Jay Ford, PhD
University of Wisconsin - Madison
What is readiness?
Why is readiness important?
“Help healthcare organizations
detect potential obstacles and
improve chances of successful
implementation
What does RIM measure?
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
Readiness for Implementation Scale
Organizational Motivation
22%
Awareness & Support
18%
Meeting Needs & Usefulness
18%
Departmentatl Fit
14%
Organizational Environment
11%
Implementation
11%
Promotion
6%
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
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
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
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
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.
Implementation
Establish a positive organizational view
about the implementation process by
1. Incorporate the role of the technology within
2.
3.
4.
5.
organizational guidelines
Ensure that the technology can be
customized during implementation to meet
agency needs
Develop a clear process to identify, refer, and
support users of the technology
Provide staff training during implementation
Use implementation feedback to remove
barriers and improve processes.
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
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.
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.
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.
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
RIS Performance in Behavioral Health
RIS Overall Score by Agency
90
82.5
80
70
60
65.9
54.4
50
59.6
65.1
59.2
41.1
40
30
20
10
0
Agency A Agency B Agency C Agency D Agency E Agency F Agency G
F=30.76, df=4, p=0.00
RIS Performance
Agencies Scoring 75% of Total Factor Scores
Level of
Influence
Organizationa
l Motivation
Meeting
Needs &
Usefulness
Awareness
& Support
Departmental
Fit
Implementatio
n
Organizational
Environment
Promotion
22%
18%
18%
14%
11%
11%
6%


Agency A
Agency B
Agency C




Agency D

Agency E

Agency F
Agency G





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,
Impact of Tenure on RIM
RIM Factor
Tenure Comparison
Organizational Environment 3 to 5 Years vs. 5 Years +
[F=2.10, df=2, p=0.134]
(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)
Impact of Job on RIM
RIM Factor
Job 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)
Issues in EBHR Implementation
RIM Factor
Staff Issues in EBHR Implementation
Organizational 1. Unsure if EBHR addresses key
Motivation
organizational goal.
2. Questioned leadership support
3. Not clear if resources (technology, staff )
would be adequate during implementation
Meeting Needs 1. Would technical support be available?
Departmental 1. Integration of EBHR into workflow
Fit
2. Staff unfamiliarity with EBHR
3. Concern over implementation difficulties
Issues in EBHR Implementation
RIM Factor
Staff Issues in EBHR Implementation
Implementation 1. Concerns about customization & training
2. Fit within organizational guidelines
Awareness and 1. Concern about impact on clients
Support
2. Trust in technology
3. Staff Resistance to technology
Promotion
1. Existence of administrative or clinical
champion
2. Effectiveness of the individual (how
influential)
Organizational 1. Concerns about past success
Environment
2. External pressure does not promote
implementation
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!!!
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
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