Introduction:

Related:

Great chefs have the culinary/cooking knowledge and skills to make good food, but this is not a guarantee that he or she can do this or even make food that is safe to eat. These outcomes often require chefs to have additional non-culinary knowledge and skills. Chefs must demonstrate effective leadership to ensure 100% compliance with safe food handling procedures throughout every stage in the supply chain even though they do not directly oversee many steps. Without such compliance, there is a risk that the food presented may not be safe to eat. They need to be able to forecast ingredients list and use checklists so that all, not some or most, of the items needed for meals are at the restaurant when preparation begins. They need financial knowledge, so they do not spend $20 on ingredients to make meals that are sold for $10. Some chefs will need to know the features of suitable equipment and have the influencer skills to get these, not less durable items, purchased, while others will need advanced business skills to manage a restaurant. Most chefs will need a few non-culinary skills to make good food that is safe to eat.

Strategic non-clinical skills needed by providers to safeguard patient care:

Culinary expertise alone does not guarantee food is good or even safe to eat, just as clinical expertise alone does not guarantee medical care meets standards or is even safe. Many healthcare providers need non-clinical skills to consistently reach patient and other safety standards. A basic requirement is that all essential equipment, supplies, and medications are available and ready where they are needed. Any omission puts safe patient care at risk, especially in time-sensitive areas of care such as ambulances, emergency rooms, and throughout perioperative care. To achieve this objective some providers will need proficiency in planning need or forecasting and organization. Negotiation skills may be needed if there is resistance to purchasing essential items and budgeting skills may be needed if there are spending limits in place. These topics are mostly not found in medical education curriculum. Providers have unique knowledge in their specialty. This can be of great value to hospitals if it can be used to avoid shortages and outages of items during purchasing and inventory management, enable cost-effective expansion of services, and facilitating additional operational improvements. For this to happen, providers need to be included in the conversations and have a seat at the table where decisions are made.  Sitting at this table and being heard requires communication skills and various business knowledge and skills. Healthcare providers also have a unique knowledge of specific equipment. When providers lack knowledge of the essential features of equipment that make it complete, cost-effective and suitable, poor purchases decisions may occur. This can impair the capacity to deliver safe medical care.

Non-clinical skills needed by providers in management and other non-clinical roles:

Providers often give lectures and take on other responsibilities like simulation directors, crisis managers, as they did during Covid-19 outbreaks, and teach. Sometimes providers need to train workers in support roles, other specialties, and train future trainers. Leadership, teaching and lecturing skills may be useful for some providers with these duties.

Non-clinical skills needed by providers to ascend into management:

Every department needs a chief, and this is often one of the providers at the site. Often chiefs will need to make schedules, settle disputes, allocate resources, and report recommendations to management often without training in these areas. While some providers have these skills from family and community roles, others will need these non-medical skills, often quickly, to be successful. Providers often ascend hospital management and become CEO or CMOs. Hospital survival increasing depends on being able to provide quality care that is efficient. These young leaders must know the language of business and other financial skills. Providers often need some non-clinical skills and knowledge, to be able to provide safe, quality healthcare and to fill other medical roles.

Objectives of Healthcare Delivery Success:

“Healthcare Delivery Success – Part 1: Topics” is designed to be a calm space where providers can identify the strategic knowledge and skills they need to thrive and deliver safe, cost-effective healthcare. “Part 2: Seminars and Curriculum” is a collection of tools and resources designed to enhance the curriculum presented in “Part 1: Topics” and offer a diverse - including non-traditional – methods for effective instruction. It also has tools designed to help learners apply the information more easily. Both are incomplete and intended to serve as the initial framework to establish the space. Once an effective forum is established, “Topics” and “Seminars” in “Healthcare Delivery Success” can be modified or something better created, both are good options. Blessings, DS  

1.         Part 1: Topics of Strategic Non-Clinical Knowledge and Skills Needed for Healthcare Delivery Success: Is a list of topics that some providers will need for safe and successful healthcare delivery and to fill other roles.

2.         Part 2: Seminars and Curriculum to Strategically Equip Providers with the Non-Clinical Knowledge and Skills Needed for Healthcare Delivery Success: Is the resources and tools that support the curriculum and both teaching and applying “Topics”. It includes resources like WHO standards, checklists, SSIP guidelines, One Standard (OS) Assessments, Roadmap, and more. It also has tools like teaching videos, forecasting spreadsheets, schedule makers and more.

Part 1: Topics of Strategic Non-Clinical Knowledge & Skills Needed for Healthcare Delivery Success:

Key Skills and Knowledge for Success

Communication skills: *Clear, concise, closed loop, understood, professional, and heard are a few qualities of a successful communicator. Additional points include:

ð      Active listening

ð      Public speaking, technology, power point, zoom meetings +

ð      Delivering and interpreting various communication types: Verbal (what is said and not said and how it was said), non-verbal, visual, and written communications

ð      Professional

ð      Assertive communication to ask for items to increase the chance of getting them

ð       

General Workplace Skills for Efficiency, Quality, and to Avert Omissions

ÿ      Organization, site maintenance, using a checklist, accountability, site security, and oversite

ÿ      Standardization

ÿ      Checklists, and visual checklists

ÿ      Opening, closing, time and event related procedures, and Cross Checks

ÿ       

Negotiation skills:  

ð      And success in: Reporting issues, defending position, and giving opinion

ð      Having a seat at the table where decisions are made

ð       

Career success planning:

ð      Networking, self-introduction, linked-in, media+

ð      Contracts, employment, benefits, retirement+

ð      Non-medical related opportunities like tv, radio, influencer, speaker, team physician, community outreach

ð       

Self-care:

ð      Intentional time with our Lord

ð      Buffer time, rest, managing stress- tools and techniques

ð      Exhausted, tired, hungry, temptation, addiction, burn-out

ð      “No” and boundaries

ð       

Money-individual:

ð      Financial fundamentals: Residency to retirement, savings, loans, debt, children’s education +

ð      Benefits: Wages, health, injury, and life insurance, retirement funding, pay date, time-off, vacation, attending national meetings, CME, equipment stipends

ð       

Business skills applicable to non-clinical, management, and other roles

Leadership:

ð      Decision making, even when decisions are unpopular and risk personal harm

ð      Delegation

ð      Team building, coaching and motivating staff to reach targets

ð      Resolving conflict, opposition by those who do not want lead

ð      Debriefing after a bad event

ð       

Money:

ð    Transparency

ð    Cash flow, profit and loss, fixed costs

ð    Revenue engines, such as orthopedics and surgical services to offset financial deficits such as infectious disease and neonatal ICU

ð    Funding, grant application, insurance, debt

ð    Accounts receivable: The most important function of any business

ð    Operational fitness: The hospital’s side: Money, profit, loss, accountability,

ð    Cost-effective decision making

ð     

Workplace Operations and Efficiencies:  

ð      Safety first: Safety as a primary goal not a byproduct. The importance of systems grounded in safety, a culture and system of safety, infrastructure, the team, and no-blame

ð      The cost of unsafe, inefficient, fractured, fragmented healthcare. Economic and human impact of poor health care, non standardized care, duplication of services, on hospitals, communities and healthcare systems. (SSIP guidelines, antibiotic pressure)

ð      *Strategic planning and implementing cost-effective hospital improvements: Achieve safety standards, enhance quality, develop a competitive healthcare product, and strengthen hospital resilience

ð      Industry standards: For all staff groups, processes, departments, and algorithms

ð      *Proficiencies needed for all staff groups, provider types, and management (communications, accountability…)

ð      *Standardization

ð      *Checklists

ð      Operational fitness: Standardization, efficiencies, and protocols…

ð      Measurements of success Who is measuring. Why? (For funding? Healthgrades?)

ð      Cost to treat/cure: Benefits, who is paying/benefiting?

ð      Grant writing, Workflows

ð      Efficiency in the surgical suite: Safety first, block time, flip rooms, centers of excellence”, 1 orthopedic surgeon, 2 physician assistants, 2 operating theatres, 2 anesthetists, 1 anesthesiologist, 6 joint replacements in 8 hours, and 4 as outpatients

Management:

ð        Strategic Plan, business plans, and proposals

ð        Transparency, policy, oversite and accountability for safety and efficiency

ð        Situations: Impaired providers, bullies, theft, contagions…

Purchasing:

ÿ        The economics of good and bad purchases

ð        Planning purchases, evaluating and ranking needs, ensuring transparency, and executing the purchasing process.

ð        Sustainability, action and inaction

ð        Outcomes/costs

ð        Sustainability and the efficient use of resources

ð        *Equipment

ÿ  Qualities of equipment that make it durable and suitable, luxury vs essential

ÿ  Types of maintenance: preventative, curative and periotic care

ÿ      Daily maintenance and use of equipment

Costs:

ÿ      Calculating the total costs of items: Purchase price + operating costs + maintenance costs (preventative and corrective) +training expenses for use and upkeep + other ongoing expenditures

ÿ      Cost-effective purchasing with limited resources

ÿ      Cost of time and inaction

ÿ      Who pays/who benefits and cost allocation

ÿ      Predictable consequences of not investing in infrastructure

ÿ       

Equipment:

ÿ      *Needed Qualities in Equipment:

Quality improvement:

ÿ      Continuous improvement mindset and the path forward…

Budgets and forecasting needs:

ÿ     *Forecasting needs and budgets for a year and short term

ÿ    *Forecast needed items easily and without omission

Inventory maintenance:

ÿ LIFO, FIFO, rotation, meeting needs, theft…

Security:

Teaching skills:

ÿ Non-traditional learning: Problem-based learning, workshops, simulations, gamification, role-playing

ÿ Equipment, technology, and media

ÿ  

Practice management:

ð    Workforce: Projections, job descriptions and scope of practice, professional development, retention, burn-out…   

ð    Making work schedules

ð    Policy, benefits, conflict resolution…

ð    Human Resources: Recruiting, training, retaining, making contracts, firing staff …

ð    Payroll

ð     

Emergency readiness and Disaster plan: Emerging threats (Ebola/covid) and preparations, Sudden threats: Natural disaster (earthquake) and emergency responses. Sudden threats: Site, intruders in ORs +. Mass casualty, preserving capacity to provide care: Public voice+

ð      Emergency readiness

ð      Coordinating crisis responses, first response

ð      Press and media correspondence

ð       

Project management, planning and organization:

ÿ       

The next generation:

ÿ      Training programs – starting and sustaining, making tests

ÿ      Mentoring (Paul, Titus, Timothy, Phi) and being mentored

Notes: * Indicates One Standard (OS) resources for this topic

Part 2: Seminars and Curriculum to Strategically Equip Providers with the Non-Clinical Knowledge and Skills Needed for Healthcare Delivery Success: Work in Progress

1.   The first part of Healthcare Delivery Success begins with “Strategic knowledge and skills…”. The goal is to equip providers with specific knowledge and skills that they need or want and not everything about the topic. They will learn how to tell time and not how to make a watch.

2.   It is called “Seminars…” because the topics will be presented and learned quickly and concisely thus many learning opportunities are done in seminars.

3.   Ideally “Seminars…” will mostly not be taught in the traditional read, lecture and learn format. Many of the learners will be staff who work full-time. The traditional approach may be a sedative and perhaps sleep provoking after a full workday. Role playing communication styles, gamifying budget creation, and using problem-based learning and other – non-traditional teaching techniques, is the key to quick-efficient learning.

4.   One Standard has several resources to make proficiency in some subjects – like budgeting and forecasting need - easy. There are spreadsheets that calculate the number of items that will be needed in a year and their costs once data is entered.

Key Skills and Knowledge for Success: Resources – work in progress

Communication skills:

ð      Seminars – Additional Resources 1 – Dale Carnegie

ð       

Negotiation skills: 

ð    Book: Never Split the Difference: Negotiating As If Your Life Depended On It―Unlock Your Persuasion Potential in Professional and Personal Life Hardcover – May 17, 2016 by Chris Voss (Author), Tahl Raz (Author)

ð     

Career success planning:

ð       

Self-care:

ð       

Money-individual:

ð       

Business skills applicable to non-clinical, management, and other roles

Leadership:

ð      How to coach and motivate staff to reach targets: How to Coach Employees to Maximum Achievement | Dale Carnegie

ð       

Money:

ð       

Operations: 

ð      Standardization: Standardization in patient safety: the WHO High 5s project International Journal for Quality in Health Care 2014; Volume 26, Number 2: pp. 109–11610.1093/intqhc/mzu010 AGNÈSLEOTSAKOS1  10.1093/intqhc/mzu010 AGNÈSLEOTSAKOS1*,

ð      One Standards: Roadmap for Hospitals in Emerging Markets to use to Cost-Effectively: Achieve Safety Standards, Add Quality, Develop a Competitive Healthcare Product, and Strengthen Hospital Resilience -October 2025 by Donna Spratt, MD

ð      One Standards checklist – templates

ð       

Management:

ð       

Costs:

ÿ      Total cost of purchased items includes initial and ongoing costs. Initial costs include transportation to site, set-up and training costs, purchase price and more. On-going expenses include costs for semi-durable parts like backup batteries that will last only a few years. They include limited use items like CO2 absorbers, some that only last a few months. There is ongoing fixative, preventative maintenance and more. The goal here is for the total cost of an item to be known before its purchase. This supports good purchases and allows for ongoing costs to be calculated so that provisions can be made for ongoing expenses

ð   

Purchasing: Purchasing decisions will be made with or without input from the providers who use the items. Poor purchasing decisions compromise safety, waste time and money, and linger at a site for a long time because of the cost. Therefore, it is essential that providers are equipped to offer informed recommendations -proactively when necessary.

ð      Seminars – Additional Resources 2 – game that asks players to identify all essential items at a site-per international standards

ð       

Equipment: Providers should understand what makes equipment “suitable” such as its performance in environments without climate control, its maintenance need, and the availability of local parts and labor. They should be able to identify the components necessary for a complete equipment setup, such as inclusion of all pediatric accessories. They should request additional non-durable accessories like BP cuffs and cables to maintain functionality. They should also request multi-session lessons to learn to use and care for the items. With this knowledge and more providers can give good recommendations for purchases -proactively when necessary.

ÿ  One Standard: Definition of “suitable”

ÿ      One Standard: Equipment assessment (This will identify brands of items that are at the site, their functionality, strengths and weaknesses, so that good purchases, going forward can benefit from whatever is already at the site)  

ÿ      One Standard: Needed Qualities in Equipment Purchases

ÿ       

Quality improvement:

ÿ      Team charter form and instructions-simplified and specific

Budgets and forecasting needs: Annual department budgets -based on the forecasted supplies and medication estimates - will be made with or without input from the providers in those departments. While many of the commonly needed items are included, often essential lifesaving items - that are rarely needed - like epinephrine, bougie stylets, tracheal suction, and many pediatric items are left out. Poor planning compromises safety and is wasteful. Therefore, it is essential that providers are equipped to offer informed recommendations -proactively when necessary.

Sometimes – quite informally – like in a hallway, a provider might be asked what items their department will need in the following year. They may be asked to review forecasted needs and budget documents that are complicated and incomplete without access to additional information. When input is requested from providers and even when it is not requested, providers have the responsibility of telling management what they need to do their job to the standards of care. To do this provider will need to know:

ð      All items they need to perform their duties – for usual and crisis events - and their amounts to work at standards of care

ð      How to forecast needed items at all perioperative sites without omissions. This must be easy.

ð      One Standard: Forecasting all perioperative anesthesia and nursing equipment, supplies, and medications that will be needed at a site for one year – Template (This How to do this for a year and short term

ÿ    can be changed to calculate the cost or to

ÿ     

Inventory maintenance: Providers will need working knowledge of how to calculate the amount of each item that should be in inventory at the hospital and near the care site, like 10% of forecasted yearly need. Needing to request buying an item when the last one is used is not safe. It creates a period when preparedness for standards is not possible. Relying on others to maintain sufficient inventory sometimes does not work. Sometimes other group keeps items at their site, not making it available to points of care, to maintain their own inventory levels. By equipping providers with a basic knowledge about inventory levels and teaching them how to calculate these easily, providers will know what should be at the site. They will be more likely to recognize inadequate inventory levels and ask for corrections. To get here providers will need to know:

  How to calculate needed inventory levels easily

  How to communicate urgent needs with purchasing

  How to open communication with purchasing/inventory so they will immediately warn providers of expected shortages and unavailability of items. This will allow for substitutions and conservation.

ÿ  LIFO, FIFO, rotation, meeting needs, theft…

Security:

Teaching skills:

ÿ  Non-traditional learning: Problem-based learning, workshops, simulations, gamification, role-playing

ÿ  Equipment, technology, and media

ÿ   

Practice management:

ð      Workforce: Projections, job descriptions and scope of practice, professional development, retention, burn-out…   

ð      Making work schedules

ð      Policy, benefits, conflict resolution…

ð      Human Resources: Recruiting, training, retaining, making contracts, firing staff …

ð      Payroll

ð       

Emergency readiness and Disaster plan: Emerging threats (Ebola/covid) and preparations, Sudden threats: Natural disaster (earthquake) and emergency responses. Sudden threats: Site, intruders in ORs +. Mass casualty, preserving capacity to provide care: Public voice+

ð      Emergency readiness

ð      Coordinating crisis responses, first response

ð      Press and media correspondence

ð       

Project management, planning and organization:

ÿ       

The next generation:

ÿ      Training programs – starting and sustaining, making tests

ÿ      Mentoring (Paul, Titus, Timothy) and being mentored

Seminars – Additional resources

1.         Dale Carnegie “3 ways to improve relationship skills: 1.Build self-confidence, 2. Enhancing people skills, and 3.Advance communication skills

“6 features that build strong relationships: 1.showing genuine interest in others 2. Smile. 3 remembering names 4. being a good listener 5. being sincere 6. avoiding arguments

1. Don’t Criticize, Condemn or Complain 2. Give Honest, Sincere, Appreciation 

3. Arouse In The Other Person An Eager Want 4. Become Genuinely Interested In Other People 

5. Smile 6. Remember That A Person’s Name Is To That Person The Sweetest And Most Important Sound In Any Language 7. Be A Good Listener. Encourage Others To Talk About Themselves 8. Talk In Terms Of the Other Person’s Interests  9. Make The Other Person Feel Important – And Do It Sincerely  10. The Only Way To Get The Best of An Argument Is To Avoid It 11. Show Respect For The Other Person’s Opinion. Never Say, “You’re Wrong.” 

12. If You Are Wrong Admit It Quickly And Emphatically 

13. Begin In A Friendly Manner 14. Get The Other Person Saying “Yes, Yes” 

15. Let The Other Person Do A Great Deal Of The Talking 16. Let The Other Person Feel That The Idea Is His Or Hers 17. Try Honestly To See Things From The Other Person’s Point Of View 18. Be Sympathetic With The Other Person’s Ideas And Desires 

19. Appeal To The Nobler Motives 20. Dramatize Your Ideas 21. Throw Down A Challenge 

22. Begin With Praise And Honest Appreciation 

23. Call Attention To People’s Mistakes Indirectly 24. Talk About Your Own Mistakes Before Criticizing The Other Person 25. Ask Questions Instead Of Giving Direct Orders 

26. Let The Other Person Save Face 27. Praise The Slightest Improvement And Praise Every Improvement. Be “Hearty In Your Approbation And Lavish In Your Praise”. 28. Give The Other Person A Fine Reputation To Live Up To 29. Use Encouragement. Make The Fault Seem Easy To Correct 30. Make The Other Person Happy About Doing The Thing You Suggest “

2. Essential Items that should be at all points of perioperative care: Format: Lecture (L), game (G), and roleplay

Background: Here the challenges of anesthesia providers are used as an example as this is what I know. Please adapt it to other groups, and consider keeping the learning format as a game

  Anesthesia providers will be asked to resuscitate patients in various perioperative sites using the items at each site. If there is incomplete preparedness of items, like at the neonatal cart in the operating theatre, providers will still be expected to resuscitate patients, but may not have the items needed to do this. In this example, patients are exposed to avoidable risk, and providers are not set-up for success.  Resuscitation is limited by the missing items. (another example is not having a pediatric facemask, ambu bag, or airway equipment in PACU)

  Providers can tell each site what they think should be at that site. This is problematic because other providers may have different thoughts, and the item choice at the site will usually be the smaller number of items, which is usually not good. In the example above, if the provider needed something to resuscitate a newborn baby with, and they did not say it was needed at the site, it will not be at the site.

  To achieve safety and quality, all sites need to have the items that should be at the site per international WHO/WFSA 2019 standards (+). These are the goals, and each provider must know these (and have reference material like WHO document- to show standard to others). Moreover, most of the items are inexpensive and reusable, thus there is no reason they should not be at the site. Anesthesia providers – often with no control over these sites - must somehow get these sites to comply with standards. Providers will need to know what is on the WHO/WFSA 2019 document, and get a copy of this.

Game: Group format-Ask providers to name all items that should be at points of care (POC) (Like in anesthesia: monitors, pediatric airway equipment, intraoperative medication. Ask about sizes, quantities, and the features of “suitable” and durable items

ÿ      Introduction to:

ÿ      The perioperative Points of Care (POC)

ÿ      A complete list of all essential items should be at each POC

ÿ      One Standard perioperative site assessment– paper and excel

ÿ      OS checklists – paper and excel (PC)

Review: Job descriptions, accountability, importance of secure sites (locks) MAIDS (PC)

Discuss: How to get other providers, whom them may have no control over, to maintain preparedness at these points of care 

ÿ      That most of these items are inexpensive and reusable, thus low resources is not a reason for inadequate preparedness                 

ÿ      Standardization: Providers will ask others to get items for them. Helpers will not know the name of the needed item but must get it quickly during a crisis. Stating where to find the item in organized and standardized resuscitation boxes and at other points of care will save time during a crisis. It will save time when providers work in different operating theatre. This avoids omissions and makes site checks quicker and less maddening. To get to item organization and standardization providers will need to know:

ÿ      That not finding an item is the same as it not being there.

ÿ      That organization and standardization of item placement in resuscitation box and POCs across the facility adds safety: Avoids omissions, delays in retrieval, makes site checks quicker, +.

ÿ      That accessibility and suitable security of sites must be achieved.

ÿ      The cost (in hours) to sustain different organization styles so that it can be match this to what is available. (ie: maintaining an anesthesia cart takes 8 hours per week and but maintaining an anesthesia box takes only two)

ÿ      The importance of site maintenances being in the job description of specific providers or provider grouts and that they are accountable for it.

ÿ      The importance of this job description including: When the site is maintained like after every use and on every Tuesday. The protocol for reporting needed items, like a written note to the department head or their replacement that day, with follow up the next day. How the site maintenance is documented like on a tablet at the site with: checkers name, date of check, and more. How the site is secured.