Implementation Guide for the CANDOR Process: Appendix A

Building the Business Case Worksheet

Purpose: To provide guidance to leaders and staff who are building a business case for implementing the CANDOR process in their organization.

Who should use this tool?  Leaders (administrators, director of nursing, medical director, etc.) and any staff who are leading the implementation of the CANDOR process in the organization.

How to use this worksheet: Review each element of the business case, and use the examples to build a business case tailored to the organization. Respondents should answer these questions honestly and to the best of their ability. Adapt the business case to the audience being addressed, whether it is the CEO, risk manager, or frontline staff, focusing on the elements of the business case they are most interested in highlighting. If the organization has already adopted a business plan template or format, then use the organization's format to summarize key elements of the plan.

<YOUR ORGANIZATION'S> BUSINESS CASE FOR THE CANDOR PROCESS

Recommended Business Case Elements

 

Your Business Case

 

Executive Summary <Your organization's> Executive Summary
  • The Executive Summary should be a brief but succinct answer to the question, "Why implement the CANDOR process?" The question should be answered on a strategic level and should address the following:
    • A brief description of the CANDOR process implementation plan, including all program elements (one or two paragraphs).
    • Alignment of the plan to the organization's strategic and risk/quality/patient safety goals.
    • Identification of the clinical areas involved in the rollout and the key stakeholders, as well as the anticipated timeframe from development to execution, including evaluation.
    • Identification of key success factors and related measures such as resource commitment, process changes, and leadership engagement.
 
Current Climate <Your organization's> Current Climate
  • The Current Climate should address current culture related to risk/quality/ patient safety, especially how to handle adverse events.  Should the organization decide to move forward with the CANDOR process, a detailed Gap Analysis will be conducted.
    • Outline the organization's risk/quality/patient safety program and how the CANDOR process connects to the goals and objectives.
    • Analyze the organization's frequency of adverse events and malpractice claims to support the rationale/urgency for implementing the CANDOR process.
    • Discuss efforts to improve communication and response to adverse events to date, including the clinical areas engaged, the implementation steps used to develop and/or spread the practices and strategies, and key leaders who have supported the efforts.
    • Provide information about accomplishments to date, especially audits of practices, observations by staff and leaders, and evidence of execution of principles and practices. Identify what you believe are the critical success factors.
  • Performance measures that reflect the culture of an organization include:
    • Length of time to report the adverse event:
      • Number of adverse events reported >24 hours after occurrence
    • Severity level of adverse events reported.
    • Length of time it takes to disclose the event.
    • Length of time to complete investigation and analysis of the event.
    • Number of claims asserted.
    • Number of law suits filed compared to the claims settled or dismissed for < $500.
    • Proportion of, and dollars subsequently paid for, adverse events identified outside of the organization vs. those identified internally by existing processes.
 
CANDOR Process Overview <Your organization's> CANDOR Process Overview
  • Briefly describe the program elements and the CANDOR process.
  • Describe exactly what you want to achieve with the CANDOR process in the organization.  Set specific measures and related goals.
  • Include a description of who needs to be involved to support the project; what is needed in terms of money, time, people, or other resources; create a high-level timeline that demonstrates the timing for each phase of implementation; and the plan to achieve, spread, and sustain CANDOR processes.
 
Financial Impact <Your organization's> Financial Impact
  • Prepare a budget that details costs for salaries, supplies, contracted services, equipment, materials, and any other expenses that require allocation of capital or operating funds.
  • Assess what is occurring in the organization's legal community regarding medical litigation. (Track, analyze, and compare adverse events managed pre‑implementation, then follow up with additional analysis post‑implementation of the CANDOR process).  Performance measures to be compared include:
    • Dollars involved in settlements.
    • Dollars involved in actual suits.
    • Median and average payment to claimants.
    • Settlement authority versus actual disposition.
    • Verdict comparisons.
    • Physician approval with resolution process.
    • Comparison of actual results to settlement authority extended.
    • Legal costs (dollars spent on litigation and loss adjustments).
    • Professional liability premiums.
  • Collaborate with finance and the risk/quality/patient safety division to calculate the projected costs of harm events in terms of reimbursement loss, penalties, risk management claims, medical liability expenses, and/or added costs to the patients. Determine a return on investment that ties to reduced adverse events.
 
Indirect Impact <Your organization's> Indirect Impact
  • The indirect impact of CANDOR process implementation is significant and should be included.  Some organizations will be able to tie a financial impact to some of these items, while others might not be able to do so.  Please address financial impact whenever possible, and discuss measurement before and after CANDOR process implementation.  Performance measures to consider include:
    • Patient experience (use measures such as HCAHPS scores).
    • Staff and physician experience (utilize existing satisfaction measures, HSOPS scores, and other human resource metrics such as reduced staff turnover or improved retention.
    • Care for the caregiver (only in organizations that have an existing Care for the Caregiver program in place):
      • Number of peer-to-peer interactions.
      • Level of support provided.
  • Describe how the program can build the skills, knowledge, and confidence of the workforce, thereby affecting the ability of the organization to be resilient and more successful in sustaining reliable processes.
  • Discuss the effects on community confidence or market capture due to more favorable communication and response to adverse events.
 
Implementation Risk <Your organization's> Implementation Risk
  • Assessment of the Implementation Risk should address risks associated with allocating resources (human and other) to implement, spread, or sustain the CANDOR process if leadership is not engaged or fully supportive. (Present a plan to track FTEs and any other expenses associated with implementation, spread, and/or sustainability in this circumstance aligned with other outcomes previously discussed.)
  • Include potential risks to the organization if the practices and principles are not fully integrated, spread, or sustained.
 
Conclusions/Recommendations <Your organization's> Conclusions/Recommendations
  • Keep this section brief by focusing on three or four key conclusions or recommendations.  Circle back to the question, "Why implement the CANDOR process in this organization?" Support the "why" with evidence gathered in the measurement of the various outcomes suggested throughout this worksheet.
  • Be specific about what is needed to support implementation and sustainment in the organization and about the level of readiness to pursue the work.
  • Focus on patient safety improvements, the involvement of patients and families in the CANDOR process, and how these actions will benefit the organization and its goals.
 

HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems
HSOPS = Hospital Survey on Patient Safety Culture

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Proceed to Appendix B

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Page last reviewed February 2017
Page originally created April 2016
Internet Citation: Implementation Guide for the CANDOR Process: Appendix A. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/impguide-apa.html