Greencastle readiness assessment webinar 14 aug13

Project Readiness Evaluation Process

Introducing a Best Practice Model for

Readiness Assessments August 14th, 2013

Webinar held on 14AUG13 and

a recording is available at http://goo.gl/dR4hxE

Greencastle Associates Consulting, LLC 2013 c2

Readiness Assessment Webinar

Presenter: Celwyn Evans

Moderator: Joe Crandall

Objective: Review readiness assessment best

practices, process and goals

Agenda

Readiness Assessment Background

Overview of the OPTI PREP model

Use Case


Readiness - Definition

Readiness is

Plans / Business Case

Resources

Commitments

Readiness Assessment Use

Go / No-Go Decision

Go Decision has the required

Plans / Business Case

Resources

Commitments

Greencastle Associates Consulting, LLC 2013

Time

Perf

orm

ance

Maximizing the Value of Change

Change Decision

is Made

Initial excitement

for Change

“Valley of Despair” Inevitable to every change initiative is a period

of decreased productivity and enthusiasm

Change takes

effect

1

2

4

Assessment of

proposed

Change

3

1. Value of Change realized sooner

2. Internal negative reaction minimized Improved stakeholder & client

satisfaction

Cohesive integrated teams

The Value of Change

1

2

Readiness Assessments minimize

the negative impact of Change

3


Too many projects, not enough time or resources

Problems

1) Hospitals identify too many top priority

projects, with insufficient resources to

perform these projects

2) Hospitals do not consistently achieve

100% of the planned benefits from

large complex initiatives

Causes

1) Failure to proactively identify and address all direct and indirect risks prior to project start

2) No standard form of evaluation or comparison

3) Lack of customer buy-in and commitment of resources are major contributors

Impact

1) Because the cost of making changes rises

greatly during a project, late attention to

risks often lead to expensive workarounds

2) Late discovery of potential problems

precludes solutions that would have been

available earlier

3) Late surprises are more disruptive to the

schedule, due to our limited timeframe to

develop adequate means of resolution

4) Max benefit realization

5) Execute the right projects


Introducing PREP

Project Readiness Evaluation Process (PREP) is a systematic look at the

full spectrum of issues associated with implementation.

In advance of a complex, multi-stakeholder initiative, we will examine

impacts to the organization, people, technology, and process necessary for

results – with a deliberate eye on the key success factors for

implementation.


OPTI PREP

OPTI PREP is the central tool of the PREP — Our model for assessing readiness

and identifying essential steps to ensure project success. The OPTI PREP model

captures all the critical dimensions of effective change — with nothing left to

chance.

Each element is assessed from three key perspectives: process improvement,

organizational change management and project management.


Process

Improvement

Add an “Implementation” Perspective

Change

Management

Improvements Take Hold

To realize the benefits, the

clinical & administrative

users must embrace the

outcome of the project

Do the right work

Ensure the project will

have a tangible impact on

mission; clinical and/or

business

Execute Flawlessly

The project should be

conducted efficiently &

effectively, which will

reduce the cost of

implementation

Project

Management

Organization

People

Technology

Process

Reality


The OPTI PREP Dimensions

OPTI PREP contains the right dimensions to capture and address all major

opportunities and issues associated with complex, multi-stakeholder initiatives.


OPTI PREP Model – Drill Down


OPTI PREP Model - Organization Change Readiness

Climate For Change

History Of Change

Communications

Current Tools And Templates

Reporting Structure

Accountability For Outcomes

Improvement Capability

Gap Between Practice And Policy

Integrated Vs. Silo-ed Processes

Metrics & Goals

Availability, Capability And

Capacity Of Resources

Priorities

Barriers & Obstacles

Performance Outcome Level

Change Leadership Style

Availability For Training

Experience With Change

Process Ownership

Employee Evolution

Organization People

Process Reality

11


OPTI PREP Score Sheet

Project

Management

Process

Improvement

Change

Management

RealityProcess(Admin & Clinical)

TechnologyPeopleOrganizationScore: 42

Project

Management

Process

Improvement

Change

Management

RealityProcess(Admin & Clinical)

TechnologyPeopleOrganizationScore: 42

1 4

4

2

4

4

1

2

33

33

33

33

33

33

2

Ready to Proceed

Some Risk: Additional Preparation

High Risk: Significant Preparation For each of 15 cells on the score sheet

Score: 1 = low; 5 = high

Key findings

Items to sustain

Items to improve


Change Readiness – Dashboard

Organization People Process Reality

Practice A

Practice B

Practice C

Practice D

Practice E

Ready to Proceed


High Risk: Significant Preparation

13


Change Readiness Component Analysis Component: Organization

A. Key Findings

1. The organization reacts generally well to change (survey response, adoption of process changes), however Ad hoc approach to change is a concern, need a better change process.

2. The overall climate for change to new CIS is positive and enthusiastic. How things have been adopted in the past has caused some anxiety

B. Items to sustain

1. Key sponsors are requesting new technology

2. Customer Service users are aware of the change and impact

3. Good use of standard communication plans

4. Senior leaders participate in staff meetings

5. Effective use of Steering Committees for project reporting

C. Items to improve

1. Ad hoc Change Management practices

2. Alignment: Sense of urgency is not consistent amongst employees

3. Alignment: New technology skills not currently present – requires preparatory training to assist in project delivery

4. Staff concern that technology efficiency will reduce overtime shift availability

5. Not incorporating all available communication vehicles

6. No consistent message for the purpose and drivers of the initiative

14



Gathering Assessment Data

Be sensitive to the amount

of time required by

individuals to provide

information during the

assessment phase.

All interviews and data requests

are vetted prior to execution.

15

Observations 1

Document Review 2

Survey 3

Focus Group 4

Interview 5

Sequence o

f E

vents


PREP Assessment Timeline


Two Applications

Single, Complex Project

Detailed Project Readiness Evaluation

Determine the specific readiness of the initiative

Identify areas to improve (opportunities & requirements)

Guides preparatory activity

Project Portfolio (Operating Plan)

Rapid concept review per dimension

Relative numeric comparison of projects

Identify & capture clear issues & actions

Enable portfolio decision making

Patient Centered Medical Home (PCMH)

Readiness Assessment


When assessing

less than 100% of

practices it is

imperative that

Early Majority

adopters be

included.

19

Adoption Considerations

Most organizations have initiatives led by the Innovators and Early

Adopters

Level of effort for adoption by these groups is minimized

because of passion and desire that was already driving initiative

Can be frustrated with lack of organization’s progress on

initiative that brought great value to them

Early Majority involvement helps identify real and perceived barriers to

change

Might not know of value

Initiative might be of wrong value to them

Might not want to change

Despair (resistance to change) is

deepest for Late Majority and even

deeper for Laggards

Impact of “Valley of Despair”


Critical Dynamics of Adoption (rate)

Relative Advantage – The degree to which the

change/innovation is perceived to be better than the current state

Trialability - The ability to try out an innovation without total

commitment and with minimal investment

Observability - Seeing how an innovation works by watching

someone else use the innovation and acknowledging that it is

safe and/or beneficial

Compatibility - Familiarity and compatibility with the existing

environment


Planning Phase

should receive a lot

of time and focus to

mitigate issues later

Plan Initiate

Implementation Process

Execute Control Close

Planning Phase helps answer:

Are we ready to make this change?

What will the impact be?

Where are we today?

Why are we at level x today?

What will it take to get to next level?

What do I need to invest to get to next level?

What are the current standards and how do we measure against those?

We are thinking about doing something new/different, are we at a point to make

a commitment to change?.

What course of action (COA) should we take?

Can we do this ourselves or do we need outside help?

1 2 3 4 5


PCMH Approach Considerations

Organizational change management is essential

The fiat versus incentive approach doesn’t work. A

blended approach works best

Maximize what can be leveraged across all

practices

All practices are different from an organization,

people, process, technology and patient

perspective

Patient Care Coordinator role is critical

22


PCMH Readiness Assessment

What It Focuses On:

The NCQA PCHM standards

The organization’s change readiness stature

What the Components are:

Course of Action (COA) Development

Benefits of becoming a PCMH

Resource requirements (people, time, budget, technology)

Limitations and Constraints

Recommendations

What is the Value

Enable Leadership to make an informed decision on the best course of

action to pursue regarding PCMH NCQA recognition

23

Greencastle Associates Consulting, LLC 2013 24


Establish the Goals

Determine the practices to assess using objective criteria:

• Early Majority Type Physicians

•Type of Patients

• Payer Mix

• Location

• Age of Practice

• Meaningful Use Attestation

• Type of Practice

• Number and Composition of Staff


Establish the Assessment Standards

NCQA 2011 PCMH Standards NCQA ’s Patient-Centered Medical Home (PCMH) 2011 is an innovative

program for improving primary care. In a set of standards that describe

clear and specific criteria, the program gives practices information about

organizing care around patients, working in teams and coordinating and

tracking care over time.

Organization Change Readiness Tools Clinical transformation begins with a clear definition of value outcomes

and lays a foundation for future initiatives while furthering the

organization’s immediate mission. Healthcare providers have many

opportunities to improve care, enhance access to care or contain costs.

Greencastle helps clients sort through the possibilities and maximize the

value of clinical transformation.

26


Points Standard and Element No. FactorsMust Pass

50 % score

MU

Core

MU

Menu

20 1 Enhance Access and Continuity 34

4 A Access During Office Hours 4 X

4 B After-Hours Access 5

2 C Electronic Access 6 2 1

2 D Continuity 3

2 E Medical Home Responsibilities 4

2 F Culturally and Linguistically Appropriate Services (CLAS) 4

4 G The Practice Team 8

16 2 Identify and Manage Patient Populations 34

3 A Patient Information 12 5

4 B Clinical Data 9

4 C Comprehensive Health Assessment 9

5 D Use Data for Population Management 4 X 2

17 3 Plan and Manage Care 24

4 A Implement Evidence-Based Guidelines 3 * 2

3 B Identify High-Risk Patients 2 *

4 C Care management 7 X

3 D Medication Management 6 1

3 E Use Electronic Prescribing 6 3 1

9 4 Provide Self-Care Support and Community Resources 10

6 A Support Self-Care Process 6 X 1

3 B Provide Referrals to Community Resources 4

18 5 Track and Coordinate Care 25

6 A Test Tracking and Follow-Up 10 1

6 B Referral Tracking and Follow-Up 7 X 1 1

6 C Coordinate with Facilities/Care Transitions 8 1

20 6 Measure and Improve Performance 22

4 A Measure Performance 4 *

4 B Measure Patient/Family Experience 4 *

4 C Implement Continuous Quality Improvement 4 X

3 D Demonstrate Continuous Quality Improvement 4

3 E Report Performance 3

2 F Report Data Externally 4 1 2

0 G Use Certified EMR Technology 2 * 1

100

POINTS28 Elements

152

Factors

6 MP Elements

29 Points

(+8 points)

15

Points

11

Points

Determine what

elements and factors

will be assessed

Level Points

LEVEL 1 35 – 59 points



6 of 6 elements required

Must pass > 50%

NCQA

PCMH

Standards

27


Organization Change Readiness Tool Components

Climate for Change

History of Change

Communications

Current tools and templates

Reporting Structure

Accountability for Outcomes

Improvement Capability

Gap between Practice and

Policy

Integrated vs. Silo-ed

Processes

Metrics & Goals

Availability, Capability and

Capacity of Resources

Priorities

Barriers & Obstacles

Performance Outcome Level

Change Leadership Style

Availability for Training

Experience with Change

Process Ownership

Staff Evolution

Organization People

Process Reality

28



Gather Assessment Data

Be sensitive to the amount

of time required by

individuals to provide

information during the

assessment phase.

All interviews and data requests

are vetted prior to execution.

30

Observations 1

Document Review 2

Survey 3

Focus Group 4

Interview 5

Sequence o

f E

vents


Gather Data – NCQA PCMH Standards

The assessment

must capture why

each element was

either a yes or no.

This information is used to capture elements to be shared across

the enterprise or establish the breadth and depth of a gap

31



Change Readiness – Dashboard

Organization People Process Reality

Practice A

Practice B

Practice C

Practice D

Practice E

Ready to Proceed


High Risk: Significant Preparation

33


Change Readiness Component Analysis Practice A

Component: Organization

A. Key Findings

1. The organization reacts generally well to change (survey response, adoption of technologies), however Ad hoc approach to change is a concern, need a better change process.

2. The overall climate for change to EHR is positive and enthusiastic. How things have been adopted in the past has caused some anxiety

B. Items to sustain

1. Key Physician champions are requesting new technology

2. Physician users are aware of the change and impact

3. Good use of standard communication plans

4. Senior leaders participate in staff meetings

5. Effective use of Steering Committees for project reporting

C. Items to improve

1. Ad hoc Change Management practices

2. Alignment: Sense of urgency is not consistent amongst staff

3. Alignment: New technology skills not currently present – requires preparatory training to assist in project delivery

4. Staff concern that technology efficiency will reduce overtime shift availability

5. Not incorporating all available communication vehicles

6. No consistent message for the purpose and drivers of the initiative



PCMH Summary Dashboard

35

Practice Specific


PCMH Gap Analysis

1A Access during Office Hours MUST-PASS Pass Sustain Improve

1AF1 Provide same-day appointments

1AF2 Provide timely clinical advice by telephone during office hours

1AF3 Provide timely clinical advice by secure electronic messages during office hours

1AF4 Document clinical advice in the medical record

Factor Worksheet – Sustain and Improve Items for Each Factor

Record Review Worksheet – For Elements 3C,3D, 4A

Pati

en

t

Nu

mb

er

Clinically Important Condition

1. Preventive

Services?

2. Allergies/

Adverse

Reactions?

3. Blood

Pressure? 4. Height? 5. Weight?

6. Head

Circumference? 7. BMI?

8. Lab Test

Results? 9. Imaging Results?

10. Pathology

Reports?

11. Advance

Directives?

2 C—Use of Electronic Clinical Data

1

2

3

4

5

6

7

8

36



PCMH Course of Action

Courses of Action

COA 1 COA 2 COA 3

Decis

ion C

rite

ria

Yields Best Results / Value

Accountability

Stakeholder Buy-in / Fewest Barriers

Speed

Cost

Manageable

Feasibility (easy to complete)

Suitability (fit)

Totals

In order to select a Course of Action (COA), score each COA

using decision criteria

38


Readiness Assessment Benefits

Feature Benefit

Practice Readiness Current readiness for adoption of PCMH defined and

understood

Change Focused on the

Process Not the People Reduces defensive behavior of stakeholders

Leadership Understanding of

End-users Attitudes Toward

PCMH Changes

Help choose the correct approach for gaining widest

possible adoption

Executive Assessment

Summary

Creates awareness among senior leaders regarding the

opportunities / decisions / leverage points

Detailed Assessment Report Identification of strengths / obstacles / watch areas

Clear COA Direction Ongoing actionable items to address increasing

functionality and as well as closing adoption gaps

3rd Party Assessment Provides unbiased assessment of your process while

leveraging best practices from many industries


Questions?


Contact Information

Presenter

Celwyn Evans

[email protected]

610.640.5598 ext 222

Moderator

Joe Crandall

[email protected]

856.685.0737

Health & Medicine

Greencastle readiness assessment webinar 14 aug13