1. Institutional Assessment Dana Burns, Kailey Hamrick, Holland Porter and Abby Ward November 1, 2013

2. Introduction  Assessment Theories  Nature of Change  Stakeholders  Focus of Change  Change Theories  Vested Interest  Drivers & Resistors  Resource Implications  Evaluation Theories

3. Bradshaw’s Taxonomy of Social Needs  4 Categories of Needs: 1. Normative Need 2. Expressed Need 3. Comparative Need 4. Felt Need

4. Bradshaw’s Taxonomy of Social Needs  4 Categories of Needs: 1. Normative Need 2. Expressed Need 3. Comparative Need 4. Felt Need

5. Maslow’s Hierarchy of Needs

6.  Fundamental/Basic Need:  See, read, and understand written and verbally presented materials regarding disease management techniques.  The remaining four levels of needs cannot be addressed if patients cannot effectively manage their disease.

7. Nature of the Change  New Behavior  Simple vs. Complex

8. Stakeholders  Health Providers  Employers  Payers  Patients

9. Focus of Change  Not a national policy, standard or mandate but a national priority.  A report by the Institute of Medicine indicates:  “ Efforts to improve quality and reduce cost and reduce disparities cannot succeed without simultaneous improvements in health literacy” (Health Literacy, 2013)

10. Focus of Change  “From a 2003 study conducted by the US Department of Education, approximately 80 million adults in the United Stated have limited health literacy” (Health Literacy, 2013).

11. Conceptual Frameworks for Change  Rosswurm and Larrabees’  Lewins’ Change Management Theory

12. Rosswurm and Larrabees’ Model 1. Assess the need for change in practice. 2. Link the problem with interventions and outcomes using standardized classifications and language. 3. Synthesize best evidence. 4. Design change(s) in practice. 5. Implement and evaluate the change. 6. Integrate and maintain the practice change.

13. Lewins’ Change Management Theory  Unfreezing  Change  Refreezing

14. Applying Lewin’s Theory  Unfreezing- What is wrong? Why change is needed.  Change- Introducing new education guides.  Sticking to One Idea  Focus on Need  Avoid Lengthy List  Use Active Voice  Limit Jargon  Refreezing- Enforcement of change and continued education and resources available to stakeholders.

15. Vested Interest  Gain  Patients  Physician  Nurses  Office Staff  Loss  Physician  Nurses

16. Drivers and Resistors  Human Drivers  Nurses  Office Staff  Human Resistors  Physician

17. Resource Implications  Time  Educational Material

18. Kirkpatrick's Evaluation Model  “Donald Kirkpatrick, Professor Emeritus at the University of Wisconsin and past president of the American Society for Training and Development (ASTD), first published his Four- Level Training Evaluation Model in 1959, in the US Training and Development Journal. The model was then updated in 1975, and again in 1994, when he published his best-known work, ‘Evaluating Training Programs’” (Kirkpatrick's Four- Level Training Evaluation Model, 2013).

19. Kirkpatrick’s Evaluation Model  Four Levels of Evaluation 1. Reaction 2. Learning 3. Behavior 4. Results

20. Cognitive Evaluation Theory  Motivating Factors  Intrinsic  Extrinsic

21. Conclusion  Institution:  Primary Care Clinic  Assessment Theory:  Maslow’s Hierarchy of Needs  Nature of Change:  Improve Health Literacy  Change Theory  Lewins’ Change Management Theory  Evaluation Theory  Kirkpatrick’s Evaluation Model

22. References