2. Running Your Onsite Clinic Like a Business
From Rollout to Maturity

3. 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.

4. 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

5. 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.

6. 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?”

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

8. Developing Your Plan
Christine Kalina

9. 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

10. 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

11. 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.

12. 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

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

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

15. 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?

16. 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:

17. 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

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

19. Marketing Strategy Product Price Cost Analyze Process Promo Placement
Source:

20. 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?

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

22. Finance Fundamentals
Patrina Smith

23. 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

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

25. Return on Investment
Source:

26. 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

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

28. 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

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

30. 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

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

32. 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

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

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

35. Telehealth Support
Michael Sanford

36. 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”

37. 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

38. 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

39. 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

40. 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?

41. 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

42. 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).

43. 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

44. 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

45. 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!

46. 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?

47. 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?

48. 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

49. 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!

50. 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)

51. Questions and Discussion