Assessing & Improving Organizational Readiness for Integrated Care to Reduce Health Disparities We will present our work on increasing readiness for integrating behavioral health and primary care services in diverse healthcare practices via the Integrated Care Leadership Program (ICLP). The ICLP is a multi-year initiative aimed at promoting health equity among vulnerable populations through developing the capacity of health leaders. We will describe the ICLP hybrid model of capacity building, and how the Readiness for Integrated Care Questionnaire (RICQ) is used to assess and improve integrated care efforts.
Transcript
Assessing & Improving Organizational
Readiness for Integrated Care
to Reduce Health Disparities
We will present our work on increasing readiness for integrating behavioral health and primary care services in diverse healthcare practices via the Integrated Care Leadership Program (ICLP). The ICLP is a multi-year initiative aimed at promoting health equity among vulnerable populations through developing the capacity of health leaders. We will describe the ICLP hybrid model of capacity building, and how the Readiness for Integrated Care Questionnaire (RICQ) is used to assess and improve integrated care efforts.
Assessing & Improving
Erin Godly-Reynolds, MEd & Sharon A. Rachel, MA, MPH, CSEUniversity of North Carolina at Charlotte Morehouse School of Medicine
Presenting on behalf of the ICLP/Readiness Team:
Victoria Scott, PhD, MBA, Gilberte “Gigi” Bastien, PhD, Tara Kenworthy, Sayon Cooper, MPH, Ariel Domlyn, MA, Courtney McMickens, MD, MPH, Glenda Wrenn, MD, MSHP, & Abraham Wandersman, PhD
Organizational Readiness for Integrated Care
to Reduce Health Disparities
Session Overview
How integrated care can improve health equity
o The Integrated Care Leadership Program (ICLP)
Organizational readiness (specifically, R=MC 2).
o The utility of the R=MC2 approach to measuring and improving readiness for integrated care.
The Readiness for Integrated Care Questionnaire (RICQ)
Practical uses of the RICQ
o Practice #1: MacCreery Center*
o Practice #2: Eastchester Family Services
* Pseudonym
Why Integrated Care?
• Practices that effectively integrate behavioral health services and primary care have been shown to improve:
o Clinical outcomes
o Mental health, wellbeing, and quality of life
o Team performance
o Satisfaction
o Health system cost savings
Integrated Care and Health Equity
• Developing the next generation of public health leaders.
• Primary care practices that effectively integrate behavioral health services are better positioned to improve clinical outcomes and quality of life for their patients.
• ICLP emphasizes creation and advancement of opportunities for underserved populations to experience optimal health outcomes.
There is no health without mental health.
The Integrated Care Leadership
Program (ICLP)
• 12-month learning collaborative/communities of practice
• Components
o Online training curriculum
o Technical assistance and coaching
o Webinars
o Site visits
o Eligibility for innovation awards (Georgia-based sites)
• Program evaluation
• Semi-annual analysis of site-specific readiness data
ICLP 2016 Inaugural Cohort
• 11 sites (5 states)o Children/
adolescents (2)o Adults (8) o Seniors (1)
• FQHC primary care practices, non-profit, for-profit
• “Reverse integration”ICLP Kickoff , January 11, 2016 Morehouse School of Medicine
Online Curriculum
Three modules:1. Transformative leadership
2. Essentials for practice change & improvement
3. Sustainability
Jinjie Zheng, PhD, unveils the ICLP curriculum at the 2016 kickoff
Technical Assistance & Coaching
• Coaching callso Small groups (monthly)o All sites (quarterly)
• Leadership and clinical coaching
• Leadership observations and feedback
• Successes, challenges
• Knowledge-sharing
Sharon Rachel, MA, MPH and Sayon Cooper, MPH lead an ICLP coaching call
Webinars• Topics:
o Models of integrated careo Hiring behavioral health
Dr. Kisha Holden leads a webinar on stress management and burnout prevention
Site Visits• Facility tour
o Clinical environment to better understand Assets and barriers for patient experience
• Personalized feedback and intensive technical assistanceo Site engagement,
facilitators, and barriers to integrated care
• Site reflectionso Feedback, other questions
and concernsLaurie Auora, Bryan Dovichi, Sharon
Rachel, & Dr. Gwen Graddy at PACE Southeast Michigan site visit
Innovation Awards (GA sites)• One (1) year, $5,000 grants
• Supports projects to “jumpstart” systems change for integrated care
Research & Evaluation
Internal (program-level) External (clinic-level)
Process evaluation
• Did ICLP deliver information and skills as intended?
• What are the lessons learned?
• How will we sustain the program?
Outcome evaluation
• What did the sites report in their PDSAs?
• How was theparticipants’ experience?
• What are the benefits of integrated care to the practices?
• What are the barriers to implementing integrated care?
• What impact did the project have on the practice?
• Were desired outcomes achieved?
• How will practices sustain integrated care?
ICLP research protocol approved by Morehouse School o f Medicine Inst i tut ional Review Board (IRB)
Pair & Share…Think of a time when your organization worked to adopt a new innovation (policy, program, practice) or an innovation your organization is implementing now…
Tell your partner (30 seconds each):
What does your organization need to be ready to adopt a new innovation?
R=MC2 Definitions• Motivation: Beliefs about an intervention
which contribute to the desire to adopt a practice.
• Innovation-specific capacity: The human, technical and fiscal conditions important to the successful implementation of a particular innovation.
• General capacity: Pertains to aspects of organizational functioning (e.g., culture, climate, staff capacity, leadership).
Organizational Readiness:
The extent to which an organization is both willing and able to implement a particular practice.
Ready to Implement
Motivation Innovation-Specific Capacity
General Capacity
The Readiness for Integrated Care Questionnaire (RICQ)
Motivation:
• Relative Advantage
• Complexity
• Priority
• Compatibility/ Alignment
Innovation-Specific Capacities:
• Intervention-specific KSAs
• Program Champion
• Implementation Climate Supports
• Inter-organizational Relationship
General Capacities:
• Culture
• Climate
• Org. Innovativeness
• Resource Utilization
• Leadership
• Structure
• Staff Capacity
• Process Capacity
Readiness for Integrated Care Questionnaire (RICQ)
R=MC2: Defining Features
o Readiness is viewed on a continuum, rather than dichotomously as “ready or not.”
o Readiness is dynamic. The readiness of an organization for implementation fluctuates over time.
o R=MC2 is part of a comprehensive planning, implementation, and evaluation approach. Readiness is not just a precursor to implementation, but also a construct that encompasses the conditions necessary to quality implementation throughout the lifespan of the EBI.
Practice #1: MacCreery Center*
* Pseudonym
• Innovation grant: Retreat as an intervention
• RICQ completion:
o Prior to the retreat (May – July)
o After participants attended the retreat (August)
• The report compares how respondents rated the readiness of their practice at both time points.
o Aggregate
o Specialty: Participants grouped based on their position
• Nurses
• Mental health providers
• Physicians
MacCreery Center
MacCreery Center: Reporting on the retreat as an intervention
Hard copy being passed around the room.
5.66 5.69
5.64 5.90
5.67 5.80
5.66 5.79
Motivation
General Capacity
Innovation-Specific Capacity
Full Readiness Score
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Changes in Organizational Readiness: Data Collected Pre & Post-Retreat (N=22)
MacCreery Center: All retreat attendees
5.47
5.575.49
5.56 5.75
5.53 5.57
Motivation
General Capacity
Innovation-Specific Capacity
Full Readiness Score
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Mental Health Providers (N=7)Changes in Organizational Readiness, Before & After Retreat
Mental Health Providers
Nurses5.85 5.92
5.84 5.98
5.88 5.99
5.86 5.96
Motivation
General Capacity
Innovation-Specific Capacity
Full Readiness Score
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Nurses (N=12) Changes in Organizational Readiness, Before & After Retreat
Nurses
Physicians5.31 5.66
4.78 5.29
5.15 5.37
5.08 5.44
Motivation
General Capacity
Innovation-Specific Capacity
Full Readiness Score
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Physicians (N=2) Changes in Organizational Readiness, Before & After Retreat
Physicians
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Compatibility/Alignment
Program Champion
Priority
Relative Advantage
Leadership
Process Capacities
Resource Utilization
Culture
Innovation-Specific Knowledge& Skills
Organizational Innovativeness
Implementation ClimateSupports
Climate
Inter-OrganizationalRelationships
Structure
Staff Capacity
Complexity
Pre-Retreat
Nurses (N=12) Mental Health Providers (N=7) Physicians (N=2)
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Compatibility/Alignment
Program Champion
Priority
Relative Advantage
Leadership
Process Capacities
Resource Utilization
Culture
Innovation-Specific Knowledge &Skills
Organizational Innovativeness
Implementation Climate Supports
Climate
Inter-OrganizationalRelationships
Structure
Staff Capacity
Complexity
Post-Retreat
Nurses (N=12) Mental Health Providers (N=7) Physicians (N=2)
Comparing Changes by Position
Figure 19. Comparing Changes in Nurses’, Mental Health Providers’, and Physicians’ Average Subcomponent Scores Pre-Retreat & Post-Retreat
Component/Subcomponent Physicians (N=2) Mental Health Providers (N=7) Nurses (N=12)
INNOVATION-SPECIFIC CAPACITY AVERAGE 0.35 0.00 0.07
Culture 0.83 0.05 0.39
Process Capacities 0.32 -0.06 -0.11
Staff Capacity 0.50 0.43 0.25
Leadership -0.19 -0.08 -0.07
Organizational Innovativeness 0.13 0.21 0.16
Resource Utilization 0.33 0.57 -0.19
Structure -0.17 0.40 0.29
Climate 0.00 0.00 0.21
GENERAL CAPACITY AVERAGE 0.22 0.19 0.12
FULL READINESS 0.36 0.04 0.10
Practice #2:Eastchester Family Services
Eastchester Family Services:
Reporting on Waves 1-3
Hard copy being passed around the room.
We hope this report can help you:
• Understand different aspects of readiness.
• Identify changes in readiness across three assessment time points and 11 months of ICLP participation: Wave 1 (January 2016) vs. Wave 2 (June 2016) vs. Wave 3 (November 2016).
• Identify strengths and areas for improving your practice’s readiness for integrated care.
Eastchester Family Services
Wave 1 (N=4) Wave 2 (N=11) Wave 3 (N=11)
Innovation-Specific Capacity 4.41 5.28 5.42
General Capacity 5.33 6.04 6.10
Motivation 5.66 5.21 5.31
Overall Readiness Score 5.13 5.51 5.61
1
2
3
4
5
6
7HIGH READINESS
LOW READINESS
Wave 3, 6.10
Wave 3, 5.42
Wave 1, 5.33
Wave 1, 4.41
1 2 3 4 5 6 7
General Capacity Average
Innovation-Specific Capacity Average
Increases in Capacity (Wave 1 to Wave 3)
Figure 2. Statistically Significant Changes in Organizational Readiness at the Component-Level
Eastchester Family Services
Scores range from 1-7: Strongly Disagree (1), Disagree (2), Slightly Disagree (3), Neither Agree or Disagree (4), Slightly Agree (5), Agree (6), or Strongly Agree (7). Note: Wave 1 N=4; Wave 3 N=11.
Figure 3. Statistically Significant Changes in Organizational Readiness at the Subcomponent-Level
Eastchester Family Services
Wave 3, 6.31
Wave 3, 5.93
Wave 3, 5.13
Wave 3, 5.05
Wave 1, 5.66
Wave 1, 5.06
Wave 1, 4.30
Wave 1, 3.13
1 2 3 4 5 6 7
Climate(General Capacity):
How employees collectively perceive, appraise, andfeel about their current working environment.
Process Capacities(General Capacity):
General knowledge and skills needed to implement aninnovation.
Table 2. Average Individual Item-Level Scores from Readiness for Integrated Care Questionnaire
(RICQ)
Note: Scores range from 1-7: Strongly Disagree (1), Disagree (2), Slightly Disagree (3), Neither Agree or Disagree (4), Slightly Agree (5), Agree (6), or Strongly Agree (7). *, **, *** Denotes a statistically significant difference at alpha level of p < .05, p < .01, p < .001, respectively. These cells are also highlighted yellow.
Eastchester Family Services
Utility of R=MC2
o Sheds insight into organizational readiness
o Enhances member engagement
o Provides data to foster buy-in
o Facilitates progress monitoring
5.18
4.59
4.88
4.92
Innovation-Specific Capacity
General Capacity
Motivation
Full Readiness Score
5.75
5.73
5.86
5.78
1.00 2.00 3.00 4.00 5.00 6.00 7.00
Consistent, positive changes in organizational readiness from Wave 1 (Nov. 2015-Mar.) to Wave 2 (May-July) to Wave 3 (Aug.)
W1W1 W2W2W2
Term DefinitionMotivation SubcomponentsRelative Advantage The degree to which a particular innovation is perceived as being better
than comparative processes or methods.
Compatibility/Alignment The degree to which an innovation is perceived as being consistent with existing values, cultural norms, experiences, and needs of potential users.
Complexity The degree to which an innovation is perceived as relatively difficult to understand and use.
Priority The extent to which the innovation is regarded as more important than others.
Innovation-Specific Capacity SubcomponentsInnovation-Specific Knowledge and Skills
The knowledge and skills needed for the innovation.
Program Champion The individual(s) who put charismatic support behind an innovation through connections, expertise, and social influence.
Specific Implementation Climate Supports
The extent to which the innovation is supported; in particular, this subcomponent assesses the presence of strong, convincing, informed, and demonstrable management support.
Inter-Organizational Relationships Relationships between providers and support systems, as well as relationships between different provider organizations that are used to facilitate implementation.
General Capacity SubcomponentsCulture How the organization functions, namely expectations about how things
are done in an organization.
Climate How employees collectively perceive, appraise, and feel about their current working environment.
Organizational Innovativeness General receptiveness toward change.
Resource Utilization How discretionary and uncommitted resources are devoted to innovations.
Leadership Whether power authorities articulate and support organizational activities.
Process Capacities General knowledge and skills needed to implement an innovation.
Structure Processes that affect how well an organization functions on a day-to-day basis.
Staff Capacity General skills, education, and expertise that the staff possesses.
Conclusion• Health inequities impact individuals and
communities, threaten economic productivity, and trivialize our nation’s character and commitment to social justice.
• Integrated care is a promising mechanism for addressing disparities.
• The ICLP develops health leaders equipped to further integrate behavioral health in primary care.
• Use of the RICQ for measuring readiness and guiding integrated care implementation has the potential to further health equity.
Comments and Questions
Special thanks to Eastchester Family Services for their high level of engagement in the ICLP, and for granting us permission to share their data/stories with you today!
