Change Achievement Success Indicator (CASI)
Downloadable from Institute of Health Improvement
http://www.ihi.org/resources/pages/tools/changeachievementsuccessindicatorcasi.aspx
Below is version 3 (25th January 2004, updated 29may2014)
Dr John Øvretveit, () Director of Research, The Karolinska Institute Medical Management Centre, Stockholm, and Professor of Health Policy and Management, The Nordic School of Public Health, Gothenberg, and Bergen University Faculty of Medicine, Norway. Address: The Nordic School of Public Health, Gothenberg, Box 12133, Sweden, S-40242.
What is it?
This method helps to assess to what extent an organisation has taken the necessary actions to carry out a change successfully. It is based on a review of research into different types of organisational change, with a focus on health care (Øvretveit (2003)). Items should be removed or added to make the assessment more relevant to the particular change and specific organisation which is being considered. Some factors are more important than others for particular changes: you may wish to add a “weighting index” to each score (suggested three weightings of: 0.5 or 1.0 or 1.5).
The assessment items are conditions and factors which either make the change easier, or have been found necessary for an organisation to make a successful change to personnel behaviour, processes or structure. The assessment does not only consider the type of change, such as its complexity, or how well the change is planned or managed: research shows that other “context factors” are important to a successful change, such as the support of higher management, the organisational culture, the number of other changes competing for personnel attention, and political and economic “environmental factors”. These “context factors” can help or hinder the most carefully planned and competently managed local change.
What can I do with it?
Highlight which factors or conditions are weak or missing and work to strengthen them, either before or during a change. This should increase the chances of success, not least because many of the factors interact and support each other to produce the change.
Calculate the “change score” every 3 months, as one measure of change risk and to assess whether some factors have weakened and need attention.
What are the different parts?
1) The immediate management of the change, such as skills, resources and authority.
2) The nature of the change itself, such as its complexity and time-scale.
3) Factors within the organisation which are important for the change
4)A set of “environmental pressures” to which the organisation must respond – the change needs to respond to or at least align with this pressures which are critical to its survival.
The higher the score the greater the chances of a change being achieved. A score of over 60 indicates a likelihood of the change being achieved. A score of below 30 indicates low chances of achieving the change. You can adapt it for your local situation but deciding the weighting of importance of each factor, and by adding and subtracting factors.
1 Local change management
1.1 Formal change leadership
Has responsibility and authority for making the change been assigned to one person, who reports regularly to senior management? Does this person have the time and the technical-skills, people-skills and political skills to plan and carry through the change and adapt to surrounding changes?
Score 5 if yes, 0 if no, or choose a number between 1 and 4 to represent the extent to which this is partially present (what would be evidence to justify your score?)
(After you have scored all the factors in this assessment, come back to this factor and decide how important this factor is to the success of the change, by giving a weighting of 0.5 for” not very”, 1 for “quite important”, and 1.5 “for very important”).
Remember, the higher the score the greater chance of change success.
1.2 Formal change team
Has the right mix of people been assigned to a “change team”, with sufficient time and skills to help carry through the change? Is it likely that over 60% of this team will remain in the team until the change is completed? (score 5-0 as appropriate (and give weighting later as appropriate). The higher the score the greater chance of change success, so give a low score if these elements are not present and high score if they are present).
1.3 Planning
Does a plan for the change exist, which allows flexibility to adjust to a changing situation? Does the plan have measurable objectives and a timetable of actions with responsibilities? Is there an agreed process for reviewing and replanning at regular intervals which includes input and assistance from senior management? (score 5-0 as appropriate (and give weighting later as appropriate)).
1.4 Progress measurement, reviews and reporting
Have progress indicators been designed to give feedback about the change, and are these data regularly reported and used in reviews, which adjust the change to the changing situation? Are there regular meetings and other ways to communicate with management and “key others” about the change? (score 5-0 as appropriate (and give weighting as appropriate))
1.5 Other resources
Are there provided for the change and the change team sufficient finance, access to expertise, training as needed, data support and other resources necessary for the change? (score 5-0 as appropriate (and give weighting as appropriate)).
2 The nature of the change
These are features of the change itself, which increase or decrease the chances of successful change being made. A complex change which takes several years to carry through is less likely to be successful than a simple “one dose” change, demanding little of employees.
2.1 Complexity
Does the change involve:
- little or much new learning or skills,
- a small or large number of people?
- involve people from few or many different occupational groups?
- affect or is it of concern to many different “interest groups” or stakeholders, each with different interests in the change and its outcome (highly “locally political”)?
- a single short change or a number of different changes spread out over time? (number of sub-changes and timescale or change).
o If many changes, is success highly dependent on each of the sub-changes being completed or is there flexibility to the change plan (dependency and flexibility)
Decide a score between 0-5 to represent the complexity. Remember - The higher the score the greater chance of change success, so the more complex the change the lower the score (and give weighting as appropriate))
2.2 Compatibility, advantage, tested and trialability
Is the change is compatible with current values and operating procedures (will “fit in”), with a clear advantage over the current situation? Have similar changes been made elsewhere and is this knowledge and evidence used to make the change? Has the change been tested in the organisation on a small scale and lessons used to help the full change?
(score 5-0 as appropriate (and give weighting as appropriate)) 5= fully compatible.
2.3 Cost-benefit
Are there credible numbers showing that the change will lower recurrent operating costs, and requires few “investment” resources to carry through, relative to the savings (including little extra personnel time)? As calculated, and as perceived.
(score 5-0 as appropriate (and give weighting as appropriate))
3 Organisational context
Under this heading are conditions and factors within the organization, which set the local context for the change.
3.1 Linking between the change and the environment
Is there a process for “linking” the change to the critical environmental pressures, or people who are responsible for planning and adjusting the change to relate to the environmental pressures? (In theory senior management are responsible for making changes within the organisation to adjust to, and in anticipation of, the above environmental pressures. Do they take this role, and do they frequently initiate and supervise changes to respond to these pressures?)
(score 5-0 as appropriate (and give weighting later as appropriate))
3.2 Harnessing to other changes
Has an assessment been made of other changes in the organisation, and the change linked to these to strengthen it? Is the change related to what “wants to happen in the organisation” and emergent movements?
(score 5-0 as appropriate (and give weighting later as appropriate))
3.3 Senior management
Do top management of the organization authorize the change and provide resources? Have they set measurable objectives and time targets for the change? Will one of the top management formally supervise the change and receive reports of progress and problems?
(score 5-0 as appropriate (and give weighting later as appropriate))
3.4 Middle management
Are there some middle managers whose support for the change is required? Are these middle managers genuinely convinced that the change is needed and accountable for helping the change to be achieved? Will the change help them meet their objectives and do they spend time and resources to remove obstacles? Is there a mechanism for keeping them regularly informed about the progress and consequences of the change?
(score 5-0 as appropriate (and give weighting later as appropriate))
3.5 Other leaders
Is it known which other formal and informal leader’s opinion is needed for the change to proceed? Has action been taken to influence their opinion, and do they have a positive attitude to the change? Is there one or more respected professional who actively advocates for the change and is involved in the change (a “change champion”)?
(score 5-0 as appropriate (and give weighting as appropriate))
3.6 Rationale and tension for the change
Are those affected by the change dissatisfied with the current situation and do they believe the change will improve things? Has evidence or good reasons been provided that the change will improve the situation of concern to them? Has a vision of the future intended state been presented which is believed to be possible?
(score 5-0 as appropriate (and give weighting as appropriate))
3.7 Change culture and attitudes
Is the organization “change friendly”? Are changes like the one in question normally welcomed or met with cynicism? Are personnel used to and comfortable with change like this one?
(score 5-0 as appropriate (and give weighting as appropriate))
(Note: this factor is the most difficult to try to strengthen positively in support of the change).
3.8 Change saturation
Are personnel exhausted from and currently responding to many other changes? Does the change in question add another burden to peoples already over-stretched “change coping capability? (Assess this factor by considering the number and depth of current and recent changes relative to the current workload, staffing and morale).
(score 0 if few other competing changes, 5 if many other demanding changes are taking place5 (and give weighting as appropriate)).
4 External context
These are conditions and factors external to the organization which make the change easier. Some are necessary preconditions for a successful change.
4.1 Customer pressure:
Are there pressures from customers for a change, and how much will or does the change respond to these pressures?
(Score 5 if there is customer pressure for this change. Score 0 is this change will not respond positively to current demands from customers or is irrelevant to them. (Decide how important meeting customer pressure is to the success of the change by giving a weighting of 0.5 for” not very”, 1 for “quite important”, and 1.5 “for very important”).
4.2 Political pressure:
Is there pressure from local or national politicians for the change, and how much do they support the change?
(Score 5 if there is political pressure for this change. Score 0 is this change will not respond positively to current political concerns and is irrelevant to them.(Decide how important meeting political pressure is to the success of the change by giving a weighting of 0.5 for” not very”, 1 for “quite important”, and 1.5 “for very important”)).
4.3 Economic pressure
Does the change respond positively to the current economic or market pressures on the organization, or will it make it more difficult for the organization to gain income or compete for customers and employees.
(score 5 if yes to the first part, 0 if no, or choose a number between 1 and 4 to represent the extent to which this is partially present (what would be evidence to justify your score?(Decide how important this factor is to the success of the change by giving a weighting of 0.5 for” not very”, 1 for “quite important”, and 1.5 “for very important”).
4.4 Other external pressures
Is there any other very strong pressure on the organization which demand a change and to which the organisation must respond to if it is to survive? Then assess whether the change will help the organisation respond to this pressure or not.
(score 5 if yes to the first part, 0 if no, or choose a number between 1 and 4 to represent the extent to which this is partially present (what would be evidence to justify your score?(Decide how important this factor is to the success of the change by giving a weighting of 0.5 for” not very”, 1 for “quite important”, and 1.5 “for very important”).
References
The change achievement success indicator is based mostly on the following models and research:
Eccles (1994) Succeeding with change, McGraw-Hill.
(8 preconditions for successful change pressure for change; a clear and shared vision of the goal and direction of improvement; effective liaison and trust between those involved; the will and power to carry-on acting; capable people with sufficient resource; suitable rewards and accountabilities; actionable steps to take to ensure the change; a capacity to learn and adapt).
Gustafson, D Cats-Baril WL. and Alemi F. Systems to support health policy analysis: Theory Models and Uses. (Chicago. Health Administration Press. 1992). P45
Gustafson D. Organisational Change Manager. Madison: Madison Healthcare Improvement LLC, 1998.
Molfenter, T Gustafson, D Kilo, C (2002) “Prospective Evaluation of a Bayesian Model to Predict Organizational Change” (draft paper), Center for Health Systems Research and Analysis, University of Wisconsin-Madison.
Organisational Change Manager (OCM): A model of factors to predict whether an organisation would successfully carry out a change. The model was tested in 21 US health care organisations and revised and a further model is now thought to have high predictive value (Molfenter et al (2002)). This model was further developed in Swedish health care and in UK healthcare.