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 2013c2
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
Performance
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 PreparationFor 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
Observations1
Document Review2
Survey3
Focus Group4
Interview5
SequenceofEvents

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
PlanInitiate
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

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. Factors
Must 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
POINTS
28 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
Observations1
Document Review2
Survey3
Focus Group4
Interview5
SequenceofEvents

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
Patient
Number
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
DecisionCriteria
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
evansc@greencastleconsulting.com
610.640.5598 ext 222
Moderator
Joe Crandall
crandallj@greencastleconsulting.com
856.685.0737

Greencastle readiness assessment webinar 14 aug13

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