Running Head: ORGANIZATIONAL READINESS FOR CHANGE

Organizational Readiness for Change

Mary Ann Moultray, Emilie Renninger

Western Washington University

NURS 422 Organizational Change for Quality and Safety in Healthcare

Bonnie Blachly

5/29/2017
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ORGANIZATIONAL READINESS FOR CHANGE
Organizational Readiness for Change

Introduction

The Vaccine For Children (VFC) program is a nationwide program that allows providers

to administer, free of cost, routine vaccines to pediatric patients who qualify. In order to still

make a profit, the participating providers can charge an administration fee. Part of the

responsibility of being VFC affiliated requires each vaccination to be documented on the

Washington State Immunization Information System (WAIIS). This online database allows

healthcare workers throughout the state to log in, search, and review a patients immunization

record. In the past (and sometimes currently), vaccines were documented on paper or computer

charting systems at the facility they were administered at, and also recorded on small vaccination

booklets that went home with the patient. Although this system is adequate if the child goes to

the same provider throughout their adolescence; if they move or switch clinics their

immunization status is significantly harder to keep track of.

The Whatcom County Health Department (WCHD) is currently unable to accurately

collect vaccination rates in the area for multiple reasons. The old vaccination booklets are often

lost or not updated, and some children dont receive all of their vaccines in one place, making

most facility records incomplete. Some physicians in Whatcom County participate in updating

the WAIIS system, but not all do. Each provider who is partnered with the VFC program is

required to log administrations into WAIIS, but the system can also be used independently by

non-VFC clinics or pharmacies. The ultimate goal of the Whatcom County Health department is

to get all establishments that provide vaccines to participate in one if not both of the programs.

For this student-lead project, the focus was solely on reaching out to pharmacies.
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ORGANIZATIONAL READINESS FOR CHANGE
Currently no pharmacies in Whatcom County participate in either the VFC program or

WAIIS, even though they are a large vaccine source in the community. Without having all

administrations logged in a uniform area, the Health Department has a difficult time compiling

accurate vaccination rates for the region. A nationwide Healthy People 2020 goal is actually to

get at least ninety-five percent of kids under the age of six to have their vaccination records

logged into an online database, such as WAIIS (Jackson, Henrikson, & Grossman, 2014). To

help with the lack of pharmacy participation in VFC and WAIIS, the plan and goal for this

project was to reach out to all of the pharmacies (corporate and independent) in the county to

identify which facilities were aware of each program, and which would potentially be interested

in participating in either.

Change Theory and Planning Phase

We formulated a multi-question survey that was distributed via the Health Department to

gauge pharmacy knowledge and interest in each program, in order to identify restraining and

driving forces. The original plan was for the survey to be emailed out, responded to via an

online survey website, and emailed back. Although it was simple enough to compile a list of

pharmacies in whatcom county, email addresses were not as readily available. The surveys

ended up being scanned and faxed to each pharmacy by the health department, which reportedly

was a long process. Although faxing was the only option aside from mailing, it did come with

drawbacks. Unlike the convenience of a computerized response, the faxing method caused more

work on the pharmacies part. Not only did it have to be filled out by hand, but all six pages had

to be scanned, and then faxed back. The estimated response rate was low to begin with, but with

the added work of faxing the expectations were even lower.

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Although the goal was not to create a pilot program or even test a change, Lewins

Change Theory did influence the plan of action. It was thought that if both restraining and

driving forces were identified, it would be easier for the Health Department to assist pharmacies

later on in overcoming barriers, in order to move past the unfreezing stage and implement

change.

Becoming a VFC clinic obviously assists patients and the Health Department, but

unfortunately does not greatly benefit participating providers. As previously stated, providers

can charge the patient an administration fee to gain some degree of profit, but the responsibilities

of being involved with VFC may not be worth the profit made. For example, vaccine storage

must be in compliance with VFC guidelines which includes the necessity of special refrigerators,

freezers, and thermometers, which can be costly if not already owned. Fridge and vaccine

temperatures must be checked and logged twice daily, requiring a staff member to come in on

weekends and holidays. In addition, the provider must apply each year to become a VFC clinic,

and be prepared for regular visits from the CDC.

According to the five survey responses we received, only two pharmacies have adequate

vaccine storage units (standalone freezer and refrigerator), one has a refrigerator but no freezer,

two have an acceptable data logger, and none have backup data loggers or continuous data

recording thermometers. If willing to participate in the VFC program, each pharmacy would

have to acquire at least one piece of costly equipment to qualify.

When related to Lewins Force Field Analysis, these responsibilities and costs would be

definite restraining forces. In contrast, the main driving forces would include the profit made

from administration fees, and the overall benefit of the patients and Health Department.

However, it is unclear how much profit a provider can actually make off of one administration
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fee. Malos article published in the Maternal Child Health Journal in 2013 claims that providers

can bill Medicare for the administration fee, but that the reimbursement can be low. If the

profit reimbursed from Medicare is lower than the cost of new equipment and burden of VFC

responsibilities, the pharmacy may not have the motivation to participate. Because of this, the

restraining forces seem to overbear the driving forces, skewing the equilibrium of the analysis. It

is predicted that for these reasons, there will be pushback and resistance in the refreezing stage of

Lewins Change Theory.

Recommendations

Based on the data received, there are multiple recommendations for the Health

Department. First, it is recommended that the Health Department reach out to the pharmacies

that expressed interest in either program. Out of the five results received, two pharmacies

wanted to learn more about VFC, and one requested more information about WAIIS.

In regards to the process of reaching out to these pharmacies, we are suggesting that the

Health Department nominate and support a champion individual to be in charge of reaching

out. Having a champion person from the DOH will provide a chance for camaraderie and help

build a positive working relationship between the two facilities. If the pharmacy feels well

educated and supported, they might be more open to program participation, and the restraining

forces might not feel so burdensome.

Over half of the pharmacies contacted didnt respond to the initial survey. The health

department might consider having the new appointed champion attend local and regional

pharmacy meetings in order to network with the unresponsive establishments in person. Two of

the pharmacies noted that being part of a corporation was a barrier to change, due to the

company being in charge of policies and procedures, but it is assumed that even corporate
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pharmacists attend regional meetings. If a strong relationship is built with a corporation's

regional manager, there is a chance that the idea can spread up the chain to people of power

within the company.

At the beginning of the project, there were ideas about reaching out to local dentist

offices to assess their willingness to log onto WAIIS and provide patients with their vaccination

records. This could potentially alert patients when theyre due for routine vaccines, and let them

know to make an appointment with their primary care provider or visit a pharmacy. All that

would be required of the dentist office is to log onto WAIIS, print the vaccination record, and

hand it to the patient. Unfortunately there was not enough time during the project to explore this

possibility or reach out to dentists, but it is still recommended that the Health Department revisit

the idea. The survey sent out to pharmacies could be altered and sent out to dentists offices to

assess the level of interest. Then a dentist champion could be assigned to further reach out,

similarly to how the pharmacy champion would work.

Conclusion

Convincing pharmacies in Whatcom County to participate in VFC and/or WAIIS will be

an ongoing challenge for the Health Department. Based on the survey results obtained, albeit

small, there is a level of interest in each program. With continued education, support, and

interaction, it is believed that pharmacies in the area will become more open to the idea of

change.
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References

Jackson, M. L., Henrikson, N. B., & Grossman, D. C. (2014). Evaluating Washington states

immunization information system as a research tool. Academic Pediatrics,14(1), 71-76.

doi:10.1016/j.acap.2013.10.002

Malo, T. L., Hassani, D., Staras, S. A., Shenkman, E. A., Giuliano, A. R., & Vadaparampil, S. T.

(2012). Do Florida medicaid providers barriers to HPV vaccination vary based on VFC

program participation? Maternal and Child Health Journal,17(4), 609-615.

doi:10.1007/s10995-012-1036-5
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Appendix A

Survey Results

Costco Custom Fred Meyer Fairway Fred Meyer-

Prescription Drug Brooksview
Shoppe

Are you aware of No No Yes No No

what a VFC response
(Vaccination For
Children) clinic
is?

Are you aware of Yes No Yes No Yes

the WAIIS response
(Washington
State
Immunization
Information
System)
program?

Would you or Yes No No No Yes

your
establishment
like additional
information on
the VFC
program? Y/N

1. Would you Yes No No No No

or your
establishment
like additional
information on
the WAIIS online
database? Y/N
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ORGANIZATIONAL READINESS FOR CHANGE

2. Which of None: None at this WAIIS None at None at this

the following Corporate time this time time
programs would decision, they
you be interested would have to
in participating approve and set
in? up

3. How does Computerized Computerized Computerized Other: Computerized

your facility charting or charting or charting or N/A charting or
currently EMAR EMAR EMAR EMAR
document given
vaccinations?

4. The -Stand-alone Stand-alone Digital data None of -Stand-alone

following is a list freezer that refrigerator that logger with this freezer that
of CDC- keeps keeps valid equipment keeps
approved temperatures temperatures Certificate applies temperatures
equipment for between -50 between 2 and testing for each between -50
vaccination and -15 8 degrees storage unit and -15
storage. Please degrees Celsius Celsius degrees Celsius
select all of the -Stand-alone -Stand-alone
equipment refrigerator that refrigerator that
already present at keeps keeps
your temperatures temperatures
establishment. between 2 and between 2 and
8 degrees 8 degrees
Celsius Celsius
-Digital data
logger with
valid
Certificate
testing for each
storage unit
-Backup digital
data logger
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ORGANIZATIONAL READINESS FOR CHANGE

Regarding the Corporate **Left this Not sure, N/A Cost, and
VFC program, decision question blank please divert to corporate
please check any main office
of the following
potential barriers
you perceive
your
establishment
having

Please rate the

following
benefits of the
VFC program
using the scale
provided to
indicate how
important they
are to you.

Increased access Very important Very important Very important Neutral Very important
to vaccines

Increased Very important Very important Very important Neutral *Left this
vaccination rates question blank

Convenience for Very important Very important Very important Neutral Somewhat
clients important

Vaccines Somewhat Somewhat Very important Neutral Very important

provided at no Important important
cost to the clinic
or patient

More accurate Very important Somewhat Very important Neutral Neutral

tracking of important
vaccination
records

Appendix B
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ORGANIZATIONAL READINESS FOR CHANGE
Logic Model
Statement of Need: Pharmacies in Whatcom County need to participate in the Vaccine for
Children (VFC) program and/or the Washington State Immunization Information System
(WAIIS).
Resources/Inputs Activities Outputs Outcomes Impact

In order to In order to We expect that We expect that if We expect that

accomplish our set of address our once accomplished if accomplished
activities, we will problem or asset accomplished these activities these activities
need the following: we will these activities will lead to the will lead to the
accomplish the will produce following following
following the following changes in 1-3 changes in 7-10
activities: evidence or then 4-6 years: years:
service
delivery:

List of pharmacies in -Utilizing Who to reach 1-3: We expect WCHD will be

Whatcom County hospital out to; needed that the DOH will knowledgeable
pharmacy in order to continue to about their
resources contact them update the list current
(hospital about regularly to keep pharmacies in
pharmacy lists?) VFC/WAIIS track of all the the county as
-Internet pharmacies in the they are a large
searches area resource to the
4-6: Pharmacies community.
will be included
in pertinent
WCHD
communications
as their
information will
be up to date.
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Contact information -Internet Way to reach 1-3: DOH has a WCHD will be
for each pharmacy on searches and the pharmacies way to contact able to reach
the above list resources (email, fax, pharmacies out to
-Resources location during the next community
available address, etc) to few years as they pharmacies
through the be able to send try to persuade readily and
DOH (state out each easily using
contacts, etc.) information establishment to their preferred
participate in the method of
programs contact.
4-6: Hopefully
the DOH would
be able to stay in
contact with each
pharmacy,
forming good
work
relationships.

Questionnaire/survey -Gain access to -Once sent out, -Based on the -WCHD will
one of the completed, and survey results the have a tool to
DOHs online returned we hope is that in the screen potential
survey machines can organize DOH would be VFC/WAIIS
(Surveymonkey the data to able to use the participants and
or Google) to evaluate which data in the near use this to
generate a pharmacies future to educate provide targeted
survey to go out would be and assist education.
to all pharmacies interested in pharmacies in - Use of this
-Formulate the programs, becoming tool may be
questions to and which involved in used to increase
assess the level need further WAIIS and VFC. VFC/WAIIS
of knowledge, education use in our
and level of county which
interest each will increase
pharmacy has in access to
VFC/WAIIS vaccines in our
county.

Appendix C
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PDSA

Aim: First test of change: Improve pharmacy participation rates in the Vaccine for Children
(VFC) program and/or the Washington State Immunization Information System (WAIIS).
Plan
Person responsible When Where to be done
to be
List the tasks needed to set up done
this test of change

-Research and understand what Both N422 students 4/18/17 Independently using
each program (VFC and WAIIS) online resources
is. provided by the
WCHD

-Compile list of pharmacies in Both N422 students 4/25/17 Independently using

the Whatcom County area and the Whatcom online resources
County DOH if provided by the
needed WCHD

-Find and list the contact Both N422 students, 4/25/17 Independently using
information for all of the DOH as needed online resources
pharmacies (phone and fax
numbers, email addresses, etc.)

-Formulate a survey to assess the Both N422 students 5/9/17 Independently using
interest of pharmacies in regards WCHD survey monkey
to each program account

Predict what will happen when the test is Measures to determine if prediction
carried out succeeds
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After the survey is sent out, we are expecting
at least a quarter of the pharmacies to respond.
We are not expecting a high rate of
pharmacies to be interested in participating in
the programs at this time, but are hopeful that
they will be open to further education.
We will organize all of the data received in a
chart to make the data easy to compare and
review. Data is measured based on the
response of yes or no questions.

Do Describe what actually happened when you ran the test

-There was an issue with emailing the surveys, so they ended up needing to be
faxed instead. The secretary at the WCHD ended up completing this task for us because each six-
page survey had to be separately scanned and sent out; a task that we were told took longer than
expected. So far out of over twenty establishments, only five have responded at this time. The
downfall about having to fax the survey out is that it puts more work on the pharmacy, as they
have to answer the questions by hand, and then take the time to fax the whole thing back rather
than a more user-friendly email version. The email response rate was estimated to be low to
begin with, but that rate dropped more when it had to be faxed. Overall, there were more barriers
than originally expected.
Study Describe the measured results and how they compared to the predictions
***Not all results are back at this time. Only five surveys have been completed and returned, out
of over twenty that were sent out.
Act Describe what modifications to the plan will be made for the next cycle from
what you learned
The next plan in the cycle (that will be carried out solely by the WCHD) is to send out a
modification of the same survey to dentists in the area, hoping that they will participate in the
WAIIS program. The dentists are not eligible to be a VFC clinic, but they can access the WAIIS
database, and provide their patients with vaccination information to alert them when they are due
for a vaccine. Learning from the previous cycle, it is recommended that the WCHD goes straight
to faxing the survey, instead of attempting to email it out.