Description of the Organization Change to be investigated

The main aim of this report is to investigate the change management strategy that was adopted in the implementation of a new policy framework for pain management in a health center. The center initially lacked elaborate policies to govern pain management and as such, it aimed to institute elaborate policies to this effect.

Data Collection Methods

To determine the effectiveness of the change, the senior management and other key stakeholders closely monitored the operations of the health center in a bid to identify any changes that could be attributed to the pain management policy framework. To this end, a myriad of quantitative and qualitative data collection designs were utilized to gather information related to pain management. The main quantitative designs that were used include individual patient randomized controlled trials, cluster randomized traits, both controlled and uncontrolled before and after studies and time series designs. All these designs were leveraged to establish general causal relationships across the population of interest. Given the wide variety of data collection designs, the research team made deliberate attempts to minimize potential bias and maximize the generalizability of the results.

The key internal stakeholders that were involved in the change included doctors, physiatrists, psychologists, nurses; physical and occupational therapists, pharmacists, biofeedback therapists, dietitians, chaplains and nicotine-cessation therapists. However, the committee only constituted five members of staff from different departments and hierarchical levels within the organization. These include a surgeon, a pharmacist, a psychologist, a physiotherapist and me, the head nurse. I was very humbled by the opportunity to participate in the committee because I was the most junior employee.

The main external stakeholders, on the other hand, include all the patients that were treated for pain related illnesses at the hospital before and during the policy formulation period. Self-administered questionnaires were issued to these patients and they were allowed to carry them home and bring them during their next appointment. Those who had appointments occurring more than seven days after the date they were issued the questionnaire were asked for contact information and home addresses so that the questionnaires could be collected from their homes. Apart from the questionnaires all the medical staff in the health center made deliberate attempts to conduct personal interviews with their patients. Furthermore, data were collected from patients’ medical records, administrative and pharmacy data, claims, complaints, appeals, telephone service data and appointment data.

Because there are numerous instances of patients suffering from pain (both mild and severe) every day, the committee decided to collect data from health records for 20 days per month. Moreover, the health center handled a relatively small number of patients per day so collecting data at this frequency was manageable. The records were analyzed based on the requirements of the new pain management policy framework. The main focus of the analysis was therefore the impact of the new policies on the overall performance of the center.

Identified Organizational Change

The organizational change that took place in the health center entailed the institution of an elaborate policy framework to govern pain management. Successful implementation of this policy required necessary tools and infrastructure to promote practice and research advancement in pain management. Moreover, basing on available evidence, the health center had to build a full spectrum of best practices of the continuum of chronic and acute pain. Finally, the center had to foster a culture of pain awareness, proactive intervention and education. To achieve these objectives, apart from being cognizant of the various alternatives to medication, it was in the best interests of all practitioners to have a good understanding of the personal and spiritual needs of patients concerning pain management. Moreover, they had to endeavor to ensure that discharged patients have the capacity to manage their pain. Once the new pain management strategy has been fully implemented, the center will be in a better position to take care of its patients, which will translate into customer loyalty hence boosting its overall profitability.

Data Collection Measures Used by the Organization

Before implementing the program, data were collected to reflect the initial state of pain management in the health center. First, the initial principles and values governing pain management were investigated. To achieve this, the committee that had been charged with the responsibility of implementing the program ensured that they were all familiar with the role played by each stakeholder within the center to promote pain management. As such, they had to investigate the initial structures and roles played by different employees in pain management. Secondly, the initial patient outcomes were investigated to determine whether the initial model of care delivery was safe, whether it provided equity of access and whether it was based on the most appropriate available evidence. Other than that, members of the community were interviewed to determine their perception about pain management at the hospital.

To evaluate the health center’s capacity to adopt a new pain management strategy, all the medical practitioners who have a direct bearing on the effectiveness of the pain management program were interviewed to determine whether they have the right set of skills to adopt to the new strategy. The results of these interviews were used to pinpoint the key areas in which they needed further training and development. These results also helped the center to determine the research tools and infrastructure that would be required to promote the new pain management program. Finally, the committee investigated the initial cost of pain management incurred by the center and the total cost incurred by patients on pain related medical attention on an annual basis.

Improved Data Collection

To improve the data collection exercise, the health center should have first sought the advice of external consultants that specialized in data collection and analysis. Notwithstanding, its data collection strategy was relatively successful. The employees were however not included in the change. The committee should have first collected data on employee’s views about the proposed change and encouraged them to give any suggestions that would help the health center to implement a more effective pain management policy framework (Cameron & Green, 2012). The employees’ participation in the change would have not only encourage them to embrace it, but also made deliberate efforts to facilitate data collection.

How Change Was Evaluated

The change was evaluated against industry benchmarks and predetermined targets set by the committee. By the first measurement period, seven policies had successfully been implemented. A target was set to implement at least six of the policies within two months and as such, the change was, so far so good, considered to have been successfully implemented. Even though all ten policies had been implemented by the deadline, the policy framework was only able to meet average industry standards. As aforementioned, data were collected from all the departments within the organization to determine whether the new systems and procedures postulated by the policy framework were being followed to the letter. A similar procedure was used to evaluate the successful implementation of tools and infrastructure available for research and development of pain management and the costs incurred by patients in pain management. This is illustrated in the QIA Form.

Were the Stakeholders Successful?

The stakeholders were successful in implementing the change because at least 95% of the deliverables that had been set out by the committee were met. However, not all the employees in the health center were apparently on board with the change because they were reluctant to use the tools and infrastructure that was availed for research and development of pain management.

How Change Project could have been improved to Increase Quality Care Outcomes

The change project could have been simply improved by involving the employees in the organization in the formulation and implementation of the Pain Management policy framework (Reiss, 2012).

References

Institute of Medicine. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academy of Sciences.

Cameron, E., & Green, M. (2012). Making sense of change management : a complete guide to the models, tools and techniques of organizational change. Philadelphia: Kogan Page.

Mayo Clinic. (2015, July 20). Pain Rehabilitation Center in Minnesota. Retrieved from mayoclinic.org: http://www.mayoclinic.org/departments-centers/physical-medicine-rehabilitation/minnesota/pain-rehabilitation-center/overview

Reiss, M. (2012). Change management : a balanced and blended approach. Norderstedt : Books on Demand.

Stewart, K. (2010, Ocotober 11). Do You Need a Pain Specialist? Retrieved from Everyday Health: http://www.everydayhealth.com/pain-management/do-you-need-a-pain-specialist.aspx

Appendix

QUALITY IMPROVEMENT FORM

NCQA Quality Improvement Activity Form (an electronic version is available on NCQA’s Web site) Activity Name:

Section I: Activity Selection and Methodology

A. Rationale. Use objective information (data) to explain your rationale for why this activity is important to members or practitioners and why there is an opportunity for improvement.

There are more than 76 million Americans over the age of 20 who say they have had pain lasting more than 24 hours (Stewart, 2010). Chronic pain alone affects at least 100 million adults in the U.S. Furthermore, it adversely affects the quality of life and costs taxpayers between $560 billion and $635 billion annually (approximately $ 2,000 for every citizen). According to the Institute of Medicine (2011, p.5), pain can appropriately be addressed through population-health-level interventions. Pain Management is therefore critical not only because of its contribution to patients’ recovery but also its influence on their positive engagement to the health center. Consequently, the ability of practitioners to understand and respond appropriately to the pain effects of patients and their overall experience with the health center is an integral part of the center’s overall performance. The health center initially lacked elaborate policies to govern pain management. As such, the main objective of the change was to institute elaborate policies to govern pain management. Additionally, it aimed at providing necessary tools and infrastructure to promote practice and research advancement in pain management. Moreover, basing on available evidence, it would build a full spectrum of best practices of the continuum of chronic and acute pain. Finally, the center would foster a culture of pain awareness, proactive intervention and education. To achieve these objectives, apart from being cognizant of the various alternatives to medication, all practitioners should have a good understanding of the personal and spiritual needs of patients concerning pain management. Moreover, they should endeavor to ensure that discharged patients have the capacity to manage their pain. Once the new pain management strategy has been fully implemented, the center will be in a better position to take care of its patients, which will translate to customer loyalty hence boosting its overall profitability.

B. Quantifiable Measures. List and define all quantifiable measures used in this activity. Include a goal or benchmark for each measure. If a goal was established, list it. If you list a benchmark, state the source. Add sections for additional quantifiable measures as needed.
Quantifiable Measure #1:	Implementation of Policy Framework.
Numerator:	Number of policies implemented
Denominator:	Number of policies in the complete policy framework
First measurement period dates:	Two months from initial date (15th March 2015)
Baseline Benchmark:	Mayo Clinic, Pain Rehabilitation Center
Source of benchmark:	Mayo Clinic in Minnesota has been recognized as one of the top rehabilitation hospitals in the country for 2014-2015 by US News & World Report. Mayo’s pain rehabilitation programs was one of the first in the world (Mayo Clinic, 2015). It offers a variety of rehabilitation programs, which are administered by a team of healthcare professionals including doctors trained in pain management, physical medicine and rehabilitation (physiatrists) and mental health conditions (psychologists); clinical nurse specialists; nurses; physical and occupational therapists; biofeedback therapists; pharmacists; nutrition specialists (dietitians); vocation rehabilitation psychologists; chaplains; and nicotine-cessation therapists.
Baseline goal:	To have an industry recognized pain management policy framework within three months
Quantifiable Measure #2:	Availability tools and infrastructure to promote practice and research advancement in pain management. This includes a program that would facilitate the attendance of seminars and visits to the best performing hospitals in the country to investigate how their pain management programs have been implemented.
Numerator:	Number of employees who have access to tools and infrastructure for research and development of pain management.
Denominator:	Number of employee who should have access to the aforementioned tools and infrastructure
First measurement period dates:	Four Months from initial date (15th May 2015)
Benchmark:	Mayo Clinic
Source of benchmark:	US News & World Report, Best Hospital Rankings
Baseline goal:	To have all employees participating actively in the advancement of pain management

Quantifiable Measure #3:	Reduction in Cost of Managing Pain
Numerator:	Average Amount of money spent by patients in managing pain annually
Denominator:	Average amount of money spent by patients in the U.S. for managing pain annually ($2,000).
First measurement period dates:	After 6 months (16th June 2015)
Benchmark:	Pain costs taxpayers between $560 billion and $635 billion annually (approximately $ 2,000 for every citizen)
Source of benchmark:	Institute of Medicine
Baseline goal:	Reduce the cost incurred by patients in managing pain by 25%

C.    Baseline Methodology.

Before implementing the program, data was collected to reflect the initial state of pain management in the health center. First, the initial principles and values governing pain management were investigated. To achieve this, the committee that had been charged with the responsibility of implementing the program ensured that they were all familiar with the role played by each stakeholder within the center to promote pain management. As such, they had to investigate the initial structures and roles played by different employees in pain management. Secondly, the initial patient outcomes were investigated to determine whether the initial model of care delivery is safe, whether it provides equity of access and whether it is based on the most appropriate available evidence. Other than that, members of the community were interviewed to determine their perception about pain management at the hospital. To evaluate the health center’s capacity to adopt a new pain management strategy, all the medical practitioners who have a direct bearing on the effectiveness of the pain management program were interviewed to determine whether they have the right set of skills to adopt the new strategy. The results of these interviews were used to pin point the key areas in which they needed further training and development. These results also helped the center to determine the research tools and infrastructure that would be required to promote the new pain management program. Finally, the committee investigated the initial cost of pain management incurred by the center and the total cost incurred by patients on pain related medical attention on an annual basis.

C.1  Data Sources.

[ü] Medical/treatment records [ü] Administrative data: [ü] Claims/encounter data                            [ü] Complaints                      [ü] Appeals                  [ü] Telephone service data                    [ü] Appointment/access data [   ] Hybrid (medical/treatment records and administrative) [ü] Pharmacy data [ü] Survey data (attach the survey tool and the complete survey protocol) [   ] Other (list and describe): _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________

C.2  Data Collection Methodology. Check all that apply and enter the measure number from Section B next to the appropriate methodology.
If medical/treatment records, check below: [   ] Medical/treatment record abstraction If survey, check all that apply: [ü] Personal interview [   ] Mail [   ] Phone with CATI script [   ] Phone with IVR [   ] Internet [   ] Incentive provided [   ] Other (list and describe): _______________________________________________ _______________________________________________				If administrative, check all that apply: [     ] Programmed pull from claims/encounter files of all eligible members [     ] Programmed pull from claims/encounter files of a sample of members [ü] Complaint/appeal data by reason codes [ü] Pharmacy data [     ] Delegated entity data [     ] Vendor file [     ] Automated response time file from call center [     ] Appointment/access data [   ] Other (list and describe): _________________________________________________________________ _________________________________________________________________
C.3  Sampling. If sampling was used, provide the following information.
Measure	Sample Size	Population	Method for Determining Size (describe)			Sampling Method (describe)
Random Sample	20 Records per month	Record views of patients suffering from both chronic and acute pain	Because there are numerous instances of patients suffering from pain (both mild and severe) every day, the committee decided to collect data from health records for 20 days per month. Moreover, the health center handled a relatively small number of patients per day so collecting data at this frequency was manageable.			The records were analyzed basing on the requirements of the new pain management policy framework. The main focus of the analysis was therefore the impact of new policies on the overall performance of the center.
C.4  Data Collection Cycle.					Data Analysis Cycle.
[   ] Once a year [   ] Twice a year [   ] Once a season [   ] Once a quarter [ü] Once a month [   ] Once a week [   ] Once a day [   ] Continuous [   ] Other (list and describe): _________________________________________________________ _________________________________________________________					[    ] Once a year [   ] Once a season [   ] Once a quarter [ü] Once a month [   ] Continuous [   ] Other (list and describe): _________________________________________________________ _________________________________________________________
C.5  Other Pertinent Methodological Features. Complete only if needed.
D.    Changes to Baseline Methodology. Describe any changes in methodology from measurement to measurement.
Include, as appropriate: ·  Measure and time period covered ·  Type of change ·  Rationale for change ·  Changes in sampling methodology, including changes in sample size, method for determining size and sampling method ·  Any introduction of bias that could affect the results __________________________________________________________________________________________________________________________________ No changes were made to the initial baseline methodology___________________________________________________ ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________

Section II: Data / Results Table Complete for each quantifiable measure; add additional sections as needed.
#1 Quantifiable Measure: Implementation of Policy Framework
Time Period Measurement Covers	Measurement	Numerator	Denominator	Rate or Results	Comparison Benchmark	Comparison Goal	Statistical Test and Significance*
January 15th	Baseline:           0	No clear policy framework	10 elaborate policies	Pain management standards in place account for 5% of the policy framework	100%	Pain management strategy does not meet industry recognized standards	N/A
March 15th	Remeasurement 1:	7 policies successfully implemented	10 elaborate policies	70% complete implementation	100%	At least 50% of industry recognized standards are fulfilled	N/A
April 15th	Remeasurement 2:	All policies successfully implemented	10 elaborate policies	100% complete implementation	100%	Goal met (At least 70% of industry recognized standards are fulfilled)	N/A
	Remeasurement 3:
	Remeasurement 4:
	Remeasurement 5:
#2 Quantifiable Measure:
Time Period Measurement Covers	Measurement	Numerator	Denominator	Rate or Results	Comparison Benchmark	Comparison Goal	Statistical Test and Significance*
January 15th	Baseline:           0	No tools and infrastructure available for research and development of pain management	Full access to tools and infrastructure available for research and development of pain management	0% availability of tools and infrastructure	100%	Lack of tools and infrastructure for research and development	N/A
May 15th	Remeasurement 1:	Availability of IT infrastructure dedicated to research and development	Full access to tools and infrastructure available for research and development of pain management	30% availability of tools and infrastructure	100%	Partial availability of tools and infrastructure for research and development	N/A
June 15th	Remeasurement 2:	Availability of both infrastructure and tools dedicated to research and development	Full access to tools and infrastructure available for research and development of pain management	90% availability of tools and infrastructure but plans are still underway for seminars and corporate visits	100%	Full availability of tools and infrastructure but partial access to adequate training	N/A
	Remeasurement 3:
	Remeasurement 4:
	Remeasurement 5:
#3 Quantifiable Measure:
Time Period Measurement Covers	Measurement	Numerator	Denominator	Rate or Results	Comparison Benchmark	Comparison Goal	Statistical Test and Significance*
January 15th	Baseline:           0	$1,850	$2,000	The cost is lower than the country’s average by 7.5%	25%	Despite the lack of an elaborate pain management strategy, the center’s patients spent less on pain related medical attention	N/A
June 15th	Remeasurement 1:	$1,600	$2,000	The cost is lower than the country’s average by 20%	25%	The implementation of the pain management strategy has significantly reduced the cost of medical attention	N/A
December 15th	Remeasurement 2:	_	$2,000		25%		N/A
	Remeasurement 3:
	Remeasurement 4:
	Remeasurement 5:

* If used, specify the test, p value, and specific measurements (e.g., baseline to remeasurement #1, remeasurement #1 to remeasurement #2, etc., or baseline to final remeasurement) included in the calculations. NCQA does not require statistical testing.

 

Section III: Analysis Cycle Complete this section for EACH analysis cycle presented.

A. Time Period and Measures That Analysis Covers.

B. Analysis and Identification of Opportunities for Improvement. Describe the analysis and include the points listed below.

B.1 For the quantitative analysis, include the analysis of the following: Comparison with the goal/benchmark Reasons for changes to goals If benchmarks changed since baseline, list source and date of changes Comparison with previous measurements Trends, increases or decreases in performance or changes in statistical significance (if used) Impact of any methodological changes that could impact the results For a survey, include the overall response rate and the implications of the survey response rate B.2 For the qualitative analysis, describe any analysis that identifies causes for less than desired performance (barrier/causal analysis) and include the following: Techniques and data (if used) in the analysis Expertise (e.g., titles; knowledge of subject matter) of the work group or committees conducting the analysis Citations from literature identifying barriers (if any) Barriers/opportunities identified through the analysis Impact of interventions

 

Section IV: Interventions Table
Interventions Taken for Improvement as a Result of Analysis. List chronologically the interventions that have had the most impact on improving the measure. Describe only the interventions and provide quantitative details whenever possible (e.g., “hired 4 UM nurses” as opposed to “hired UM nurses”). Do not include intervention planning activities.
Date Implemented (MM / YY)	Check if Ongoing	Interventions	Barriers That Interventions Address
January 15th 2015	Baseline formulation and implementation of pain management policy framework	a)     A committee was formed and put in charge of the formulation and implementation of the pain management policy framework. b)    Policies and procedures that were initially in place were reviewed to identify their strengths and weaknesses. c)     Gap analysis was also leveraged to identify further strengths and weaknesses. d)    A literature review was carried out to identify emerging trends in pain management. e)     A target was set to implement at least 6 of the policies within 2 months.	a)     The center did not have adequate resources to facilitate the implementation of the pain management program. As such, the implementation of the policy framework has to span over a longer period of time. b)    Apart from offering the committee poor incentives, the management could not afford to hire external consultants to advise them on how they would go about instituting change. c)     The health center could not afford specialized personnel for the committee, or temporary replacements for the committee members. Consequently, the members were prompted to hold their meetings after working hours. This proved to be an uphill task and resulted in a lot of absenteeism.

Section V: Chart or Graph (Optional)

Attach a chart or graph for any activity having more than two measurement periods that shows the relationship between the timing of the intervention (cause) and the result of the remeasurements (effect). Present one graph for each measure unless the measures are closely correlated, such as average speed of answer and call abandonment rate. Control charts are not required, but are helpful in demonstrating the stability of the measure over time or after the implementation.