1. Jay Ford, PhD University of Wisconsin - Madison

2. What is readiness?

3. Why is readiness important? “Help healthcare organizations detect potential obstacles and improve chances of successful implementation

4. What does RIM measure?

5. Readiness for Implementation Scale Development Designed to predict success in implementing interactive health communication system Tested using two decision-analytic approached Validated in 25 ICHS Implementation Cases Two of seven factors were the most important in predicting implementation readiness Organizational Motivation Meeting User Needs

6. Readiness for Implementation Scale

7. Organizational Motivation 1. Articulate how implementation fits with organizational and client/patient care goals 2. Help address or solve a key organizational problem 3. Consider the implementation business case 4. Create awareness of client benefits 5. Understand the level of leadership support 6. Examine resource allocation supporting implementation

8. Awareness & Support 1. Encourage key opinion leader perception of and support 2. Gain support of clinical managers or supervisors 3. Enhance key stakeholder understanding of technology implementation and how it will be used 4. Help clinical staff see how implementation will benefit clients 5. Allow clinicians to build client trust in order to promote active use 6. Address the concerns of powerful organizational skeptics who can block implementation

9. Meeting Needs & Usefulness 1. Ease and frequency of technology updates 2. Affordability (e.g., Business case) 3. Accessibility in the agency for staff using the technology 4. Ease of navigations for staff and consumers 5. Technical help for users and staff 6. Adaptability: what is the expected use of by staff

10. Departmental Fit 1. Work with a well-respected department in the organization 2. Ensure that implementation will be successful in the selected department 3. Integration into agency workflow (e.g., services and procedures) 4. Anticipate and being prepared for technical difficulties 5. Use adequate training to ensure staff familiarity and acceptance 6. Measure the effect of implementation on staff workload 7. Understand the effect of implementation on the care provider role and clinician/client relationship

11. Organizational Environment 1. Prior history of successful innovation of technology implementation 2. Leader innovativeness 3. Internal turbulence (e.g., restructuring, staff turnover, miscellaneous organizational change, etc.): 4. Teamwork and cooperation 1. Within departments 2. Across departments 5. Degree to which external influence from the field support EBHR adoption.

12. Implementation Establish a positive organizational view about the implementation process by 1. Incorporate the role of the technology within organizational guidelines 2. Ensure that the technology can be customized during implementation to meet agency needs 3. Develop a clear process to identify, refer, and support users of the technology 4. Provide staff training during implementation 5. Use implementation feedback to remove barriers and improve processes.

13. Promotion During Implementation the organization should 1. Persistently promote its benefits to the organization and for clients 2. Identify an influential administrative champion to promote its benefits 3. Identify an influential clinical champion to promote its benefits 4. Provide regular reports about implementation to key stakeholders impacted by the EBHR

14. Unique Characteristics of RIM Quick and easy to use. Can be completed in about 15 minutes. Response options for each question are exclusive descriptions rather than Likert-type scales. Forces respondents to choose an answer that best describes their organization’s readiness. Fosters a better understanding of their organization’s readiness to change by respondents. Each of the seven factors can be weighted differently.

15. Application of the RIM Conduct the assessment at multiple time points Complete the RIM by 5 to 7 individuals Identifies factors critical to IHCS implementation Allows an organization to assess its own strengths and barriers to adoption and prepare for implementation. Monitor progress over time to keep the effort on track and measure the effect of actions taken between evaluations.

16. RIM Development Two factors were most important in predicting implementation readiness Organizational motivation and Meeting user needs RIM was a better predictor for the one-year implementation outcome than the half-year outcome.

17. Application in Behavioral Health Modified tool to focus on electronic behavioral health record implementation Asked staff from seven behavioral health organizations to complete the tool Assessed differences across agencies, by staff job category and tenure with agency Identified potential areas for improvement

18. RIS Performance in Behavioral Health F=30.76, df=4, p=0.00

19. RIS Performance Agencies Scoring 75% of Total Factor Scores Organizationa l Motivation Meeting Needs & Usefulness Awareness & Support Departmental Fit Implementatio n Organizational Environment Promotion Level of Influence 22%18% 14%11% 6% Agency A  Agency B  Agency C  Agency D  Agency E  Agency F  Agency G 

20. Agency RIM Comparisons RIM Factor Agency Comparison Organizational Environment (F=6.42. df=4, p=0.000) Agency A vs. Agency B [Δ = -2.083, p=0.000] Agency A vs. Agency C [Δ = -1.962, p=0.000] Agency A vs. Agency D [Δ = -1.357, p=0.007] Agency A vs. Agency G [Δ = -1.346, p=0.003) Organizational Motivation (F=4.79, df=4, p=0.003) Agency C vs. Agency B [Δ = 2.375, p=0.000] Agency C vs. Agency D [Δ = 1.887, p=0.002] Agency C vs. Agency G [Δ = 1.228, p=0.017] Promotion (F=2.36, df=4, p=0.070 ) Agency A vs. Agency B [Δ = 2.678, p=0.021] Agency C vs. Agency B [Δ = 2.500, p=0.017] Awareness & Support (F=2.93, df=4, p=0.033) Agency C vs. Agency B [Δ = 1.977, p=0.004]Agecny C vs. Agency G [Δ = 1.409, p=0.013] Fit in the Department Agency C vs. Agency D [Δ = 1.747, p=0.033]Agency C vs. Agency B [Δ = 1.818, p=0.035]

21. Impact of Tenure on RIM RIM FactorTenure Comparison Organizational Environment [F=2.10, df=2, p=0.134] 3 to 5 Years vs. 5 Years + (Δ=-0.732, p=0.046) Organizational Motivation [F=2.49, df=2, p=0.094] Two Years or Less vs. 5 Years + (Δ=1.067, p=0.031) Meeting User Needs [F=2.20, df=2, p=0.122] Two Years or Less vs. 5 Years + (Δ=0.938, p=0.055) Promotion [F=1.77, df=2, p=0.182] Two Years or Less vs. 3 to 5 Years (Δ=1.295, p=0.094)

22. Impact of Job on RIM RIM FactorJob Responsibility Organizational Motivation [F=1.779, df=2, p=0.180] Directors/Administrators vs. Clinicians (Δ=-1.000, p=0.067) Implementation [F=1.548, df=2, p=0.225] Directors/Administrators vs. Clinicians (Δ=-0.764, p=0.086)

23. Issues in EBHR Implementation RIM FactorStaff Issues in EBHR Implementation Organizational Motivation 1.Unsure if EBHR addresses key organizational goal. 2.Questioned leadership support 3.Not clear if resources (technology, staff) would be adequate during implementation Meeting Needs1.Would technical support be available? Departmental Fit 1.Integration of EBHR into workflow 2.Staff unfamiliarity with EBHR 3.Concern over implementation difficulties

24. Issues in EBHR Implementation RIM FactorStaff Issues in EBHR Implementation Implementation1.Concerns about customization & training 2.Fit within organizational guidelines Awareness and Support 1.Concern about impact on clients 2.Trust in technology 3.Staff Resistance to technology Promotion1.Existence of administrative or clinical champion 2.Effectiveness of the individual (how influential) Organizational Environment 1.Concerns about past success 2.External pressure does not promote implementation

25. Key Success Factors Align technology with organizational goals Understand the customer (staff and clients) Lead change – gain support from champions (administrators, clinical) Dedicate sufficient resources Choose the “right” teams Select realistic time lines Analyze workflows, benchmark performance Measure cultural support & resistance Market the benefits & challenges “Be” the credible, informed expert Exude ENTHUSIASM!!!

26. Resources Gustafson DH, Brennan PF, Hawkins RP. Investing in e-Health: what it takes to sustain consumer health informatics. Springer Verlag; 2007. Wen, K.Y., Gustafson, D.H., Hawkins, R.P., Brennan, P.F., Dinauer, S., Johnson, P.R., & Siegler, T. (2010). Developing and Validating a Model to Predict the Success of an ICHS Implementation: The Readiness for Implementation Model. JAMIA

27. Contact Information: Jay Ford, PhD Center for Health Enhancement Systems Studies University of Wisconsin – Madison 1513 University Avenue – ME Bldg Room 4161-C Madison, WI 53706 608-262-4748 (Office) 608-890-1438 (Fax) Jay.ford@chess.wisc.edu