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Reporting improvement in impact measures is an important step in a healthcare project evaluation that leads to the money. The question comes up (as it should): How much of this improvement was the result of the project? Unfortunately, the answer is rarely provided with any degree of accuracy and confidence. Although the change in performance may, in fact, be linked to the project, other, nonproject-related factors may have contributed to the improvement as well. If this issue is not addressed, the results reported will lack credibility. This chapter explores useful methods for isolating the effects of the project, sometimes labeled attribution. These methods have been used in some of the most successful organizations as they attempt to measure the ROI from projects.



Alberta Health Services (AHS) is Canada's largest healthcare organization, serving the entire province of Alberta, including the two large metropolitan areas of Calgary and Edmonton. AHS offers programs and services at 400 facilities throughout the province, including hospitals, clinics, continuing care facilities, mental health facilities, and community health sites.1 With almost 100,000 employees, AHS faces a serious shortage of nurses. Each year, AHS recruits about 5,000 nurses and projections for the future show an impending acute shortage. Because of this serious issue, AHS has created a variety of programs to attract students and other professionals to the healthcare industry, particularly in the field of nursing. One program is a cooperative education program where students alternate work and school. This program is attractive to students because it provides a way for students to fund their education, while gaining valuable work experience in the process.

For several years, the cooperative education program has been producing a steady stream of nurse talent. Now, the executives at AHS would like to understand the full value of this program. To conduct a study, the human resources team tracked a group of co-op students to study the success on the job and the retention rates among them. In order to compare the success and retention of this group of students (experimental group) with the non–co-op students (control group), a comparison group was selected. The comparison group was matched carefully with the co-op students for the study using criteria of age, gender, type of degree, and tenure with AHS. Essentially, the study had a matched group of non–co-op students to compare with the success of the co-op students. This classic experimental versus control group arrangement provided AHS with a way to sort out the effect of this particular program and show the contribution directly attributed to it.


The Veterans Health Administration, one of the largest healthcare providers in the United States, operates under the Department of Veterans Affairs. The Veterans Health Administration is home to the United States' ...

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