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Even the best-designed evaluation process, model, or technique is worthless unless it is effectively and efficiently integrated into the organization. This level of accountability represents significant change for healthcare organizations. This change leads to resistance to the use of ROI. Some of this resistance is based on fear and misunderstanding. Some is real, based on actual barriers and obstacles. Although the ROI Methodology presented in this book is a step-by-step, methodical, and simplistic procedure, it can fail if it is not integrated properly, fully accepted, and supported by those who must make it work within the organization. This chapter focuses on some of the most effective means of overcoming resistance to implementing the use of ROI in an organization and shows how to sustain its use for years.



When the VA system decided to embrace the ROI Methodology in 1999, it was initially organized by the Employee Education System (EES) with a goal of using ROI to measure all types of learning and development programs in the VA medical centers. As this implementation began to spread, it moved into other areas, which ultimately involved all types of studies throughout the medical centers and clinics.

Implementation began by having groups of people develop capability in the ROI Methodology. These individuals were pursuing the designation of Certified ROI Professional. In total, over an eight-year period, more than 150 people participated in certification, with two-thirds of them obtaining the CRP designation. The results of the studies that were conducted were published on their website. At one point, 45 ROI studies were on the VA website. In addition, one- and two-day workshops were conducted with all types of teams, introducing them to the concept of ROI. Individuals were trained to conduct the two-day workshops to help with implementation.

This structure of delivering ROI was developed with a goal of having a core team of ROI specialists in headquarters, and with ROI certified professionals in each of the regional delivery systems knows as VISNs. This goal was achieved and as studies were conducted, analyses were performed to see how the results crossed different areas and to gain more insight into how ROI is making a difference.

As data from the studies were accumulated, improvement actions were initiated. Each study sparked improvement for the same or similar studies in the future. Improvements were captured and summarized on the website. In essence, the VA system was showing the value of this level of accountability and what it meant to the organization. Issues were identified and addressed throughout the process. Finally, the VA captured the ROI on the ROI, showing how the use of the ROI Methodology had added value in excess of what it cost.



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