Running Your Onsite Clinic Like a Business From Rollout to Maturity

Conflict of Interest We hereby certify that, to the best of our knowledge, no aspect of /our current personal or professional situation might reasonably be expected to affect significantly our views on the subject on which we are presenting, other than the following: We are employed by a national company that provides occupational health services to employers, including the operation of Onsite Clinics.

Learner Outcome Based on this education, the learner will… …Understand how to become active participants in building and sustaining clinic operations; better identify needs of their “customers” (e.g., senior executives, supervisors, HR/benefits managers, frontline employees); and astutely apply business and marketing principles in keeping with best clinical practices. The objective is to produce better health outcomes for employees and a positive return on investment for employers

Objectives/Agenda Discuss ways to use a gap analysis to identify onsite service opportunities and inform development of a business and marketing plan for an onsite clinic at one location or across multiple sites. Review basic financial concepts, including budgeting, to conduct a cost-benefit analysis, obtain management buy-in for necessary resources and prepare for anticipated growth over time. Identify ways telehealth can be used to provide clinic backup coverage at peak times when onsite staff are busy and after routine operating hours.

Reflection Reflection is an evidence-based effective strategy to enhance engagement and learning. The idea is to perturb or provoke the learner’s brain using a question or invitation that makes the topic relevant to them personally, this takes about 1 minute. Ask a question related to why the learner is participating in this activity (…Why are you here? …What do you hope to learn from this session?) Describe possible practice gaps or issues related to this education. “Do you ever wonder about…” “Have you ever had a patient who…” “Have you seen this … at your hospital/clinic?”

Introductions Christine Kalina, MS, MBA, RN, COHN-SCM/ FAAOHN Patrina Smith, PhD, MSN/MHA, BSN, COHN-S Michael Sanford, RN, MBA

Developing Your Plan Christine Kalina

Identifying Onsite Opportunities To develop a business and marketing plan using a gap analysis, you must understand: Overall strategy and strategic planning process Where you are, where you want to be and how you are going to get there (business plan) What you have to offer customers (marketing plan) Resources you have and what you need (gap analysis) to achieve business and marketing goals

What Do You Want to Accomplish? Leader and Team must fully identify, understand and commit to support the: Vision – Dream, define future state Mission – What your organization does best and can deliver Goals – How to make the mission come alive Objectives – Step-by-step to attain goals

Take resources and manage to the success of the company Getting it Done The Manager’s role: Take resources and manage to the success of the company What is strategic planning? Moving resources into position to identify optimum path to attain mission, etc.

Strategic Plan Components Vision Statement Mission Statement Goal(s) Long- and short-term objectives Lifecycle of your business/clinic Key competencies, differentiation, competitive analysis Align to the parent organization’s goals

Strategic Planning Process What we need to do What we do not need to do Roadmap and car

Strategic Plan Building Blocks Purpose Values SWOT Priorities & Dashboard Strategies & Campaigns Action Plans Vision Operational Strategic Source:

Determine the current state of your business SWOT Analysis Determine the current state of your business Type of strategy developed based on quadrant placement: Turnaround? Aggressive? Defensive? Diversification?

Numerous Environmental Opportunities Major Environmental Threats SWOT Analysis Cell 3: Supports a Turnaround Strategy Cell 1: Supports an Aggressive Cell 4: Defensive Cell 2: Diversification Substantial Internal Strengths Critical Weaknesses Numerous Environmental Opportunities Major Environmental Threats Source:

KPIs – Measure what you are doing What’s Your Approach? Type of strategy? A living pathway Plan, execute, measure, rethink KPIs – Measure what you are doing Remember: What gets measured gets managed If you measure everything you measure nothing; nothing is meaningful Gap Analysis Many types of gap analysis Our focus is “Performance Gap Analysis” Business Plan fit

Gap Analysis Process Describe General Area Determine Current State Determine Action Steps Describe General Area Identity Specific Improvement Areas Determine Targets Source: www.expertprogrammanagement.com

Marketing Strategy Product Price Cost Analyze Process Promo Placement Source:

If You Build it They Will Come Not true! Market analysis Competitive Advantage 5Ps of Marketing Get the answer from strategic planning and financials Advertising vs marketing – What’s the difference?

Pulling it all Together The “fit” of gap analysis, strategy, strategic planning, marketing, finance

Finance Fundamentals Patrina Smith

We do not speak the same language Clinical versus Financial Speaking C-Suitish We do not speak the same language Clinical versus Financial The bottom line

Basic Financial Concepts Revenue Direct costs - Expenses - Indirect costs - Profit revenue-expenses=profit - Tangible costs Intangible costs - Variance - Real Costs - Payback period - ROI

Return on Investment Source:

What is the purpose of budgeting? What is a budget? What is the purpose of budgeting? Capital budget versus Operating budget Typical capital budget items Typical operating budget items

Fixed costs Variable costs Actual versus budget Actual revenue vs. budgeted revenue Actual expenses vs. budgeted expenses

Steps in the Budget Process Ensure funding proposals align with strategic objectives. Assess variances between actual and budgeted figures in the previous period's plan. Identify and prioritize business needs and objectives for next period. Forecast and evaluate: Incoming revenue Current trends or changes that have implications for spending or revenue inflows Growth opportunities

Cost-Benefit Analysis What is a cost-benefit analysis? What is the purpose of a CBA? Key elements of the technique

Identify costs and benefits Ways to identify costs CBA Components Framework Identify costs and benefits Ways to identify costs Ways to identify benefits Calculate costs and benefits aggregate information Direct costs Indirect costs

Present Value PV=F/(1+r)n Analyze Results Present Value PV=F/(1+r)n

Purpose of the project analysis Details or list of alternatives Costs Setting up the CBA Executive Summary Purpose of the project analysis Details or list of alternatives Costs Benefits Evaluation and Comparative Cost Benefit Analysis Summary

Ensure alignment with employee and company needs The impact Payback Getting Buy-in Ensure alignment with employee and company needs The impact Payback

Growing into the Future Devise a successful growth strategy Where are we now? Know your customers Clients Employees

Telehealth Support Michael Sanford

Virtual Health Care Delivery - Definitions Telehealth: “Delivery, management, and coordination of health services that integrate electronic information and telecommunications technologies to increase access, improve outcomes, and contain or reduce health care costs” Telehealth Nursing: “Delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing”

Virtual Health Care Delivery - Definitions Telephone Nursing: “All care and services within the scope of nursing practice that are delivered over the telephone” Telephone Triage: “An interactive process between nurse and client that occurs over the telephone and involves identifying the nature and urgency of client health care needs and determining the appropriate disposition” TNP: Telehealth Nursing Practice

Advances in Telehealth Nurses have used telecommunications technology since the ’70s (Espensen, 2009) Telehealth momentum significantly advanced with demand for telemedicine at NASA in’90s Internet ushered in more advanced level of nursing, i.e., Nursing 2.0 Connectivity with security features allows OHNs to extend scope of practice beyond traditional brick-and-mortar environment Telenursing the Bio-information Cornerstone for 21st Century Health Care

Telehealth Applications Onsite nurses often responsible for and use telenursing to: Cover multiple sites/jurisdictions Provide 24/7 availability Support onsite and telephone triage Promote wellness programs using social media Perform case management

Recognizing Telehealth Demands Long hours, 24-hour availability and burnout may decrease quality of care What can you do to protect yourself/team from these impacts?

Managing Telehealth Demands Do you have systems to support telephone triage? How do you manage injury calls? What does it take? Systems Call recordings Documentation platform Protocols Workflows

Nursing process and scope of practice does not differ with telenursing Telehealth Process Nursing process and scope of practice does not differ with telenursing  American Nurses Association defines telenursing as subset of telehealth focused on specific profession’s practice (i.e., nursing).

Telehealth Process Nurse needs highly effective communication skills to obtain sufficient, clear information and relate to a caller by: Entering into the relationship Connecting with the person Sharing and reviewing information Recognizing patterns and trends Recording and reflecting patient information Putting pieces together over time Transitioning out (Nagel et al., 2016) Refer to American Academy of Ambulatory Care Nurse Scope and Standards of Practice for Professional Telehealth Nursing, 6th edition 2018

Telenursing is Complex Care Requires the nurse to: Create a picture of caller’s condition using communicative strategies only Ask the right questions Listen to non-verbal cues to verify or exclude serious symptoms Develop trust and empathetic relationship Misjudging a caller’s need for care may have serious or even fatal consequence and/or lead to malpractice claims

All using only communicative strategies! Objective During a short period of time, telenurses: Assess care-seekers need for care Independently triage need for care Give individualized care (e.g., self-care advice, information and support) Refer to appropriate health care provider All using only communicative strategies!

Develop standards of practice: What happens if nurse is unavailable? Quality Assurance Develop standards of practice: What happens if nurse is unavailable? Publish agreed upon workflows Are protocols different if video is used? Can you request pictures? Do you ensure consistency and staff are not taking risks? Create agreed upon telephone protocols How do follow-ups occur? Nursing licensure Do you manage calls from additional states? (Know eNLC enhanced Nurse Licensure Compact) Do you manage international calls?

Telenursing Vendors If selecting a telenursing vendor, consider how candidates fit with your company’s culture Does the vendor provide telephone protocols for staff and a documentation platform?

Manage burnout and long hours to maintain quality care. Takeaways Manage burnout and long hours to maintain quality care. Identify Standards of Practice, Protocols and Scope of Work: Practice within your scope Nursing licensure in states where call originates Develop triage guidelines Use resources: American Academy of Ambulatory Care and AAOHN

Takeaways As the onsite health care professional, you must advocate and educate your employer on Standards of Practice and Scope of Work Protect your professional license and prevent your employer from participating in unacceptable practices You are the specialist!

Reflection Returning to a short reflection at the end of the learning is also proven to help increase learner engagement and likelihood to take action. This helps close the loop so that the learner will intentionally identify the ‘pearls’ or ‘take away’ from the education. This takes about 1 minute. Below is an example, please use your own words and style. At the beginning of the session, I asked you to take a moment to think about what brought you here and what you hoped to learn. Now, I want you to take another moment and think about what you plan to do based on this education. Feel free to jot down what you want to take home and do. (short pause)

Questions and Discussion