Position Strategy_CHC_2015
- 1. Andor Fuhrer Cerner EMR Analyst October 11-14, 2015 Position Strategy: Using Cerner tools to gain efficiencies and create guiding principles around positions
- 2. 1 Faced with a number of legacy processes and positions, Boston Children’s Hospital initiated a project to optimize their position strategy by reducing the number of active Millennium positions. Using Cerner’s Position Comparison Tool, Boston Children's Hospital gained efficiencies and created guiding principles around positions.
- 3. 2 Boston Children’s Hospital • #1 Pediatric Hospital US News and World Report • 395 Licensed Beds Average Daily Census: 311.7 • 1551 Registered Nurses (FTEs) • 351 Nurse Practitioners • 3200 MDs • Powerchart • FirstNet • SurgiNet • RadNet • PharmNet • PathNet
- 4. 3 Boston Children’s Hospital • US News & World Reports Ranked #1 in 8 out of 10 pediatric specialties by US News & World Report: 2014 Honor Roll • Magnet status Since 2008 • Leapfrog Group Leapfrog Group Quality and Safety Designation 2014 & prior. • HIMSS Analytics Only Massachusetts HIMSS Analytics Level 7 designated hospital 2014 & prior.
- 5. 4 Boston Children’s Hospital What’s Boston Children’s Hospital strategy around CORE/Positions?
- 7. 6 Why so many positions? • Easy workaround for new solutions Clinical Apps Team develop custom solutions which are added to PowerChart new position will serve as a security mechanism • Lack of organization and structure Currently there is no department/committee that provides guidelines for positions, new or old • Customer Service Driven Ask for a priv/pref change, we will do it
- 8. 7 Why so many positions • Accommodation/Easy to create New position request will usually be copied from a similar position, gets renamed and privs/prefs get tweaked. Minutes to create a new position vs. time to analyze/review an existing position • PrivMaint, PrefMaint Cerner tools were challenging to compare privs and prefs across one or multiple positions
- 9. 8 The Outcome? Redundancy: CHB2 Clinical Assistant Ambulatory CHB2 Clinical Assistant CATCR CHB2 Clinical Assistant DFCI CHB2 Clinical Assistant Dialysis/Apheres CHB2 Clinical Assistant ED CHB2 Clinical Assistant Inpatient CHB2 Clinical Assistant Inpatient NICU CHB2 Clinical Assistant Peri Procedure CHB2 Clinical Assistant Scribe CHB2 RN Ambulatory CHB2 RN Ambulatory Cardiology CHB2 RN Ambulatory ORL CHB2 RN Ambulatory Peabody CHB2 RN Ambulatory Procedure CHB2 RN Anesthetist CHB2 RN CATCR CHB2 RN CATCR BMDI CHB2 RN CATH Lab CHB2 RN CICU CHB2 RN CICU Complex Care CHB2 RN Community CHB2 RN DFCI CHB2 RN Dialysis/Apheresis CHB2 RN ED CHB2 RN ED with Reporting CHB2 RN Inpatient CHB2 RN Inpatient Psych CHB2 RN MICU CHB2 RN MSICU CHB2 RN NICU CHB2 RN Radiology CHB2 RN Transport CHB2 RN Waltham CHB3 RAD NURSE CHB3 RAD NURSEDFCI CHB3 RAD RN PACU CHB3 SN RN CHB3 SN RN CT Manager CHB3 SN RN DSU PreOP CHB3 SN RN GPU CHB3 SN RN Pacu CHB3 SN RN Pacu BMDI CHB3 SN RN PC INV CHB3 SN RN Prefcard CHB2 Ambulatory Service Rep DFCI CHB2 Ambulatory Service Rep ED Reporting CHB2 Ambulatory Service Representative CHB2 ASR Audiology CHB2 ASR Neurophys CHB2 ASR Urodynamics CHB2 Athletic Trainer CHB2 Practice Assistant CHB2 Non-Patient Care IN-ERROR CHB2 Cast Room Tech CHB2 Food Service Personnel CHB2 Departmental Indexing CHB2 COPP
- 10. 9 The Outcome? Maintenance Nightmare “We approved this Change Request to add the Atrius Web Portal tab to Clinical positions” - Senior Management
- 11. 10 The Outcome? Hard to identify which positions have the privileges to do certain tasks/workflows “I need a position for a non-clinical staff member but needs to be able to add documents and powerforms”
- 12. 11 The Outcome? Makes the team look bad Takes a long period of time to accommodate a simple request I submitted a request asking to have the Clinical Assistant access to Chart Search, its been 4 weeks!
- 13. 12 The Final Straw… Change Control No. - New PowerChart Position for Dental Hygienist
- 14. 13 To Recap What are we faced with: • Lack of structure/categorization for positions • Lack of documentation explaining role types/positions and privs/permissions – Users would be place in wrong positions • Lack of governance that decides privs/permissions • No transparency or reporting capability for positions • Difficult naming convention; Position name = job title
- 15. 14 Looking into the Future • Specialty specific workflows (DyDoc), which will require clinical positions for specific specialties • MD Cardio, MD GI, MD Derm, etc • This means even MORE positions will be created • Cleanup and organization is crucial
- 16. 15 Position Strategy The aim of this initiative is to: Reduce the number of positions by consolidating similar positions and retiring old positions • Categorize/classify positions • Align the positions, yes, all 290… • Create guiding principles and standardization for BCH positions
- 17. 16 Position Strategy • Engage Health Informatics Management (HIM), HR and Compliance teams to mandate permissions and privs for positions • Create guidelines for teams requesting new positions • Reinforce collaboration/change culture • Transparency • Update/Reform position naming convention*
- 18. 17 Position Strategy – Getting Started Categorize/Group all positions
- 20. 19 Position Strategy – Getting Started Design a position matrix to classify positions on a macro level with standard tasks/solutions
- 21. 20 Position Strategy – Analysis • Once matrix is in place, we will use this to show current state – start the conversation • Engage Compliance and HIM to review current state • Out of compliance? • Guiding principles? • Who can see what? • How do we handle scope of practice? • How flexible are we – Conservative? • Make necessary changes and DOCUMENT changes • Changes were made because…
- 22. 21 Cerner Tools Position Comparison • Improves maintenance substantially • Ability to compare privs and prefs for one or many positions at once • Align privs and prefs across multiple positions • Easy to use • Provides transparency to position set up HNAUser • Provides functionality to create/store Position Roles and associate them to positions • Ability to associate Position Roles with ‘Responsibilities’
- 24. 23 Position Comparison - Privileges
- 25. 24 Position Comparison Not all RN positions are created equal: Position Comparison allows us to align all of our privs and prefs
- 26. 25 Position Comparison - Preferences
- 27. 26 HNAUser • HNAUser has the functionality to store Role Types and associate them to positions • The position matrix can now be stored in Millennium • The ‘Responsibilities’ functionality is being used to: • Define the category/role type • Associate major tasks category/role type has permission
- 28. 27 HNAUser – Role Types Associate positions to corresponding role
- 30. 29 HNAUser – Role Type Management • Outcome: Role Type with associated positions and responsibilities
- 31. 30 Next Steps: Positions to target • ASR – Ambulatory Service Rep • ‘Front Desk Staff/Schedulers/Registration • Solution Specific positions • SurgiNet / RadNet / PathNet • Scheduler positions for SN • 61 Non-Clinical / Admin positions • RN’s and Clinical Assistants • Reduce DBA Positions
- 32. 31 Next Steps: Projections Lab Positions will be cut in half (12 positions) Admin Positions will be reduced by more than half (30) Approximately 15/20 positions we know we can retire Finalize guidelines for position roles: • Access • Permissions • Privileges Estimated to reduce positions from 290 to 200
- 33. 32 Next Steps: Ideas Numerical Level for Positions Who said positions have to be the name of a role or job title? Instead of a naming convention that is dependent on licensing, what if its based on a numeric level? Similar to HR’s grading level i.e. managers are levels 12-15, directors are levels 16-21
- 34. 33 Next Steps: Ideas Eliminates the need to create positions for ‘new’ roles Allows more fluidity Eliminates the need to create positions for ‘new’ roles Role Position Job Title/Role Non- Clinical Read Only Level 1 Read Only Positions/Tracking Board Admin Level 2 Level 3 Level 4 Help Desk Level 5 Medical Records Level 6 Auditors Level 7 Schedulers Level 8 Non-Patient Care Level 9 ASR Level 10 Level 11 Level 12 Clinical Licensed Direct Pt Care Level 13 Patient Care/CA/Case Manager Licensed Non Direct Pt Care Level 14 COPP Level 15 Pharmacist Non-Licensed Direct Pt Care Level 16 Medical Students RN Level 17 - Ambulatory RN Level 17 - Inpatient NP Level 18- Cardiology NP Level 18- Ambulatory Level 18- GI Level 18- Neurology Level 18- ORL PA Level 19 PA MD Level 20 - Cardiology MDLevel 20 - Ambulatory Level 20 - GI
- 35. 34 Ideas HR Role Types Review HR Roles and determine if appropriate Millennium will be in sync with HR role type; may be more logical that licensing approach No need to recreate the wheel, recycle what has already been established
- 37. 36 Contact Information Andor Fuhrer Boston Children's Hospital Cerner EMR Analyst Andor.Fuhrer@childrens.harvard.edu
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