I-PASS Secondary Assessment (Coverys)

I-PASS Implementation - Secondary Assessment (Coverys)

Respondent Contact Information

Current State of Handoffs & Patient Safety

Quality Improvement (QI) Environment & Team Structure

Organizational Context

Technology Solutions for Handoff Communication

Overall Safety Goals & Organizational Strategy

Thank you for expressing interest in implementing the I-PASS handoff methodology at your organization, in partnership with Coverys and the I-PASS Institute. Please respond to the questions below, providing as much context in the free text responses to support your answers as possible. This survey should take 25-30 minutes to complete. Responses are confidential and will be used for evaluation purposes only.

You will be asked to respond to a series of statements across five categories. It may be necessary to gather input from other leaders and subject-matter experts in your organization before submitting your responses. Please note that you may save responses and continue within 30 days using the button at the end of the survey.

Please complete the fields below before beginning this survey.

Hospital Name(Required)

Number of Beds at Hospital(Required)

Number of Clinical Employees(Required)

Name of Respondent(Required)

First Last

Respondent Title within Organization(Required)

Respondent Email(Required)

Respondent Phone Number(Required)

How would you describe your institution?(Required)

Community Hospital

Academic Medical Center

Pediatric Hospital (free-standing)

Tertiary Care Facility

Other (please specify)

Other Institution Type

Did other individuals contribute to the responses in this survey?(Required)

Yes

Other Contributor Information

If other individuals contributed to the responses submitted in this assessment, please list their names with titles in parentheses. Example: John Smith (CEO)

Please respond to the statements below regarding the current state of handoff communication within your organization.(Required)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Unknown
My organization has institution-wide or system-wide requirements for handoff training.
My organization conducts regular auditing of handoff workflows and assesses the content and quality of the handoff.
My organization reinforces structured handoff communication as part of annual reviews.

Current State of Handoffs - Free Response(Required)

Please use this section to expand on your responses to the above statements relative to the current state of handoffs at your organization.

My organization has individuals who are skilled in QI processes that will have the capacity to support an I-PASS implementation.(Required)

Please respond select a response to each statement provided.

My organization has a clear leader who would be engaged as a site lead for the I-PASS implementation and has the following qualities:(Required)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Unknown
A long relationship with or within the organization
Professional and effective relationships with stakeholders at all levels within the organization
Experience with implementing large-scale QI or patient safety initiatives

Please respond select a response to each statement provided.

The following elements are present within my organization to support the implementation of I-PASS:(Required)

Please respond select a response to each statement provided.

The following barriers are present within my organization and could negatively impact the implementation of I-PASS:(Required)

Please respond select a response to each statement provided.

QI Environment - Free Response(Required)

Please use this section to expand on your responses to the above statements relative to the QI environment at your organization.

Please respond to the statements below regarding the organizational context of your institution with respect to handoff communication.

Organizational Context - Free Response(Required)

Please use this section to expand on your responses to the above statements relative to your organizational context.

Please respond to the statements below regarding technology solutions for handoff communication within your organization.(Required)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Unknown
My organization's EMR handoff tools can be easily customized to the content needs of each care area and clinician type.
My organization has standard HL7 interfaces for demographic and clinical data built for our EMR/EHR that can interface with I-PASS.
Testing environments at my organization are aligned with the production environment (version control, customizations, builds and integration).

My organization has resources in the following IT or IS areas that will be dedicated to the I-PASS implementation:(Required)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Unknown
Server: Analyst and engineer(s)
Network: Connectivity, VPN, Provide IP addresses/ports, endpoints
Security: Access and risk management
User Authentication: Can provide standards and resources for SSO
HL7: Integration domain specialist (ADT, orders, results, meds, care teams)(system owners/application analysts)
Governance: Management and adherence to policies
Database: Development, Testing, Production
User Acceptance Testing Resources: Testing for clinical and technical use cases
Support: Provide support during implementation and post-implementation (point of contact for I-PASS for issue reporting, triage, and resolution)

Technology Solutions for Handoff Communication - Free Response(Required)

Please use this section to expand on your responses to the above statements relative to your organization's technology solutions for handoff communication.

Strongly disagree

Strongly agree

Presence of support from mid-level leadership

Support/buy-in from clinical staff: Physicians (Attendings, faculty, residents); Advanced Practice Providers (NPs, PAs); Nurses

FTE support for project team roles: Site Lead, Project Manager/Coordinator, Training Champion, IT Champion, Data Champion, Campaign Champion

Internal competency for implementing QI processes & methodologies (data collection, reporting to stakeholders, etc.)

Please respond to the statements below regarding the overall goals for patient safety within your organization.(Required)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Unknown
My organization has an intended strategy for the timeline of I-PASS implementation.
My organization has other priorities or initiatives that are being pursued or implemented and would be synergistic to I-PASS implementation

Overall Safety Goals & Organizational Strategy - Free Text(Required)

Please use this section to expand on your responses to the above statements relative to your organization's overall safety goals.