MMHA 6475 Week 6 Service Launch Plan Example

Build, Pilot, Expand: A Phased Launch Plan for Tamarack Hospital at Home With Readiness Gates

Student Name

Walden University

MMHA 6475: Program Planning, Implementation, and Evaluation

Instructor Name

Month Day, Year

Build, Pilot, Expand: A Phased Launch Plan for Tamarack Hospital at Home With Readiness Gates

Approach

This plan launches Tamarack Health's hospital-at-home program in three phases: build, pilot and expansion. Each phase ends at a gate, a short set of checks that must pass before the next phase begins. Phasing limits the harm a mistake can do; a problem discovered with ten patients is easier to fix than one discovered with sixty. Gates make the decision to move forward explicit, so that momentum alone does not carry the program past a problem. Tasks are listed with an owner by role, start and finish months counted from leadership's approval, and the task each depends on. All timings are illustrative and would be adjusted to Tamarack's actual contracting and hiring times.

Phase 1: Build

The build phase creates everything that must exist before any patient goes home. Table 1 lists its tasks.

Table 1

Build Phase Tasks

Notes on the Build Phase

Two tasks set the pace. The payer agreement is outside Tamarack's control and may take longer than five months; without it, the pilot could still proceed with patients whose coverage pays for home hospital episodes, but the number of eligible patients would shrink. The electronic health record build depends on the clinical protocol being final, so the protocol must be approved early. Recruiting nurses and paramedics may compete with inpatient units for the same staff, and the nursing lead should agree with inpatient nurse managers on how positions will be filled without leaving units short. The command center is the last element to be ready because it needs trained staff before it can open.

Gate 1: Ready to Enroll

Before the first patient enrolls, the program manager presents the steering group with evidence that each build task is complete, and the group checks readiness in two senses. Weiner (2009) describes organizational readiness for change as the combination of change commitment, members' shared resolve to implement a change, and change efficacy, their shared belief that they can do it. The gate therefore asks, in addition to the task list: Do the hospitalists in the pilot group, the emergency department leaders and the home care nurses say they are committed to making the program work? Do they believe they have the training, tools and staffing to carry it out? A short survey of the people involved, followed by a meeting to discuss its results, answers both questions. If commitment or confidence is low, the gate holds until the reasons are addressed.

Phase 2: Pilot

The pilot limits enrollment to one hospitalist group and four conditions. Table 2 lists its tasks.

Table 2

Pilot Phase Tasks

Notes on the Pilot

Limiting the pilot to one hospitalist group lets the program build a working relationship with referring physicians before expanding. Five diagnoses make up the pilot list, the same five the needs case identified, and they mirror what established programs have treated safely at home (Levine et al., 2020). The 20-mile service area keeps courier and nurse travel times within the protocol's response window. The pilot's purpose is learning: the daily huddle and weekly escalation review are where problems surface, and the monthly fidelity report shows whether visits, rounds and deliveries are keeping to the protocol. Gate 2's timing is also tied to the calendar: if possible, the pilot should run through at least part of a winter, when boarding is worst (Janke et al., 2022), so that the program is tested under the pressure it was built for.

Gate 2: Ready to Expand

Before expansion, the steering group reviews the pilot against four checks: escalation and readmission are within the limits set in the Week 3 objectives; at least 90% of scheduled nurse visits occurred within the protocol window; no serious safety event remains unexplained; and the second hospitalist group has met with the program and expressed readiness to refer. The readiness survey is repeated with the second group and with home care staff, since commitment measured before the pilot may have changed once the work became real.

Phase 3: Expansion

Expansion proceeds in two stages. In months 12 to 15, the second hospitalist group begins referring, and the program adds staff to reach an average daily census of six patients. In months 16 to 18, the third group joins, and the condition list may expand to include selected patients with infections requiring intravenous antibiotics, if the pilot's escalation data support it. Each stage ends with a brief review using the same checks as Gate 2. The sister campus is not part of this plan; it serves as the comparison site in the Week 9 evaluation, and adding it would remove the comparison.

Risks to the Timeline

The plan's main timeline risks are a delayed payer agreement, slow hiring and low referral volume. A delayed payer agreement would narrow eligible patients but need not stop the pilot. Slow hiring would delay Gate 1 and should be addressed by temporary reassignment of experienced home health nurses. Low referral volume during the pilot is the most serious risk, since it would leave too few episodes to judge safety or readiness, and it would point back to the action-model weakness identified in the Week 5 stress test. The medical director's first response would be to attend the pilot group's morning meetings and review missed referrals case by case.

References

Janke, A. T., Melnick, E. R., & Venkatesh, A. K. (2022). Hospital occupancy and emergency department boarding during the COVID-19 pandemic. JAMA Network Open, 5(9), Article e2233964. https://doi.org/10.1001/jamanetworkopen.2022.33964

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67