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A Change Process:
Patient Intake Paperwork
Coastal Carolina Neuropsychiatric Center
SWRK 380 Social Work Practice-III
Professor Shirley Fineran, LISW
Author: Alexis Goodrich, BSW Student
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Table of Contents
Introduction…………………………………………………………………………………..……3
The Need for Change……………………………………………………………………….……..6
Identifying the Change……………………………………………………………………….……7
Analyzing the Change Opportunity……………………………………......................………….10
Goals and Outcomes…………………………………………………………………..…………15
Designing and Structuring………………………………………………………………..……...19
Determining Resources…………………………………………………………………..………21
Implementing the Change Process..……………………………………………………..…….…22
Monitoring the Change………………………………………...………………………..……….23
Evaluating the Change Process……………………………………………...……………..…….24
Reassessing and Stabilizing……………………………………………………………….....…..24
Conclusion……………………………………………………………………………………….25
References…………………………………………………………………………..…………....26
Appendices
Appendix A: Practicum Contract……………………...……………..…………………..27
Appendix B: Agency Mission Statement………...………………………..……………..29
Appendix C: Agency Policies on Patient Care…..………………………..……………..30
Appendix D: Sanctioning Letter………………………………………..………………..31
Appendix E: Patient Satisfaction Survey……...………………………..………………..32
Appendix F: Staff Feedback…………………………………..………..………………..33
Appendix G: CARF Behavioral Health Standards………..……………………………..34
Appendix H: HIPAA Privacy Rule……………………………………………………....38
Appendix I: Gantt Chart…….……………………………………………..……………..39
Appendix J: Change Process Budget…………….………………………..……………..40
Appendix K: Current Patient Intake Paperwork…………………………………………41
Appendix L: Revised Patient Intake Paperwork…………………………………………42
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Introduction
New York Times best-selling author Darynda Jones once said, “Paperwork wouldn’t be
be so bad if it weren’t for all the paper. And the work.” This statement couldn’t be more true
than within the behavioral health field. When it comes to receiving mental health services, many
new patients are often inundated with lengthy and confusing paperwork. Many individuals do
not have computer access to be able to print and complete paperwork before their initial
appointment which causes long wait times and disgruntled patients and employees. The patient
intake process is vital to the formation of any therapeutic relationship, therefore it is essential for
behavioral health agencies to have a standardized intake paperwork format that is both efficient,
accurate, and easy to understand.
The history of case management and paperwork requirements is one that hearkens back
to the 1950’s in the United States. Between 1950 and 1960, the mental health
deinstitutionalization movement began. This was centered around the development of new
pharmacological interventions and a belief that individuals could be treated less expensively in
their own communities. In 1963, The Community Mental Health Center (CMHC) Construction
Act was passed, leading to the funding of numerous mental health outpatient centers across the
country. The purpose of CMHC’s was to provide treatment for those individuals that had been
deinstitutionalized. In 1977, the National Institute of Mental Health (NIMH) founded the
Community Support Program (CSP) as a response to the fragmented community mental health
system and unmet needs of people suffering from mental illness, many of whom had previously
been patients in state hospitals. During this time, the term “casework” was changed and renamed
“case management” and becomes the forefront of the CSP’s vision for the future of mental health
services (Ashcroft & Anthony, 2009). Since then, case management has become a prominent, if
not the central component of many behavioral health agencies.
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Although the behavioral health field has changed considerably since 1977 due to new
research and legislation, many case management and paperwork requirements have stayed the
same. Many social service agencies make it their mission to provide the best possible service to
their clients as well as create an optimal work environment for employees. Although paperwork
is an essential component of the patient intake process, oftentimes it is cumbersome and
redundant for all parties involved. Precious time and resources are wasted on handling outdated
paperwork instead of focusing on patient care. While keeping records is extremely important, an
agency’s paperwork policies and procedures should always take into account the best interests of
the patient and the employees completing the intake process (Ashcroft & Anthony, 2008). This
can be difficult when an agency has multiple regulatory bodies and accreditation standards to
comply with, however improving upon current processes would prove well worth the effort.
Concerning clinical documentation, the American College of Physicians states, “Clinical
documentation in the era of EHR’s (Electronic Health Records) should first and foremost support
the delivery of care that improves patient care and outcomes. To achieve this goal, providers,
policymakers, and EHR developers need to view clinical documentation as a fundamental tool
for improving patient care rather than a regulatory burden or gateway for reimbursement”
(Sequist, 2015).
Research also shows that a high documentation to clinical service ratio for mental health
workers leads to occupational stress, dissatisfaction, and burnout. It should also come as no
surprise that “as time spent on paperwork increases, so time spent on direct care with service
users decreases”. When patients are forced to spend a large portion of their appointment time
completing paperwork, this results in fewer scheduled treatment appointments, no shows,
cancellations, and an overall disengagement with their own treatment (Garcia, 2006). This is
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contrary to the goals that most agencies have for the care of their patients, employees and their
community.
This student completed a 450-hour internship and practicum change process at Coastal
Carolina Neuropsychiatric Center (CCNC) from November 2015- April 2016 in order to fulfill
requirements for her Bachelor’s of Social Work degree. Sister Shirley Fineran, LISW, (BCU
Social Work Field Director) informed this student that her internship would be both demanding
and rewarding and that the change process component of the course would be an integral part of
her learning. CCNC Clinical Director and Vice President, Dr. Kristina Hobby, PsyD., graciously
agreed to be this student’s Field Supervisor and provided Sister Fineran with all required
paperwork and supporting information to complete the practicum contract (Appendix A).
Netting, Kettner, McMurty, & Thomas (2012, p. 304) define macro social work as having four
distinct parts: “1) understanding the important components to be affected by the change- the
problem, population, and arena; 2) preparing and overall plan designed to get the change
accepted; 3) preparing a detailed plan for intervention; and 4) implementing the intervention and
following up to assess its effectiveness”. Under this framework, the change process is an
optimal way for students to apply macro social work skills in a tangible way during their
practicum experience.
Coastal Carolina Neuropsychiatric Center (CCNC) in Jacksonville, North Carolina is a
mental health agency working to serve individuals in their surrounding community and address
larger mental health issues that affect eastern North Carolina. They are a prominent agency in
the local area and a leader in providing a wide range of mental health services to a diverse
population. CCNC’s mission is to “provide quality, patient-centered, evidence-based mental
health care in a warm, caring environment where there is respect between the staff, providers,
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and patients”, found on their website at www.coastalcarolinapsych.com (Appendix B). CCNC
brings together mental health providers of such a diverse range of educational backgrounds,
experience, and interests. They provide services including:
- Supportive therapy - Individual psychotherapy
- Couples/marital therapy - Family therapy
- Parenting skills education - Diagnosis of mental disorders
- Medication assessment and management - Treatment and support
CCNC is a “business built on patient care”. Their policies regarding customer service,
professionalism, and communication reflect this statement, as evidenced in their Employee
Orientation & Training Manual on page 6, “Within any business there are many tasks that must
be accomplished on a given day in order to keep the doors open and business running; however,
we must never lose focus on the simple fact that the reason we opened our doors was to provide
patients with a necessary and valuable service for the benefit of their mental health. Those many
business tasks must be accomplished in a way that never puts quality patient care, customer
service, and professionalism as secondary considerations” (Appendix C).
Need for Change
This student met with Dr. Hobby in the beginning stages of the internship to discuss the
internship process and go over expectations, assignments and questions. During the meeting, this
student brought attention to the “change process” requirement for the practicum experience. The
change process was created by Sister Fineran and is significant in that it is a structured, yet fluid
framework for making change within a macro system. This process may take place in a variety
of settings including groups, agencies, institutions, communities, and government entities. The
change can entail newly identifying a need or becoming involved in a change that is already in
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progress or that has been previously attempted. This might consist of a short or long term
project, a program, a policy, or a combination therein. While discussing the components of a
change process and how it can make a difference at the macro level, Dr. Hobby shared her
thoughts on the current client intake paperwork at CCNC. She elaborated on the antecedent
conditions of the client intake process and explained that the patient intake paperwork that
CCNC patients are required to complete is cumbersome for all involved in completing and
processing it. She expressed the need for a revised and streamlined paperwork packet for CCNC
clients and stated that both patients and staff are not satisfied with the current format. This
student and Dr. Hobby agreed that the CCNC patient intake paperwork would be a good
candidate to undergo the change process. To address the need for a revised intake paperwork
format, this student assumed the role of “change agent” and resolved to be a leader in the change
process. This student further defined her change process statement as “to revise CCNC patient
intake paperwork for both patient and staff purposes”.
Phase I: Identifying the Change Opportunity
This student was ready to begin her change process of revising the patient intake
paperwork, but before she could take any further steps she needed approval from her supervisor,
Dr. Hobby by means of a sanctioning letter. A sanctioning letter or memo is a document that
gives the permission and support of the supervisor in order to proceed with the change process. It
is important because “without sanctioning, the change agent’s efforts will be met with
indifference or opposition. Even staff that may support the concept of the change process may
not get behind the idea unless there is approval from the appropriate persons” (Fineran, 2014, p.
39). After speaking with Dr. Hobby, this student requested and received a sanctioning letter
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(Appendix D). This allowed her to continue with change process and ensured support from the
rest of the CCNC staff.
With the permission of Dr. Hobby, this student compiled and assessed data previously
obtained by staff from CCNC patients in a “Patient Satisfaction Survey” using questions 3-6
under section “A” (Appendix E). She also documented feedback from staff members about the
patient intake paperwork (Appendix F). The staff was very helpful and contributed many ideas
about the weaknesses of the current paperwork and how it could be better. Everyone this student
spoke with was in favor of a revised patient intake paperwork packet. After speaking with Dr.
Hobby, Tanya Hopkins, LPC and Christy Harness, LCSW were recommended to provide
assistance for the change process (in addition to Dr. Hobby herself) and be a part of the change
process planning committee. Ms. Hopkins is a therapist who also has additional responsibilities
as a subject matter expert on the Commission on Accreditation of Rehabilitation Facilities
(CARF), the accrediting body for CCNC. Ms. Harness is also a therapist who has previous
experience at CCNC working with the front office and patient intake staff, and is very
knowledgeable about HIPAA and how it relates to patient paperwork. Ms. Hopkins and Ms.
Harness both provided insight on the data collected from patients and staff concerning the patient
intake paperwork. Ms. Hopkins provided online sources to research applicable CARF standards
and Ms. Harness also selected helpful resources highlighting the role of HIPAA and records
management (Appendices G & H).
The planning committee was supportive of the change process throughout and each
member volunteered to be involved as much and in any way needed. This included
brainstorming ideas, providing suggestions for research, analyzing data, and providing feedback.
Each member played different but important roles in facilitating the change process.
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This student examined how the change would affect the clinical staff members as well as
the patients at CCNC. After looking at the budget and determining that funding would not be an
issue, focus was placed on other potential challenges that might arise. This included possible
reluctance from staff members to accept the change, HIPAA and CARF regulations limiting the
scope of revisions that could take place, and the feasibility of revising the 21-page document in
the given timeframe.
In order to progress, this student also needed to identify the systems involved in the
change process, including her own role as “change agent”. As described by Fineran (2014, p.
21), a change agent “may be a direct service worker, a planner, a development resource person, a
manager, an administrator, a board member, or community worker. The change agent
orchestrates or coordinate’s the change process but need not personally carry out all of the
change efforts”. The initiator system, a collection of individuals or groups who bring attention to
a need, also needed to be defined within the change process. This system consisted of Dr.
Hobby, the student’s internship supervisor, who reported each need and requirement for the
change process.
In addition to this student and Dr. Hobby, Ms. Harness and Ms. Hopkins were a part of
the change agent system. The change agent system mobilizes individuals to work towards
providing better services for the change taking place. The new patient intake paperwork will
provide better service for the client system (CCNC patients), who directly benefit from the
paperwork once implemented. The primary beneficiaries include all new patients at CCNC and
any patients required to refill out the new patient intake paperwork. The secondary beneficiaries
who benefit indirectly consist of the CCNC clinical and clinical support staff. According to
Fineran (2014, p. 45), the target system is the individuals and the organizations that need to be
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changed in order to achieve the objectives of the change process. This system consists of Dr.
Hobby and the clinical department of CCNC. This target system will be learning about the
revised patient intake paperwork, how it changes current practices, and how it results in better
services for the patients. The target system will have to adapt from how they have learned to
explain and process the old paperwork to how to complete the new paperwork. The leader of this
student’s sanction system is Dr. Hobby and as such, she can formally give authority to approve,
disapprove, and order the implementation of the proposed change. The implementing system
was the last system this student needed to define. This consisted of Dr. Hobby due to her
overall authority to approve and instruct CCNC staff on the implementation and the clinical
support staff as they are the individuals implementing the new paperwork face to face with
patients.
The various components just described form an action system- all individuals and groups
that are involved in the change process in any way. This student’s action system included Dr.
Hobby, Ms. Harness, Ms. Hopkins, clinical/clinical support staff, and applicable CCNC patients.
Each individual involved had a unique role that was essential to this student’s success in
designing and implementing the change.
Phase II: Analyzing the Change Opportunity
According to Fineran (2014, p. 49), the analyzing phase “examines why the change
opportunity exits and to define its aspects and implications. Analysis of the change opportunity
gives impetus to setting goals, objectives, and outcomes. Analysis provides the information
needed for the change process design and implementation”. If completed successfully, this
phase will assist in identifying a change opportunity and deciding how to respond to it.
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To give context as to the need for change and analyzing how this came to be, this student
researched what a typical patient coming in for their first appointment at CCNC could expect to
experience. They are advised to arrive 30-45 minutes before their actual appointment time in
order to complete the 21-page new patient paperwork packet. They must also complete their
initial psychiatric evaluation which usually lasts about one hour from start to finish. During this
process they are asked about the reason they are visiting CCNC (chief complaint) and what has
been happening over the past several weeks/months that is important for the practitioner to
know. This includes past and current use of medications, past mental health treatment history
and medical history, and other questions about their family, living situation, and functioning in
school or employment. All of these questions help CCNC practitioners learn about the patient’s
life and the symptoms they are experiencing. After acquiring all of this information, a doctor
will come in and review the information with the psychiatric evaluator. After the doctor has
obtained the necessary information to make a diagnosis and formulate a treatment plan, he or she
treatment options for medication, therapy, and/or further psychological testing with the patient.
Once a treatment plan is determined, the doctor will write a prescription (if medicine is
indicated) and/or refer them for an appointment with one of the therapists. From start to finish,
a new patient at CCNC can expect to spend roughly 2-3 hours on their first appointment, with
30-60 minutes of that devoted to completing paperwork. It was easy for this student to see why
the need for change existed and that revising the paperwork could drastically improve services
for patients.
This student also knew that in order to accurately revise the patient intake paperwork, she
would need to understand the specific requirements of the CARF standards relating to
administration and records management. Ms. Hopkins provided information about CARF
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standards for behavioral health agencies and this student was able to research these requirements
in detail within the CARF Behavioral Health Standards Manual (Appendix G). The role of
CARF is to “promote the quality, value, and optimal outcomes of services through a consultative
accreditation process and continuous improvement services that center on enhancing the lives of
the persons served”. CARF has specific standards regarding patient records and clinical
information. These standards provided a sound framework within which to revise the current
patient paperwork and are as follows:
G. Records of the Persons Served
1. The organization implements policies and procedures regarding information to be
transmitted to other individuals or agencies that include:
a. The identification of information that can legally be shared without an
authorization for release of information.
b. Forms to authorize release of information:
1. Comply with applicable laws.
2. Identify, at a minimum:
a) The name of the person about whom information is to be released.
b) The content to be released.
c) To whom the information is to be released.
d) The purpose for which the information is to be released.
e) The date on which the release is signed.
f) The date, event, or condition upon which the authorization expires.
g) Information as to how and when the authorization can be revoked.
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h) The signature of the person who is legally authorized to sign the
release.
2. The individual record communicates information in a manner that is:
a. Organized.
b. Clear.
c. Concise.
d. Current.
e. Legible.
3. All documents generated by the organization that require signatures include original or
electronic signatures.
4. The individual record includes:
a. The date of admission.
b. Information about the individual’s personal representative, conservator, guardian,
or representative payee, if any of these have been appointed, including the name,
address, and telephone number.
c. Information about the person to contact in the event of an emergency, including
the name, address, and telephone number.
d. The name of the person currently coordinating services of the person served.
e. The location of any other records.
f. Information about the individual’s primary care physician, including the name,
address, and telephone number, when available.
g. Healthcare reimbursement information, if applicable.
h. The person’s:
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1. Health history.
2. Current medications.
3. Preadmission screening, when conducted.
4. Documentation of orientation.
5. Assessments.
6. Person-centered plan, including reviews.
7. Transition plan, when applicable.
i. A discharge summary.
j. Correspondence pertinent to the person served.
k. Authorization for release of information.
l. Documentation of internal or external referrals.
In the context of patient records and documentation, the Health Insurance Portability and
Accountability Act (HIPAA) was another component this student had to thoroughly analyze to
ensure a patient’s privacy and rights would be protected under the newly revised paperwork.
HIPAA also has specific regulations and standards for compliance with the HIPAA Privacy Rule
outlined in the HIPAA Privacy Rule and Sharing Information Related to Mental Health
(Appendix H). The HIPAA Privacy Rule “provides consumers with important privacy rights and
protections with respect to their health information, including important controls over how their
health information is used and disclosed by health plans and health care providers. Ensuring
strong privacy protections is critical to maintaining individuals’ trust in their health care
providers and willingness to obtain needed health care services, and these protections are
especially important where very sensitive information is concerned, such as mental health
information.” During this change process, it was essential for this student to understand the
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implications of HIPAA and how it influences what changes/additions/deletions would be in
compliance in the new patient paperwork packet for CCNC.
Other data sources that were collected included gather patient feedback from previously
administered Patient Satisfaction Surveys (Appendix D) determining any issues and
recommendations for the new patient paperwork and intake process. Feedback was also
collected from staff regarding their own issues and recommendations (Appendix E). Once the
planning committee reviewed this data, it was clear there were similarities between the patients
and staff concerning what they believed to be challenges with the intake paperwork in its current
state. The staff members and the patients had recurring themes on the change, including that the
current paperwork took too long for patients to complete, that certain sections were difficult to
understand, and that the same information was asked for repeatedly (redundancy). All of the
data allowed this student to identify the elements that needed to be addressed in the current
intake paperwork at CCNC in order to improve services for patients and allow staff to do their
jobs more easily. Contrary to what she expected, this student did not have any restraining forces
that were against the change; there was unanimous support from CCNC employees and funding
for the change would not be needed.
Phase III: Setting Goals and Outcomes
Once the need for change has been established and there is consensus on how to respond
to it, the planning committee must then outline goals, objectives, and outcomes for the change
process. As Fineran (2014, p. 59) states, “A clear direction in which the change is to move is
critical for the ultimate success of the change process. In Phase III setting goals give direction to
the planned change process and providing outcomes prepares for measuring progress”. CCNC’s
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mission statement is “to provide quality, patient-centered, evidence-based mental health care in a
warm, caring environment where there is respect between the staff, providers, and patients”
(Appendix B). This student kept CCNC’s mission in mind when setting goals and evaluating the
progression of the change process. Setting goals includes actions steps and objectives to assist in
monitoring outcomes, all of which are essential to further defining the change and ensuring the
planning committee has a framework to work with.
Goal One: To identify components of CCNC’s patient intake paperwork that need revising.
Objective One: To receive approval and support for change process.
Action Steps:
________Will obtain sanctioning from field supervisor to move forward with the
change process.
________Will put together change process planning committee.
Objective Two: To collect feedback from staff and patients regarding current patient
intake paperwork.
Action Steps:
________ Will compile feedback on patient intake process from “Patient
Satisfaction Surveys”- historical data previously gathered by CCNC in 2015.
________Will summarize feedback and comments from staff regarding patient
intake process.
Outcome: CCNC patients and staff benefit from providing feedback regarding current patient
intake paperwork.
Goal Two: To conduct additional research relevant to revising CCNC patient intake paperwork.
Objective One: To research CARF requirements for patient intake paperwork.
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Action Steps:
________ Will summarize information gathered through research and
consultation with change process planning committee.
________Will discuss findings with field work supervisor to address and
questions and/or concerns.
Objective Two: To research HIPAA requirements for client intake paperwork.
Action Steps:
________ will summarize information gathered through research and consultation
with change process planning committee.
________will discuss findings with field work supervisor to address and
questions and/or concerns.
Outcome: CCNC will benefit from patient intake paperwork revisions that comply with CARF
and HIPAA accreditation requirements.
Goal Three: To make revisions to current patient intake paperwork and get new, revised version
approved.
Objective One: To make a draft of proposed patient intake paperwork revisions for
CCNC management review.
Action Steps:
________Will include patient and staff feedback in revisions.
________Will include supplemental research in revisions.
________Will consult with field work supervisor for any questions or concerns.
Objective Two: To get revised patient intake paperwork approved by CCNC
management.
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Action Steps:
________Will consult with change process planning committee prior to
submitting for approval.
________Will request sanctioning letter to implement revised paperwork within
the patient intake process after approval by CCNC management.
Outcome: CCNC patients and staff will benefit from patient intake paperwork revisions that
utilize their feedback and are sanctioned by CCNC upper management.
Goal Four: To implement the new patient intake paperwork in the CCNC intake process.
Objective One: To define components involved in change process implementation.
Action Steps:
_______Will identify individuals assisting with change process implementation.
_______Will identify resources needed for change process implementation.
_______Will identify tasks/responsibilities for individuals assisting with
implementation and request feedback prior to taking action.
Objective Two: To execute action items needed for change process implementation.
Action Steps:
_______Will discuss action steps needed to proceed with field work supervisor
prior to implementing any changes.
_______Will initiate instruction to applicable staff in order to implement revised
client intake paperwork unless advised otherwise by field work supervisor.
_______Will determine how staff will be notified of the change in patient intake
paperwork.
Outcome: Implementation will improve intake services received by CCNC patient.
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Goal Five: To monitor and evaluate the revised patient intake paperwork at CCNC.
Objective One: To monitor the process and development of the patient intake paperwork.
Action Steps:
______Will develop a Gantt chart.
______Will monitor the process status using Gantt chart.
Objective Two: To evaluate the effectiveness of the patient intake paperwork.
Action Steps:
______Will issue and evaluate “Patient Satisfaction Surveys” to CCNC patients.
______Will issue and evaluate verbal feedback and comments collected from
CCNC staff.
Outcome: Patients at CCNC will benefit from an intake process that is reviewed by staff and
patients for improvement.
This student utilized a Gantt chart (Appendix I) to track her goals, objectives, and
activities. The Gantt chart can be compared to a timeline bar chart, providing visual deadlines of
the development of the new patient paperwork. The Gantt chart was also useful for keeping
track of the overall change process progression and ensuring all goals, objectives, and activities
were being met.
Phase IV: Designing and Structuring the Change Effort
The planning committee is an integral component of the change process and contributes a
great deal during the “Designing and Structuring” phase. The “design” aspect of this phase
includes defining the purpose and structure of the change, creating a delivery system, and
specifying overall responsibility. The “structure” aspect includes defining specific jobs,
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positions, responsibilities and outlining their relationship to each other (Fineran, 2014, p.66) This
student was able to use her communication skills and professionalism to assist the planning
committee during this phase by assigning roles and responsibilities.
This student’s role was to obtain sanctioning for the development and implementation of
the change process (Appendix D), compile data on patient and staff feedback (Appendices E &
F), research CARF and HIPAA applicable standards (Appendices G & H), analyze the current
patient paperwork packet (Appendix K) and develop the revised patient paperwork packet
(Appendix L). Ms. Harness’ and Ms. Hopkins’ roles were to assist with analyzing data, provide
sources for research, and help with implementation at the patient level. Dr. Hobby had the role
of formally giving authority to approve, disapprove, and order the implementation of the
proposed change as well as monitor the change after implementation. Each member of the
planning committee volunteered to be involved helping with the development the revised patient
paperwork and being available to the student for questions and suggestions. This student
successfully managed the process to ensure each aspect of the change process was thoughtfully
reviewed with the help of the planning committee before final implementation.
This student also explored whether the change process fell under a project, program, or
policy approach. She decided that the patient paperwork revisions would fall under a program
approach initially, since “The program approach involves change regarding an existing or
developing a new service program. This procedure is used when the change systems decide to
alter an existing program or create a new client service” (Fineran, 2014, p.68). Once the patient
paperwork was revised, a policy approach would be needed for implementation, as “The policy
approach deals with…developing or changing policies for the agency” and would require
multiple levels of approval (Fineran, 2014, p.67).
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Phase V: Determining Resources
The next step in the change process was determining resources, an important phase to
consider for all involved, in particular those granting approval for the change process to be
developed and implemented. This student knew that determining her resources for this change
process were essential for the simple reason that “decision-makers often look at the cost before
they even consider the rationale for implementing the change”. Improvement in quality of life
for patients is not enough of a rationale by itself to dedicate valuable resources and personnel in
support of the change effort. The change agent should ideally have an idea of the cost of the
change during the sanctioning process to help decision-makers determine if it is worth the
investment (Fineran, 2014, p.74).
An important part of determining resources for the change was identifying any expenses
through the use of a budget. This student requested to be allowed access to the budget, however
due to company policy, only management is allowed access to this sensitive information. For the
sake of the change process, this student was able to work with her supervisor, Dr. Hobby, to get
an idea of CCNC’s revenue and expenses in order to put together a budget for the change process
(Appendix J). Funding for printing and related supplies are already included in CCNC’s existing
budget, resulting in a $0 expense. Ultimately, all expenses required to design and implement the
change process amounted to $0. Since the patient intake paperwork would be revised (and
ultimately reduced in length), the change process results in CCNC spending less money on paper
and ink. After completing the budget, this student identified that cost would not be a factor that
would stop the development and implementation of the change process. Implementing the
change process will benefit the patients at CCNC without incurring any additional expenses for
the agency.
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Phase VI: Implementing the Change Process
The implementation phase of the change process is a description of how the change will
take place and focuses on the actions that will be taken by the change agent and planning
committee. The change process is “implemented according to the plans that have already been
determined in the Goals and Outcomes, Design and Structure, and Determining Resources
phases” (Fineran, 2014, p.75). The planning committee members were all involved by assisting
in various areas including providing ideas, input, and feedback and gathering and analyzing data.
This student took action within her assigned roles by obtaining sanctioning for the development
of the change process (Appendix D), compiling data on patient and staff feedback (Appendices E
& F), researching CARF and HIPAA applicable standards (Appendices G & H), analyzing the
current patient paperwork packet (Appendix K) and developing the revised patient paperwork
packet (Appendix L). Dr. Hobby was responsible for reviewing and approving the revised
paperwork and forwarding it to higher management and the Business Operations department for
further evaluation, approval, and eventual implementation. Each member of the planning
committee was involved and supportive in helping with the development and implementation of
the change. There was no resistance, residue or lack of support throughout the process. Any
issues that arose were quickly addressed and this student was fortunate to have developed
positive relationships with the rest of the planning committee and experienced no interpersonal
conflicts. Final implementation at the patient level (replacing the current paperwork with the
revised paperwork) will occur once all levels of management and appropriate authorities have
given approval. This student is pleased that the change process is undergoing final review and
anticipates the revised paperwork to be implemented by June 2016. It should be noted that the
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revised patient paperwork in Appendix L is a draft and is not an official CCNC document until
such final approval is granted.
Phase VII: Monitoring the Change Process
According to Fineran (2014, p.79) “Monitoring involves developing a process-and a
simple tangible method-to keep the change effort on course and to keep track of implementation
activities”. This can be achieved through the use of tools such as a checklist for implementation
or a post-change survey. This student knew in order to meet the goals, objectives and outcomes
of the change, it would be important to have tools that would collect the necessary data and
information to effectively monitor the change process.
This student referred to her Gantt chart (Appendix I) to ensure she and the planning
committee were meeting all milestones. The Gantt chart is similar to a timeline bar chart and
provided a visual as to when goals needed to be met and also helped with time management. It
explains in detail the goals of the change process and how it will affect new patients at CCNC. It
was a valuable tool in showing that all action steps were completed on time. Another monitoring
tool utilized is the Patient Satisfaction Survey (Appendix E). Data was compiled from
previously completed surveys to assist in developing the change process and showing a need for
change. This survey will be used again after the revised patient paperwork is implemented to
determine if there is an improvement in patient satisfaction. These monitoring tools allow for
tracking the development and implementation process and determining if the change is having
the intended effects. The checklist shows what was intended to be changed and all items have
been completed. Although it can seem tedious to track the change process in such detail, it is
imperative to ensure all steps are being taken to maximize the success of the change.
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Phase VII: Evaluating the Change Process
The next phase in the change process is evaluation which means the change agent and
others involved must make a judgment about or attach a value to the change that is being
monitored. In addition, the purpose of evaluation is “to develop information that will lead to
effective and efficient interventions” (Fineran, 2014, p.79). The utilization of the CCNC patient
satisfaction survey (Appendix E) provides this student with an effective tool to gather feedback
on the revised patient paperwork and whether or not is has improved patient services. The
patient satisfaction survey will be distributed to new CCNC patients by the direction of Dr.
Hobby approximately one month after the new paperwork receives final approval and is
implemented. Dr. Hobby and CCNC staff will be responsible for distributing and gathering data
from these surveys since this student’s internship experience will be completed by that time.
This post-change data will be compared with the pre-change data in order to determine if the
revised patient paperwork was a success in improving the new patient intake process. Currently,
the revised paperwork is 16 pages long as opposed to the original paperwork which was 21 pages
long. It has been reformatted and reorganized to assist patients and staff with completing and
processing the information easier and eliminated unnecessary and redundant information.
Already, the revised paperwork is shorter in length, but only time will tell if CCNC patients are
receptive to the changes that have been made and if the change process was a success.
Phase IX: Reassessing and Stabling the Change
The reassessment and stabilization phase is the last phase of the change process and is a
“time of transfer of responsibility” (Fineran, 2014, p.85). During the evolution of the change
process, this student recognized that a responsible party would need to be in place to reassess and
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stabilize the change after her internship concluded. She knew she would need to bring closure to
the change and ensure that the revised patient paperwork would be implemented and continually
reassessed after her departure. It was decided that the individual accountable for this would be
Dr. Hobby as she has both the authority and the means to carry out any further needed actions for
the change. There is no additional cost needed to compensate her as she is already employed at
CCNC and clinical paperwork falls under her scope of responsibility already. The patient
satisfaction survey (Appendix E) will help determine if any adjustments need to be made to the
revised patient paperwork. Dr. Hobby and her staff will be in charge of making any adjustments
if they are needed. Dr. Hobby will also reassess the success of the change with the input of her
staff, in particular Ms. Harness and Ms. Hopkins as they were key players in the change process.
Conclusion
By implementing the revised new patient paperwork at CCNC, it will improve the
services the patients receive while reducing the administrative burdens on the staff. The focus of
CCNC is to deliver patient-centered care in a warm and caring environment. Improving the
intake process through direct feedback from patients and staff serves the mission of “patient-
centered care” and certainly contributes towards a better overall patient experience. The change
process experience has allowed this student to apply her social work education in a tangible way
that improves the quality of life for patients and staff at CCNC. It has also been a tremendous
learning experience and source of professional growth that this student will draw upon in her
future educational and career endeavors.
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References
Ashcroft, L., & Anthony, W. A. (2008). Don't let paperwork be a barrier. Behavioral Healthcare,
28(6). Retrieved from
http://search.proquest.com.briarcliff.idm.oclc.org/docview/228051836?accountid=9720
Ashcroft, L., & Anthony, W. A. (2009). Case management: It's time to emphasize less
paperwork, more recovery. Behavioral Healthcare, 29(10). Retrieved from
http://search.proquest.com.briarcliff.idm.oclc.org/docview/2230438294?accountid=97
Fineran, S. (2014). Macro social work change process handbook. Sioux City, IA, Briar Cliff
University.
Garcia, I. (2006). Administrative duties: Weighing up the problem. Mental Health Practice,
9(10), 32-34. doi:10.7748/mhp2006.07.9.10.32.c8074
Netting, F., Kettner, P., McMurtry, S., & Thomas, M. (2012). Social work macro practice (5th
ed.). Upper Saddle River, NJ: Pearson Education.
Sequist, T. D. (2015). Clinical Documentation to Improve Patient Care. Annals of Internal
Medicine Ann Intern Med, 162(4), 315. doi:10.7326/m14-2913
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Appendix A
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Appendix B
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Appendix C
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Appendix D
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Appendix E
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Appendix F
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Appendix G
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Appendix H
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Appendix I
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Appendix J
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Appendix K (Click image for link)
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Appendix L (Click image for link)
