PREPARE

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There are some important preliminary steps to take before planning implementation. These steps are:

  1. Understand the science behind PREP2
  2. Form your implementation team by identifying who needs to be involved in implementation at your site
  3. Carry out a stakeholder analysis
  4. Carry out a cost analysis
  5. Obtain organisational clearance by finding out if you have the permission, and time, to explore implementing PREP2 at your site

 

1. Understand the science
It’s important to understand the rationale and evidence for PREP2. The PRESTO website has detailed information.

 

2. Implementation team
You will need to form a team that will be responsible for implementing PREP2 at your facility. This team will need to meet regularly to plan, prepare and train for PREP2 implementation, and provide ongoing leadership to ensure the sustainability of PREP2 at your healthcare organisation.

Your team should consist of people who can be responsible for leading implementation in their areas. For example, each of the following disciplines could be represented, by clinical staff and management from acute and rehabilitation settings:

    • Physiotherapy
    • Occupational therapy
    • Nursing
    • Physicians
    • Psychologists
    • Allied Health Management
    • Therapy assistants

Consider the following as you put together your team:

  • Leadership: Assigning a leader will be useful. This person will take overall responsibility for leading the implementation of PREP2. Ideally, they will be an experienced, well-respected clinician who can champion the prediction tool.
  • Diversity: Try to include staff from each part of the patients’ rehabilitation journey, including acute, rehabilitation, and community services.
  • Sustainability: Where possible include staff in senior permanent positions rather than rotational or casual staff.

 

3. Stakeholder analysis
Healthcare organisations are complex, with a large number of stakeholder groups, such as patients, therapists, nurses, physicians, management, external agencies, and government.  These groups have different roles and expectations. Understanding who your stakeholders are, and their influence and interest in PREP2, is a key first step in the implementation process. This will help you to identify the key messages that need to be conveyed to each stakeholder group, to engage them and gain their support. It will also help to identify how they might play a role in PREP2 implementation, and what support they might need to be involved.


Who are your stakeholders?

Activity:
Make a list of the people, groups, and organisations who may need to know about PREP2 implementation. Remember to consider downstream users of prediction information, such as community services, general practitioners etc.

For example:

  1. Patients
  2. Patients’ families
  3. Physical therapists – acute, rehabilitation, community
  4. Occupational therapists – acute, rehabilitation, community
  5. Physicians – acute, rehabilitation, community
  6. Nursing staff – acute, rehabilitation, community
  7. General practitioners
    Etc…. Continue to list all appropriate


Stakeholder Matrix

Mapping your stakeholder groups on a stakeholder matrix is an effective way to classify them by their influence over, and their interest in, PREP2 implementation.

Activity:
Print out the Stakeholder Matrix. For each stakeholder group you have identified, position them on the matrix according to the level of interest and influence they have for PREP2.

The position on the matrix can help to understand the actions that need to be taken, such as managing them closely, keeping them satisfied or informed, or monitoring them.

For example, high influence/high interest stakeholders must be most engaged with and the greatest efforts made to satisfy. In contrast, high influence/lower interest stakeholders need to be kept satisfied but do not require as much effort to do this. 

 

4. Cost analysis
Completing a cost analysis is a systematic way of considering the economic effects of implementing PREP2 at your healthcare organisation. The executive leadership team at your organisation is likely to need this before deciding whether PREP2 can go ahead.

Cost analysis for PREP2 can be divided into Phase 1 and Phase 2 costs and includes an initial phase (implementing PREP2 into clinical practice) and a consolidation phase (sustaining PREP2 in clinical practice).

PREP2 Costs and Benefits is a template that can be adapted for your cost analysis.

 

5. Organisational clearance
Before you start PREP2 training or implementation, consider gaining clearance from:

  • Your institution
  • Any overarching regional or national regulatory bodies
  • Professional governing bodies

The example below outlines the steps taken for consultation and clearance in a large New Zealand healthcare organisation.

 

Consultation level Who Outcome
Directorate Stroke Unit Director Supported PREP2 implementation, responsible for submitting a proposal to the executive management team
Allied Health Directors relevant to stroke and rehabilitation services
Executive Management Chief Health Professions Officer PREP2 was in line with its values and services and therefore organisational clearance was given
Regional Clinical Practice Committee Committee that decides what changes can be made to clinical practice, based on evidence and a consideration of the costs and benefits PREP2 is a prognostic tool rather than a new treatment, and the cost:benefit was favourable. Therefore the committee supported its use in clinical practice.
Professional boards Physiotherapy Board New Zealand PREP2 assessments were deemed to be “practising within a defined field,” but it was the physiotherapist’s responsibility to ensure that:

· they have undertaken appropriate, relevant and recognised training

· they have professional support and mentoring in place, and meet their professional and ethical obligations

· they maintain competence in this defined field

 

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