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The process of developing monetary value, including ROI, represents a comprehensive, systematic methodology that includes defining the types of data, conducting an initial analysis with objectives, forecasting value (including ROI), using the ROI process model, and implementing and sustaining the process. This chapter describes the approach for achieving the level of accountability needed for project evaluation in today's healthcare climate.


A group of hospitals in the Birmingham, Alabama, metro area participated in adopting new procedures to reduce bloodstream infections in the intensive care unit. Participating hospitals comprised a mix of religious-affiliated, government-owned (city, county, and state), university-affiliated, and private-sector organizations. These hospitals were concerned about the excessive number of central line blood infections that were occurring as a result of a central vascular catheter, inserted into a large vein in the chest, introducing infection.

As participants implemented a new set of procedures for reducing the number of infections, they realized that the procedures represented a cultural shift in the way they operated. It required participants to use checklists, gain knowledge, double check, and speak up. In order for the new procedures to be successful, various levels of data were needed beyond the traditional monitoring of infections, length of stay, and costs associated with these infections. Successive sets of data were needed that would examine the team's reaction to the new procedures, the learning of new processes and procedures, and correct application of new information and tools, all of which are aimed at the impact: infections, mortality rates, length of stay, and operating costs. This group envisioned sets of data that represented a chain of impact that must be present for the project to be effective. These sets represent four levels of outcome data (reaction, learning, application, and impact). A fifth level, financial ROI is possible and is sometimes necessary to calculate in today's environment. Collecting data along these levels and using a method to isolate the effects of this program from other factors provides comprehensive data that show the impact of this program. Figure 2.1 shows the types of data from this study, according to The Birmingham News.1


Example of Levels of Evaluation

Source: Data from Alabama Hospital Association/The Birmingham News/ROI Institute, Inc.


The richness of the ROI Methodology is inherent in the types of data monitored during the implementation of a particular project. These data are categorized by levels. Figure 2.2 shows the types and levels of data that represent value. Subsequent chapters provide more detail on each level.


Types and Levels of Data

Level 0 represents the input to a project and details the number of people and ...

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