1. Building Effective Workforce Management Practices Through Shared Governance and Integration © 2013 API Healthcare Corporation. All Rights Reserved. Jacob Krive, Ph.D. Project Manager – Information Systems, Advocate Health Care

2. Advocate Health Care Overview Based in Oak Brook – Largest IDN in metropolitan Chicago and the state of IL Related to both the Evangelical Lutheran Church of America (ELCA) and the United Church of Christ (UCC) More than 250 sites of care including: –10 hospitals, 2 children’s hospitals, 3300 beds –The state’s largest physician network –Home Health Services/Hospice © 2013 API Healthcare Corporation. All Rights Reserved.

3. Advocate Health Care Overview 5 Level One Trauma Centers; 2 Level Two 4 Hospitals with Magnet Status 4 Teaching Hospitals Recognized as a Chicago Tribune Top Workplace in 2011 Over 250 sites of care –Advocate Medical Group –Dryer Medical Clinic –Occupational health –Imaging centers –Immediate care centers –Surgery centers –Home health/Hospice Joint Lab venture with Aurora Health Care © 2013 API Healthcare Corporation. All Rights Reserved.

4. Advocate Health Care Overview © 2013 API Healthcare Corporation. All Rights Reserved.

5. Advocate Health Care Overview 32,000 Time and Attendance users 12,000 Staffing and Scheduling users Staffing and Scheduling areas implemented to date: © 2013 API Healthcare Corporation. All Rights Reserved.

6. Advocate’s Original State of the Workforce Management Process Staffing and Scheduling (API Healthcare) Time and Attendance (API Healthcare) Payroll and HR (Lawson) Limited functionality link to shared data Separate goals, business processes, objectives Finance – business owner for Time and Attendance Information Systems (I/S) – business owner for Staffing and Scheduling I/S in the business owner role © 2013 API Healthcare Corporation. All Rights Reserved.

7. Nursing Operations Governance Nurse Staffing and Finance (NSF) – shared governance committee as a nursing operations council guiding staffing and scheduling functions; meets monthly Patient Care Council (CNE Council) – Shared governance council of nurse executives; meets monthly NSF committee reports to Patient Care Council and presents core outcomes on a quarterly basis © 2013 API Healthcare Corporation. All Rights Reserved.

8. Finance Governance, as Relevant to Payroll and Time and Attendance Enterprise Connection Steering Committee: group of executive leaders in charge of financial systems/technology governance Finance Directors group: representing I/S, Finance, HR, and Supply Chain Enterprise Connection Team Leader group: representatives of I/S and business areas working through detailed project initiatives of shared concern HR/Payroll group: representatives of I/S, HR, and Finance in charge of the change control for these areas © 2013 API Healthcare Corporation. All Rights Reserved.

9. AdvocateWorks Project as a Collaboration Catalyst A new integrated workforce management platform based on a combination of Time and Attendance and Staffing and Scheduling applications from API Healthcare Required re-thinking all process, philosophies and business strategies Bring Nursing and Finance to the same table as co-creators and co-workers of a single shared platform Changes made in any of the core applications have potential to affect both groups © 2013 API Healthcare Corporation. All Rights Reserved.

10. Example: Security Framework © 2013 API Healthcare Corporation. All Rights Reserved. Manager Staff Scheduling Time & Attendance I/S Security Authorization System Administrator T&A Manager/ Supervisor Nursing Office Council Chair+ Backups I/S Security Team I/S Applications Team Customer

11. Example: Change Control Due to Time and Attendance and Staffing and Scheduling integration, Advocate could no longer rely on direct communications to approve application changes New process and form development Process/form require business owners’ and I/S signatures Serves as both communication and approval tool, even in cases when only one owner is affected by a change © 2013 API Healthcare Corporation. All Rights Reserved.

12. Staffing and Scheduling Ownership Problem I/S was not the right owner of application driven by business decisions made by clinical areas and operations leaders Uncomfortable position for both I/S and Finance groups Impediment to productive planning of AdvocateWorks and future shared governance of the integrated business model Clear need for active Nursing participation in technology decisions © 2013 API Healthcare Corporation. All Rights Reserved.

13. Staffing and Scheduling Shared Governance Innovation No single leader available to take traditional business owner role NSF as a shared governance owner Patient Care Council as an executive decision maker, critical decisions escalation committee and executive sponsor © 2013 API Healthcare Corporation. All Rights Reserved.

14. Staffing and Scheduling Shared Governance Innovation Advantages –Decisions satisfy all groups and facilities –“Automatic” buy-in –Shared values and interests Challenges –Need efficiency in making decisions as a group –NSF meets monthly © 2013 API Healthcare Corporation. All Rights Reserved.

15. AdvocateWorks Project Governance © 2013 API Healthcare Corporation. All Rights Reserved. Project Sponsors: Information Systems and Finance Directors Training Team Technology Team Communications Team and Change Management Deployment and Training Project Manager: Finance Leader and Outside Contractor Executive: Enterprise Connection Steering Committee Hospital Leadership Team Councils Project Manager

16. Post-Implementation Governance Challenge Initially large volume of decisions to establish common ground between Nursing and Finance Ongoing discussion points requiring joint decisions and collaboration Shared decisions at all detail levels necessary, from strategic to technical implementation © 2013 API Healthcare Corporation. All Rights Reserved.

17. Business Ownership and Shared Governance Model © 2013 API Healthcare Corporation. All Rights Reserved. Executive: Patient Care Council Nursing Operations Leadership: Nurse Staffing and Finance Committee Information Systems Nursing/Finance Subgroup

18. New Challenges: Detailed Analysis Under aggressive Staffing and Scheduling roadmap planning, new groups required participation in shared governance NSF goals are management of nursing operations and meeting financial goals of the organization Nursing/Finance Subgroup goals are discussions of shared concerns between financial and clinical areas Needed new avenue for shared governance at technical/detailed levels + involve adminstators/FSAs from new customer groups © 2013 API Healthcare Corporation. All Rights Reserved.

19. Current (2013) Business Ownership and Shared Governance Model © 2013 API Healthcare Corporation. All Rights Reserved. Executive: Patient Care Council Nursing Operations Leadership: Nurse Staffing and Finance Committee Information Systems AdvocateWorks Business Owners Nursing/Finance Subgroup Technical: FSA Group (Monthly Meeting)

20. Information Systems Support Structure for AdvocateWorks © 2013 API Healthcare Corporation. All Rights Reserved. AdvocateWorks Application Team Technical Services Team (servers, databases, network, telecom) I/S Security Administration Change Management and Disaster Recovery Team Information Technology Center (help desk)

21. AdvocateWorks Staffing and Scheduling Roadmap Aggressive rollout the past few years Rollout and outreach grow to impact more areas of the organization Has gone beyond clinical areas and into any areas that schedule Challenge: Staffing and Scheduling is not only for Nursing anymore, so need to adjust/change/amend existing governance to include new owners. Or introduce new owners to existing shared governance venues. © 2013 API Healthcare Corporation. All Rights Reserved.

23. LaborWorks Staffing & Scheduling: optional dept use for inpatient nursing 2005 - 2008 AdvocateWorks: integrated workforce management platform 2009 2012 2011 FSA Group Shared ownership by NSF with escalation path to Patient Care Council Nursing/Finance Subgroup LaborWorkx Roadmap: ancillary clinical departments AdvocateWorks – core labor mgmt product, varied use, busy roadmap AdvocateWorks Roadmap: open to all Advocate units with scheduling needs 2010 - 2011 2011

24. Lessons Learned There is room for innovation and taking risks in evaluating new governance models Business ownership as a shared governance works well despite its drawbacks Getting governance right has power to make or break key strategic initiatives Successful ownership and governance strategies are keystone for future process and technology innovation © 2013 API Healthcare Corporation. All Rights Reserved.

25. Moving Forward… Challenges and opportunities engaging new customers in the shared governance process Moving towards integrated/enterprise level change control process across clinical, financial and HR organizations Becoming more effective and efficient in making shared decisions from input provided by a large group of leaders Ensuring creative strategic innovation supported (not hampered) by shared governance © 2013 API Healthcare Corporation. All Rights Reserved.

26. Jacob Krive jacob.krive@advocatehealth.com FOR MORE INFORMATION Q & A Or visit apihealthcare.com