Good afternoon. Thank you for joining us for our Staying Connected When Working Anywhere session. Before we get started, I wanted to let you know that there will be some polls available for this session. So get your devices ready for the poll, pull out your phones, go to the mobile app, select our session, and then click on the question and answer button and the poll will show up on the right-hand side. Now you're going to have to excuse me on this next part because the print is really tiny. Or I'm really old. I'm not sure which. Maybe a little bit of both. So again, thank you. And I want to introduce you to our speakers. I'll introduce them both now and then we'll get started with the session. So our first speaker is Sheila Nichols, which you've probably heard introduced a few times throughout our session. She is the Manager of the Cardiovascular Registry Abstraction at Allegheny Health Network, which is a 14-hospital healthcare system in Pittsburgh in northern Pennsylvania. Sheila oversees operations for 10 cardiovascular registries across 6 hospitals within the network. And there's a whole lot of other, but you've already heard that. So I'm going to go back. And our next speaker then will be Heather Sacco. She has served for healthcare for 17 years. Her diverse nursing experience spans emergency medicine, inpatient nursing and cardiovascular cath lab, which is where she found her passion for improving outcomes for cardiovascular patients. In her current role as Cardiovascular Outcomes Coordinator for an integrated health system in the Midwest. Heather has elevated the focus on cardiovascular outcomes improvement across a multi-hospital footprint. Through influence and collaboration Heather has successfully implemented abstract or best practices and outcomes improvement initiatives resulting in increased efficiencies and system standardization. In her free time she enjoys spending time with her family, running races and listening to music. So I'll put this back here. And get you started here. Sheila's first? There you go. Okay. Oh boy, I'm really short. I can't even see over the computer here. I'll move over a little bit so I can see you guys. First of all, thank you so much for coming to our session. Because there's a lot of really great sessions going on now. And it's the end of the day. And we're all tired. I'm a little get and slap happy, so we should have fun. So we're going to talk about staying connected when working from anywhere. The objectives for our talk are to provide techniques for keeping remote and hybrid staff engaged, describe measures of staff engagement, identify tools to capture accountability, and how to develop clear expectations and deadlines. I have no disclosures. So a little about my role, my hospital system. So Allegheny Health Network, like Michelle said, is a 14-hospital health system in Pittsburgh, northern Pennsylvania, and western New York. We do registries for six of those hospitals. You see them listed here with our little map there. So a little background on my team. It's a centralized CV registry team. And AHN decided that they were going to centralize. About 2019, things got put on hold. So it really wasn't, you know, because of COVID. So it wasn't until 2020 that they were really actively looking for who's going to manage this team, who's going to run this team, who has experience in the cardiovascular registries. Because they already centralized the other side of the registry team, like core measures, guidelines, things like that. So the role, you know, came across my radar, and I applied for it. And at the beginning, they had no intention to hire somebody remote, no less, in a different state. But when I interviewed, you know, I let them know I live in Ohio, and I'm not moving. So either, you know, I'm your person or I'm not. It's about two hours away. So I do travel there occasionally, which I told them, you know, I'll come once a month, whatever you need. I can't do that, to be honest, at this point. But they went ahead, you know, and hired me in August of 2020, of course, remote and in a different state. That started the proof of concept, because it was very successful. I started engaging with the different hospitals. We took individuals that were already implanted in all of the different hospitals and primarily worked on registries and kind of created a team from there. So that started the proof of concept. Then I hired my remote coordinator, Barb, who's here with me at the meeting this week. And she's another out-of-state employee. So we officially centralized the team in June of 2021. We originally had 11.6 FTEs, which was 13 people, and we were doing seven registries across five hospitals. Now we're doing, we decreased our team a little bit to 9.8 FTEs, 10 people, and we're doing 10 registries for six hospitals. And for those of you that do multiple registries, we count TVT as one, but it's pretty much three registries. We count VQI as one, but it's six registries, because we do six modules, you know. So really, it could be more than that. This is what our org chart looks like for my team specifically. We report up to quality analytics, which is included in our quality, safety, and value department, and we have a dotted line to CVI. So myself, the manager, then we have the coordinator, and we follow a pod model. So we have pods for all of these registries that we abstract. My Work From Anywhere team is myself from Ohio. My coordinator lives here in Florida. We have seven registry abstraction nurses that live in Pennsylvania. And although they're in Pennsylvania, one of them is four and a half hours away from Pittsburgh. So they're not even all local. We have another abstraction nurse that lives in Ohio, and then we also have one in Oklahoma. Ten of us work from home. One person does still work on-site. Our responsibilities, we abstract approximately 11,000 base cases plus follow-up annually. We abstract into our registries one to two weeks post-discharge, daily communication, inquiry for documentation needs, things like that that all of you I'm sure do. We submit weekly. We perform drill down and we disseminate an outlier report to all of those hospitals for all of those registries every two weeks. And then some of them we send out an M&M report on a monthly basis. We provide network reports quarterly and then any ad hoc reporting that is requested from us. So now that you know a little about my health system, we want to ask you about yours to get an idea of what all of you are doing. So our first polling question is, what is your team's primary work location? Is it A, remote, B, in person, or C, a hybrid model of remote and hybrid? Great. Okay. It is shown. There's our results. So we got 26 response remote, 3 in person, wow, and 23 hybrid. So good. Because I'm going to, you know, talk about the remote. Heather's going to talk about more of the hybrid. So it's a good mix. You know, and I want to bring up, when I say remote, I know a lot of people were remote before COVID came. Abstractors maybe were abstracting from home. So that part of it was already happening. What makes my team different is the work from anywhere, that we were able to hire talent from anywhere. That was a new concept. Yes, abstraction businesses did that, but hospitals didn't. So big change. So here I want to know, if you answered that you're remote or hybrid, is your team located in one state, or is it located in multiple states? Sorry for the people over there. I can't see. Yeah, like, does this thing come down, you know, like the microphone? All right. Oh, you know, almost half and half again. So one state, 24, and 19 in multiple. That is awesome. That's exciting. That's exciting. I would love to hear about the multiple states more myself, to be honest. So I'm going to go over a couple things that we do for keeping our remote staff engaged and connected. And one of the key, key things is communication. And we've decided as a team to do that with our cameras on whenever we have a team meeting. When we first got together, we made it voluntary. You know, nobody wants to have their camera on. Even if you did your hair and put your makeup on today, you generally don't want it on. But we agreed as a team that would benefit us to be connected, because don't forget, we came together, one, as a new team, two, out of state, and we didn't, a lot of us didn't know each other. I think four are from the original AHN network at this point. So that's one of the things we do. We have team huddles twice a week. This is where we go over network and team updates. Staying connected to the organization itself and helping our team feel part of that organization, although some of them have never even stepped foot, you know, on the ground at those organizations. We check in socially. We share pictures. We talk about stories, what we did over the weekend, things like that. We ask each other opinions on, you know, life things. One of the best things that we did, if you guys are looking for a great icebreaker, was a getting-to-know-you storyboard activity. And I learned this, actually, Colette Carlson did a talk at our organization once, and that's where I got the idea. It's just a PowerPoint slide. We created a template, but they made it their own. You share as much as you want or as little as you want, but really, it's just about yourself. People maybe put a picture. When they were younger, they talked about where they went to school, when they became a nurse, why. They talked about their family. Are they, you know, married? Do they have children, grandchildren? What do you like to do? What are your hobbies? What kind of food do you like? Things like that. It's a great connector because, you know, if you're a Harry Potter fanatic and someone else on the team is, you guys got an instant connection. We have a girl that hunts. Who would have thought? You know, so it was so interesting to learn those things about each other. That probably would have taken us five years to learn about each other, if we even did, to be honest with you. So highly recommend if that's something that would benefit you. We have registry-specific huddles once a week. This is where we go over if that registry went through an inner rate of reliability. Our coordinator provides education to the team of what we learned, where we have room to grow. We go over FAQs, announcements. And what's especially important at those meetings, we talk about where we are with abstraction. Each time the pod lead has to say how many cases I have on my case list and what date is, you know, the farthest from abstraction. And that's how we make sure we stay up to date. Like I said, we have a lot of registries. We have a monthly one-on-one touchpoint with the manager. So I meet with each team member individually, and they have the opportunity to ask me questions, you know, that maybe they don't want to ask in front of other people, things like that. Maybe they put that off, but we're on that one-on-one. It kind of pulls it out. A big thing that we talk about at the beginning, and sometimes even now, is transition to working from home. Because a couple of the people that we hired did not come from an abstraction background. Some did, lucky for us. Others did not. They came from the bedside. They came from the cath lab. Things like that. So it's a big transition. We talk about how you're going to go from getting 8,000, 10,000 steps to 2,000. You know, things like that. Kind of how you stay focused. Because you want to do the laundry, or, you know, just now we got dogs to take care of because we're home. If we were at work, they'd be in their kennel. So talking through that adjustment on those one-on-ones, they could ask questions. They provide me feedback. I ask them how they, you know, want to be managed and things like that. We review their productivity, and we talk about their goals. We have a monthly social lunch. One rule, no shop talk. And so that's fun. And then we have a quarterly education. This is provided sometimes by external vendors, data management groups, and also we have internal providers. And this helps us stay up with the latest and the greatest. So that's all work. Yeah, we have some fun. There's some social. Well, you know, one thing with keeping a remote staff engaged and getting to know each other better is being connected even outside of work. If we were all together, those that wanted to get together, maybe we would be doing that. So be creative with social activities beyond work. So we have a friendly competition. Is anyone a Cleveland Browns fan? Come on. I got a couple people back there. Thank you. Pittsburgh Steelers? Oh, come on. I'm glad I didn't do a poll, because I would have had to share that with my team. So the background there is epic rivalry for I don't even know how many years between the Pittsburgh Steelers and Cleveland Browns. So we have some fun with that. We have some friendly competition. There might be some betting going on, some smack talk, things like that. And sometimes the prizes are you have to mail the person that won cookies. Sometimes you got to put a background. I refuse to put it without writing lost a bet behind my thing. I am sorry to say that at the next Browns-Steelers game, I have to wear a Steelers t-shirt. So I said I will stop at the shaving our head bet. Not going that far. One of the really fun things we did, decorating gingerbread houses after hours. So people went to Five Below, wherever they wanted to, got gingerbread houses. We got on after hours. Voluntary. You know, if you want to do it. I think all of our team participated. And you know, you're at home, and it's after hours. So you can have whatever you want for beverages. You can involve whoever you want. We had kids helping. We had animals, you know, make appearances. It was a lot of fun. We did adopt a family for Christmas. So although we're remote, you can still engage in these things. The Caring Place is an organization that provides services for children that have lost their parents or their guardians and loved ones that take care of them. So we adopted a family. We will assign either you can send money to the designated person or buy the gift and mail it. The people that could get together in person did that. And then we did a team's meeting to include everybody. And we socialized with those that were on the team's meeting, and they got to watch the wrapping. No, you didn't get to participate, but you know, you donated your hard-earned money too. And you need to be part of that. Lottery. If we want to get in on lottery, we take a picture, send it in our group, you know, chat. And we didn't win. Somebody in California won the big one. Did you see that? First, I thought it was at Cleveland, which didn't matter because I didn't buy a ticket. You know, sponsoring the community, if we can. We do go to these things to stay connected to the organization. United Way Fundraiser, we participated in that. And we share the responsibility. It's not always one person doing it, and we'll mail that. The organization supports that remote work and us being to participate, being able to participate in things going on in person. So that's how we, you know, do that engagement. The last talk we had, they talked about, you know, morals and humanity and connecting. And that is so much part of being connected in a remote environment. So how do we measure that engagement? One, you know, probably the simplest and most obvious is observation and communication. You know, are people involved and attentive or are they distant and preoccupied and distracted? Another reason to have your cameras on because I could tell when someone else is working on something else, sometimes they're texting each other, I could tell that too. But, you know, then I call them out on the meeting. But, you know, it just keeps people involved. And then, you know, you wanna make sure that everyone feels that they're contributing to the organization and that ultimately they're impacting patient care. So sharing, you know, some of our team, they don't all do cath PCI, but we're gonna share those outcomes reports. They don't do adult cardiac, but we're gonna share our star ratings and celebrate that together. Participation, you know, is everybody participating? If someone's not, I'm gonna maybe reach out to them individually. Hey, everything, you know, okay? And sometimes you learn someone's dog died or something, they don't wanna share it with everyone, but they're down and, you know, things like that. Surveys, most of us, if not all of us have surveys, whether it's third party or provided by our organization, this is a great way to measure engagement. And if you, you know, they're once a year. So if you wanna do your own thing internally to measure your team's engagement, you can do that too. This just kind of shows a couple of the metrics that were very important to us. The mission and purpose of our organization makes me feel my job is important. And you see the 2021 score was 3.6. That was when we came together as a group. Not everybody was happy we came together as a group. 2022, after we implemented a lot of these things, there was probably some, you know, definitely replacement through attrition and people moving on to different positions, but we had a 30% improvement. I know what's expected of me at work, 4.9 to 18% improvement and then my supervisor or someone at work seems to care about me as a person. That one of course is, you know, near and dear to my heart. So I try to make sure that everyone feels appreciated because if it wasn't for the people on my team, they make me look good. And I recognize that, you know, and you gotta make sure that you appreciate them for that. So accountability. How do you hold your staff accountable in this remote environment? How do you know they're not doing laundry, you know, visiting with their daughter that's home from college or I don't know, you know, things like that? Because we do have set schedules. Another, I would say probably different from maybe a third party vendor model or an outsourcing abstraction model, I believe, you know, you get your assignment, you do them when you have to do them. I'm not in that environment, so I don't know, but we are, all of my team punches a clock. They clock in and clock out. We do have flexibility, but you know, they're expected to be working during that time. So you wanna determine and define what those expectations are related to productivity. What's your expectation for the time to abstract? And that's registry dependent. We did our own internal, you know, time studies. I think we all kind of know what we would consider the average for, you know, the nation. And the volume of cases to be abstracted. Looking at that too, because that's gonna depend. We have a few different roles. There's a pod lead role, and there's a primary abstractor. The pod lead is the one that's doing the submitting, the cleanup, the creating that report to send out the outliers. So they're not gonna be abstracting as many cases, so taking that into consideration. How we measure productivity is we have a tracker that everybody has to fill out daily. Yes, it is a pain in the butt, and nobody likes it, but I also remind them, you're working from home every day, and the hospital's paying you a nice wage. We have to show what we're doing. So, you know, it's just a necessary evil, to be honest. And then I receive a manager report weekly. And what this includes, cases, like I said, based on time, registries, submission, drill down, things like that. This is what it looks like. So, let's see, to your left. That's the registry abstraction form that they fill out. Basically, they're putting in a MRN. They only account for the patient once. We like to do a one and done, but let's face it, you can't always, you know, we need addendums, we need things like that. But they don't count it again. They only count it once. And then they pick their registry. And the time is applied to it. So let's just say cath PCI. They have 60 minutes. Well, sometimes one's gonna be 40, sometimes one's gonna be two hours. It's really based on averages. And looking at it from that aspect. Then, to the right of the slide, it's the other tasks. Because they're not always abstracting. You know, you're, like we said, submission, deadlines, helping with audits. You know, IT support, that's a big one if you're working remote. So, things like that that we have to consider. This is the report that I received. This one is showing this individual. So, up to the left, it's charts per month. Then the top right is hours per month. So that correlation, because like I said, different times are applied to different registries. And then down below on the left, that's a pie chart of how many cases they did for which registry. This individual, as you can see, abstracts a lot of different registries. And so it's a quick view for me. I can filter it by day, by month, by, you know, multiple months, however I wanna look at it. The part I use the most is to the right to the bottom. It's a quick view of what they're doing on a daily basis. And I can look at that. This is another example. This person just started, you know, this year. And so when I look, I know if someone just started or they're being trained in a new registry, they're not gonna be doing as many cases. That would be our expectation. So again, taking all of those things into account. So this pie chart, you know, shows a few, you know, less registries, but most of our people do more than one registry. And we make sure that every registry has at least two people doing it. So if somebody goes out or anything like that, we do have coverage. And for this one, when we look down below to the bars, you know, I can see where on a Monday there's one, on a Tuesday there's one. Well, that's when they're doing drill down. She's our ICD pod lead. And the gold color is the ICD registry. So that's my expectation is that on those days she would be abstracting less cases. Okay, so that accounts for abstraction. What about, oh, well, let me before I jump ahead. So this is another view that I have. And this is one individual. It's a week period, and it's a quick view of looking at productivity. I mainly, the first one is item count. But because this is a Tableau report, and if they're adding anything, like maybe they're adding an other, or they helped with audit for 30 minutes, it's gonna be counted as an item. So I don't pay too much attention to that. It's really not giving me that much information. The thing that gives me the most information on this view is that weekly hours. It's the second row over. And you probably can't see it really good, but this is showing, you know, this person had data submission meetings, other minutes, and they described those, outlier review, and some bases and follow-up cases and things like that. But that weekly hours, 53.3. She's a 40-hour employee. So hey, she's got some good productivity. You know, she's for the time that's either allowed to her for the specific registry, or the thing she's doing extra, you know, she's doing 40 hours, 53.3 hours worth of work in that 40 hours. And sometimes, like I said, it'll be 35, it'll be 34, it'll be less. Maybe, you know, they have different responsibilities, or they're learning a registry, things like that, taking all that into accountability. So this is where I was going before. When they have other responsibilities or things that we don't have listed out, we listed out the common things. If they aren't listed out, they're able to pick other and then describe it. So here, you know, TVT missing pieces, updated case list, started my M&M, and then plugging in their minutes. So it's all right there. You know, if you're in this type of model, I highly recommend something to measure your productivity. This is just a very high-level view, and I think this may be, no, this is a monthly view, again, but it's all of us and all of our registries. So I can easily see, you know, we abstracted 1,061 cases this month, or whatever the case is. So a great way to measure productivity and be able to answer those questions when I'm asked by leadership in a fairly quick manner. Also, like I said, we talk about those. I talk about them with the abstractor on that, those monthly one-on-ones to, you know, be sure that they understand the expectations. So, you know, so we got engaged. We're measuring our accountability, but really, how do you keep the staff engaged? Because this is a daily, day-after-day thing. Part of that is being sure that you have clear expectations and deadlines. People need to know what's expected of them. If they're not clear what's expected, it's easy to get distracted, especially in a remote environment where you have to be self-driven. You know, nobody's there keeping tabs, things like that. So, you know, and the key here, my opinion, standardize, standardize, standardize. You've heard that probably many times, you know, during our last couple days about decreasing variation, and that's gonna improve your efficiencies. So, like I said, we have set schedules, roles, responsibilities, it's very clear what the coordinator's responsibilities are versus a pod lead, versus a primary abstractor. Almost all of our team members have additional responsibilities, but some don't. We wanna meet them where they wanna be. If they are, you know, scared to death to present in front of someone, I'm not gonna make them present in front of someone. And I know there's different, you know, trains of thought. I definitely push people out of their comfort zone, but I want them to enjoy their job. And if you're, you know, that's something you don't wanna do, and we have those conversations. So being very clear on what the expectations are. You know, we have an abstraction process map. Yes, it varies a little because registries are different, but the premise is the same, and it's spelled out very clearly for them. Caseless, statement of work. How many cases should they be picking? How do you pick them so that we know two abstractors aren't doing them at the same time? Things like that. How do we communicate within that caseless to say what was missing or what we need to follow up on in case this person all of a sudden is out for, you know, a couple weeks or something? Or if they win the lottery and never come back. You know, primary, secondary, short document. I know I brought that up in one of the other talks. You know, list out. It's tedious and it takes a while to make your initial document, but once you do, it's very, very useful for many different things. And then outlier review and feedback process. How do we do that? What do I do when I find an outlier? Who do I go to? Who double checks it? When do I go to a physician or a clinician or things like that? All spelled out. Who do I go to? We have six different hospitals with 10 different registries. So we have a very large contact list, but everybody knows I can go to this spreadsheet and know who I should contact at this hospital. Audit process. We have that all spelled out. And then, of course, the productivity tracker. So, you know, everyone knows how to use it and what's expected of them so that there's no surprises when it comes to a, whether it be an annual performance review or anything else. Something that's very important in the remote model, especially, like I said, when some of us have not even met in person, is to develop team norms. And team norms are a set of guiding principles and actions that set clear expectations on how a team will work together in a remote or a hybrid model. We went through three steps to establish our team norms. We had discussion, we established our beliefs, and then we said what our action items would be. And we did this as a team. So it wasn't, you know, just this is how we're gonna communicate. We talked, how can we communicate best? Because that's probably, like I said, one of the most important things. So for communication, like we said, we believe team members deserve a timely response. So we will email for non-urgent, we'll use our teams, we have teams channels for each registry, and then one for our whole team. If we need to answer right away, we're gonna send the message in Teams, or, of course, call. And then also, though, being respectful that people's phones or their personal devices, we're not just gonna text or things like that. We're gonna communicate within our job roles. And then, you know, innovation. Actually, collaboration. We believe everyone should be included regardless of where they work. This is an important one because when we work in person, you know, you have those water cooler, we know that isn't true, but it's cliche, the water cooler conversations, things like that. Sidebar conversations still go on when you're remote. And sometimes decisions are made between a few people. Share it with your pod or with the team. Something we agreed that we would do. The other thing, always include a virtual option, which is, you know, pretty obvious, but consider people's time zones. We are not all in the same time zone. So don't schedule a meeting that someone has to be on at 6 a.m. when they're not expected to work at 6 a.m. Things like that. And it's an adjustment. I'm not gonna go through all of these. Accessibility. You know, everyone deserves downtime. One of the, I would say, probably, I don't know if I would say negative things, maybe negative things, you are expected to be available all the time. When my boss can't get me on, you know, the teams, it's, oh, I was trying to reach out to you. Well, every now and then I have to go to the bathroom. No, you know, things like that. So it's kind of like when your kids text you. My daughter is the kind of person, mom, mom, I'm gonna send out the police. Mom, you know, and I'm young. She doesn't need to worry about me falling and I can't get up or anything. But it's just, we have this expectation that you have your phone on you all the time and you're available anytime. So just to have respect for that. And then, you know, have our core hours for collaboration, things like that. The other thing is accountability. You know, we are on our teams a lot, things like that. You know, we still wanna be professional. We like to have fun, but you have to be professional. Be aware of what's in your background, what you're putting on your background, things like that. When it's a team meeting, you can be more casual. But if you're in a physician meeting, a quality improvement team meeting, anything like that, because we collaborate with all these hospitals and all these services, dress professional, at least from the waist up. Wash your hair, things like that, or whatever the case is, you know what I mean. Just be professional. So in summary, to keep your team engaged, it really communication, communication, communication is key and that's professional and personal. Recognition, it's hard enough to recognize people when you're in person, but I think even more difficult when you're not in person. And like I said, especially because you haven't even met some of these people, I want them to think I care about them, or I do care about them, I shouldn't say think. I want them to feel and know that I care about them, like they're my family and friends, and they do. I truly believe they do. So it's possible to establish that. Set clear expectations and deadlines, standardize for ease and efficiency, provide them what they need so that there's no questions, and a safe atmosphere to talk to you about anything. And then accountability. You know, you have to figure out a way to measure their productivity and things to stay accountable, and it's beneficial to them as well as it is to you, because like I said, then there's no surprises when it comes to a performance eval and things like that. And that's all I have. Thank you. Thanks. So I'm gonna go ahead and hand it off to Heather, and she's gonna talk about more of a hybrid model. Okay. So Sheila shared with you how she's able to hold her team accountable through authority as their manager. I'm going to share a different view with you. And I'm going to share with you my perspective on also keeping your staff engaged, measuring staff engagement, capturing accountability and developing clear expectations through influence rather than authority. I am not their manager. I have no conflicts to declare. Before we get started, I am going to start with a polling question. So is your abstraction department a centralized model like Sheila shared with you, hers is, an individual hospital model or a mix of both, a hybrid model? Okay. So pretty good mix. I work for UnityPoint Health and we are a hybrid model. We have our markets or our individual hospitals and they have direct oversight for their abstractors. And then we have our cardiovascular service line. And we're able to make changes among our system through influence rather than authority. Later you'll hear me refer to our hospital as a matrix environment. What I mean by that is team members who report to multiple leaders. So this is a quick map of UnityPoint Health. So we provide a network of care to communities, an integrated health system that spans 17 regional hospitals, 19 community hospitals. We have three colleges, greater than 400 clinics and home care services are provided. We are in the Midwest. We span Iowa, Illinois and Wisconsin. In my current role I split my time. I am a data abstractor at two of our local hospitals. And then my other time is split being the Cardiovascular Outcomes Coordinator for ten of our hospitals. We have ten hospitals which are cath lab-enabled. Last year in 2022 we abstracted 16,333 cases. That's not including any of the follow-ups. We have ten hospitals within eight markets, 24 cath labs. We participate in heart caths, structural heart, electrophysiology and vascular procedures just to name a few. Our reporting differs from Sheila's in that we have six markets who report to cardiovascular. We have two who report to quality, and then me as the Outcomes Coordinator. I started this role in September 2021. Prior to that there was no oversight over the entire system. It was individualized to each hospital. And each hospital kind of did their own thing with their abstractors. So it's very new to us still. Even though we're two years in, we're still trying to align processes. So I'm going to walk you through kind of our process of where we are and where we're heading. So we have 13 dedicated data abstractors. We have 16 who are hybrid. And what I mean by that is their primary job is either in quality or cath lab. And they do abstraction in addition to their main duties. Through influence and collaboration I've teamed with both the market abstractors and the Outcomes Coordinators in the individual regions to successfully implement workflow, best practices and outcomes improvement initiatives. These have resulted in increased efficiencies and system standardization across all of UnityPoint. So keeping staff engaged. At UnityPoint we have what's called our Focus Values. And our Focus Values help us to encompass our standards of behavior. It's what helps us to keep the patient at the center of care. It helps us to focus our patients, that we provide the best outcome to every patient every time. It helps guide our service line in our day-to-day work. It helps us to remember that the patient is our why regardless of our job or our location. Most of our data abstractors are in-person. We do have a few that are hybrid. So what does FOCUS stand for? F stands for FOCUS. What that means is collaboration across all departments and regions. This is where my split role comes in, and I'm working with trying to align our practices that had previously been very individualized. O is for owning the moment. Connecting with each person, treating them with courtesy, compassion, empathy and respect. C is for champion excellence, committing to the best outcomes and highest quality, believing and sharing our results, learning from our mistakes and celebrating our successes together. U is for unity point. S is for seizing opportunities. We embrace and promote innovation and transformation. We create partnerships that improve care delivery, encourage to challenge the status quo. So just because it's always been that way doesn't mean that's how it needs to remain. So when I first started in this role, like I said, everything had been individualized to each hospital. So my first year within the Cardiovascular Outcomes Coordinator role, I spent digging into everyone's data. I went back two years and I was able to go to each individual hospital and say, okay, here's the areas we're going to focus on. Here's how we're going to fix this. I had to build a relationship with those abstractors first, because if you come at them and just say here's what you're doing wrong, then yeah, it doesn't go over well. So I hold monthly meetings individually with each abstractor. I also hold a monthly data abstractor forum with everybody. During those meetings we discuss any update, any NCDR updates, any UnityPoint updates. We go through FAQs that they may have submitted. We share what we're learning. If one person had a question, then somebody else is going to have it as well. So we work together and try to share what we're using. During those meetings we also share any current projects that we're working on, any expectations of these are the metrics that there's focus on this month or in the next several months. So then they know where we're at and what we're working towards. I meet each person where they're at. I had a couple abstractors when I first started that they were very, very reserved. They didn't want anyone coming in and digging into their data. I had to realize that I had to meet them where they were and start working at their pace instead of jumping all in excited. So identifying shared opportunities for improvement. So how can we align these processes? We know that that's what we need to do. So we've changed some things since I started. When I started we had some people entering data directly into NCDR. We had some third-party vendors. We had some that were abstracting on paper and then entering in. So we do direct data entry now. I was able to identify not everyone had two monitors at their computer to be able to directly abstract. So we were able to set that up with all abstractors. Those who were working at home, we were able to identify that some of them only had one monitor at home. So they felt like it was slowing them down when they were working from home versus in the office. So we were able to set them up with getting a second monitor at home. So they could be just as efficient while at home. We developed internal tools and resources to support outcomes improvement. Looking at everyone's data, we realize that not everyone gets into NCDR and looks at the dashboards like we do. We're all very familiar with them, but not everyone is. So within NCDR we have exported the information and created kind of our own simple dashboards. And with those we share those with directors. We share those with the physicians. We share them monthly with the physicians. So they know where we're at. And it just helps us to share where we are, where we're going, and working together as an entire system versus individually. So how do you measure staff engagement when you're not their manager? With the use of EMR to support evidence-based care, we use smart phrases. We use order sets. This all supports clinician decision-making for both our inpatients and our outpatient units. We notice quite a few fall-outs after discharge. How do we fix that in real-time? We started doing real-time review of heart failure patients, MI patients. We created a discharge checklist for our inpatient units for these MI patients, PCI patients. And it's a last check for them before the patient gets out the door. Are they going home on the appropriate medications? Do they have cardiac rehab? Has cardiac rehab seen the patient before they leave? If not, is there proper documentation within the patient's chart that they don't need to be on it? And if not, they're making a phone call and putting a note in that they discussed it with that provider. Communication remains key to involve everybody. You're working with multiple departments. So I'm not just working with the data abstractors. I'm working with the inpatient nurses. I'm working with our same-day discharge nurses to make sure that we're all keeping the patient the center of care and that we're discharging them appropriately. I take our metrics back to them as well. You know, here's the improvements we've made for the work that you guys are doing. The SMART Phrases we use on our same-day discharge unit instead of the checklist. We had the checklist used first. They did really well with it. So we just built it into our EMR system. So capturing accountability through influence rather than authority, I split this between my two roles. So locally our abstractors are expected to, kind of like Sheila went through, expected to enter their productivity in a tracker. We just have an Excel spreadsheet that we keep, that they enter at the end of the day. This accounts if they get pulled to cath lab. Some of them cover cath lab launches. It covers if they had education that day, or if they got pulled to another department. It's just, it helps with transparency and accountability of what they have completed on a daily, weekly and monthly basis. I touch base slightly on the real-time review process. So we do this currently for our MI and our heart failure patients. We run a list every morning from our EMR system that shows us where these patients are at. We're able to get in the chart and look, are they on the appropriate medications and dosing? Has cardiac rehab been ordered? If not, I'm reaching out to our providers. I'm reaching out to our NPs and saying, hey, we don't have these. We either need a note or we need the order. It helps us to provide the best care for the patient while they're still admitted versus after discharge, finding out that these are fallouts. Communication with the entire cardiac clinical team. I am right across the hallway from our Cardiac Rehab Department. So they'll stop in and talk to me, hey, it looks like this patient had a stent and I don't have an order. Can you contact the provider? And just having that open communication so we're all taking care of the patient appropriately. And then at the system level, we do a monthly provider meeting. And this is just sharing with them our data. We share our data transparently. It has their names all over it. We do not blind their data. We used to and things weren't improving. And as soon as we unblinded their data and put their name out there in front of their friends and everybody could see it, things started changing and they started communicating. So for us it's been very helpful. I was in another session and they were saying be careful with that. But it's been a good thing for us. It's really helped to drive change. Additionally tools within our EMR system help support staff and patient care with utilization of the Smart Phrases Checklist. We have BPAs, Best Practice Advisories, I don't know if you guys are familiar with those. For MI patients for example, when the provider logs into the computer it will pop up and say, hey, did you order cardiac rehab? Do you want cardiac rehab on this patient? We also run reports to see what they're using and what they're not. So when we have fallouts we turn around and run and say, did they use the Smart Phrases? Did they use the Discharge Checklist? And then that's able to kind of drill into where the problem is. So developing clear expectations in a matrix environment. Priority setting is key. Like I said, I split this role. So I work at the system level half of the time. I'm a data abstractor the other half. So setting the goals, setting the expectations. So we're working towards where we need to be. This can be locally driven or system. We continue our work to align our practices. We have a lot of projects where we've been able to align our practices. But it's still a work in progress. We're still getting there. There's still projects to work on. Abstractors, directors, managers and physicians are all important stakeholders. Keeping everyone involved, bringing them all to the table to have these conversations, it allows everyone to have their voice heard. It helps us to align and standardize our abstraction process across our markets, assisting with clear expectations. Sharing our system-wide data transparently shows that we live our focus values and we believe in sharing our results, learning from our mistakes and celebrating our successes together. Collaborating with physicians sets clear expectations to our providers that we expect the best outcomes for every patient. I want to thank you guys for taking the time to listen to Sheila and I as we shared our different views on keeping staff engaged, accountable and having clear expectations. What I hope you take away from this is that staying connected from anywhere requires intentional connections and relationships. Transparent communication and alignment to a shared why are key to effectively impacting change, whether you're in a matrix environment or a more traditional. And then engagement and accountability through influence and collaboration can also achieve results. So thank you. Thank you both very much. We have several questions that have come in. So Sheila, this first question is for you. And I'm going to combine it because it was multi-factor. So basically they want to know what program you used, how you created the accountability tracker and will you share it? So it's a Tableau program. So our analytics builder built it. Will I share it? Screenshots of it are in my slide deck. As far as how it's built or anything like that, I really am unable to share that aspect of it. Even when I created my PowerPoint, I had to send it to compliance and it was a question always of what you share. And if you have a Tableau builder and you show them the pictures, I'm sure the person could build it. But other than that, I wouldn't. But yeah, it's a Tableau report. And of course we fed in, we told that person what we wanted included in it. So we said the registries, I told them the minutes that should be in for the registries. I said what should be in that other list. So all that came from myself. And then the rest of it, analytics, IT person built. Thank you. »» Actually both of you can answer this question very briefly. How do you get quality projects rolled out to your staff if you do? And how do you get buy-in when you're remote? I'm not sure that I heard that you actually start quality projects, but you participate by including data. But I'll let you guys respond. »» Yeah. Our network within the hospital, there are actually, we're growing in being a network. And recently every hospital has a quality improvement team. And we work very closely with them. But we also have connections at each of the hospitals. So whether it be I need documentation, whether I'm not, like we said a little bit in a different session, if I'm not getting shared decision making, I'm going to the EP lab manager. Whereas at a different hospital, maybe I'm going to the quality team lead for something. I try to give for the quality individuals at the hospitals, they have access to the dashboard. So they can look at, they don't have access to anything that we enter data in. But they could look at the dashboard and see where we are, knowing if you're looking at any recent data, we potentially are going to be changing it and it's going to look a little different. So we stay engaged in that way. We identify areas for improvement and we work with them through us providing the data to support their quality improvement projects. »» So for us, having the cardiovascular service line that we started in 2021, that kind of started the drive of where are we going to start? What are we going to work on? And bringing managers and directors, physicians into the conversation of, okay, here's all of the problems, where do we start? And just putting a list together, so to speak. And then you start working through your top priorities. You get through your quick wins first, and then the longer, the things that might take you a little bit longer, then you figure out how you work those through. So for us, it was the drive of starting the cardiovascular service line that really started pushing everything to an alignment of how we started for us. »» Thank you. Sheila, how do you address feelings of micromanagement when they know their activities are being tracked? »» Oh, that's a good question. I think they all felt that way at the beginning. The majority of people that were moved over, they were salary. Everybody was salary. And they got moved to this position as part of the centralization, not because they wanted to, but because it's the direction the network was going. So a lot of people definitely felt that way. It potentially contributed to who remained on our team and who didn't as the people moved over. I said just give the team a chance. If you don't like it, I'll support you, I'll give you recommendations, things like that to move on. And some individuals did that. And we had those conversations. One, they had a difficult time now needing to clock in and clock out. And then the second piece was the tracker. But they all enjoy their job and they enjoy the freedom, the flexibility. We have a lot of flexibility. They can punch out and take their child to a doctor's appointment and come back or make up an hour here and an hour there by the end of the week. So they know this is the tradeoff. The tradeoff is we have to show that we're productive and we're doing our job. And at this point, you know, when we came together as a centralized team, I was so busy. I couldn't do everything. And now we're in a good place. I can keep track of everything. But that would kind of slide by the wayside. And then I went to look at it because I was asked for productivity numbers. While I wasn't watching it, well, everybody wasn't filling it in very well. So lesson learned. And that's why now every time that we have a one-on-one, we look at that productivity tracker together. And honestly, now it has become more of a, it's a habit for them now, I think. »» Thank you. We have time for just a couple more questions. So for Heather, what was the benefit of getting rid of the third parties for data entry? »» Time. For us, it was much quicker to enter directly instead of running, you know, entering here than running your report, uploading. We were entering directly, hitting submit. With working with the abstractors and trying to make changes, we had to try to utilize our time. We did 17,000 charts last year without follow-up appointments. So we had to figure out ways to start saving time and that was one of them for us. »» Thank you. Sheila, you mentioned socials. How do you fund those socials? »» Sometimes I fund them. Sometimes the team funds them themselves. It's voluntary. Like Barbara and I were going to send out the gingerbread houses. And then, you know, the team's like, they're five bucks. We could go buy our own, you know. So the majority of it are self-funded. I personally send them cookies once or twice a year from myself to show them that I appreciate them. So we've become this family that people want to, they want to participate at this point. So they're willing to do that. »» And the last question, and you both can take the opportunity to answer. It says thoughts on the number of registries to FTE ratio? »» Oh, that's a good one. Thoughts. I don't know if I have a specific thought of how many I would specifically say for which registry because they're dependent on the registry and how long it takes. I mean, we do the ELSO registry. It was four hours to abstract a case when we started. We are down to basically two, whereas, you know, ICD, it could be 45 minutes. So when you think of it that way, you can't necessarily just come up with a number because there's so many other things. And that's just talking the abstraction piece. It's not even, you know, discussing all the other services that we have to do and provide. So for yourself, I would say come up with your own. Do time studies. Where are you at and what makes sense to you? And then like Heather said, create efficiencies. Standardization really creates a lot of efficiencies. Anything you could migrate, things like that, creating efficiencies will help with that FTE. I'm sorry I didn't answer it very specifically, but I don't have a specific answer. »» And I agree with the time watching. Starting the cardiovascular service line, I had no idea where everyone else was for abstraction. I knew where I was. I knew where my local team was. But I had no idea for the others. So I just put together a spreadsheet and I put all of our regions on there. I put each registry and then I went through and I just asked them individually, how long does this registry take you? How long does that one take you? And then we looked how much time on average for each registry and how their volume. And then we looked what their FTEs were. So we've been analyzing it that way as well. »» I know everybody always wants an answer to that question, just like they always want to know how long it should take to do the abstraction. You're never going to get an answer for that because it's different for everybody depending on where they are in their career and learning that. But we still ask the question every year. Thank you both very much. Appreciate your time. »» Thank you. Thank you very much.

remote work

engagement

communication

clear expectations

accountability tracker

productivity

hybrid model

relationships

EMR tools

staff engagement