[Introduction]
[Music]
[Narrator]
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 (IAFN) and the National Sexual Violence Resource Center (NSVRC). Thiscourse highlights ways in which to cultivate leadership and build a successful, sustainable SANE program with presenter Laura Rogers, who is the Director ofEmergency Services, Urgent Care Clinic, and Memorial Star Transport at Memorial Hospital in Colorado Springs.
[PowerPoint Presentation]
[Slide 1: Making the Argument]
[International Association of Forensic Nurses (IAFN) logo and tagline: heart and cross within a magnify glass and tagline Leadership. Care. Expertise]
[National Sexual Violence Resource Center Logo]
(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.
[Slide 2:]
[Caduceus in teal]
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.
[Slide 3: Cultivating Leadership and Professionalism]
[LEAN model with arrow and sequence of words: Where are you now? What does “vision” look like? What will it take to get there?]
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 we’ve 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 you’re looking at LEAN, to develop an A3 of your program and look at with a SWAT analysis, what are your strengths of your program, what are your weaknesses? What opportunities can I capitalize on? And thenof course the last box of any SWAT 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.
[Slide 4: Essential Tools]
[Stethoscope laying on coins]
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 withthe SANE group. Let’s take a look at those.
[Slide 5: Sustainability Fundamentals]
[Nurse at station looking at a paper]
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’recaptializing on what other people have already developed and moving forward.
[Slide 6: Program Assessment and Evaluation]
[Felt heart patch with two band-aids crisscrossed on the heart]
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.
[Slide 7: Funding, Support and Billing]
[Hand with pointer finger balancing a stack of coins]
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.
[Slide 8: Funding, Support and Billing]
[Stethoscope wrapped in money]
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 seniorleadership 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.
[Slide 9: Managing People]
[3 nurses walking down a hallway in a line]
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 deliveringa 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.
[Slide 10: Managing People]
[Nurse holding and looking through a binder]
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.
[Slide 11: Program Expansion]
[chart with blue arrows and ascending blue bar graph in the background]
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.
[Slide 12: Collaboration (Intra- and Inter-Disciplinary)]
[Colorful cartoon type of drawing of people with speech bubbles. Picture is in the shape of a heart]
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. Wewouldn’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.
[Outro]
[Music:]
[Slide 13]
SANE Sustainability Education Project
This project was supported by Grant No. 2011-TA-AX-K077 awarded by the Office on Violence Against Women, U.S. Department of Justice (OVW DOJ). The opinions, findings, conclusions, and recommendations expressed in this course are those of the author(s) and do not necessarily reflect the views of the OVW DOJ.
[Slide 14]
This podcast is part of the SANE Sustainability Education Project mobile app which is designed for Sexual Assault Nurse Examiner (SANE) 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
[Slide 15: Connect With Us]
[IAFN Logo and Tagline]
6755 Business Parkway, Suite 303, Elkridge, MD 21075
Online:
Call: (410) 626-7805
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