You will need your 2016 Sustainability plan for this pre assessment. You will look at the answers you put for each capability and measure your level of implementation.
 
For Example: If for Standardization you said you'd "Make sure home therapy options and referral is presented to each new patient upon admission to the facility and the first plan of care meeting"

-you haven't done this with any new patients then you would answer "Not implemented"

-you have educated and referred 50% of your new patients then you would answer "Somewhat implemented"

-you have educated and referred every new patient then you would answer "Fully Implemented"

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* 2. Complete the below information.

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* 3. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
STANDARDIZATION: In order for this to become the culture, standard, or usual business in your facility, please provide specific examples of how you will hardwire and prioritize these processes into your current system?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 4. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
UTILIZATION: How will you utilize frontline staff and corporate leadership to implement these changes?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 5. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
SHARE: How will these new changes, or changes to existing processes, be communicated with existing staff, new staff, PRN staff, patients and family members? How will feedback be obtained and addressed from each group?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 6. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
TRANSPARENCY: How can you make these changes transparent to support and foster a culture of trust between management, staff, and patients?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 7. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
ACCOUNTABILITY: How will you build accountability and escalation steps into this sustainability plan to alert you when problems arise that will keep you from sustaining performance and meeting goals?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 8. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
INTEGRATION: How will these processes be integrated into daily work and how will you align them with organizational or departmental goals?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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* 9. Using your answers from your 2016 Sustainability Plan, rank your facility's current level of implementation of the below sustainability capabilities.
 
NEVER GO BACK: How will your staff, patients, and corporate leaders maintain the gains and continue the interventions learned in this QIA?

Not Implemented Somewhat Implemented Fully Implemented
i We adjusted the number you entered based on the slider’s scale.

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