Seattle-Denver Center of Innovation (COIN)

Implementation and Adaptation Guide

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Time and Cost Tracking and Reporting

One of the most important issues in evaluating program impact is understanding the costs, including staff time and burden relative to the effects produced. This “ratio” will be one of the most important factors determining value and if and how a program will be continued.

Assessing and interpreting costs and impact are complex and interrelated. Costs need to be considered and assessed from the perspective of multiple parties-- budgetary decision makers, organizational unit supervisors, staff who deliver the program, and the Veterans/patients and families intended to receive the program services.

Three resources for strategies and guidance for assessing costs and determining budget impact analysis are available for download (though we recommend searching for additional resources):

• Estimating downstream budget impacts in implementation research
• Rethinking how we measure costs in implementation research
• A pragmatic method for costing implementation strategies using time-driven activity-based costing

Two issues that are important, independent of the specific economic evaluation approach adopted, that are discussed below involve:

1. Understanding staff time required and the burden of program delivery on different staff and Veteran/family recipients; and
2. Summarizing and displaying these results in a way that is understandable to and addresses issues of importance to decision makers who will review and make decisions about the future of your program

Tracking Staff time and evaluating burden

Create or refer to a process map that illustrates who on the staff does what in what order to produce the desired outcomes. After determining this, estimate how much time will be required, how often, by each key staff member. Determine how best to track this information so you can evaluate if actually delivering the program is taking more or less than this initial estimate.

It is best to assess staff time required over a period of a couple weeks to get a reliable estimate of time required (depending on number of clients per day/week, this could be shorter or longer). Keeping records of time spent by different staff can help to identify steps in the process requiring the greatest amount of time and also clarify if some staff are delivering the program more efficiently than others. After you have a reliable estimate of time required, assess if this is feasible in the long run, if this creates an unreasonable burden on some staff members, and if so, if they can either be relieved of some other duties or have others help with their roles in this program.

Patient time and burden. It is also important to consider the amount of time and effort required by patients to participate in the program. For virtual, telephone, or telehealth visits, this time is often minimal and does not require driving, talking time off work, finding parking, or other hassles. For other programs that require travel or greater time commitments by patients, periodic review of these demands and considerations of possible ways to reduce them is warranted.

Summarizing Your Time and Cost Estimates

The table below provides a convenient way to summarize your program costs, but feel free to use another method or modify this in a way that makes sense for your project and setting. Things to keep in mind in collecting and reporting costs are:

• Include costs spent preparing for sessions, making notes, and activities such as attempting to reach patients on the phone.
• Collect cost data for at least two weeks, or for programs with low frequency of contact for at least 10 patient contacts for each staff person involved to obtain a reliable estimate.
• Do not worry about being precise-- usually recording time to the nearest quarter hour (15 minutes) is sufficient.

Example: Reporting Program Time Requirements

Your Program Time Requirements

Now create or refer to your process map and record the time various staff spend delivering your program in the table below. This table can then be printed so you have a record.

Now that you have calculated and summarized your program delivery costs, it is time to put these together with your Impact Evaluation Results to produce your final report as explained in Sharing your Findings.

This concludes the Sustainment phase. You can review the Pre-Implementation Phase and the Implementation Phase.

Previous: Sharing Your Findings / Next: Table of Contents

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