Acute Special – transplantation - 2

http://www.legis.nd.gov/information/acdata/pdf/33-07-01.1.pdf?20140322170247

Nursing Facility - 80 (12,213 residents in 2012)◦ http://www.legis.nd.gov/information/acdata/pdf/33-07-03.2.pdf?2014032

2170725

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Intermediate Care Facility for Intellectual Disabilities◦

http://www.ndhealth.gov/HF/PDF_files/ICF%20MR/Appendix_J_-_Guidance_to_Surveyors.pdf

Basic Care Facility – 68) (4,152 residents in 2012)◦ http://www.ndhealth.gov/HF/North_Dakota_Basic_Care_Facilities.htm

Assisted Living Facility – 73 (3,195 residents in 2012)◦ http://www.legis.nd.gov/cencode/t50c32.pdf?20140322173003

Hospice – 13◦ http://www.legis.nd.gov/information/acdata/pdf/33-03-15.pdf?20140322

170854

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“Treatment” Centers - (Mental Health/Substance Abuse)◦ http://www.nd.gov/dhs/info/pubs/docs/mhsa/nd-licensed-addiction-treat

ment-programs.pdf

Group Homes◦ http://www.nd.gov/dhs/services/disabilities/

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Home Health – 35◦ http://www.legis.nd.gov/information/acdata/html/33-03.html

Therapy -- Physical, Occupational, Respiratory, Speech/Language◦ http://www.ndsbrc.com/◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html

Hospice – 13◦ http://www.legis.nd.gov/information/acdata/pdf/33-03-15.pdf?20140322

170854

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SINGLE FACILITY “SYSTEM OF SERVICES” http://jrmcnd.com/

CO-LOCATED FACILITIES http://www.coopermc.com/

“OWNED”/”MANAGED” SYSTEM http://www.altru.org/find-a-location/

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Physicians – Primary and specialty care – 3,323 279 PAs

◦ https://www.ndbomex.org/

Dentists - 455◦ https://www.nddentalboard.org/

Pharmacists◦ https://www.nodakpharmacy.com/

Advanced Practice Nurses – 558 with prescriptive authority◦ https://www.ndbon.org/

Optometrists/Opticians◦ http://www.ndsbopt.org/

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Chiropractors◦ http://ndsbce.org/

Psychologists◦ http://www.ndsbpe.org/

Counselors◦ http://www.ndbce.org/

Addiction Counselors◦ http://www.ndbace.org/

Podiatrists◦ http://www.ndpodiatryboard.org/

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Massage Therapists◦ http://www.ndboardofmassage.com/

Reflexologists http://www.legis.nd.gov/cencode/t43c49.pdf?20140524160717

Massage Therapist http://www.legis.nd.gov/cencode/t43c25.pdf?20140524165633

Audiology and Speech-Language Pathologists http://www.legis.nd.gov/cencode/t43c37.pdf?20140524165810

Hearing Aid Dealers http://www.legis.nd.gov/cencode/t43c33.pdf?20140524165924

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PREVENTIVE ACUTE CARE

REHABILITATIVE CARE CHRONIC CARE

PALLIATIVE CARE

LONG TERM CARE

END OF LIFE CARE

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COMMUNITY SERVICES

WELLNESS CENTERS

MEDICAL CLINIC

HOSPITAL

OUTPATIENT PROVIDERS

THERAPIES

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MEDICAL CLINIC

AMBULANCE – FIRST RESPONDERS – EMERGENCY SERVICES

HOSPITAL

OUTPATIENT PROVIDERS

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CLINIC

HOSPITAL

ESRD

LONG TERM CARE PROVIDERS

IN-HOME

COMMUNITY

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ASSISTED LIVING

BASIC CARE

NURSING FACILITY

IN-HOME

GROUP HOMES

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Personal Care – Family, Private, HCBS (Home & Community Based Services)

Homemaking◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html

Telehealth

Diagnosis -- Lab draws, Mobile radiology◦ http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c06.pdf◦ http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_d_xra

y.pdf

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GOVERNMENT FORCES LEGISLATURE – LAWS

◦ State agencies – Selected Examples listed here DOH DHS BON BPH BMX

CONGRESS – LAWS◦ FEDERAL AGENCIES –

HHS, FDA, DEA, OSHA, CDC, DOL

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NONGOVERNTEMENTAL GOVERNANCE

GOVERNING BODY(IES) OF PROVIDER/PRACTITIONER

PROFESSIONAL ASSOCIATIONS

PROVIDER ORGANIZATIONS

ACADEMIA

PAYERS OF SERVICE

PUBLIC

PATIENTS/CUSTOMERS

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LICENSURE – STATE -- description of service & enforcement

http://www.nd.gov/

CERTIFICATION – FEDERAL -- MEDICARE/MEDICAID

– description of service/ payment http://www.cms.gov/

Accreditation - The Joint Commission, etc. – no regulatory authority. CMS Contractor

http://www.jointcommission.org/ http://www.thecompliancedoctor.com/#!corf-accreditation/c1jj

b http://www.achc.org/

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APPLICABLE TO PROVIDERS AND PRACTITIONERS ◦ Examples

Letter of Reprimand Warning with Plan of Correction (POC) Disciplinary Action - Notification Civil Money Penalties Limit Scope of Practice Limit Reimbursement Termination of Licensure or Certification Prohibition from Participating (future)

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PRIVATE HEALTH INSURANCE (MUCH BASED ON MEDICARE)

http://www.nd.gov/ndins/

PRIVATE SELF PAY

MEDICARE http://www.cms.gov/

MEDICAID http://www.nd.gov/dhs/services/medicalserv/medicaid/

POPULATION BASED VAMC, IHS, Migrant Health, Public Health

http://www.va.gov/health/vamc/ http://www.ihs.gov/ ttp://bphc.hrsa.gov/about/specialpopulations/

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COVERED SERVICES

PARTICIPATING PROVIDERS/PRACTITIONERS

QUALIFIED PROVIDERS/PRACTITIONERS

PROSPECTIVE PAYMENT SYSTEM

FEE FOR SERVICE – COST-BASED

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PREMIUM

DEDUCTIBLE

MEDICARE PART A

MEDICARE PART B

MEDICARE PART D

CO-PAY

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MEDICAL HOMES◊ The patient-centered medical home is similar to managed care approaches and health maintenance organizations, but asks providers

to focus on improving care rather than managing costs.◊ A continuous relationship with a Personal Physician coordinating

care for both wellness and illness using these Elements: Practice

Management, Health Information Technology, Quality and Safety, Practice-based

Care Team, Care Coordination, Care Management, Practice-based Services,

Access to Care and Information http://www.medicalhomeinfo.org/state_pages/north_dakota.aspx

http://knowledgecenter.csg.org/kc/content/state-initiatives-patient-centered-medical-homes

http://www.transformed.com/MHIQ/scoring.cfm

OVERALL EFFECT OF ACA UNKNOWN. OVERALL COST OF HEALTHCARE PROJECTED TO

INCREASE.

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LEGAL DESCRIPTION◦ Licensure – www.nd.gov◦ Certification – www.cms.gov◦ Accreditation – www.jointcommission.org

ORGANIZATIONAL STRUCTURE ◦ Ownership - Corporation, proprietorship, partnership,

government◦ For Profit/Nonprofit◦ Single site? – Multiple sites?◦ Related Providers

ORGANIZATIONAL GOVERNANCE◦ Who is responsible

MISSION/VISION STATEMENTS ◦ From Organizational materials

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Visual representation of how a firm intends authority, responsibility, and information to flow within its formal organizational structure. It usually depicts different management functions (finance, human resources, marketing, nursing, environment,) and their subdivisions as boxes linked with lines along which decision making power travels downwards and answerability travels upwards. http://www.businessdictionary.com/definition/organization-chart.html

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SERVICES PROVIDED POPULATION SERVED COMMUNITY INVOLVEMENT TEACHING SITE ?

MANAGEMENT TEAM HIRING, ORIENTATION, TRAINING, RETENTION LEVEL OF DECISION-MAKING

POLICIES PROCEDURES/PROCESSES QUALITY ASSESSMENT/PERFORMANCE

IMPROVEMENT

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ORGANIZATIONAL LOCATION - refer to Organizational Chart

INTRA-ORGANIZATIONAL COMMUNICATION◦ Clear Expectations◦ Two-way Interactions

POSITION DESCRIPTION

PATIENT CARE POLICIES

STAFFING PATTERNS

“SYSTEMS” OF TASK ORGANIZATION

CONTRIBUTE TO ORGANIZATIONAL DECISION-MAKING?

4444

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APPLY THE NURSING PROCESS

BE MINDFUL –

USE PERSONAL SKILLS TO INFLUENCE REALIZE YOU ARE PRIMARY TO PATIENTS

REMEMBER THE NURSE IS MOST TRUSTED CARE-GIVER

USE YOUR POSITION TO PROMOTE COORDINATION OF CARE: internal & external

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Demonstrate your knowledge of the health care system to help a patient (and family) consider and access viable options for achieving personally desired health out comes.

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NURSING PROCESS:

a five-part systematic decision-making method focusing on identifying and treating responses of individuals or groups to actual or potential alterations in health. Includes assessment, nursing diagnosis, planning, implementation, and evaluation.

Bexhill-on-Sea, UK, MediLexicon International Ltd © 2004-2014 All rights reserved. http://www.medilexicon.com/medicaldictionary.php?t=61900MediLexicon International Ltd,

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--- a successful Hand-Off is defined as a transfer and acceptance of responsibility for patient care that is achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another or from one team of caregivers to another to ensure the continuity and safety of that patient’s care. A hand-off process involves “senders,” the caregivers transmitting patient information and transitioning care of a patient to the next clinician, and “receivers,” the caregivers who accept patient information and care of that patient. http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf

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Abrupt transitions between settings Brief hospital stays Sudden self-management with minimal preparation Poor communication between care providers

National Perspective Hackbarth, Reischauer, and Miller. Medicare Payment Advisory Committee. 2007

1 in 5 Medicare beneficiaries are readmitted to the hospital within 30 days

1 in 3 beneficiaries are readmitted within 90 days 2 of 3 patients with medical conditions are either rehospitalized or

die one year after discharge 90% of rehospitalizations were unplanned 76% of 30-day readmissions are potentially preventable

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Eric’s detox patient

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MIXED PRIORITIES – PATIENT VS SYSTEM PHYSICAL LIMITATIONS – (hearing, sight) FINANCIAL LEGAL LANGUAGE/CULTURAL/BELIEF SYSTEM EDUCATIONAL GENERATIONAL GEOGRAPHIC NO PRIMARY PROVIDER – REGULAR SOURCE OF

CARE http://www.news-medical.net/health/Disparities-in-Access-to-Health-Care.aspx

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LACK OF INSURANCE LACK OF EMPLOYMENT LACK OF COORDINATED CARE

Multiple providers and levels of service

UNWILLING TO MAKE PERSONAL INVESTMENT LITTLE KNOWLEDGE OF COST OF SERVICE LIMITED UNDERSTANDING OF 3RD PARTY

PAYMENT

INCOMPLETE MEDICAL DOCUMENTATION & CODING

MEDICARE “OBSERVATION” VS “INPATIENT” STATUS Hospital

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ADVANCE DIRECTIVES - OR LACK OF VULNERABLE ADULTS DYSFUNCTIONAL FAMILY DYNAMICS LICENSING LAWS FOR PROVIDERS AND

PRACTITIONERS

MEDICAL ERRORS INCOMPLETE MEDICAL DOCUMENTATION &

CODING

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STEREOTYPING, BIASES LIMITED OR NO ENGLISH ACCESS TO INTERPRETERS TRADITIONAL (Non-Western)

HEALTH BELIEFS AND PRACTICES

ACCESS TO SOCIAL SERVICES LIFE-STYLES DRESS UNCERTAINTY OF CARE-

GIVERS

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STEREOTYPES SOCIAL MEDIA REVERSE MENTORING WORK-LIFE/HABITS TECHNOLOGY FLEXIBILITY PERFORMANCE COMMUNICATION

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TRANSPORTATION WEATHER RURAL & INNER CITY

◦ Limited access to health and community resources◦ Limited technology connections◦ Limited transportation ◦ Limited support services

HOMEBOUND◦ Limited technology capability◦ Limited transportation◦ Limited support services

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Patients and families hate it that we can’t make this work Poor hand-offs lead to delays, lapses in care, adverse drug effects,

and other situations that may be dangerous to health

Ensure transfer of correct information Provide patient support to wellness Track referrals & help resolve problems

Less waste Enormous waste is associated with duplicate testing, unnecessary

referrals, unwanted specialist-to-specialist referrals, and failed transitions from hospitals, EDs, & nursing homes.

Clinical practice will be more rewarding Fewer problems – for patient and for health system Improve the health of the population Encourage personal responsibility for health status

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http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-300.html

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An established “system” for change in responsibility for patient care

Accurate and complete documentation

Patient Identification, Diagnoses, Events, Anticipated Outcomes

Patient education and understanding

Verbal Communication Verification of available

resources Shared Responsibility (for

the Patient)

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At the heart of this coordination is assessing patients’ and families’ readiness to manage their care and their capability to do so. We should NEVER assume that they can do it all on their own.

ndhcri video

Rural Hospital Transfer Decision-Making:

A Qualitative Approach Patricia Moulton, PhD Mary Wakefield, PhD, RN Alana Knudson, PhD Rob Beattie, MD Marlene Miller, MSW Presentation at the National Rural Health

Association Annual Conference May 9, 2008, New Orleans, Louisiana

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ND Dept of Health --- Health Facilities

◦ http://www.ndhealth.gov/HF/

ND Dept of Health – Children’s Services

◦ http://www.ndhealth.gov/familyhealth/publications/ConnectionDirectory.pdf◦ http://www.ndhealth.gov/cshs/docs/cshs-provider-list.pdf◦ http://nd.bridgetobenefits.org/◦ http://www.ndhealth.gov/cshs/

ND Dept of Human Services Available to all ND Residents Adult Services

◦ https://carechoice.nd.assistguide.net/site/423/useful_links.aspx◦ https://carechoice.nd.assistguide.net/site/371/find_a_service.aspx◦ http://www.acl.gov/www.acl.gov/About_ACL/FederalInitiatives/VeteransCare.as

px◦ http://ndipat.org/

http://www.agingcare.com/Elder-Care◦ http://www.nd.gov/dhs/services/adultsaging/reporting.html◦ http://www.nd.gov/dhs/services/adultsaging/ombudsman.html

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Mental Health and Substance Abuse Treatment Centershttp://findtreatment.samhsa.gov/MHTreatmentLocator/faces/quickSearch.jspx

ND Free Lance Interpreter List http://www.nd.gov/ndsd/outreach/doc/freelance-interpreters.pdf

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◊ ND Long Term Care Association (NDLTCA) - Economic Pulse Report 2012 http://www.ndltca.org/documents/NDLTCA_2012PulseReport-lowres.pdf. 

◊ ND Hospital Association (NDHA) – Economic Pulse Report 2012 http://mabu-ndha.taopowered.net/?id=63

◊ An Environmental Scan of Health and Health Care in North Dakota: Establishing the Baselines for Positive Health Transformation. March 2009

http://ruralhealth.und.edu/pdf/escan/vol1-2.pdf

◊ Rural Care Coordination Toolkit. Webinar : Care Coordination in Rural Communities. recorded February 12,

2014 http://www.raconline.org/communityhealth/care-coordination/1/defining- care-coordination

◊ Lin Grensing-Pophal: Leading when You’re Not the Formal Leader. Advance Healthcare Network for Nurses. April 2, 2014

http://nursing.advanceweb.com/Lifestyles-for-Nurses/Lifestyle-for-Nurses/At-Work/When-Youre-Not-the-Formal-Leader.aspx

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2013 Actuarial Report on the Financial Outlook for Medicaid. Report to Congress

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Downloads/medicaid-actuarial-report-2013.pdf

The Care Transitions Program. Health Care Policy & Research University of Colorado School of Medicine. © 2007 Care Transitions Program. Denver Colorado

http://www.caretransitions.org/

CFMC, Medicare Quality Improvement Organization for Colorado, prepared under contract with CMS. © 2013 CFMC

http://www.cfmc.org/integratingcare/default.htm)

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American Association of Critical Care Nurses http://www.aacn.org/dm/csi/finalprojects.aspx?menu=csi

◦ Don't Fumble the Handoff: Tackling Effective Communication - Presentation Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston

◦ Don't Fumble the Handoff: Tackling Effective Communication - Project Summary Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston

◦ Don't Fumble the Handoff: Tackling Effective Communication - Toolkit Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston

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◊ Brian D. Smedley, Adrienne, Y. Stith, and Alan R Nelson, Editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health CareCommittee on Understanding and eliminating racial and ethnic disparities in health care. Institute of Medicine. 2009

http://books.google.com/books?hl=en&lr=&id=__uouFvf9z4C&oi=fnd&pg=PR1&dq=language+barriers+to+health+care+coordination&ots=0ZbIrqpOBC&sig=5F3nDqEgrJPJGmUDl1_B6cyz4Yw#v=onepage&q=language%20barriers%20to%20health%20care%20coordination&f=false

◊ A Distinctive System of Health Care Delivery – Jones & Bartlett Publishers (recommended*)

http://www.jblearning.com/samples/076374512x/shi4e_ch01.pdf

◊ V M Arora, J K Johnson, D O Meltzer, H J Humphrey: A Theoretical Framework and Competency-based Approach to Improving Handoffs. Quality Safety. Qual Saf Health Care 2008 17:11014. doi: 1136/qshc.2005.018952

http://qualitysafety.bmj.com/content/17/1/11.full.pdf+html ◊ Quyen Ngo-Metzger MD, MPH*, Michael P. Massagli PhD, Brian R. Clarridge PhD, Michael

Manocchia PhD, Roger B. Davis ScD, Lisa I. Iezzoni MD, MSc and Russell S. Phillips MD Perspectives of Chinese and Vietnamese Immigrants

Article first published online: 17 JAN 2003 DOI: 10.1046/j.1525-1497.2003.20205.x http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2003.20205.x/full

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◊ Beth Ann Swan: A Nurse Learns Firsthand That You May Fend For Yourself After A Hospital Stay. Health Affairs, 31, no.11 (2012):2579-2582. dpo: 10.1377/hlthaff.2012.0516◦ http://content.healthaffairs.org/content/31/11/2579.full.html

◊ Joe Tye (with Dick Schwab). The Florence Prescription. From Accountability to Ownership. Copyright 2009, 2014 by Joe Tye

http://theflorencechallenge.com/

◊ John Kenagy, MD, MPA, ScD, FACS (Slide #42) Designed to Adapt. Leading Healthcare in Challenging

Times. Second River Healthcare Press, 26 Shawnee Way, Suite C, Bozeman, MT 59715. 2009 http://www.designedtoadapt.com/

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Evidence of completion of the four (4) Leadership Modules (Copy of certificate of completion for contact hours).

Complete one project at the end of each of the modules that demonstrates your application of knowledge, skills, abilities, and judgment of the content from each module. (See individual modules for ideas).

Use a format that lends itself to professional presentations:◦ Electronic poster presentation, PowerPoint presentation, videotaped

presentation, evidence of presenting project to a professional group, manuscript for publication, or other method.

Collect all your projects in a portfolio (prefer electronic) and submit at the end of the 4th module.

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Describe your employer organization using the outline provided Define your present position within the employer organization. Perform and document a successful patient handoff noting the

following:◦ 1. The patient’s desired health outcome◦ 2. Assessment of each of the listed barriers◦ 3. Indivisuals/agencies involve in thehandoff (remember the patient).◦ 4. Elements of the handoff (documents, other communication, transportation, etc.)◦ 5. Success (2 weeks after the fact) of the handoff.

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Reflect on the complexity of the overall healthcare system

Reflect on your organization within the system Reflect on your position within your organization Reflect on the result of your patient advocacy

experience

How could a different reality make your experience more successful and satisfying?

What will you do to move toward that different reality?

And so we move into the Change & Innovation Module

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