In the Strategic Driver section, it would be helpful to have a direct response about the stage of completion of every goal.

COMPLETE. Please see the updated responses to the Strategic Driver narratives. At the beginning of each response, we provided a status descriptor before providing more clarity on each goal/set of goals.

Acronyms – please clarify the following acronyms:

• IR: ACGME Institutional Requirements
• APE: Annual Program Evaluation
• AIR Work Plan: Annual Institutional Review Work Plan – this work plan is the product of an internal annual review of all ACGME programs and the institution where we focus on things that went well and things that require improvement.
• PD: ACGME Program Director – each of our ACGME programs has a required Program Director
• IHI: Institute for Healthcare Improvement
• NCQA: National Committee for Quality Assurance
• RPRS: Right Person, Right Seat – in sum, in the EOS model, this means that the person shares our mission and core values (Right Person), and has the capacity to do their specific job (Right Seat)

Employee Turnover

•  What is the national and state average for turnover in healthcare organizations?
  “According to the 2024 NSI National Healthcare Retention & RN Staffing Report, the hospital turnover rate stands at 20.7%, a 2.0% decrease from 2022, and Registered Nurse turnover is recorded at 18.4%, a 4.1% decrease . . . In the past five years, hospitals have turned over 106.6% of their staff. Further data shows that voluntary terminations accounted for 95.4% of all hospital separations.” In terms of healthcare workers overall, “a study in the United States revealed that 18% of healthcare workers left their jobs as a result of the pandemic. . . . Globally, about 17% of all nurses are expected to retire within the next ten years. In particular, the aging workforce in the United States and Europe means that retirement rates will remain high over the next ten years,” according to a 2023 article published by the National Institutes of Health. According to self-reported data collected by Pennsylvania’s Community Community Health Centers (PACHC), the state’s turnover average is approximately 23%.
•  What areas/roles have the highest turnover?
  The roles with the highest turnover rates were clinical administrative assistant (front desk), LPN, and Infectious Disease Case Manager.
• What is the specific action plan for amelioration of the statistical gap?
  Response: There are several different types of considerations that contribute to staff turnover. We complete an exit interview of each person that voluntarily resigns employment with us to better understand their lived experiences, and to identify any trending training, personnel, or other issues that we are in a position to address. For clinical administrative assistants, we identified a lack of consistency in training, and are addressing that with a multi-factorial approach. First, we have hired individual front desk supervisors for each of our three largest clinical locations: Wilkes-Barre, Scranton, and Mid Valley. This will help to create more capacity for practice managers in those locations by giving the front-line assistants access to a mid-level supervisor for more direct guidance, education, and accountability. Second, we reviewed the recently received compensation analysis from the outside consultant, which indicated that it would be beneficial to increase hourly wages for that position from $16.50 per hour to $20 per hour, which will make us more competitive in the market. For LPNs (Licensed Practical Nurses), two challenges were identified: (1) compensation and highly enticing sign-on bonuses being offered by other health care facilities to lure them away; and (2) our specific operational incorporation of LPNs into our chronic care management model to ensure that patients with chronic and complex conditions are connected to care even in between appointments in the office. Although we raised the hourly rate for LPNs from $28/hr to $30/hr, we are not in a position to match the steep sign-on bonuses. The second factor, i.e., our model, is sometimes not the model preferred by LPNs who envisioned their careers involving more direct hands-on patient care, rather than telephone outreaches to connect with patients on their care plans, symptoms, etc. We are currently utilizing our clinical teams at the top of their respective licenses. HR has more clearly articulated the precise nature of the role in the position descriptions to avoid any misunderstandings of how LPNs function for TWCCH. Finally, there has been turnover in the Ryan White/Infectious Disease Clinic Case Manager role due to several factors relating directly to personnel changes last fiscal year. The previous Clinic Manager was transitioned out of the position for lack of performance, and a project manager transitioned in to ensure compliance with federal laws, rules and regulations governing the Ryan White program. This caused expected cultural ripples, and several case managers chose not to accept the enhanced compliance-based oversight of the clinic, instead choosing to leave the organization to join the Ryan White Clinic’s previous Medical Director in a competitive venture she is creating in the region.
• Who is directly responsible for that work effort?
  HR and Clinical Operations are co-leading the work effort for the specific positions identified above, but in general, retention is an enterprise-wide commitment and responsibility shared among all executives and departments.

The Faculty Satisfaction AIR Plan is not visible to me

The AIR Work Plan is one document – all action plans are included in it. We reset the link.

What is the didactic curriculum? How is it structured? Does it differ among PGY 1,2, and 3?

Each Program has a structured didactic curriculum that is planned out for the entire academic year. The curriculum aligns with the required elements of the ACGME, clinical competencies expected throughout the training, common disease conditions, and resident and faculty interest areas, as well as topics to prepare residents for the board exams. Each program has at least one didactic resident leader and a faculty mentor. They are responsible for developing the schedule, coordinating presentations, and engaging the learners. Program didactics are held during a protected time each week to ensure residents and fellows have access to this learning method. Didactics across program years can vary and is structured to ensure each program year is receiving a robust learning experience. In addition to the structured didactic session, education is available through journal clubs, board review sessions, grand rounds, visiting professors, and special events.

• How is it planned? Didactics are planned in collaboration with the program director, coordinator, and chief residents.
• How is it aligned to specific learning outcomes as offered by ACGME? The ACGME does require some specific topics to be covered in didactics. Those required topics such as wellness, fatigue mitigation strategies, and equity are incorporated into the overall structured didactic schedule throughout the year. The residents and fellows are asked in the annual ACGME survey if these topics were presented. We are at the national mean for complying with this requirement.
• What are the formative assessments implemented? Who does this? Specific to the assessment of the didactic session, only the National Family Medicine Residency program sends a Google form after each didactic session for resident feedback. The didactic coordinator for NFMR distributes the assessment.
• How is learner feedback noted and used both for individual and institutional improvement? Learner feedback is indicated on internal surveys, ACGME surveys, as well as through program meetings and interactions with the chiefs. All feedback is reviewed and used for both programmatic and institutional improvement processes.
• Does the content change from year to year based on both formative and summative assessments? If so, how? If not, why? Yes, program leadership does send a request to all residents, fellows, and faculty to propose topics. These topics are vetted and incorporated into the structured didactic schedule.

Did the TWCGME budget for the academic year 2024-2025 reflect the reduced number of resident FTEs in the National Family Medicine and Regional Family Medicine Residency Programs? Also, did the budget reflect the closure of Psychiatry and the elimination of Psychiatry resident FTEs?

Yes, the TWCGME budget incorporated all of those changes.