Moving the needle on outcomes, part 2

Needs assessments that enable great work

By: Jenifer Cartland, PhD
January 09, 2020

Needs assessments are a key tool for designing an improvement or system change that will be effective and sustainable. Indeed, one leader told me years ago ‘to go slow so you can go fast.’ What she meant is to plan and really think your steps out. If you do that, when the time comes to go live with your intervention, things can then happen quickly and well.

But sometimes the needs assessment process, as important as it is, can feel meandering and endless. It can take on the scope of a very large and complex project itself. The project team may feel they cannot move forward until the needs assessment is done. And sometimes it comes to feel as if the analysis is the intervention itself rather than supportive of the real intervention.

How do you shape a needs assessment so that it does not become a barrier to implementing well-planned programs in a timely way? In this post, I’d like to call out a couple of things that might help a needs assessment happen more quickly while at the same time enabling the project team to be more effective.

As a precursor, note that you will never know everything you want to know before starting a new program, improvement or intervention. A needs assessment cannot foretell the future, and ultimately you will need to walk into the unknown. This is what change is. So be efficient and thoughtful about the needs assessment, knowing that sometimes the best way to learn what needs to be done is to just get going!

A basic needs assessment process

Step 1: Define the problem you want to solve. Write it down and make sure the project team and executive leaders agree. Part of the job of the needs assessment is to refine the problem statement. The more precise the statement is, the faster the needs assessment will go.  ‘We have a problem with room assignments’ is far broader than ‘We have a problem with assigning rooms on Sundays when staffing levels are low.’

Start with a gap analysis. A gap analysis is a comparison between your key metric and some outside standard, like Children’s Hospital Association data or another clinic in our own hospital.

Make sure the gap analysis is fair. If there appears to be a gap in one time point and the number of cases is small, it is hard to know if there really is a gap. So looking at multiple time points or multiple benchmarks can be helpful.

The gap analysis gives you your goal, your desired outcome. So write it down next to your problem statement and allow it to guide all the rest of your discussions and learning. This is the start of your logic model.

Step 2: List out which interventions you are considering. Starting with a proposed list will help focus the needs assessment. I sometimes think of these as ‘strawman’ proposals. Just a place to start. And project team members who are front line staff will have an excellent sense of which interventions they think would help.

Pause and ask yourself and the stakeholders if your list of possible interventions could conceivably get you to your outcome. This is a moment to be honest with yourself, and perhaps talk to other hospitals or others around the organization who have tried to accomplish similar outcomes. “Is it conceivable that x intervention can result in y outcome?” The answer needs to be ‘yes’ to move forward with the next steps.

Assess the interventions. Are they all the same cost, similarly acceptable to leadership and staff?  You might lay out some tables that allow leaders to compare the interventions apples-to-apples in terms of cost, time it will take for the change to occur, staff training, etc.

Step 3:  Think about which data points you need before moving forward. This is not a list of everything you might want to know, but more a list of things that could erase critical uncertainty. Example: If you are planning to train nurses, you need to know what they know already about the topic you want to train them on. You do not need to know about all the training they ever have had.

Some data will already be available.  Other data will not.  Now, it is time to focus: What MUST you know before moving forward?

(a) You will need data that confirm or infirm the stakeholder perspectives on the different interventions. Stakeholders are experts at describing what troubles them, but they are rarely experts at what troubles everyone or at observing patterns reliably in their environment.

(b) You will need baseline data on any outcomes, processes or behaviors your intervention is intended to change.

A summary and a story . . .

Having a clear focus on your goals, the improvement or intervention you want to put into place, and being systematic in your pursuit of information will narrow the needs assessment and keep it in scope so your project can be successful.

Here is my story: My dad ran his own business his whole life and when I was a young professional struggling with a problem at the office, he said, ‘When everything is going right, change nothing. When something is going wrong, change everything.’ It took a while to digest this, but I eventually realized that he was pushing me to be courageous and innovative in the face of the unknown – and that I did know one key thing, that things were not going right. Sometimes that is all you need to know to jump into the breach.

A needs assessment helps decrease unknowns, but it cannot actually change anything or innovate on its own. People need to do that. They need to respond to problems when they don’t have perfect information. So put the needs assessment in its place – keep it narrow and focused.  Doing so will make sure you get the insights you need to start the hard work of organizational change, and it will improve the likelihood of success.

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