Assessing Behavior Change Using the Recommendation Adoption Process Model

Transcription

1 600 East Superior Street, Suite 404 I Duluth, MN I Ph or I Assessing Behavior Change Using the Recommendation Adoption Process Model Kate Stenehjem Nat l Rural Health Resource Center Information Specialist II

2 RHPI Serves Rural hospitals <199 beds that are located in Delta Regional Authority (DRA) counties / parishes in 8 state region

3 Project Development Process Prioritize performance improvement (PI) needs Define the PI activity Select a consultant Develop a scope of work (SOW) RHPI Selection Considerations: No pending or anticipated issues that would hinder the consultation process. Congruence between hospital needs and available consulting services

4 Project Development Process Scope of Work (SOW) Includes: Purpose of consultation Objectives of the consultation Strategies to complete objectives Sustainability plan Work plan and timeline Define purpose, objectives, & anticipated outcomes in general terms Define timeline and pre-schedule onsite consultation dates to prepare staff for the consultant visit. RHPI does NOT accept date TBA!!

5 Example: Business Office Assessment SOW Purpose Objectives Anticipated Outcomes The objective is to conduct rapid and focused analyses of targeted areas within the 1. Identify areas of compliance risk due to chargemaster or business office operational errors. 1. Drive higher gross revenue and net reimbursement while business office that result in 2. Identify areas of lost mitigating compliance the identification of reimbursement due to issues with concerns. concrete opportunities for operational and financial performance gains. We facilitate the initital implementation of business office policies, procedures and processes. 3. Identify areas of lower reimbursement due to issues with contract management. 2. Increase the opportunity departmental ownership and accountability improvements to process with the goal of increasing gross and net reimbursement while mitigating compliance 4. Identify areas of compliance concern and risk within the business office. Present opportunities, training and steps to mitigate the identified risks. 3. Increase business office operational efficiency and effectiveness

6 Project Completion Process Consultant final reports should include: 1. Overview of services provided 2. Findings from assessments 3. Recommendations to improve performance 4. Action plan that outlines next steps to implement recommendations 5. Specific anticipated outcomes 6. Measures / indicators to track progress Metrics should be standard industry accepted financial, operational ratios / measures and/or quality indicator(s)

7 600 East Superior Street, Suite 404 I Duluth, MN I Ph or I Post-Project Evaluation: Recommendation Adoption Progress (RAP) Reporting

8 What is RAP? Recommendation Adoption Progress (RAP) reporting is an evaluation tool that captures the degree to which program activities have been implemented and/or services utilized by the program participants.

9 RAP Goal & Purpose The goal is to demonstrate the hospital s progress over time by indicating the extent to which the facility has implemented the consultant recommendation. The purpose is to summarize the overall impact of activities and services. Hospitals are able to discuss accomplishments, identify outcomes, and determine the impact of activities and services.

10 Loosely Based on Appreciative Inquiry RAP approach is loosely based on Appreciative Inquiry (AI) and modified to RHPI needs Seeks to discover the best of what is Integrates the collection of data concerning expected measurable outcomes and how has this affected the hospital bottom line?

11 Loosely Based on Appreciative Inquiry RAP is a coaching tool Encourages the hospital to stay the course by celebrating accomplishments and recognizing the effort already expended increases awareness for the CEO to embed the PI process into the hospital culture RAP is an integral part of RHPI process to support sustainability

12 Application of the RAP RAP process can easily be modified to accommodate other purposes. AI concepts can be learned by those wishing to utilize the RAP process. The process should be used when gathering strong data and information is critical and there is a need to dig deeper. Questions can then be developed to meet the purpose of the interviewer.

13 Application of the RAP The Interviewer: Does not have to be a content expert but should have some background knowledge Must have good rapport building skills and be able to fluidly facilitate a conversation Must be able to follow threads of possible issues and not stay tied to a set of questions

14 The RAP Interview RAP interview is scheduled 9 12 months post-project RAP evidence indicates hospitals require at least years to fully implement the consultant recommendations RHPI does not contact the hospital at 3 or 6 months

15 The RAP Interview Interview is scheduled with the CEO Interview package, which is forwarded prior to the call, includes: The final report and action plan Scope of Work Pre-/ Post-Project outcomes work sheet RAP interview questionnaire

16 The RAP Interview Why forward all the documents again? Prepare the CEO for the interview Remind the CEO of project details Enhance probability of obtaining postproject values Simplify process to augment the interview experience and improve outcomes capture

17 The RAP Interview RAP interview focuses on: Measurable results of anticipated outcomes What is going well Next steps Project impact

18 RAP Questionnaire 1. On a scale of 1 5, rate the extent to which the hospital has implemented consultant best practice recommendations. 1 = none or few recommendations implemented 5 = all implemented and the project is sustained with outcomes Assesses the status of the implementation phase Provides a score to compare projects in the ROCI analysis and selection process Determines if the hospital requires more time before supporting another RHPI project Evaluates if a hospital is ready and deserving of another project

19 RAP Questionnaire 2. Please refer to the Pre/Post Project Outcomes Worksheet included with this . Please complete the worksheet and return to prior to the scheduled call. Encourages CEO to return worksheet prior to RAP. Considered in selection process 2. What is your hospitals current status with regard to implementing the performance improvement recommendations made by your RHPI sponsored consultant(s)? Focuses on all the accomplishments.

20 RAP Questionnaire 4. What are your hospitals expected next steps towards adopting your consultants recommendations? Focuses on next steps to refocus on project May discuss any recommendations not implemented and why 5. Aside from the measurable outcomes, what are some of the ways this project has impacted your hospital, its culture, and the community? Looks at long term impact of this project and how to sustain the project gains Summarizes the call and tends to energize the team

21 RAP Score and Concept RAP Score ranges from 1 to 5 1 = none or few recommendations were adopted by the hospital 5 = all recommendations were adopted by the hospital The higher the score, the greater the number of recommendations implemented by the hospital. The hospital should see performance improvement and the project should be sustained.

22 RAP Scores of 4-5 Hospitals are able to provide detailed evidence of performance improvement gains Indicates very successful projects that are sustained Reasons for score of 4.0 (<5.0) Some recommendations take longer to implement Financial limitations of implementation Target low hanging fruit first for quick fix Target top 20 for the biggest bang for the buck Individualize to fit their culture

23 RAP Score 3 RAP score of 3 is considered by RHPI as very positive and indicates that: the project is in process leadership is committed to continuing and sustaining projects Correlated with initial outcomes associated with cost savings and/or cost containment

24 RAP Score Unsuccessful Project! Hospital needs more time to implement the consultant recommendations Hospital must take action to implement recommendations It s the Hospital s sole responsibility to implement the recommendations, and NOT the consultant s!

25 RAP Score 0-2 Hospitals with scores of <2 <5 hospitals reported score of 2 Only 1 hospital reported a score of 1 Only 2 hospital reported a score of 0 Why? Majority - Change in leadership during the project! Many -Hospitals took on too many projects at once Minority Fewer than 3 hospitals decided that ALL the recommendations were not feasible

26 Scoring System RAP interviews are considered in the selection process for future projects. Hospitals are scored based on completion of RAP interview and its robustness. Hospitals are not weighted on their RAP scores in an effort to encourage honest interview responses and provide an incentive to the implementation process.

27 Variability in Outcomes Many variables may impact performance Clearly defining project objectives Indicators to quantify progress Hospitals should be well-positioned to explain outcome variables that could enhance/impede their adoption of recommendations, and thus, performance

28 Variability in Outcomes External variables may impact the performance and may be beyond the control of the hospital Triple Aim and Medicare reimbursement

29 Example: BO Assessment RAP Findings RAP Anticipated Score Outcomes 4 1.Drive higher gross revenue and net reimbursement while mitigating compliance concerns. 2.Increase the opportunity departmental ownership and accountability 3.Increase business office operational efficiency and effectiveness Actual Reported Outcomes 1. Recovered 440k cash after addressing observation patient billing; Use same model in ER and capture $30 more per patient at 10,000 visits per year=$300k 2. Yes, with revenue cycle meetings 3. Dropped AR days from under 50 to 36 Administrative Feedback and Project Impact We found that we didn t have a coordinated revenue cycle team to look at nuts and bolts, now have that, doing department by department charge master review, observation patients charge master capture. Able to rebill some of those patients and 400k cash that they would have lost. Using same model with ER and increase visit capture by $30 and do about 10,000 visits year so about $300,000. Department managers present to revenue cycle meeting about how they are doing Impact: Better efficiency in business office Increased revenue and charge capture Increased ownership of department managers for their revenue Improved AR dates Taken revenue reporting to a different level Increase business savvy of management

30 600 East Superior Street, Suite 404 I Duluth, MN I Ph or I RHPI Outreach: Dissemination of Lessons Learned

31 RAP Limitations & Program Improvements FY of RAP Interview Year Evaluated Response Rate FY13 FY12 93% FY12 FY11 88% FY11 FY10 71% FY10 FY09 71% FY10 FY08 67%

32 RHPI ROCI External Evaluation RHPI utilizes a Return on Community Investment (ROCI) Analysis for the external evaluation, which should be completed 3 consecutive years for good representation of actual impact. The evidence gathered through RAP reports demonstrate the individual hospital project outcomes, but also illustrate the overall impact of the program.

33 ROCI Key to RHPI Improvements RAP information used for ROCI In the first year of completion, ROCI identified areas of RAP that needed strengthening, which consequently, improved outcomes capture Improved RAP process led to stronger ROCI report in its second year, which is in turn provided new options to improving project planning In each case, RAP and ROCI has improved the project planning and/or reporting processes

34 RHPI RAP Evaluation Summary Approach Purpose Objective Method Limitations The purpose of the RAP is to gather information on the adoption of consultant best practice recommendations, and ultimately project outcomes. The goal of RAP is to demonstrate a hospital s progress over time by showing the extent to which a facility has implemented recommendations. To document project outcomes, successes, and lessons learned from RHPI sponsored projects. To demonstrate how the project impacted the hospital and how it s being sustained long-term. Data is gathered by interviewing CEOs approximately 6 12 months post-project. Utilizes a scoring system to determine the overall adoption rate. -RAP Score ranges from 1 to 5. The concept is that the higher the score, then the greater number of recommendations were implemented by the hospital to sustain the project, which should improve performance. -Progress on anticipated outcomes is recorded. Impact on the hospital is also explored as it is an indicator of sustainability. Data may be limited due to: Completion of the RAP interview, availability of the data from the hospital, and robustness of the CEO response to the data request and interview questionnaire. Accuracy of the reported financial and outcome data is dependent upon the CEO s knowledge at the time of reporting. Anticipated Outcomes RAP results represent individual project outcomes and status of progress. Assessment findings and outcomes data are used to monitor and modify internal processes to improve services to hospitals. Correlation Between Evaluations RAP is primary data for ROCI analysis. Also provides background information and possibly supporting evidence to the financial and quality evaluations.

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