Needs Assessment: Getting There from Here

In my experience, the decision to implement an electronic health record is usually an attempt to solve ongoing practice problems. Whether or not an EHR successfully meets expectations depends on the complexity of the problems and how appropriate an EHR is for solving them.    Some problems are straightforward and readily solved by implementing an EHR–remote access to patient records falls into this category.  However, most issues that affect practice efficiency, productivity, or profitability are multifaceted, making it more difficult to achieve an ideal solution simply by implementing an EHR.   The key to solving any problem is understanding why it exists. This is where needs assessments come in handy.

Many people assume that needs assessments are expensive and require a team of experts, but that isn’t the case.   A needs assessment is nothing more than a systematic approach to identifying current problems; determining why they exist; deciding what can be done about them; and then prioritizing the identified solutions. Anyone who is well-organized and has an eye for details can conduct a needs assessment.

Step 1-What are the issues?
Gap analysis is the first step. In this step, problems are identified and the differences between the current state and the ideal state (i.e., the gaps) are analyzed.  For example, if the current wait time is 20 minutes or more, and the practice has determined that the ideal wait time should be five minutes or less, then the 15-minute difference has to be accounted for in terms of practice processes.  When looking for problems, everyone in the practice should be involved.  At this stage, don’t worry about how important the problems are; instead focus on getting a comprehensive list of things that everyone would like to improve. Next, go in the opposite direction. Think about how the practice should run in the best of all possible worlds.  I usually refer to this as the wish list.   Combining the problem and wish lists provides the final set of items that will serve as the focus of the needs assessment.  Here is an example of a simple gap analysis document.

Step 2 – Why do they exist?
Once the gap analysis is complete, the hard part begins—determining why the gaps exist.   This requires data collection.   In small practices, this may be accomplished by interviews, brain-storming sessions, reading books and articles, patient satisfaction surveys, and reviewing current policies and procedures.  The goal is to find out why current processes fall short in delivering the ideal state.  Typical reasons for gaps are lack of resources (money, people, technology), poorly designed policies and procedures, failure to implement policies and procedures as written, inadequate training, and high staff turnover.   If done properly, this step provides the information needed to address the concerns identified.  Honesty and a willingness to question the status quo are essential for success at this step.

Step 3 –In what order should issues be addressed?
After Step 2, the issues that require attention should be clear.  However, since resources are limited and not every item will be equally important, priorities must be established.  Start with the most important problem and work down the list.  If patients are complaining about service quality issues (e.g., wait time, results notification, etc.) and leaving the practice, obviously these issues will take priority.  Alternatively, if there are no patient issues, but providers are stressed because they lack chart access while on call, then that would take priority. Each practice must determine which issues are most important and the order in which they will be tackled.

Step 4 – What to do?
It is a good idea to capture assessment findings in a report because the process of drafting and writing a report often helps clarify issues and encourages consensus. Once completed, the report provides a collective record of how things used to be and acts as a resource for planning activities.

Step 4 is where many practices go off course by prematurely deciding to implement an EHR. Not all problems can be solved with an EHR.  In fact, issues such as poor training, staff with inadequate skills, and ineffective policies and procedures will likely become worse with an EHR, not better.  Aside from EHR considerations, review available resources, management practices, and current policies and procedures.  Any practice that diligently completes all four steps should have the information required to improve the way it functions.

Needs assessments are effective tools for helping organizations improve how they perform.  Needs assessments can be costly endeavors that require large investments of time and expertise, but they don’t have to be.   If you are trying to determine how to improve your practice, a needs assessment is a great tool for determining how to advance from where you are to where you want to be.


A Practical Guide to Needs Assessment. K Gupta, C Sleazier, D  Russ-Eft.   This book clearly explains all aspects of needs assessment.  It has a tone more akin to a tutorial than a business or academic text.  Highly recommended.



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