As with any new project or process, there is the opportunity to know more than we knew before!
Lessons learned were described during the RAP reports, peer sharing calls and project reports. Many hospitals were clear and realistic concerning their strengths and weaknesses. A lesson learned that was not predicted was that some hospitals were “less ready” to take on this project than they reported, even with using the IBH Readiness Assessment as a tool. In the readiness assessment, which was used to select hospitals for individualized TA, about a third of those chosen over-rated themselves in operational and organizational readiness. While RHI was clear about the expectations of participation, once these hospitals had been chosen based on the scoring and ranking of the assessment, these hospitals struggled to meet the requirements. RHI had the freedom to choose to continue to work with them and adjust the timeline of their work rather than discontinue support. This was an important lesson for RHI as we prepared for cohort two.
Collecting Pre-project Data
A second lesson learned was that for some hospitals there was less infrastructure in place than expected. An example involved the ability to collect pre-project data. Early in the project, as RHI discussed with hospitals the measurable outcomes they would utilize to reflect progress, we discovered that some hospitals did not have systems in place to collect basic information. This included information such as the number of patients presenting to the emergency department (ED) with a certain behavioral diagnosis or the number of visits in the ED with that diagnosis. Some hospitals had to manually collect the data through chart reviews. One of their action items before moving forward was to build a system to collect accurate data. For those hospitals, this slowed down the progress towards collaboration and implementation of other activities.
A third lesson learned was a low application rate for cohort two and three. RHI staff offered an introductory call and included information about the project just as was done for cohort one. This resulted in just one application. RHI outreached then to applicants from cohort one that had not been supported previously. Phone calls were made and emails sent to speak directly to the person who had completed the application to see if they were still interested in participating. Three hospitals indicated they would like to participate. Four hospitals were included in cohort two.