PHSA

Sample:

Change Management Plan

(Insert name of project)

Version # (Insert number)

(Insert date)

Table of Contents

2Table of Contents

5Document Control

6Document History

7Acronyms and Definitions

8Approval and Signoff of the Pilot Project Change Management Plan

9Executive Summary

11Introduction

11BC PSLS Project Context

11BC PSLS Project Description

12BC PSLS Project Objectives

13Change Management Overview

15Document Usage and Deliverables

15Linkage to Health Authority Change Management Plans

17Change Management Strategy

17Objectives

17Guiding Principles

19Change Management Framework

20Resourcing

22Stakeholder Engagement

22Stakeholder Identification & Mapping

25Objectives

26Workplan

27Stakeholder Representatives

30Organization Readiness

30Objectives

31Workplan

32Assessing Existing Roles and Processes

33Defining BC PSLS Event Reporting and Management Processes

34End User Support

37Issues Management Process

38Impact Assessment

39Change Readiness Assessment

40Dimensions of Change Readiness

40Approach for Change Readiness Assessment

42Outputs

43Implementation Evaluation

43Objectives

44Workplan

45Approach and Framework

46Cultural (strategic) Evaluation

47Operational Improvements Evaluation

48Lessons Learned

52Appendix A: Stakeholder Identification & Mapping

52Stakeholder Analysis

56Stakeholder Mapping

57Appendix B: Stakeholder Engagement Strategies

69Appendix C: Organization Impact Analysis

73Appendix D: Change Readiness Assessment

79Appendix E: Change Readiness Assessment – Sample Output

80Appendix F: IHI Safety Climate Survey

80IHI - Safety Climate Survey

81Appendix G – PHSA & VCH Safety Surveys

82Appendix H – Operational Improvements Evaluation

82PSLS Operational Improvements Evaluation

Document Control

Project Title

(Insert title)

Project Manager

(Insert name and contact information)

Project Sponsor(s)

(Insert names of one or more executive sponsors)

Principal Author

(Insert name and contact information)

Contributing Authors and Distribution

(Insert name and role e.g. Project Director – pilot site 1)

(Insert name and role e.g. Project Director – pilot site 2)

(Insert name and role e.g. Project Manager)

Version

(Insert number e.g. 1.0)

Status

(Insert status e.g. Draft, Final)

Document History

Version

Date

Changes Made By

Description of Changes / Comments

1.0

(Insert date)

( Insert name)

(Insert content)

Acronyms and Definitions

Acronym

Definition

(Insert acronym or term)

(Insert definition)

Examples:

CCHSA

Canadian Council on Health Services Accreditation

CIHI

Canadian Institute for Health Information

CMIRPS

Canadian Medication Incident Reporting and Prevention System

CWG

Collaborative Working Group

EHR

Electronic Health Record

EMPI

Enterprise Master Patient Index

FTE

Full-time Equivalent

HA

Health Authority

IHI

Institute for Healthcare Improvement

IOM

Institute of Medicine

IRIS

Incident Management & Reporting Information System

IV

Intravenous

MOH

Ministry of Health

NPSA

National Patient Safety Agency

PSLS

BC Patient Safety and Learning System

RDD

Requirements Definition Document

SCN

Special Care Nursery

WHO

World Health Organization

Front-line Staff

Physicians, nurses, and other care providers.

Approval and Signoff of the Pilot Project Change Management Plan

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

(Insert name and role, e.g. Project Sponsor)

Date

Executive Summary

(Insert an executive summary for the project to help readers to understand the project and its rationale. The summary can be as long or as short as you think is necessary.)

Example:

Despite the best intentions and advanced training of the professionals in our healthcare system, patient safety issues continue to cause significant and unnecessary loss, pain and costs. Adverse event (incident) reporting and effective tools to support reporting and learning have been demonstrated to be key components in making our health care system safer.

The BC Patient Safety & Learning System (BC PSLS) is a province-wide initiative to enhance the capability of BC Health Authorities to improve patient safety by capturing adverse events electronically, managing them, and addressing risks. However, shifting to a culture that exemplifies a non-punitive approach to event reporting, supports the processes of formally reporting and thoroughly analyzing events as driving mechanisms for safer patient outcomes, and promotes learning and action based on the improved, evidence-based information available to leaders and clinicians is a significant challenge. Given the cultural change required, the BC PSLS project is positioned as a change management initiative supported by an electronic safety incident reporting and analysis system, and not a systems implementation that happens to include a change management component.

This BC PSLS Change Management Plan constitutes the framework to facilitate this cultural change. The Plan is intended to provide guidance during the pilot phase of the provincial project, then to serve as a foundation for Health Authority implementation projects during both pilot and roll-out stages. In order to be effective, change management must be tactical in nature and must equip Health Authority teams preparing to implement the BC PSLS with a starting point for their local project plans.

The BC PSLS Change Management Plan employs five streams:

· Stakeholder Engagement: Identifies people who will be involved in or may influence implementation or adoption of the BC PSLS, assesses the impacts of the BC PSLS on people and outlines strategies to engage them in the project.

· Organization Readiness: Defines the role, process and procedure changes that are prescribed by the transition to the BC PSLS environment, and describes the criteria used to evaluate the readiness of the organization to make that transition.

· Implementation Evaluation: Identifies the measures, tools, system, schedule and roles required to obtain input and feedback and evaluate the success of the BC PSLS implementation, including lessons learned from each implementation.

· Training and Education: Outlines the patient safety and information systems training required to equip people with the skills and knowledge they will need to operate successfully in the new work environment. The BC PSLS Training and Education Plan is available under separate cover.

· Communications: Describes the information that must be disseminated to people and groups of people, strategies for communication and channels through which the information may be delivered. The BC PSLS Communications Plan available under separate cover.

A key guiding principle for the successful shift to a culture of safety is the use of and integration with successful change initiatives at the local level, including safety learning programs and other projects, and the use of the existing organizational structures and processes to facilitate communication and engage people. Successful change is contingent upon the staff in each Health Authorities taking ownership for the change. The purpose of the BC PSLS Change Management Plan is to provide each Health Authority BC PSLS implementation team with the tools and information they will need to help their staff be successful in owning the necessary changes.

The BC PSLS Change Management Plan is an evolving document that will be revisited periodically as part of an overall project commitment to continuous learning through application of the Plan-Do-Study-Act Model for Improvement. This approach will ensure ongoing alignment of the BC PSLS Change Management Plan with the BC PSLS project goals and reflect the realities (including successes and lessons learned) of the initiative as it rolls out across the province.

Introduction

BC PSLS Project Context

(Insert a description of the context of the project)

Example:

In our complex healthcare system, there are times when care providers, in their efforts to help their patients, inadvertently cause them harm. Over the past decade, studies from nations around the world have consistently demonstrated high rates of accidental injury and death, many of which are thought to be preventable.

The costs associated with adverse events can be considered from several perspectives:

· The cost to the system of unnecessary added days in hospital

· Investigation and litigation costs

· Patients’ pain and suffering, loss of income, loss of function, loss of limb and loss of life

· The cost to families and loved ones, who suffer by association

· Demoralized healthcare providers, burnout, turnover and absenteeism

· Loss of faith in the health care system by the public

However, before healthcare leaders and clinicians can take action to address patient safety problems and make healthcare safer, they must be adequately informed about events occurring in their organizations so they can apply their resources and knowledge most effectively and appropriately. They need effective tools to facilitate reliable and timely reporting, analysis, learning and responsiveness.

Adverse event reporting systems are one means through which this objective may be met; reporting systems alone, however, are not enough. Borrowing from lessons learned in other complex, high-risk sectors, the thinking about safety and adverse events has expanded to include organizational culture. The concept of a culture of safety, one where the values of safety and quality are part of the very fabric of the organization, has been widely touted as the most effective means to a safer system .

BC PSLS Project Description

(Insert a description of the project)

Example:

The BC PSLS (Patient Safety Learning System) project is a province-wide initiative to enhance the capability of health authorities in BC to improve patient safety. The project will implement a province-wide web-based safety incident reporting and management information system that will support identification, investigation and analysis of safety and risk-related incidents (including safety hazards and near misses), capture and facilitate response to client feedback (including complaints, compliments and requests for information) and enable claims management.

The BC PSLS is an initiative of the BC Patient Safety Task Force (PSTF) and is a collaborative effort of all six BC health authorities and the Health Care Protection Program (HCPP), part of the Risk Management Branch of the BC Ministry of Finance, which insures BC hospitals. Although the initial focus of the BC PSLS is on acute care settings, it will eventually be used across the healthcare system – from hospitals and long term care facilities to home care and community services.

The two pilot areas for the project are the Vascular & General Surgery Unit (Tower 8) at Vancouver General Hospital (Vancouver Coastal Health Authority) and the Neonatal Intensive Care Unit (NICU) at BC Women's Hospital (Provincial Health Services Authority). These two pilots will enable configuration and set-up of the BC PSLS, prove concept, validate the implementation approach and lay the groundwork for the provincial roll-out. The pilots are planned to go live in early 2007, with BC-wide expansion planned over the next several years.

Although the BC PSLS project is centered around and relies on a web-based reporting and learning tool, it is not simply an information technology implementation project but a significant change initiative. In order to be successful, the project must consider and address all aspects of change and apply appropriate methodology to effect such change.

BC PSLS Project Objectives

(Insert the project objectives)

Example:

The overall project goal is to establish a system to help health care providers MAKE HEALTH CARE SAFER for patients in BC.

The following objectives will support this goal:

· Support a culture of safety.

· Support a non-punitive reporting environment.

· Capture, report, and provide feedback on all events: incidents, near misses, client feedback and claims.

· Analyze events, providing timely feedback (i.e. close the loop).

· Analyze events to determine root causes.

· Identify preventative measures and disseminate information (i.e. best practices) to reduce risks.

· Support efficient workflow and communication necessary to notification, follow-up, and investigation.

· Safeguard data integrity, privacy and confidentiality.

· Support common processes, reports, forms, language, data and definitions.

· Meet regulatory requirements and standards, e.g. Canadian Council on Health Services Accreditation (CCHSA) and professional bodies.

· Support compatibility with other project initiatives.

At a high level, the system will provide:

· Organizations with support for a culture of patient safety and a non-punitive reporting environment.

· Staff with access to simple, efficient methods of documenting events and information concerning the follow-up of specific events.

· Managers with effective tools to facilitate workflow related to follow up and investigation of events, and timely, efficient and relevant analysis of events within their respective areas of responsibility.

· Executives with better information about the state of care within their respective facilities.

· Specialized staff (such as Risk Managers, Client Representatives) with the ability to report, track and manage all events, e.g. incidents, near misses, client feedback and claims.

· Users with automated processes that take less time than the paper equivalent.

· Ease of use.

· Responsive technology.

· Common processes language, definitions and reporting standards.

· A safeguard to data integrity, privacy, and confidentiality.

Change Management Overview

(Insert an overview of the change management plan, include outcomes for success in the table below)

Example:

Given the cultural shift that is required within our healthcare system to support the effective management of patient safety events, the BC PSLS project is primarily a change initiative supported by technology. The BC PSLS Change Management Plan constitutes the tactical plan that will be used by the Health Authorities as the starting point for their BC PSLS implementation projects and provides guidance to help to them prepare their people and environments for this important cultural change.

The BC PSLS Change Management Plan and Health Authority-specific project and change management plans must reflect the desired outcomes of the BC PSLS project. The following table describes how the components of the BC PSLS Change Management Plan align to the key project outcomes of success:

BC PSLS Outcomes for Success

How Change Management, Communications and Education and Training will Help Achieve Outcomes

Improved event and near miss reporting with specific actions resulting in reduced or eliminated safety-related problems

Will identify stakeholders and define roles required to report events and near-misses

Will communicate outcomes and benefits of event and near miss reporting to stakeholders

Will educate stakeholders on scenarios that constitute events and near miss reporting

Will define a framework and measures to quantify improvement

Provision of more timely feedback to users and leaders on events

Will define user and leader roles within the context of a the BC PSLS working environment and these roles will prescribe workflow around event feedback

Will prescribe leadership action with respect to the BC PSLS implementation

Will facilitate the creation of communications tools as vehicles to give regular feedback

Will educate leaders on the implications of the ongoing shift to a culture of safety

Improved efficiency for event, complaint and claims management

Will educate stakeholders on process and workflow requirements

Provision of support to managers

Will define the involvement of managers in the implementation process

Promotion of teamwork and communication

Will bring together stakeholder representatives in groups who will work together to define the system and take ownership for the outcomes

Will communicate progress, next steps and anticipated outcomes to stakeholders

Provision of a better source of data for analysis

Will communicate benefits of consolidated repository for incident tracking to users

Promotion of a more effective use of resources

Will define roles and responsibilities related to the effective tracking and reporting of safety incidents

Reduced costs increased and improved information-sharing

Will define the process for tracking patient safety benefits and the success of the PSLS implementation

A created and supported culture of safety and learning

Will leverage existing safety and learning culture education programs

Will roll-out concept and process education sessions in concert with systems training

Assistance for clinicians and administrators to learn from their experiences

Will help define new or changed roles and responsibilities for sustainment group

Will leverage learning culture education

Will complete post implementation assessment as part of the organization readiness stream

Enhanced productivity

Will educate stakeholders on process and workflow requirements

Will define roles and responsibilities related to the effective tracking and reporting of safety incidents

The BC PSLS Change Management Plan is a dynamic, evolving document that will be revisited periodically as part of the overall project commitment to continuous learning through application of the Plan-Do-Study-Act Model for Improvement. This approach will ensure the Plan’s ongoing alignment with the BC PSLS project and reflect the realities (including successes and lessons learned) of the initiative as the system rolls out across the province.

Document Usage and Deliverables

(Insert a description of the purpose of this plan and the key deliverables)

Example:

Material in the BC PSLS Change Management Plan encompasses multiple deliverables as defined in the BC Incident Reporting & Management Information System (IRIS) Project – A British Columbia Multi-Health Authority Project – Proposal to Canada Health Infoway. Specifically, this document aligns to the following deliverables from Section 3c) Project Methodology of the proposal:

· Change Management Plan

· Stakeholder Engagement Strategy

· Implementation Evaluation Plan

The BC PSLS Training & Education Plan and BC PSLS Communications Plan deliverables are available under separate covers.

Linkage to Health Authority Change Management Plans

(Insert a description of how this plan will link with any other change management plans)

Example:

The BC PSLS Change Management Plan will form the starting point for all Health Authority change management plans. Health Authority implementation teams are responsible for adapting the BC PSLS Change Management Plan to the specific needs of their stakeholder communities, and for leveraging existing local forums, change initiatives and communications channels wherever possible. The following diagram illustrates the relationship between the change management plans:

ENDUSER

System

Reliability

Useful

Report

Production

Integration &

Interoperability

PSLS

Security &

Privacy

Usability

QUALITY, SAFETY

& RISK MANAGEMENT

CLINICAL

LEADERSHIP

EXECUTIVE

LEADERSHIP

Promotes

Patient Safety

IM / IT

Nursing 409, Spring 2005

Conceptual Model for Evaluating An

Online Incident Reporting System

Cost/Benefit

Analysis

Accommodation

& Differentiation

Data

Accuracy

Improved Workflow

& Productivity

Evidence of

Improvement

Adapted from the Duke University study on Patient Safety

ENDUSER

System

Reliability

Useful

Report

Production

Integration &

Interoperability

PSLS

Security &

Privacy

Usability

QUALITY, SAFETY

& RISK MANAGEMENT

CLINICAL

LEADERSHIP

EXECUTIVE

LEADERSHIP

Promotes

Patient Safety

IM / IT

Nursing 409, Spring 2005

Conceptual Model for Evaluating An

Online Incident Reporting System

Cost/Benefit

Analysis

Accommodation

& Differentiation

Data

Accuracy

Improved Workflow

& Productivity

Evidence of

Improvement

Adapted from the Duke University study on Patient Safety

Capacity for Change

Change

Readiness

Dimensions

Reinforcement and Accountability

Culture

Education and Training

Leadership

Implementation Plan

Vision

Value Proposition

Support StaffFront Line StaffPhysiciansSite Leadership

Site Stakeholders

PSLS Change Readiness Scorecard

Capacity for Change

Change

Readiness

Dimensions

Reinforcement and Accountability

Culture

Education and Training

Leadership

Implementation Plan

Vision

Value Proposition

Support StaffFront Line StaffPhysiciansSite Leadership

Site Stakeholders

PSLS Change Readiness Scorecard

Area of high risk

Area of moderate risk

Area of low risk

Priority areas for mitigation plan

Sample

3

2

1

1

1

Over

all

Risk

•Inadequate stakeholder

participation in design sessions

•Incomplete or inaccurate

incident data due to gaps in

training

•Go-Live delayed

•Incomplete or inaccurate

incident data due to gaps in

training

•Incidents go unreported and

data in incomplete –safety

benefits not realized

•Credibility of program

undermined threatening viability

of future safety initiatives

Potential Impacts

•80% of participants indicated

they had NO capacity to

support the project

•60% identified project Y as

consuming a significant portion

of their time

•Significant resistance to train-

the-train, classroom model

•40% of affected staff have no

or little understanding of PSLS

•50% of stakeholders do not

see themselves as playing a

role in flagging safety incidents

•Firm believe that “culture of

blame”persists at Site A

Change Readiness

Findings

•Capacity for Change:There

exists a critical shortage of

capacity for Site A staff to

participate in the PSLS

implementation, across all roles

•Education and Training:

Proposed training model will be a

challenge to implement

•Front Line Staff: Stakeholders

are clearly unprepared for new

PSLS system and process

Priority Risk Areas

Change Readiness Findings

and Risk Mitigation Report

•Project

Sponsor

•Change

Managem

ent Lead

•Project

Manager

Owner

•Negotiate additional backfill

funding

•Revisit make-up of

stakeholder groups to

minimize physical time away

•Re-prioritize training to

allow for Contributors and

some Reporters to be

trained later

•Physically redeploy

communications and change

resources to Site A vs.

project office

•Meet with Stakeholder

Reps to unearth specific

blockages or resistance to

the program

Mitigation Plan

3

2

1

1

1

Over

all

Risk

•Inadequate stakeholder

participation in design sessions

•Incomplete or inaccurate

incident data due to gaps in

training

•Go-Live delayed

•Incomplete or inaccurate

incident data due to gaps in

training

•Incidents go unreported and

data in incomplete –safety

benefits not realized

•Credibility of program

undermined threatening viability

of future safety initiatives

Potential Impacts

•80% of participants indicated

they had NO capacity to

support the project

•60% identified project Y as

consuming a significant portion

of their time

•Significant resistance to train-

the-train, classroom model

•40% of affected staff have no

or little understanding of PSLS

•50% of stakeholders do not

see themselves as playing a

role in flagging safety incidents

•Firm believe that “culture of

blame”persists at Site A

Change Readiness

Findings

•Capacity for Change:There

exists a critical shortage of

capacity for Site A staff to

participate in the PSLS

implementation, across all roles

•Education and Training:

Proposed training model will be a

challenge to implement

•Front Line Staff: Stakeholders

are clearly unprepared for new

PSLS system and process

Priority Risk Areas

Change Readiness Findings

and Risk Mitigation Report

•Project

Sponsor

•Change

Managem

ent Lead

•Project

Manager

Owner

•Negotiate additional backfill

funding

•Revisit make-up of

stakeholder groups to

minimize physical time away

•Re-prioritize training to

allow for Contributors and

some Reporters to be

trained later

•Physically redeploy

communications and change

resources to Site A vs.

project office

•Meet with Stakeholder

Reps to unearth specific

blockages or resistance to

the program

Mitigation Plan

Sample

1 –High Priority

2 –Medium Priority

3 -Low Priority

Change Management Strategy

Successful change management is about getting individuals and groups to do things differently to drive the business benefits of a particular initiative. This task is particularly challenging as people respond to change on both rational and emotional levels. This consideration is of particular importance to the BC PSLS initiative, where a change in front line staff behaviour can only be accomplished if the culture enables and encourages (and does not discourage) them to change, and if the negative historical associations of tracking patient safety incidents can be overcome.

To initiate this transformational journey, the BC PSLS Change Management Plan focuses on the non-technical aspects of implementing the new system. The approach involves planning and managing a set of activities to achieve one, over-arching goal:

Build the working environment required for stakeholders of the BC PSLS to successfully adopt the new system, such that patient safety outcomes are achieved.

Objectives

(Insert the objectives of the change management plan)

Example:

The objectives of the BC PSLS Change Management Plan are to provide guidance and a framework to enable BC PSLS implementation teams at all levels to:

· Communicate information to BC PSLS stakeholders in a timely and clear manner such that they are fully prepared for the impending changes

· Establish local ownership of the BC PSLS by involving stakeholders in change processes

· Formalize new roles and transfer new skills to stakeholders so that the BC PSLS is effectively adopted

· Establish the working environment where the BC PSLS business benefits can be tracked and realized

· Develop and equip a network of clinical and leadership stakeholders who will sustain the new work environment to achieve safer patient care

· Build capacity and knowledge at the provincial level and within the Health Authorities to effectively conduct similar initiatives in the future

Guiding Principles

(Insert a description of the overall principles that will guide the change management activities)

Example:

The following principles will guide the development and delivery of all BC PSLS change management activities. They provide a high-level checklist against which both provincial and Health Authority change management activities should be assessed.

· The local stakeholders will be involved in leading the change effort

As the people who work within our healthcare organizations ultimately own the patient safety system and processes, they will act as the prime deliverers of change management activities wherever and whenever possible. This approach is a key to promoting sustainable change and building local capacity and knowledge in the area of patient safety. The Health Authority implementation team’s role will be to support local stakeholders with the information, tools and coaching they need to be successful in enacting change.

· Activities will be modified to meet the needs of the Health Authorities, their sites and local stakeholders

Communications, stakeholder engagement and training and education activities will be tailored to fit each environment.

· Existing resources and channels within the Health Authorities will be used for change management activities

Patient safety issues are not new in healthcare and all Health Authorities have some form of patient safety organization and processes in place. BC PSLS change management activities will use existing patient safety resources and leverage existing initiatives aimed at improving patient safety wherever possible.

· Risk prevention will be a key consideration in the delivery of change management activities.

A shift in organizational culture may entail emotional as well as behavioural changes. Change management activities have the potential to disrupt operations, cause frustration or confusion amongst staff and leadership or divert resources. These risks will be assessed against the value of each BC PSLS change management activity; assessment will involve appropriate consultation with Health Authority, agency or site leadership.

· Change management activities will be formally recognized within overall BC PSLS implementation project plans.

All change management work will be formally recognized in the appropriate workplan, along with required timeframes, resourcing, dependencies and status, and will be tracked in the same way as all other tasks.

· Health Authority change management plans will use the BC PSLS Change Management Plan as a starting point and guidance document.

Health Authority change management plans will use the BC PSLS Change Management Plan as the foundation for local activities, specifically by ensuring that each stream of activity is reflected in the local plan to ensure completeness of the local approach against BC PSLS desired outcomes.

· Change management activities at all levels will be planned such that all change management outcomes can and will be measured.

Health Authority change management plans will define how the completion and success of each activity can be measured, what will be measured and the process for measurement.

Change Management Framework

(Insert a description of the change management framework using any format you like)

Example:

The BC PSLS Change Management Plan employs a multi-stream approach in order to meet the stated objectives for the BC PSLS project. The following diagram illustrates this approach. Each stream will be discussed in greater detail in the subsequent sections or in separate companion plans (Communications and Training Plans).

The proposed approach suggests the sequencing of project stages and activities that would be anticipated for Health Authority site implementations; duration of the project will be dependent on resources. Change management activities and tasks will need to be adjusted by local implementation teams as specific scope and technical requirements are defined.

Resourcing

(Insert a description of the resources you will engage for the project)

Example:

Successful change management at any BC PSLS site will be the result of the collective effort of a number of resources. The primary responsibility for the delivery of change management activities will reside with the Health Authority BC PSLS implementation teams. However, these changes must be supported at various levels of leadership for the cultural shift to be effective. Therefore, specific change management responsibilities are prescribed

Change Management Resources

BC PSLS Change Management Responsibilities

Canada Health Infoway

Understand and support the BC PSLS Provincial Change Management plan

Provide change management advice and guidance as required

BC PSLS Central Office Team

Manage BC PSLS Provincial Change Management Plan

Interact with local site Change Management Leads and Teams to ensure alignment between local and provincial plans

Share provincial resources, materials and expertise with local Change Management Resources and Teams where possible

BC Patient Safety Task Force

Understand and support Provincial BC PSLS Change Management Plan

Adequately resource provincial change management activities in alignment with the successful project outcomes

Champion project at provincial level

BC PSLS Project Steering Committee

Understand and support Provincial Change Management plan

Resolve Change Management issues as they are escalated

BC PSLS Project Sponsor

Understand and support both the Provincial and local Change Management plans

Resolve Change Management issues as they are escalated

BC PSLS Project Directors

Understand and support both the Provincial and local Change Management plans

Validate local Change Management plans

Resource the Change Management programs

Provide quality assurance for local Change Management deliverables

Health Authority/Agency Quality/Safety/Risk Management Groups

Understand and support both the Provincial and local Change Management plans

Champion project at local level

Support development of new roles within the organization

Make available existing safety program infrastructure as required

Support establishment of Sustainment team

Health Authority/Agency Medical Advisory Committees

Champion project at local level

Provide input into escalated PSLS-related issues

Deliver communications and stakeholder activities as required

Health Authority BC PSLS Implementation Teams

Adapt Provincial change management plan to needs of local sites

Manage local change management activities, resources and schedules

Interact with Provincial change management resources to ensure alignment of local and Provincial activities

Local Staff

Represent the project and deliver Change Management activities as per local Stakeholder Engagement plan (see Stakeholder Engagement section)

Provide input into and participate in implementation process as required

Support new or changed processes once they become operational

Stakeholder Engagement

A key first step in the Stakeholder Engagement process is the identification of all people and groups, at both the provincial and Health Authority levels, who will be impacted in some way by the cultural, procedural and system changes brought about by BC PSLS or have the potential to influence the project. These people are then grouped in terms of impacts and engagement needs, which may or may not align with their functional grouping within their organizations. Although formally part of the Stakeholder Engagement stream, stakeholder identification also provides critical input into the following BC PSLS Change Management Plan streams:

· Organization Readiness

· Communications

· Education & Training

The stakeholder identification document is regularly reviewed and updated throughout the project implementation cycle to ensure no stakeholder group or person is missed.

Stakeholder Identification & Mapping

(Insert a description of how you will identify your stakeholders, define engagement levels and influence / impact on the project in the table below)

Example:

In order to effectively and appropriately communicate with any group, you must first understand who they are and what perspective they are coming from. Each set of stakeholders has a uniquely different view of the world and understanding this is key to engaging them. Through the identification and mapping of stakeholders we get the big picture as to who we are working with as well as where the change management efforts should be focussed.

Stakeholders are first listed and grouped, identifying all potential people affected by the change. Then they are evaluated in the following areas:

Interest:

What is the stakeholder’s current level of interest in the project? The following scale is used:

High: Relative to other stakeholder groups, this group has expressed a lot of interest in the project. They desire and require a lot of information on a frequent basis.

Medium: Relative to other stakeholder groups, this group is moderately interested in the project. They want high level or summary information on a less frequent basis.

Low: Relative to other stakeholder groups, this group is minimally interested in the project. They don’t want to be inundated with information and will only seek it when it is convenient for them.

Impact:

How much does the project impact the stakeholder group? The following scale is used:

High: Relative to other stakeholder groups, this group is impacted the most by the project. Their job role will change significantly with the use of the system.

Medium: Relative to other stakeholder groups, this group is impacted in a moderate way by the project. Their job role will change minimally with the use of the system.

Low: Relative to other stakeholder groups, this group is minimally impacted by the project. Their job role will not change with the use of the system.

Influence:

How critical is the stakeholder group to the success of project? Stakeholders are ranked based on their ability to influence the outcome of the BC PSLS project and mobilize resources to support its success. The following scale is used:

High: Relative to other stakeholder groups, this group has a high level of influence on the project. They can halt the project progress at any time.

Medium: Relative to other stakeholder groups, this group has a moderate level of influence on the project. They can severely impact the progress of the project, but do not have a say in terms of stopping the project.

Low: Relative to other stakeholder groups, this group has a lower level of influence on the project. They don’t influence the progress of the project.

Target Engagement Level:

Where do we want the stakeholder group to be in terms of their engagement in the project? This is a follow-up on their current level of interest. Stakeholder engagement activities are designed to move people to their target engagement level. These engagement levels are defined as follows:

Engagement Level

Definition

Engagement Strategy

Measures of Engagement

Awareness

Aware of and have a basic understanding of BC PSLS purpose and objectives

Give information:

Keep informed through brief, regular, wide-spread communications

Make information easily available

Communication effectiveness:

# of newsletters distributed each month

Websites or pages with info or links accessible to stakeholders (e.g. HA homepages)

# of calls or email requests each month for information about project

Random surveys to ask if stakeholders have heard of BC PSLS, know its main goal

Understanding

Have a sound understanding of the BC PSLS benefits to patient safety and the impacts the new system will have on them

Give opportunity to participate:

Invite to focus groups, to give input on taxonomy or to join discussion or evaluation forums

Target areas not participating and create messages meaningful to them

Communication effectiveness, participation:

Attendance at forums and group meetings

Feedback/ evaluation form for participants; include questions to assess their uptake of information about the BC PSLS

Collaboration

Support the BC PSLS, believe it is worthwhile and would act if prompted

Give meaningful roles:

Post temporary positions on project

Acknowledge contributions publicly

Link with other similar groups across province

Participation, quality and quantity of input:

Project is fully staffed with “wait list”

Volunteers working on components of project

Demand for implementation from many directions

Commitment

Actively support the BC PSLS initiative

Give accountabilities:

Ensure role descriptions and compensation are appropriate to roles

Provide support required for people to be successful in their roles

Reward and recognize successes publicly

Offer opportunities to share successes widely

Offer professional development opportunities related to patient safety – win-win

Project milestones and deliverables:

Project is on track

Dedicated resources are available

Milestones and deliverables are met

Opportunities are identified

Advocacy

Take ownership for initiatives that will improve and sustain patient safety

Give ownership:

Provide targeted information to enable advocates

Link with larger patient safety agenda (CPSI, etc.) and offer opportunities

Provide data to demonstrate success and value of system

Business performance (see Implementation Evaluation section)

The combination of impact, influence, interest and desired level of engagement will help determine priorities for engagement, quantify effort to be expended and identify appropriate leaders for engagement activities. A sample of the Stakeholder Identification & Mapping can be found in Appendix A.

Stakeholder Engagement activities will sometimes overlap with and inform Communications and Education & Training activities. There is no risk inherent in this overlap as long as the key objectives of each stakeholder interaction are understood, communicated and achieved. The difference between the Stakeholder Engagement, Communications and Education & Training objectives can be articulated as follows:

Stakeholder Engagement: Two-way interaction with stakeholders or stakeholder groups that has a defined stakeholder input objective.

Communications: One-way dissemination of information to stakeholder groups through defined channels which may allow for or invite feedback from the audience.

Education & Training: Primarily one-way dissemination of a skill, competency or knowledge required to operate successfully in the new patient safety environment, with an evaluation component to measure uptake of new information, gather feedback on successes and lessons learned and improve subsequent training programs.

As noted previously, the Stakeholder Engagement activities will feed into both the Communications and Training plans and will provide these streams with a common understanding of the stakeholder landscape. Stakeholder Engagement also defines Stakeholder Representatives, both individuals and groups who will have specific responsibilities for the BC PSLS implementation and possibly beyond.

Objectives

(Insert objectives of stakeholder engagement for the project)

Example:

The specific objectives of the Stakeholder Engagement stream are as follows:

· Present a “snapshot in time” of the people who will be impacted by or have the ability to influence the BC PSLS

· Identify the levels of engagement required for the successful transition of the stakeholder groups to the new patient safety work environment

· Define strategies aimed at moving each stakeholder group to the desired level of engagement

· Create or leverage opportunities for people to have input into the design and implementation of the BC PSLS system and work processes

· Demonstrate linkage between stakeholder involvement and the objectives of the BC PSLS initiative

· Convene, engage and define responsibilities for stakeholder groups who will enable the successful roll-out of the BC PSLS

Workplan

(Insert a stakeholder engagement workplan using any format you like)

Example:

The activities required to engage stakeholders are the responsibility of the HA implementation team and are outlined below. A sample engagement strategy document can be found in Appendix B.

Activities

Tasks

Phase

Identify stakeholder groups

Create list of all users and stakeholders

Planning

Group and map stakeholders based on impacts, influence, interest

Planning

Define high-level engagement strategies

Design

Define engagement strategies and plan by group

Identify stakeholder representative groups

Planning

Identify existing engagement forums and channels

Planning

Develop plan for engagement of stakeholders and stakeholder groups, including forums, channels, outcomes and schedule

Planning/Design

Assign responsibilities for stakeholder forums

Design

Coordinate stakeholder engagement activities and forums

Develop materials for stakeholder forums

Design/Configure Build/Deploy

Facilitate stakeholder engagement forums

Design/Configure Build/Deploy

Evaluate success, revise stakeholder identification document and plan as required

Stakeholder Representatives

(Insert a description of stakeholder representatives, include their roles and responsibilities in the table below)

Example:

A key component of the Stakeholder Engagement stream of the BC PSLS Change Management Plan is the enrolment of stakeholder representatives, both individuals and groups. This activity supports a core BC PSLS change management principle – The local stakeholders will be involved in leading the change effort – and is critical to obtaining the buy-in required for safety improvements to be realized. These representatives may be responsible for gathering, consolidating and communicating stakeholder input to the Health Authority implementation team, and may represent stakeholders at BC PSLS functional and change management forums. Roles within these groups should be fully supported and backfilled where necessary. Each Health Authority will operationalize its implementation structure in accordance with its organizational cultures and norms, but the roles and responsibilities must be assigned.

Role

Suggested participants

Responsibilities

Connect HA implementation team, HA leaders and BC PSLS Steering Committee

Operational leaders who represent functionally impacted areas, HA implementation team lead, BC PSLS Project Sponsor

Mobilize resources at Health Authority sites

Help resolve escalated Health Authority-specific issues

Secure backfill and free up stakeholder capacity where required

Stay informed as to project progress

Deliver communications and stakeholder engagement activities as required

Connect HA implementation team, functional users and their leaders

Managers, staff, Quality/Safety/Risk Management representative, HA implementation team representative

As above

Provide input into change management and training processes

Provide physician perspective to HA implementation team

Physician(s )who will be most directly impacted by BC PSLS, HA implementation team representative

Provide physician perspective on the design of the BC PSLS system and processes within the Health Authority

Help articulate impacts on physician workload and roles

Help identify opportunities for physician engagement in the BC PSLS and to optimize use of the system

Provide subject matter expertise on specific event reporting and analysis processes to HA implementation team

Subject matter experts

Provide input into and confirm as-is event reporting processes

Help define and validate to-be processes

Deliver communications and stakeholder engagement activities as required

Identify appropriate performance measures

Mobilize additional stakeholder input where and when required

Review project materials and training materials

Train users

Educators, Quality/Safety/Risk Management staff, other Health Authority staff trained in advance of their colleagues who will deliver end-user training as part of the train-the-trainer model

Receive training (safety and use of reporting system)

Deliver training (safety and use of reporting tool)

Participate in other operational stakeholder representative groups as required

Support users and create reports

Quality/Safety/Risk Management staff, Decision Support staff, others who currently support front line staff and operational leaders in patient safety and related reporting and investigation processes

Attend Power User training

Provide coaching support to trainers and colleagues as requested

Participate in stakeholder engagement activities as required

Contribute to BC PSLS forums

Organization Readiness

The Organization Readiness stream is focused on identifying changes to roles and processes that will be required for Health Authorities to adopt the BC PSLS and determining whether stakeholders are prepared to successfully adopt them. The specific activities required to ensure readiness (such as the creation of new forms and delivery of specific training) will vary and will be determined by each Health Authority according to its unique needs and available resources. All change activities should be planned and resourced in accordance with the outcomes of the organization readiness assessment.

Objectives

(Insert objectives of organization readiness for the project)

Example:

The specific objectives of the Organization Readiness stream are as follows:

· Define impacts of the BC PSLS on each stakeholder group

· Recommend new or revised roles and processes required to support, sustain and build on the system

· Assess impacts of the new or revised roles on current work responsibilities

· Assess readiness of BC PSLS stakeholders for the transition to the new work environment

Workplan

(Insert an organization readiness workplan using any format you like, provide details of activities and tasks in the table below)

Example:

Organization Readiness activities and tasks described in the Workplan are performed by the HA implementation teams.

Activities

Tasks

Phase

Assess existing roles and processes

Identify roles and processes currently used

Planning

Define desired roles and processes

Review new roles and processes identified by Pilot Sites and modify as necessary

Design

Seek input from stakeholders to validate new processes and roles

Design

Define stakeholder impacts

Map identified stakeholder groups to new roles

Planning

Define gaps between current and new roles and processes

Design

Perform impact assessment

Design/Configure/Build

Measure readiness for change

Conduct initial change readiness assessment

Design

Consolidate findings and identify areas of stakeholder risk

Design

Define risk mitigation strategies

Design/Configure/Build

Conduct change readiness checkpoint

Configure/Build

Conduct pre go-live change readiness assessment

Deploy

Develop pre go-live change readiness report

Deploy

Develop and deliver change readiness plan

Develop workplan based on risk mitigation strategies

Design

Manage delivery of workplan

Design/Configure/Build/Deploy

Assessing Existing Roles and Processes

(Insert a description existing roles and processes)

Example:

During pilot site implementations, it is important to identify and thoroughly understand existing roles and processes related to event reporting. Tools such as process flow diagrams may be helpful in this stage, and validation from stakeholder groups is necessary to ensure the HA implementation team has the complete and accurate information they need to compare the existing processes and roles with the desired new ones. During the roll-out implementations, a basic understanding of existing processes and roles is required, but most effort should be focused on defining desired processes.

Assessment of existing roles and processes should include the identification of established safety practices. A number of safety practices have been found to be effective in shifting organizational culture towards one where safety is an embedded priority; the existence of the safety practices is a good indicator of safety culture and readiness for change. These practices are most effective when applied together. Determining the degree to which these practices are in place in any Health Authority site, agency or unit is part of the Organization Readiness assessment. The following list briefly describes each practice.

Safety Huddles, Rounds or Briefings: Regular, structured, brief safety-focused team discussions; help increase staff awareness of patient safety issues, create an environment in which staff share information without fear of reprisal and integrate the identification of safety concerns into daily work.

Executive or Leadership Walkrounds™: Regular, structured visits by leaders to clinical departments to demonstrate the organization’s commitment to safety; provide a method for leaders to talk with front-line staff about safety issues and show their support for staff-reported safety events.

Plan-Do-Study-Act (PDSA) Model for Improvement: Provides a framework for improvement through small scale, rapid cycle change by teams involving setting aims, establishing measures, selecting and testing changes in order to ensure that the changes made effect the desired improvements.

Situation-Background-Assessment-Recommendations (SBAR) communications format: Provides a framework for communication between members of the healthcare team; sets expectations for what is communicated and how, which is essential for developing teamwork and fostering a culture of safety.

Defining BC PSLS Event Reporting and Management Processes

(Insert a description of existing processes, insert each process and description in the table below)

Example:

The following table lists the processes or steps involved in event reporting and management. How these activities are conducted and the people or groups involved will vary from Health Authority to Health Authority based on each organization’s needs and resources. These processes apply to each of the three components of the BC PSLS, which are:

· Safety event (incident) reporting and handling

· Claims reporting and handling

· Complaints/Client feedback reporting and handling

Process

Performed by

Description

Report event

Reporter: Anyone with access to application

Initiates a Safety Learning Report. May have participated in or witnessed the event, or have discovered it. May perform some initial analysis of the event and/or participate in follow-up/investigation.

Review

Handler: Supervisor, manager, quality, safety or risk management staff

Checks for accuracy and completeness of information, confirms severity rating and escalates to others as necessary. Collects additional information about event. Determines degree of investigation required.

Investigate

Handler: Supervisor, manager, quality, safety or risk management staff

Collects additional information from participants, witnesses, reporter, subject matter experts, documents, etc. Uses Root Cause Analysis and other tools to analyze event causes and determine actions to be taken.

Sign off

Manager: Leader of originating and involved areas

Provides leadership, guidance and support for review and investigation as necessary, reviews and approves actions and closure, takes preventive measures, reviews trends.

Analyze, report and trend

Power user: Quality, safety or risk management staff

Completes post-investigation analysis with focus on high risk events, ensures that event management processes and policies are maintained, analyzes and reports on trends to identify safety enhancement and quality improvement opportunities, prepares regular and ad hoc statistical and analytical reports.

Support reporters, support and train handlers and managers

Trainer: Quality, safety or risk management staff, educators

Ensures that new users are fully trained on both the use of the reporting system and related safety practices.

Provide feedback to optimize and improve BC PSLS

Coordinator

Seeks input and feedback from people involved in reporting and management processes at all levels, seeks ways to optimize use of system, coordinates changes to policies and procedures, maintains HA-specific documentation regarding codes, taxonomy and user accounts, gives regular input to Administrator and other collaborative forums.

Maintain secure working system

Administrator (provincial role)

Maintains codes, forms and taxonomy, manages user access and security, and coordinates changes to event reporting system.

In addition, the safety practices described earlier are supporting processes that can contribute substantially to the successful implementation and adoption of the BC PSLS. Where possible, consideration should be given to establishing roles, responsibilities and processes to support these safety practices as part of the BC PSLS

End User Support

(Insert a description of how the project will support end users, insert details in the table below)

Example:

One area in which all Health Authorities will experience an organizational impact in is the support of the system and processes. The primary goal of end user support is to facilitate a smooth transition for the end-users to the BC PSLS. Supporting the end-users during the transition from legacy processes to the PSLS is vital to adoption, as well as on going support and use of the system for both the IM/IT and safety process perspective.

During the course of the PSLS project, a well-planned deployment support approach will promote end-user adoption of the system and maximize business case results. The details of the support plan can be found under separate cover in the Iris Operations Model document. This section of the Change Management plan will address the support structure and process as it relates to the organizational impact to the Health Authorities. This new structure should be taken into consideration as organizational readiness activities are completed.

The following support structure has been laid out for the BC PSLS:

Issue Identified

by PSLS User

Reported to

HA PSLS

Coordinator

Advanced User

notified

(Manager/

Handler)

Is the issue related to

safety processes?

Reported to

HA Help Desk

(HA IM/IT)

Yes

No – Related to

Technology

Escalated to

CO PSLS Tech

Services

(PHSA)

Escalated to

CO PSLS

Coordinator

Datix Support

Help Desk

involvement

BC PSLS End User Support

Key roles and responsibilities in this process are as followed (for more details, see the Iris Operations Model document):

Application Support Level

Primary Responsibilities

Roles Involved

Primary / End User

· Provide day-to-day “how to” support within the local HA as required

· Identify and notify PSLS Administrator of training needs within HA staff

· Provide training and engage as necessary in Health Authority new employee orientation process

· Act as local office single point of contact for the PSLS

· Provide Health Authority communications to end users on changes and issues as required

Advanced Users

1st Level Support

· Acts as internal Health Authority escalation point if application issues arise from user community

· Provide call centre support for local Health Authority users of PSLS

· Supports system access, desktop, printers, network access and data issues

HA PSLS Coordinator

HA IM/IT Help Desk

2nd Level Support

· Provide support to PSLS Advanced Users (and to End Users when Advanced Users are away/on holidays)

· Support Advance Users (HA offices) in the day-to-day use of the PSLS

· Report application errors to CO-IM/IT Help Desk as required

· Supports system access, database, citrix and taxonomy issues

Central Office (CO) - PSLS Administrator

3rd Level Support

· Day-to-day problem management for all HAs

· Diagnose and resolve issues as required and co-ordinate with PSLS Coordinators, IM/IT, and Datix support as required

· Perform day-to-day security and user rights administration and set-up in PSLS

· Supports data corrections, report development and system administration

· Technical support includes citrix, desktop and print server issues (as escalated from 2nd level support)

Central Office (CO) – Application Analyst

HA Technical Services

4th Level Support

· Datix (vendor) technical support

· SQL issues or system failures

Datix Support Desk

The Issues Management process is the most critical function that the support structure performs. The process involves the coordination of personnel, activities and information to ensure the most effective and timely resolution of issues reported to the Central Office. The Communication process establishes a single point of contact (SPOC) for issue handling. Support structure personnel will be responsible for managing the issue tracking and reporting process.

Issues Management Process

An issue is defined as a BC PSLS support request which needs to be resolved by the Advanced User support team, supervisors, or Health Authority help desk. Best practices for issues monitoring include:

· All issues are documented through a tracking system

· A priority level is determined for reported issues

· Notification is provided to management on all calls that have an impact to critical business functions (via status report, telephone message, or e-mail)

· Follow-up actions are taken promptly

· Issues are escalated as necessary

· Issues are tracked from identification through resolution

· Issues are closed upon resolution

Steps involved in effective issue management include:

1. Recording & Tracking – When a user identifies a problem, they will immediately report the issue to an advanced user (if available), or to a supervisor. After an initial analysis of the issue, if the issue cannot be resolved by the advanced user, the incident is reported via phone or e-mail to the HA PSLS Coordinator or HA Help Desk. Recording of issues in a systematic way will provide a way to easily track the progress, escalation and resolution of the issues.

2. Prioritizing – Issues will be prioritized based on their impact to the business process and severity of the issue (generally based on how many users will be affected). Assigning the right severity level ensures the attention and resources devoted to each issue are consistent with its impact to the end users.

3. Assigning responsibility notification - Assigning the right severity level ensures the attention and resources devoted to each incident are consistent with its impact to the customer.

4. Escalation - Issue escalation will be performed for all unresolved critical, high and medium, and low incidents that are time-dependent or when the severity of the problem will increase if the issue stays unresolved

5. Resolution & Closure - Issue resolution is defined, from a technical perspective, as fulfillment of a request or correction of a problem. Resolved issues should be reviewed on a regular basis to identify trends and potential process improvements

The proper end user support structure and its corresponding processes will ensure a smooth transition to the BC PSLS. This structure should be taken into consideration when evaluating the impact on the health authorities.

Impact Assessment

(Insert a description of how stakeholder impact will be assessed)

Example:

An Impact Assessment should be performed as a component of determining Organizational Readiness. The processes described above are mapped to the stakeholders and stakeholder groups who will have to effectively adopt them into their daily work. For an example of an Impact Assessment document, see Appendix C. Recognizing that there are structural and organizational differences across and within each Health Authority, the following types of questions should be asked when evaluating the role and process impacts:

· What process is currently used to track patient safety incidents? Is it manual or automated or a blend of both?

· Does the site currently conduct or utilize any other safety practices (i.e. Safety Huddles, Rounds or Briefings, Executive or Leadership Walkrounds™, Plan-Do-Study-Act (PDSA) Model for Improvement or Situation-Background-Assessment-Recommendations (SBAR) communications)? If so, how will this impact the new roles and/or processes?

· What new skills, knowledge or attitudes will the stakeholders need to receive or adopt as part of this transition?

· What is the expectation of feedback on safety incidents currently? How will this feedback change with the new system and processes?

· What are the implications to the role given the new data available to them and automation of responsibilities?

· How routine is the work currently for incident reporting and/or investigation? How will this change moving forward?

· Is there a large variance in work volume? How frequently will the role use the new system and/or processes?

· Are safety processes standardized across the organization (different locations, business units)?

· With which departments or processes does the PSLS and its related processes interact?

· What information from other departments does the role need to do their work? What information do they give to other departments to enable them to do their work?

· How do they communicate with integrating departments with respect to safety incidents? How will this change?

Change Readiness Assessment

(Insert a description of how change readiness will be assessed, insert each assessment tool and the advantages / disadvantages of each in the table below)

Example:

Change Readiness Assessments allow the BC PSLS implementation teams to gauge the preparedness of the stakeholders to successfully operate in the new environment, and to adapt the BC PSLS Change Management and Training Plans to meet their specific needs and preferences. These Assessments enable the identification of key areas of risk within stakeholder communities. Change Readiness Assessments should be deployed periodically during the implementation to gauge progress in engaging and educating stakeholders. It will be incumbent upon the HA implementation team to determine if change readiness findings justify a change to the implementation schedule or plan.

The scope of Change Readiness Assessments for pilot site implementations should be wide and inclusive to ensure a complete picture of the pilot stakeholder community is developed. For subsequent implementations, the scope of Change Readiness Assessment should be informed by the outcomes of other components of Organization Readiness assessment, such as the extent of the gap between current and new processes and roles, and the existence of safety practices.

Change Readiness Assessments will be conducted at several key points, including post-go-live, to identify lessons learned from the implementation and gauge the success of the implementation. The Post-Go-live assessment is described in the Implementation Evaluation section.

The proposed schedule for Change Readiness Assessments is as follows.

This schedule will be adapted by the HA implementation teams based on the progress of the implementation, specific needs and capacity constraints of the local stakeholders.

Dimensions of Change Readiness

The Change Readiness Assessments should capture basic demographic information about participants and should measure the following dimensions:

· Value proposition: Level of understanding of and support for the relative advantages and business benefits of the BC PSLS

· Vision: Level of understanding of and support for the overall goal of the BC PSLS

· Implementation plan: Level of understanding of and support for the planned implementation approach

· Leadership: Degree of strategic and practical leadership support for the BC PSLS

· Education and training: Expectations of BC PSLS training

· Technology: Level of competency with basic and specialized computer tasks and software applications. Degree to which computers are utilized within the department

· Culture: Degree to which safety culture exists (see Safety Culture Survey description in Implementation Evaluation section)

· Capacity for change: Number and type of initiatives being deployed in parallel to the BC PSLS and the capacity for stakeholders to support the change given their operational responsibilities

· Reinforcement and accountability: Extent to which respondents feel accountable for the success of BC PSLS

An example of a Change Readiness Assessment tool with stakeholder questions for consideration may be found in Appendix D. The questions listed should not necessarily be deployed to stakeholders in their as-is states. The inclusion of the questions and their format (open-ended, forced choice, likert scale, etc.) need to be determined by the HA implementation team as they determine their specific approach.

Approach for Change Readiness Assessment

Change Readiness Assessments are typically deployed using a combination of the following channels. It will be up to the HA implementation team to assess the appropriate mix of assessment tools, given site preferences.

Assessment Tools

Advantages

Disadvantages

Ideal Usage

Online survey

Easily distributed

Reminders easy to disseminate

Results available in real-time and easy to analyze

Standardized presentation to audience sample

Can be anonymous

Relatively inexpensive

Audience sample must be web-enabled

No opportunity to guide discussion or provide clarification

Mostly close-ended questions distributed to a large, web-enabled audience, particularly end-users

Hard copy survey

Audience sample doesn’t need to be web-enabled

Standardized presentation to audience sample

Can be anonymous

Relatively inexpensive

Data analysis more labour-intensive

Manual distribution and collection

Mostly close-ended questions distributed to a large, offline environment.

Hard copy surveys may be most appropriate for line staff at on wards

Focus groups

Opportunity to ‘dig deeper’ if needed

Opportunity to leverage existing meetings

Can re-use survey questions as required

Lose anonymity

Requires coordination of schedules and meeting rooms etc.

Labour-intensive data analysis

Potential interviewer bias

Groupthink

Mostly open-ended questions distributed to a targeted groups of Site stakeholders, where two-way communication is critical:

Managers

Front Line Staff

Support Staff

This is appropriate for all staff levels, but must rely on a carefully-selected sampling, given the logistics involved.

Interviews

Detailed information available

Opportunities to ‘dig deeper’ if needed

Labour-intensive process

Potential interviewer bias

No anonymity

Potential selection bias

Mostly open-ended questions distributed to a specific individual, usually leadership, where two-way communication is critical.

Appropriate for leadership including Physicians, Program Directors and Executives

Observation

Not dependent on audience sample responses

Less accurate information

Observer bias

Unreliable availability of information

Fleshing out existing information gathered through other channels.

Appropriate for all staff levels, provided the PSLS implementation team can have access to them.

Outputs

(Insert a description of change readiness outputs)

Example:

Analysis of the results of Change Readiness Assessments enables the identification of key areas of risk within the stakeholder communities as the site prepares to go live. These areas of risk must be addressed through well-planned mitigation activities. The sample outputs of the Change Readiness Assessment are included in Appendix E. The format and distribution of these outputs must be adapted locally.

Implementation Evaluation

The Implementation Evaluation identifies the approach to measurement and tracking of anticipated key benefits and indicators. It is critical to establish a framework whereby these benefits can naturally be driven out and easily measured within Health Authorities. This section constitutes the Implementation Evaluation Plan deliverable as per the proposal to Canada Health Infoway.

Objectives

(Insert a description of the evaluation of the project)

Example:

The objectives of the Implementation Evaluation approach are:

· Identify the measures that indicate the accomplishment of a successful PSLS implementation

· Define the reporting system and processes required to demonstrate implementation success and business benefits

· Define the roles and accountabilities related to the demonstration of implementation success

Workplan

(Insert a project evaluation workplan using any format you like, insert a description for each activity and task in the table below)

Example:

Activities

Tasks

Phase

Owner

Adapt implementation Evaluation Framework and methodology

Review and socialize Provincial framework with HA team and sponsors

Planning

HA Implementation Team

Assign implementation evaluation accountabilities and integrate into role changes plan (see Organization Readiness section)

Planning

HA Implementation Team

Revise Provincial framework based on scope and approach of HA implementation

Planning

HA Implementation Team

Develop implementation evaluation system process

Identify sources of information for each indicator

Design

HA Implementation Team

Test sources of information

Configure/ Build

HA Implementation Team

Design reports, HA measurement schedule and forums for measurement

Configure/ Build

HA Implementation Team

Define HA target performance levels per indicator

Configure/ Build

HA Implementation Team

Design corrective actions plan

Configure/ Build

HA Implementation Team

Train accountable resources as per role change plan

Configure/ Build/ Deployment

HA Implementation Team

Measure implementation success

Integrate first implementation evaluation into lessons learned evaluation as appropriate

Evaluation

HA Implementation Team

Measure implementation success as per schedule

Evaluation

HA Implementation Team

Implement corrective actions plan as required

Evaluation

HA Implementation Team

Approach and Framework

(Insert a description of the outcomes for success)

Example:

The PSLS Outcomes for Success are listed in the introduction section of this document and should be used as the starting point for the Implementation Success Framework. The are three main categories for evaluation.

1. Cultural (strategic) evaluation – addresses the cultural aspects of the change. It should be designed to address the current state (pre-implementation evaluation) as well as addressing how well the goals and objectives were met (post evaluation) from a cultural/mindset perspective.

2. Operational Improvements evaluation –focus is on the business improvements that should happen as a result of the implementation. This evaluation should be done at the start of the project to provide a baseline of the metrics and then again post-implementation to determine the effectiveness of the safety reporting process and the system which supports it.

3. Project Lessons Learned (tactical evaluation) – summarizes the effectiveness of the project structure and execution and will inform future initiatives. This will include such things as whether the project was on-time, within budget and lessons learned.

Cultural (strategic) Evaluation

(Insert a description of cultural evaluation)

Example:

A key goal of this project is to develop and improve the culture of safety within the health authorities. A reliable measure is needed to monitor the success of the initiatives. The objectives of the cultural evaluation are to measure how open the environment is in terms of incident reporting, what level of communication exists around safety and the team working dynamics. The survey should be rolled out prior to the project implementation ramp-up to obtain a baseline of the views on the safety culture, incident reporting behaviors & perceptions and follow-up/feedback perceptions. The same survey should be used post-implementation as a comparison to determine how the project, the implemented system and processes impacted the various groups. Sample metrics based on the PSLS Outcomes for Success around cultural evaluation are as follows:

PSLS Outcomes for Success

Relevant Measures

Promotion of teamwork and communication

· Increased scores on safety culture survey

· Improved staff perceptions of teamwork

Promotion of a more effective use of resources

· Reduced time for investigation

· Reduced time to resolution

A created and supported culture of safety and learning

· Increased scores on safety culture survey (caregiver satisfaction with system)

· Increased staff involvement in safety initiatives

· Increased time spent of safety activities

Existing tools to leverage are as follows:

· IHI’s Safety Climate Survey (SAQ): See Appendix F and the IHI website at: http://www.ihi.org/NR/rdonlyres/608DA1DC-7042-43F7-B110-F628378078F2/1147/SafetyClimateSurvey1.pdf

· AHRQ as used by PHSA: See Appendix G

· SAQ as used by VCH: See Appendix G

Operational Improvements Evaluation

(Insert a description of operational evaluation)

Example:

In order to determine the effectiveness of the PSLS implementation, an assessment should be undertaken to identify the operational improvements that the program is able to achieve. According to the Duke University report “Evaluation of Online Incident Reporting Systems” there are a number of areas in which to evaluate the effectiveness of an online incident reporting system. A graphical depiction of the ten areas to evaluate is as follows:

Figure 1: Conceptual Model for Evaluating an Online Incident Reporting System

As with the Cultural survey, a baseline should be taken in order to determine where the organization is starting from. Sample metrics based on the PSLS Outcomes for Success around operation improvements include:

PSLS Outcomes for Success

Relevant Measures

Improved event and near miss reporting with specific actions resulting in reduced or eliminated safety-related problems

· Increased reporting volume

· Increased near missed reporting

· Reduced # of serious events

· Increased quality and completeness of incident reporting data

Provision of more timely feedback to users and leaders on events

· Increased reporting volume

· Turnaround time for feedback to users

Improved efficiency for event, complaint and claims management

· Reduced time for investigation

· Reduced time to resolution

· Reduced duplication of data entry and reports

Provision of support to managers

· Reduced frequency of anonymous reporting

· Increased staff knowledge of incident reporting purposes and practices

· Increased quality and completeness of incident reporting data

Provision of a better source of data for analysis

· Reduction in frequency of anonymous reporting

· Increased quality and completeness of incident reporting data

Reduced costs increased and improved information-sharing

· Reduced issue resolution costs

Enhanced productivity

· Reduced # of serious events

Existing tools to leverage are as follows:

· PSLS Operational Improvements Survey: See Appendix H

Lessons Learned

(Insert a description of lessons learned)

Example:

Capturing stakeholder feedback on the successes and challenges of the PSLS implementation is a critical component of the process and can serve as important input into subsequent implementations. The approach for the lessons learned mirrors that of the change readiness assessment, but will focus on the implementation plan dimension more than any other dimension. The local implementation team itself is a critical source of input during the lessons learned assessment and therefore it must be conducted prior to contractor/temporary resources being released from their role.

The lessons learned assessment should be conducted through three primary channels:

Interviews: One-on-one interviews with local Project Sponsors, Site Manager, Local Project Managers and Process Owners (collectively known as Project Leadership for the lessons learned analysis)

Focus Groups: Group sessions with Stakeholder Representative Groups (see Stakeholder Engagement section) and the Implementation Team (grouped by functional area as required) designed to solicit structured and functionally-aligned feedback

Survey: Online or paper-based survey distributed to all the stakeholders who will have a new or changed role (or an existing role completed in the PSLS system).

· Workshops: Interactive session with the implementation team members to determine what went well and what should be improved upon moving forward. These workshops should be completed shortly after go-live to ensure prompt capture of the lessons learned.

The participants in the lessons learned process will overlap with those responsible for measuring the success of the implementation. Forums designed to solicit their lessons learned input can be leveraged to capture their reports on implementation success as per the indicators above.

The following describes the categories and suggested questions for the lessons learned assessment:

Lessons Learned Categories

Stakeholder Questions for Consideration

Change Readiness (for comparison with pre-go-live assessment)

· What is the vision for PSLS? Do you agree with it?

· Is there visible leadership for the PSLS project at Site A/Health Area A?

· Safety Climate Survey post-implementation assessment

Project Planning

· What was done during the Planning phase (note: may need to remind participant of specific activities) that you would suggest should happen again? (Continue)

· What should be done differently or not at all during the Planning phase at the next PSLS implementation site? (Stop)

· What wasn’t done during Planning that should be done at the next PSLS implementation site? (Start)

Design

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

· Were the appropriate stakeholders involved in the Design phase? Why or why not?

User Acceptance Testing

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

· Were the appropriate stakeholders involved in the UAT? Why or why not?

Change Management and Communications

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

· To what extent were you adequately informed about the PSLS implementation?

Training

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

· To what extent did the classroom training adequately prepare you to use the PSLS system?

· Which of the following are you using to increase your skills in using the PSLS system and processes and how much/how often are you using them?

· Training Materials

· Super Users

· Cheat sheets and job aids

· Training sandbox

Deployment and Go-Live

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

Post Go-Live Support

· Adapt Continue, Stop, Start questions as listed in the Project Planning phase to this implementation phase

· Where do you currently go when you need support on the PSLS project?

· What support do you need to reach full competence with the PSLS system?

Implementation Roles

· Did you understand your role with respect to the PSLS implementation? Please describe.

· What was most useful to you in completing your role on the PSLS implementation?

· What were the barriers to you completing your PSLS role?

· What advice would you have for people assuming this role at the next PSLS implementation site?

· To what extent do you understand the roles of the following groups:

· Super Users

· Process Owners

· Project Managers

Implementation Success

· What improvements to patient safety have you seen since PSLS went live?

· How would you measure the success of PSLS six months from now?

· What staff behaviours do you anticipate seeing in 6 months that will indicate success to you as a leader?

· Do you have any particular initiatives planned as a result of PSLS going live?

· How would you describe your role in driving out and supporting these behaviours?

· Who is acc