You are listening to a SANE Sustainability Education Project podcast. This podcast comes
from a portion of the SANE Sustainability 6-week online course that was offered by the
International Association of Forensic Nurses and the National Sexual Violence Resource
Center. This course highlights ways in which to cultivate leadership and build a successful,
sustainable SANE program with presenter Laura Rogers, who is the Director of Emergency Services,
Urgent Care Clinic, and Memorial Star Transport at Memorial Hospital in Colorado Springs, Colorado. (Laura Rogers) I think we're going to give you a couple
hints on how to really make your program the best it can be in the environment wherever
you are.
So really what we're talking about is making the argument for a complete program
in your hospital systems. The base of making this most successful is
understanding you have to have a culture shift. And when we moved away from us being viewed
as just a law enforcement role to absolutely now something that is viewed as medical care
for the victim of violence; medical and nursing care specifically. I think that there's
where we saw the most development of recognition from our leadership and development of that
program.
So what I'm going to ask you to do when
you're designing your program is really do a solid assessment of where you are now.
Because in all of the LEAN work that weve said is recognizing your current area where
you're working right at the moment, what does your vision look like to go to the future?
What is your ideal program? And I think we all have ideas of what that program would
be, but then writing it down, taking a look at it, and then really determining what will
it take for me to get there as a leader in my program? This is just what the LEAN process
does. Develop an A3 is a terminology, if youre looking at LEAN, to develop an A3 of your
program and look at with a SWOT analysis, what are your strengths of your program, what
are your weaknesses? What opportunities can I capitalize on? And then of course the last
box of any SWOT analysis is what are the threats to the program? And I think the main threat
we're all going to really find as we move forward is justification of our most expensive
element and that's our personnel. So how do we get the leadership in your hospital
to recognize you as integral to the patient care of this unique population.
To do that I think we look to Studer and the 5 pillars that Studer's talks about in all
of his work are service, quality, financial, people, and growth and how does that look
with the SANE group. Let's take a look at those.
Well service is how are you meeting the patient, the staff, and the law enforcement satisfaction?
You need to understand what your product is and your product is absolutely the nursing
care you're providing a patient that comes through your door.
Your delivery in this challenging
moment is truly the element that you have to take a look at. You can go to the leadership
and ask them for great growth in your program but you really need to look at the quality
of your program delivery, your product, your nursing care. Be very, very good-- It may
not be that you'll may be able to have a full in-house 24/7 program, we didn't to
start with either. But what we worked on, I believe, certainly starting with the goals
that we have is that we are going to give the absolute best quality of care that this
patient needs and that is being provided by our team.
Know your product, your delivery,
and how you're doing it refine that delivery. And you refine that by is this delver in the
most caring, time efficient quality delivery of care that you should be working on. And
work on those elements-- that's all part of the service. Your QI or PI program is the
hallmark of this and really doing 100% review so that you know you're doing well.
And
then ask all elements. One of things we worked on in the last year and half, or two years,
is closing the feedback loop with the law enforcement group and the court group. How
are we preforming in our role? Are we actually making your process better? Or are we finding
that maybe we need a little work on delivering in the court system? Is our product, nursing
care, of these patients understandable to your group? And closing that loop. And then
of course, publish your findings.
Get the team talking about your delivery of care.
Recognize that Memorial Health System in Colorado Springs is getting known as a place where
sexual assault and assault of a victim of violence is someplace that is doing it, and
doing it very well. You're starting the science. You're captializing on what other
people have already developed and moving forward. What is the reputation of your program? And
this goes back to the quality of the care of delivery.
Do you have the best staff performing
those elements? I have to say that the sexual assault nurse examiners are absolutely unique
people who have wonderful qualities in that caring world and yet being able to step back.
Are you measuring your quality in a way is how are your staff coming across? Pick the
best people. If you have the right people there they sell your product. How do your
staff interact with community and the partners? How are they interacting with the law enforcement
personnel? Or the district attorney's or the city attorneys that you work with? Are
they collaborative in where they're going but are still maintaining standards of practice?
Because this is a balance, sometimes law enforcement or the attorney's office will be asking
questions you really are, your product is your nursing care stand behind it. It is
really all about delivering the highest patient care - if you get that right you will be recognized
as the people who make this better.
Financial, and here's the big bump in the
current world in which we have to always worry about finances and being able to provide healthcare
in a diminishing return on investments you have to be smart about the finances. Identify
what you provide in services and what it brings to the people. Be able to talk about reimbursements.
Are there other opportunities for reimbursement? Are there victims assistance programs? You
suddenly are in a realm that you may not know this knowledge right now but this is understanding
your product and what you deliver to patients that the organization needs to know about.
This is medical care. Medical care costs money.
You're going to hear a lot of emotional
responses about patients not, should not have to pay for their exams. And I think that's
something worth discussing a little bit about regardless of how you feel about how your
contribution in what the victim has gone through. Remember think about what you're providing
this patient. You're providing this patient medical nursing care.
So if that's the case,
and moving out of the culture that you are collecting evidence for the police department
or for the court system, think about the services this patient is getting. Now don't get me
wrong if we could give all this funded for these patients that would be great. And I
think that there might be some resources in the future so a victim of violence such as
we're talking about wouldn't have to pay. But as I say, medical care costs money and
you need to be able to talk this through so that when your senior leadership team comes
to you and asks about "well you're costing us money" that you can translate that into
the following: make the argument that the best patient care for a stroke patient coming
in, is getting an evaluation, an NH score, and that's what the standard is, then we
need to establish the same standards for the victim of sexual assault.
And I think when
you put it into the framework of pure medical care and again, changing your culture to say
"I'm not just collecting evidence, but I'm providing medical care for this patient"--
that's where we all win, most of all, the patient.
Recognize when you're talking to senior leadership in making, sort of an argument
for a 24/7, you need to look at what's the return on investment for your organization.
And I think you need to talk about the people that are there. It is not just an ED nurse
we're talking about. We are talking about an expanded practice role for these nurses.
It's a higher quality of care than the regular ED nurse out there. We've moved beyond taking
the clipboard and just collecting the evidence.
We are now delivering a specialized medical
care for a patient. Just like stroke, just like heart attack. Keep it at that level,
in which we are providing a special care. You must remain an expert in the field.
Just
like we go to ACLS for cardiac care, this will become a standard in the future that
people are going to be certified in the care of the victim of abuse. Recognize cost in
maintaining that skill set so if you're managing a department, at the beginning of
the year when you're looking at budget, you have to look at "what is accountable
to maintain skill sets for everyone?", "How many people need ACLS?", "How many people
need those specialized testing and skill sets?" Include the SANE nurses in there, included
in the beginning of your budget. We need to retain people, we need to bring people in,
train them, take care of them, and then fund them appropriately.
Growth. You have to be able to talk your program.
Know the number of patients you're seeing,
know the reimbursement rates and mechanisms, and know the cost of 24/7 coverage. When you're
looking at that, the most expensive thing on a program is personnel and expansion is
the key. Put the hat on of senior leadership team member and when you're talking with
that member they have a lot of challenges right now in making a whole hospital system
remain in the black. Understand that, argue at their level.
And arguing at that level
is pure quality, and quality of patient care delivered to a specialized population. It
may be that you need to look at when patients are coming in, and of staff, as you expand
what else can the SANE nurse be doing? Understand that personnel, like I say, are the highest
cost for any organization so support that. Generally, here's my suggestion for you.
Have an elevator speech always available. Be able to have every member of your team,
if you've got thirty seconds or less in an elevator with a senior leadership, be able
to talk your product.
Do put the hat on of the senior leadership team and recognize that
challenges the leadership is having with finances- this is just a given. Get community partners
to sing your praises. And I will say that one of the highlights of my two years was
when the District Attorney stood in front of the cameras and said "do not touch that
forensic nurse examiner program at Memorial Hospital, when you elect to leave. They are
integral to us and our success in our whole program." Boy did the senior leadership
team take note at that point.
We wouldn't've gotten there if we hadn't worked way back
on the quality of care delivered this team. Get community partners to sing your praises.
Are you active in the community with those elements that serve this special population?
And get your good work published. Engage marketing at your hospital or/ and highlight those successes.
The programs are great press programs, so get with your newspaper to highlight those
issues also. In the end, put the right people in the position,
work on the quality of your product- be the best you can be, and know your population
and constantly improve.
(Narrator)
This project was supported by Grant No. 2011-TA-AX-K077 awarded by the Office on Violence Against
Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations
expressed in this course are those of the author and do not necessarily reflect the
views of the Office on Violence Against Women, U.S.
Department of Justice.
This podcast is also part of the SANE Sustainability Education Project mobile app which is designed
for Sexual Assault Nurse Examiner program managers. The app helps program managers learn
more about program sustainability and provides practical tools to use in their daily operations.
It was launched in 2014 by the International Association of Forensic Nurses and the National
Sexual Violence Resource Center based on best practices from almost a decade of training
and technical assistance in this area. To learn more about the SANE Sustainability
Education Project visit www.Nsvrc.Org..
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