All right, so I have the pleasure of doing another flipped classroom. So Sergio and I are going to be doing this flipped classroom. And so the first part of this is based upon the lecture that you were all provided with on how to write a business plan. So raise your hand if you've ever submitted a research grant. Okay, a number of you, about half the room. Okay, raise your hands if you've submitted a business plan of any kind. Some more of you. Okay, good. Now, raise your hand if you've done both in your career. Okay, so a fair number of you. So the take home message of the talk that was recorded, oh, this is great. You have it up there. The key message here really was that a research grant and a business plan are almost the same thing, okay? You know, I once got into a little bit of a disagreement with one of our chief financial officers who was saying, oh, you know, these physicians, they never write business plans and wish they would write their business plans. And I told him, I said, look, I said, business plan, grant, same thing. And so if you look at the elements of the business plan versus a grant proposal, they're very similar. They may have some different terminology and there may be some subtle nuances in each of those, but by and large, they're almost the same thing. So there's really no magic about it. And so I would encourage you if you haven't gone through and listened to the recorded lecture that we provided you, I'd encourage you to go ahead and do that. It'll kind of break down the differences between a business plan and a grant proposal. And there's very few differences. But what I wanted to focus on in this flipped classroom setting was really the executive summary, which is kind of like the specific aims page for a research grant proposal. So people would say that the executive summary is the most important part of the business plan. And I think that's true. I think people would also argue that the specific aims page for a research grant proposal is actually also the most important part of the grant proposal. And so they're very similar. It tells a compelling story, makes the reader want to keep reading. I'll get to that point in a second. It summarizes the key messages of the plan. It's usually about one to three pages maximum. So that's one of the differences. Typically a specific aims page is only one page, maybe a page and a half. But the executive summary of a business plan can go out to three pages. But really that's about it. You don't want it to go longer than that. You want to clearly define the problem, the solution, and the potential opportunity and why it makes sense. Unfortunately, and I can tell you it's not always the case, but it's frequently the case, the executive summary is the only part of the business plan that actually is read almost consistently. So you really want this to be, to really grab the attention of the reader and to really explain in not a lot of detail, but enough detail of why this is such an important business plan. And it's always written last. So you never write your business proposal at the very beginning with starting out with the executive summary. You wait till the very end. Just like very similarly, you write the specific aims page for a research grant proposal after you've kind of written the rest of the grant. So I would say that an executive summary or a specific aims page is kind of like an elevator pitch, right? And so an elevator pitch, so the classic story in business, if you get on an elevator with an executive, you only have a couple of minutes to sell that executive on your ID or your proposal, right? And so you have a very short window of opportunity to really make your sales pitch and really sell that executive on your idea. So the executive summary is exactly like an elevator speech or an elevator pitch. And so what I thought would be useful and, you know, in the research grant seminars that I've attended and the business plan seminars that I've attended, they've all done this, is to go through the process at each one of your tables to come up with an elevator pitch. So hopefully, you can use either a business plan or an idea that you're currently working on or one that have you worked on in the past. And I want you to work with a partner and give your elevator pitch to that person, okay? And we'll have the rest of the faculty kind of go around the room and provide input. But basically, the logical progression for this is there is a big problem. This affects people in a negative way. I'm working on this new thing or I have this new idea, which has the power to help solve the problem. So those really are the four elements of your executive summary of your business plan, your specific aims page of your research proposal. And I want you to kind of work through those examples. Does that make sense? Any questions? All right, we only have about 15 minutes and then we'll turn it over to Sergio. So thanks so much. All right, we're going to come back to the group, full group. I know I hear some of you that are working on some great business plans. It sounded really promising and a couple of tables have actually already completed a business plan, so. Who would like to share their elevator pitch? Which table? Anybody from? Eddie, you guys want to? He said, the gauntlet has been thrown down. Yeah? No, I'm taking a picture. You guys, okay. Well, go ahead. Yeah. It's a little nerve wracking. So there's a huge problem in health care, as we all know. Burnout is rampant for every single profession out there. And it affects, because we have a brain drain out of our own colleagues, and our hospitals are not staffed with people who are able to give back to the next generation. And because of the issue with burnout, I'm actually working on this new thing where I own a company called Transforming Health Care Coaching. We have a company of coaches that are all health care providers themselves, or just recently left health care and became a certified professional coach. Our energy leadership coaching actually has the power to help prevent and solve burnout, and also help executives level up in their careers so that we can thrive in our work and life. And together, we believe that we can transform health care one person at a time. That was great. And it's also real. So if you do need a coach, come find me later. I think that's exactly the point, right? Short, sweet, and very concise. Stated the problem, stated the problem's impact, the idea to address the problem, and that basically said that her team is absolutely the right people to be able to do this effectively, which is exactly what you want to put in your executive summary. So very well done. I think I want to fund it. Who else? Anybody else want to go? I know the table up front had a good idea. Do you guys? I think, yeah, I think they had already written the entire business plan. But. We were sort of talking about my notebook. We didn't really have to pitch. All right, so turn around, I feel like. Sorry if my back is to you. So one of the things that we talked about was nursing shortages. Obviously, it's a big problem everywhere. It's negatively impacting outcomes and increasing attrition due to the lack of professional development. So why has this happened? Because of post-pandemic loss of experienced mentors, et cetera, changes in nursing curriculum, and a need for just additional training opportunities. So we've come up with this idea to add something called kind of like a nurse rover. So a couple of positions where people come in and they're experienced individuals in the nursing field. And they act as a mentor kind of between a charge nurse and an actual preceptor, where the newer nurses can rely upon them to go to them for difficulties, to go to them for opportunities that they see to celebrate some of their wins, and act as a resource to help them kind of increase their confidence, increase their base of knowledge, and work towards gaining a more experienced staff. So the ask would be to just add the FTE for this new position, and then obviously considering all the costs that go along with that. All right. So I think nobody would argue that the nursing shortage and nurse retention are both huge issues in the ICU and actually in all hospitals. So as you think about that, did you have a question? They get pulled. Yep, exactly, right Yeah, yeah. No, I think that unfortunately happens So so what is you know, because I think this group was also talking about You know because that's great sounds like a great idea sounds like there, you know I'm sure there's evidence to suggest that those kinds of interventions actually improve turnover so improve retention decrease turnover, so but it is new FTE so so unfortunately and I can speak as an administrator that people get really reluctant to add more FTEs at a time when You know their budgets are really constrained. However, there's a way that you can do that. You can actually make this Sound much better and much more appealing Is there any way that you think of that how you could frame this question? To where it's an investment that actually would in the long run so so short-term pain Long-term gain where it actually would decrease costs to the institution Yeah, so decreasing, it costs a lot to actually train a new nurse, plus you lose some experience, right? So if you can invest in a program that's actually going to reduce turnover, improve retention, the costs are actually going to be better in the long run than even if it's a short-term investment. And that's probably the best way to frame that discussion. And I think as an additional example, if you look at just hospital-acquired conditions, so things like central line infections, reducing that is a good thing because it actually gets patients out of the ICU sooner and you can actually fill that bed with a brand new patient. So that was one of the arguments that we've used in the past when we've tried to invest in a program that would reduce central line infections. Not only is it the right thing to do, but if we can increase the patient turnover, get patients out of the ICU sooner, we can actually bring new patients in and there's some good data to suggest that most of the revenue associated with a patient is up front in the first few days of their ICU stay, as opposed to later on if they're beyond nine or 10 days in the ICU, they actually cost more than the revenue that you generate. So thinking creatively about how you can justify from a financial standpoint your program as a short-term investment that leads actually to long-term savings is a really, really nice strategy. Good job. Anybody else? You stepped the mic. Right behind you, there's one. We're in front. A comment on what you were saying, and with the return on investment, right, I think that to be fair, it's good when you present your own data. We lose X amount of people per year, and you can present a range of what it might cost. Don't try to oversub as a range of 20 to 40, and I think that starts giving people an idea that, oh, my God, this is like a no-brainer, right? And I think a very common example was, and Judy can speak to this, the advent over the years of really having clinical pharmacists rounding in the ICU. People would be obsessed about adding the FTE, but when you show them the numbers, it's like, hello, why don't we do this before, right? Yeah, I think the other thing that you can use and leverage is we've kind of run an experiment over the last couple years, right? So there was huge turnover. A lot of nurses left for agency positions. I know, I think at Lurie Children's Hospital, I think in the last two years, we've hired somewhere like 1,400 new nurses to replace ones that have left. So you can actually start to look at, okay, what does nursing turnover actually do in the ICU setting, and we experienced higher numbers of central line infections, higher number of pressure injuries. So you can use the experience really of the last couple years kind of as a natural social experiment to actually provide data to make your case. So I think use all the tools that are available is always important. Anybody else have an example that they want to give? Table five. So a problem that's actually made some major changes the last 20 years in our ICUs, but is we are having it in our ICU, increased number of patients in the ICU. We have less providers coverage, decreased residents, more junior residents. We currently thought we'd solve the problem by adding APPs to our trauma service, four. They only cover the days. We had four to our emergency general surgery service, just cover the days. We added four to the ICU service, they cover days and nights, twice the amount of time with essentially the same amount of people. Very negative impact on our patients and our team, we think, decreased patient coverage, increased burnout, decreased compliance with the guidelines because of experience and lack of personnel, decreased communication with our ICU team, particularly the nurses. So what's the plan to solve the problem? We are requesting more FTEs. We need two more FTEs, just essentially half of the time we're just asking two instead of four. And the positive impact would be an improvement in coverage 24-7, increased capture of revenue. We are now capturing about a third of their salaries in revenue in RVUs. The short-term investment will be, we're asking for two more FTEs. Long-term, decreased attrition, increased quality, increased compliance with our guidelines. We think, and we've seen in other studies, with increased provider coverage, decreased infections, decreased vent days, decreased length of stay. So there will be a short-term investment, but we think we will have significant long-term savings in many ways. That's great. Yeah, so absolutely, give them a round of applause. So covered the big problem, affects the people in a negative way, we have a new idea that can solve it. And so again, just like the last conversation, I think being creative about the financial modeling will help leverage. So leverage what every hospital's been through in the last couple years, and I think that's beneficial. Yeah, I think, you know, that question has come up. I mean, I think, you know, the one advantage in certain areas is we can have nurse practitioners bill directly. So we've done that. We've looked at that financial modeling. I think the other thing that we will frequently look at is, you know, you know, something that we're actually experiencing very soon is with the new changes in the residency requirements, you know, the amount of time that at least in pediatrics, I'm sure the same isn't as true in adult residencies, that residents can spend in an inpatient setting has been curtailed significantly. So we're going to have some fairly acute disruptions in our care model and in our inpatient and in our ICUs in particular. So one of the things that we're using to justify that, one, we have to hire more nurse practitioners, but two, we can also look at the turnover rates in our nurse practitioners versus our hospitalists. Right. So we could we could hire they cost about the same, maybe a little bit different. But most of our hospitalists, the turnover is, you know, a little bit different. So that, you know, again, just you have to be creative with how you how you make your justification and the financial justification in particular. Okay, that's good. Anybody else want to go? Yeah, at least a lot of that would require some changes in how we reimburse care at the national level. I don't see that changing any time soon, unfortunately. Yeah, but start a movement, maybe you'll be successful. Yeah. Okay, so real quick, I wanted to make one comment about the financial piece. So, you know, I think this is, as you write your business plan, the budget sometimes is not as straightforward as it is in a research grant proposal, okay? So, you know, what I found in particular that, you know, folks that work in the finance department at a hospital are generally very open and very willing to help healthcare providers with financial modeling, particularly if you can provide a little carrot or a little bonus for them, right? Whether it's a publication or, you know, whether it's being, you know, part of a project that they can put on their resume. So it's always important to enlist some help because there's gonna be some things that, you know, I've had some extra schooling for, but even I don't understand completely kind of some of these financial modeling pieces. And so that is looking at like things like breakeven analyses, which looks at variable versus fixed costs. And you talked a little bit about that. So, you know, at some point you can never have an ICU open. You have to have a minimum number of nurses, regardless of whether you have any patients or not. So that's part of a fixed cost, even though in some cases, you know, higher volumes in the ICU require more nurse and more staff, that would be a variable cost. So I think knowing the difference between those is important because then that allows you to do what's called a breakeven analysis. And basically what this does is tell you how many things that you need to do, whatever your idea is, what do you need to do? What is the volume that's gonna be required to pay for the fixed costs? And then once you've paid for all the fixed costs associated with the project, that's when you really start to generate revenue. So that breakeven analysis is a relatively straightforward calculation, but it's really important and something that your finance department would be willing to help and they will actually be looking for in your business plan. There's some other very complicated calculations. So the individualized rate of return or the IRR is something that if you know what you're doing, which I don't, you can calculate using Excel. We'll calculate that for that for you, but basically that's a percentage rate of return on any project and you like to see that as a positive number and then the payback period is again, you know, looking at how much time is required as opposed to volume. The breakeven analysis is volume. The payback period is how much time do we need to do this project before we pay off our initial investment. Okay, so those are the things that they're gonna wanna see as part of your project budget, which is a little bit different than what you would typically see in a research proposal. Any other questions? All right, I will hand over to Sergio. Thanks so much. Thank you.

business plan

research grant proposal

executive summary

elevator pitch

financial modeling

collaboration