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Many projects fail because of breakdowns in implementation. In those situations, project participants just don't do what they should, when they should, at the frequency they should. Measuring at this level (Level 3) is critical to understanding the success of the implementation of new processes, procedures, systems, or equipment. Without successful implementation, positive business impact will not occur—and no positive ROI will be achieved. This chapter explores the most common ways to evaluate the application and implementation of healthcare projects.



A regional healthcare firm has implemented a new enterprise resource management system. The implementation focuses on the healthcare organization's current procurement, inventory control processes, financial management system, payroll system, discount structures, and specific benchmarks. In addition, cost accounting and capital allocation systems were pinpointed to align with payroll and productivity systems such as scheduling and forecasting. To make this system work properly as it is installed, the users of the system must:

  • Manage hospital assets and resources effectively.

  • Integrate suppliers.

  • Standardize supplies, devices, and equipment across departments and physicians.

  • Develop an allocation process.

  • Identify areas where the firm is paying too much for specific items.

  • Employ more self-service procurement technology.

  • Decentralize the inventory management process.

  • Employ handheld technology.

  • Complete the implementation on schedule.

Although this system will have tremendous payoffs in cost savings, time savings, reductions in unnecessary orders, and overpayments, these benefits will not occur unless the new system is implemented properly and all users are following correct application and use.


When implementing a leadership program within the Veterans Administration Healthcare Centers, leadership skills identified as inadequate were targeted for change to improve the VA medical center system. As participants entered the program, they were asked to change behaviors, approaches, and processes as they worked to improve the medical centers. After implementation, a follow-up evaluation showed evidence that participants:

  • Applied the 11-step goal-setting process.

  • Used a 12-step leadership planning process.

  • Used 10 ways to create higher levels of employee loyalty and satisfaction.

  • Applied the concept for adjustment in at least 5 scenarios.

  • Used a creative problem solving process in 80% of problems identified.

  • Implemented at least 5 of the 7 ways to build positive relationships.

  • Used a 4-step process to address mistakes.

  • Used at least 5 ways to improve communications.

These specific improvements showed change in leadership behavior. In light of the important consequences for these behaviors and significant impact on the medical centers, the initial data provides evidence that the skills transferred to the job.

These opening stories illustrate that application and implementation are necessary for business impact and a positive ROI. A project will typically break down at this level if it is not addressed properly, measured correctly, and adjusted accordingly.

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