1. Policy
1.1. Current Policies
1.1.1. Government
1.1.1.1. HIPAA
1.1.1.1.1. Federal policy that is in place to protect patient privacy rights (in addition to other functions).
1.1.1.1.2. The HIPAA Privacy & Security Rules "ensure protected health information (PHI) is kept safe, secure, accessible, and available for those who have the authorization and a valid need to access it" (Rienton, 2013)
1.1.1.2. The HITECH Act
1.1.1.2.1. Enacted in 2009, this Act works to ensure that health information technology is used to an effective standard called "meaningful use", while also supporting and strengthening the HIPAA provisions related to electronic transmission of health information (HHS.gov, 2017).
1.1.1.3. "Battle Buddy" will have to be very cognizant of the privacy rules within HIPAA and the HITECH Act when designing functionality to ensure compliance
1.1.2. Organizational
1.1.2.1. None pertaining to anything app related
1.1.2.2. Any current organizational policies follow and cite Federal laws i.e. HIPAA, etc.
1.1.2.3. Organizational rules for bullying and disruptive behavior are established and include punishments to include the patient being seen in a different location or needing to check in with or have an on-site police escort for all appointments
1.2. New Policies
1.2.1. Governmental
1.2.1.1. Nothing planned
1.2.1.2. So hard to predict what role the government will play in healthcare policy as there are so many questions surrounding what direction healthcare will take as a whole (i.e. socialization, privatization, hybrid system)
1.2.2. Organizational
1.2.2.1. Internal policies will need to be implemented to support the integrated chat functionality that will result in serious repercussions for group members who disobey the group rules, cause harm to another group member, or have other disruptive behavior where physical intervention is impossible
1.2.2.1.1. Because the app is mobile, any potential bullying or disruptive acts wouldn't likely occur on VA grounds - this brings up the question of jurisdiction for police. Currently, VA police are the first responders. There would need to be more dissection of this issue to determine what can be done when creating any new policies as the crimes a person can be charged with would vary from local to Federal.
1.3. Plans to Change Policy
1.3.1. Policy making process for government/public policy is based on 3 steps: formulation, implementation & modification (Longest, 2016, p. 96)
1.3.2. This same process would be appropriate for policy creation and implementation for the organization
1.3.3. During implementation, it is imperative to consider the "human" factor by utilizing human resource technologies, the IT department, and a strong team of executive support to lead the change
1.3.3.1. "For example, Statistics Canada has reported that Canadian firms have achieved performance improvements of 46 percent for process innovation, 32 percent for product innovation and 25 percent for productivity improvement, when combining high usage of innovative Human Resource Management (HRM) practices with high usage of information and communication technologies (ICT), in change initiatives. When firms do not include, or use only low levels of HRM practices, and only rely on high ICT for benefits, the resulting productivity improvements were noticeably smaller: 24 percent for process innovation, 14 percent for product innovation and 9 percent for productivity improvement" (Hornstein, 2008)
2. Leadership Structure
2.1. Vision Statement
2.1.1. To provide access to mental health self-guided tools and peer support in a 24/7 format to veterans and active duty military service members
2.2. Emergent Leadership
2.2.1. As the "Battle Buddy" app comes to fruition, I will play the role of not only the leader because it is my idea but because I will be wearing many different hats. As my team grows, I may lose some of those hats and gain some different ones, but I will remain flexible in how I lead the team and support the development of the concept
2.2.2. "The system's leader recognizes the essential centrality of emergence and group process and creates the constructs, structures, frames, and processes that reflect this value in group dialogue, decision making, and action" (Porter-O'Grady & Malloch, 2010, p. 9).
2.3. Sustainability Plan
2.3.1. In order to ensure a sustainable plan with the "Battle Buddy, there are 5 challenges to overcome - time, process, ambiguity, commitment, & scalability (Weiss & Legrand, 2011, p. 174)
2.4. User Ownership/Input
2.4.1. As the "Battle Buddy" app is created and implemented, the implementation team will be coached to not only train users and other staff on the app but also to embrace the app and use it themselves so that they can speak to the user experience first hand
2.4.2. "For the innovative systems executive, creating a management team that articulates and demonstrates by their own behavior the living acceptance of change as the normative behavior becomes the seminal leadership development activity" (Porter-O'Grady & Malloch, 2010, p. 21)
2.4.3. As a new innovation, the idea when building the app was not to dictate the budget or details of pieces I didn't know much about but to provide some basic guidelines (i.e. total budget) and have the smaller pieces fit together by consulting with professionals in those fields to ensure that the final project would be more accurate and there would be fewer obstacles along the way
2.5. Facilitation Mindset
3. Objective II: Leading & Facilitating Innovation in an Organization
3.1. Change in Practice
3.1.1. Remain adaptive, assessing both context and content (Porter-O'Grady & Malloch, 2010, p.22)
3.1.2. Be aware of the resistance to change (especially in an environment like the VA) and use communication as well my own actions to demonstrate the new processes and ease in which change can take place - keep communication consistent (O'Grady & Malloch, 2015)
3.2. Systems Theory
3.2.1. As a leader, I will have to promote the fluidity of departments and providers in order to make the "Battle Buddy" successful in the VA. Government entities are very "compartmentalized" which makes this type of systems mentality difficult to bring to reality
3.2.1.1. To overcome this challenge, I will utilize the teamwork strategy mentioned below to bring the a diverse team together that will make the "Battle Buddy" a collective part of their outside role as well which will promote further engagement and adoption.
3.3. Teamwork
3.3.1. Utilize DiSC profiling to determine strengths and weaknesses of team members
3.3.2. My goal when building the "Battle Buddy" team will be to create diversity - a more diverse team will be able to tackle challenges from different perspectives and develop broad-based solutions (Weiss & Legrand, 2011)
3.4. Leadership Skills
3.4.1. High level aptitude in the skill of synchronicity - collaborative coordination of operating characteristics, team personalities and capabilities, strategy, processes, and structure
3.5. Organizational Alignment for Innovation
3.5.1. Leading not only the internal team but the external stakeholders is imperative
3.5.2. "Engaging stakeholders at the right time in the right place for the right purpose becomes a centerpiece of the exercise of formal leadership in the system" (Porter-O'Grady & Malloch, 2010, p. 25)
3.5.3. Within organizations like the VA, networking is very important and as an innovative leader it will be my one of my core roles to continue to keep the "chatter" up about the program and keep it integrated within the mental health programs
4. Project Overview
5. Finance
5.1. Budgeting
5.1.1. Sample budget provided is to give an idea of anticipated costs. The development team will work together to stay within the realm of the total budget however won't be restricted to the dollar amounts in each category listed.
5.1.1.1. Sample Budget
5.1.2. Focus on facilitation mindset - avoid "top-down" delegation
5.2. Funding Sources
5.2.1. Initially the "Battle Buddy" app will be self-funded until it has enough support within the VA and DOD to be marketed as a complete package
5.2.2. The ultimate goal of this app is to float the running and maintenance costs until fully established with strong evidence-based practices supporting its value, at which point it will be available for purchase by the VA and the Department of Defense -
5.2.2.1. The "Battle Buddy" can easily be rebranded to target additional audiences such as at-risk teens, or others who could use a tool such as this app
5.2.2.2. Once available for purchase, as a nonprofit, the initial capital would be repaid to the initial financial backer and lender and the remaining profits would be reinvested for further development and enhancement
5.2.2.3. If rebranded, this app would then ultimately be able to be purchased by other mental health providers for use with their patients
5.2.3. Donations from veteran support organizations (i.e. Wounded Warrior Project)
5.3. Return on Investment
5.3.1. ROI measures net gain or loss of a product or investment based on the initial investment and is expressed as a percentage (Investing Answers, 2016)
5.3.2. Tiiming
5.3.2.1. Downside of using ROI to calculate success is that it doesn't take timing into consideration
5.3.2.2. The "Battle Buddy" app has a goal of a 20% ROI within 18 months of launch date
5.3.3. Marketing
5.3.3.1. Print and electronic media will be utilized to promote this app, in addition to a strong "word of mouth" campaign"
5.3.3.1.1. "According to a Google and Ipsos Media CT survey, 52% of people discover new apps through word-of-mouth. When we see an app that’s sent to us from a friend, we’re far more likely to try it out than one we stumble across on the App Store" (Gray, 2016)
5.3.3.1.2. Veterans are very "referral" driven so the more users to vouch for the "Battle Buddy" app, the better
5.3.4. Financial Return
5.3.4.1. Financial return will be through donations, purchase of the license once available, and through the cost-savings recognized for the health care providers.
5.3.4.1.1. The VA treats mental as well as physical conditions and patients who are being treated for their mental health conditions are more physically healthy that those who have untreated mental health conditions (Rhode Island Psychological Association, 2016)
5.4. Financial Impact
5.4.1. As shown above, countless studies show that people who receive treatment for mental health have lower costs associated with physical medicine
5.4.1.1. Providing an app designed to support mental health treatment should significantly reduce the costs of providing treatment for physical conditions, saving the VA money
5.4.2. The "Battle Buddy" app would be established as a non-profit
5.4.2.1. Running this app through a non-profit status would allow easier access to donations to make start up faster and easier
5.4.2.2. Non-profit because it has "a mission that focuses on activities that benefit society and whose goal is not primarily for profit, public ownership where no person owns shares of the corporation or interests in its property, income that must never be distributed to any owners but is recycled back into the nonprofit corporation's public benefit missions and activities" (Fritz, 2017)
5.5. Regulatory Issues
5.5.1. The "Battle Buddy" app would use the reporting and accounting requirements of the generally accepted accounting principles (GAAP)
5.5.2. Under GAAP, some of the FASB's that apply to for-profit companies don't apply to not-for-profit and there are some FASB's that apply only to non-profits, such as FASB 117 and FASB 124 (Perry, N.D.)
6. Information Technology Strategy
6.1. Applications
6.1.1. Software Applications
6.1.1.1. Format: Mobile Application compatible with all mobile devices (i.e. Apple, Droid, etc).
6.1.1.2. Build Platform: The prototype will be built with Buildfire initially but once additional financial resources are available a custom app will be created from scratch (buildfire.com, 2016)
6.1.2. Security
6.1.2.1. Security of the background data of the app will be held by the IT administrators
6.1.2.2. The security of user data on their "Battle Buddy" apps will be secured with a password and/or fingerprint if their hardware supports it
6.1.3. Access
6.1.3.1. IT administrators will control the build data and content on secure cloud-based servers with backup servers as they see necessary
6.2. Technical Architecture
6.2.1. Devices Needed
6.2.1.1. Hardware needs: Desktop computers for designers, developers, and programmers to work on the development of the app
6.2.2. Technical Storage
6.2.2.1. Back-up cloud-based storage system
6.2.2.1.1. "Allows practices to help meet strict Meaningful Use Security Audit measures and HIPAA security requirements" (MicroMD, 2016)
6.2.2.1.2. Ideal if there is a local disaster that affects physical storage or network capability
6.2.2.1.3. More cost-effective without having the initial costs of the server hardware
6.2.2.1.4. Frees up admin staff from having to create backup storage disks, etc.
6.2.3. Have a back-up plan in place
6.2.3.1. Because the app runs through cloud storage, ensure that information is automatically redirected to a back-up cloud with mirror-image content for seamless use by veterans
6.2.4. 9-1-1- Traceability
6.2.4.1. Due to the nature of the app, "Battle Buddy" will request the most up-to-date accessibility to 9-1-1- look-ups in the case where a user threatens themselves or someone else
6.2.4.1.1. This access is state-by-state and a very underdeveloped technology at this time
6.2.4.1.2. For example, in Colorado in 2016, only 58% of the 5.8 million cellphone-to-911 calls were able to transmit an accurate location (Kelly & Keefe, 2016)
6.2.4.1.3. This app
6.3. Data
6.3.1. Importance of Data Security and Integrity
6.3.1.1. Data Security/HIPAA Requirements
6.3.1.1.1. Security mandates for this app will fall under HIPAA and the HITECH Act as there will be PHI stored on user profiles
6.3.2. Users of Data
6.3.2.1. Privacy Act verbiage will be provided to users upon signing up for an account and they will have to agree to the Terms of Use when accepting their account terms
6.3.2.2. Users will understand that the "Battle Buddy" app has their privacy as their top priority however this is an internet-based application and ultimately users are responsible for their information that they share
6.3.2.2.1. Data required will be the User's name, DOB, SSN, unique User Name, Password, at a minimum
6.3.3. Providers of Data
6.3.3.1. Initially the providers of the data will be the "Battle Buddy" development team comprised of myself, a veteran friend who is also a patient and 2 mental health providers I work with
6.3.3.1.1. As the "Battle Buddy" is developed, a formal team will be developed to ensure that the most up to date content is included and that all links are live
6.3.3.1.2. New content will be added to keep the exercises fresh and helpful
6.3.3.1.3. The same providers of data will also be responsible for downloading and analyzing usage data to ensure we are reaching our target audience effectively and providing tools that suit their needs
6.4. IT Staff
6.4.1. In-House
6.4.1.1. Developer
6.4.1.2. Designer
6.4.1.3. Programmer
6.4.1.4. Networker
6.4.2. Outside
6.4.2.1. Consultant that specializes in mobile apps who can assist with the various plug-ins and ensure we aren't overlooking any important steps
6.5. IT and Organization Alignment
6.5.1. Our IT/development team and the VA organization must find alignment in order to have the "Battle Buddy" app be utilized within the VA programs
6.5.2. Monthly meetings will reassure stakeholders that the app is meeting the goals initially set and that the needs of veterans both inside and out of the VA are being satisfied
6.5.2.1. Successful implementation of the app should show the organization that more veterans will seek care if they understand we are here to help and that our programs are non-invasive, such as the "Battle Buddy"
6.5.2.1.1. A major barrier of veterans getting help is not know what treatment will be like (VA.gov, 2016). Demonstrating some simple types of treatment through the "Battle Buddy" will help to easy this anxiety
6.6. IT Value
6.6.1. The vale of IT is diverse as outcomes can be tangible or intangible (Glaser & Salzberg, 2011)
6.6.1.1. The "Battle Buddy" will be valued from an IT perspective in how it improves patient care and access and also, on a longer term basis, through the recognition of reduced physical treatment costs as patients see improvement with their mental health
6.6.2. Contributors to IT value loss would come from investment in creating the "Battle Buddy" app but not promoting it, maintaining it, or analyzing the usage of the app
7. Innovation Process
7.1. Framework
7.1.1. Objective: To provide an interactive mobile app to military service members and veterans that will assist them with their mental health issues while they are currently enrolled in formal mental health groups or are thinking about getting enrolled.
7.2. Prototype
7.2.1. Idea began as just a social media forum to be used within treatment classes and in conjunction with mental health providers
7.2.2. Course Correction
7.2.2.1. After speaking with many providers and veterans about my idea, further additions came to me creating the complete package offering mental health support, access, as well as the chat forums to integrate with mental health treatment programs
7.2.2.1.1. Had a big "ah-ha" moment when speaking to a veteran who shared his story about being in the middle of a panic attack, questioning suicide, being too scared to call a friend, and not knowing how to pull himself out of it. When explaining the "Battle Buddy" concept, he had tears in his eyes and stated that that was exactly the tool that he needed when he was in that moment. He was able to offer further suggestions and ideas on how to improve the idea and get this app out to those who need it.
7.3. Issue Redefinition
7.3.1. The idea of this app was thought over a few different times to improve the general concept and make it clear, distinct, and manageable.
7.4. Idea Generation
7.4.1. The decision for an app focused around military mental health came with questions on how to tie things together with the military world. I developed interactive connections that keeps the app information private but that also has the ability to integrate with military programs.
7.5. Implementation Planning
7.5.1. Implementation of "Battle Buddy" will take place in a few different ways. There will be the direct interface with mental health providers as both the DOD and the VA but there will also be other organizations such as the DAV and VFW that will assist us in getting the word out about this new, veteran-focused tool.
8. Outcomes
8.1. Desired Outcome
8.1.1. Increasing numbers of downloads of the app from the app stores
8.1.2. Increased access by veterans for additional mental health support
8.1.3. Decreased number of veteran suicides/attempted suicides
8.1.4. Eliminate the stigma of mental health to all patients to speak more freely about what they are struggling with in hopes that others will come forward with their issues also
8.2. Measurable Outcomes
8.2.1. Qualitative
8.2.1.1. Survey data seeking knowledge of what the veteran struggles with
8.2.1.2. Review of medical records with patient names retracted to see the specific mental health issues that need to be addressed
8.2.1.3. Interviews with veterans to determine their needs and what they think is important with regards to their mental health
8.2.2. Quantitative
8.2.2.1. Find baseline data for number of patients currently being treated as a whole by the DOD and VA, but then also the specific numbers of patients being treated for mental health related conditions
8.2.2.1.1. The Colorado Springs VA Clinic, which would serve as the test facility, treats approximately 35,000 patients per year. Of that, approximately 18,000 are also seen in our mental health department. These are unofficial numbers as the VA doesn't formally release this information. (C.Johnson, personal communication, January 31, 2017)
8.2.2.2. Access statistics regarding veteran mental health records and suicides, both attempted and successful
8.2.2.3. Tie cost of care for a person who has been treated successfully through mental health with their physical health care to show the decrease in care costs overall
8.3. Overall Improvements in Care
8.3.1. Veterans feel more support whether they are utilizing VA services or not - gives veterans some a tool to help them even if they haven't yet begun to utilize VA services
8.3.1.1. For example, in 2014, there was a veteran population of 21,619,731 and only 6,616,963 veteran patients (Bagalman, 2014)
8.3.2. Reduction in mental health related conditions through consistent, supportive care
8.3.3. Builds trust in the VA that providers and the organization actually cares
8.3.4. Utilizes technology that caters to a large age group that is consistent with the patient base currently coming out of the military
8.4. Future Plans
8.4.1. As the system shows us what its strengths and weaknesses are, use this information to develop additional tools along those same lines
8.4.2. As technology becomes available and improves, have integrated GPS tracking to be able to locate a veteran in distress if they are posting concerning things in the open forum or reached out to the veterans crisis line and then hung up
8.4.3. Ideally, the "Battle Buddy" will grow into a tool that is utilized not just for members of the military and veterans but will grow to serve all all members of our population who struggle with mental health conditions that could be helped with this tool such as anxiety conditions, depression, and personality disorders.
8.4.4. Integrate a telehealth component that could increase better access to care which is an ongoing struggle with the VA
9. References
10. Evidence
10.1. Why The "Battle Buddy" is Needed - It's Not Just PTSD
10.1.1. Mental Health Conditions
10.1.1.1. Mental health issues that our veterans face: PTSD, TBI, MDD, Anxiety disorders, substance abuse issues, Depression, suicidal ideations, homicidal ideations, homelessness )secondary to mental health issues)
10.1.2. Barriers to Care and How the "Battle Buddy" Can Help
10.1.2.1. Barriers to Care (NVF, 2016)
10.1.2.1.1. Embarrassment
10.1.2.1.2. Long wait times to access care
10.1.2.1.3. Shame over needing to seek care
10.1.2.1.4. Fear or stigma of being seen as weak
10.1.2.1.5. Lack of awareness
10.1.2.1.6. Distance to Care
10.2. Research-Based Evidence
10.2.1. Why The "Battle Buddy" Is Needed
10.2.1.1. 20% of vets who served in Afghanistan or Iraq returned with either PTSD or Major Depressive Disorder (MDD) (NVF, 2016)
10.2.1.1.1. Of these vets, 19.5% of them suffered a Traumatic Brain Injury (TBI) (NVF, 2016)
10.2.1.1.2. 50% of vets with PTSD won't seek treatment -> of the half who seek treatment, only half of them get "minimally adequate" treatment (Veterans and PTSD, 2016)
10.2.1.2. Of the veterans returning from 2006-2010, 2.1 million received mental health treatment from the VA (NVF, 2016)
10.2.1.3. Approx. 50% of veterans returning from deployment seek mental health care, but then only a little more than half of those receive adequate care (SAMHSA, 2016)
10.2.1.4. JAMA found in a a 2014 psychiatry study that the rate of depression in veterans is 5 times greater than in civilians (NAMI, 2016)
10.2.1.5. In 2014, each 20 an average of 20 veterans died by suicide. (VA.gov, 2016)
10.2.1.5.1. Of those 20, 6 were using VA services
10.3. User-Based Evidence
10.3.1. External Mental Health Provider Input
10.3.1.1. Interviewed external M.D. psychiatrist Dr. Marciniak, regarding the concept of the "Battle Buddy" app (D. Marciniak, personal communication, January 6, 2017)
10.3.1.1.1. Dr. Marciniak states that in his experience military service members are very difficult to provide therapy to if they haven't come to terms with needing care themselves first
10.3.1.1.2. He liked the idea of "Battle Buddy" because it provided an anonymous way of receiving some "self-help" while also having additional resources at the push of the button
10.3.1.1.3. He mentioned that many people struggling with mental health can be impulsive and by having resources available (i.e. veteran crisis line) available with just one click, they may end up speaking to someone when they wouldn't have before
10.3.2. VA-Based Mental Health Provider Input
10.3.2.1. Spoke with LCSW Ms. Stone who stated the "Battle Buddy" would be a great addition to the VA tools offered (S. Stone, personal communication, January 17, 2017)
10.3.2.2. Ms. Stone loved the idea that there was an integrated chat forum for mental health group members to socialize outside of group
10.3.2.3. Brought up the question of how to moderate the forum to ensure topics remained appropriate and requests for help were responded to
10.3.2.3.1. Ms. Stone appeared to be pleased with the plan to have moderators from the group chosen based on their involvement and leadership within the in-person groups as picked by the mental health leader
10.3.2.3.2. Also liked that the exposure to some controversial topics or feelings in a more controlled environment would allow group members to exercise their resources and tools being taught within their class to better prepare them for a real life scenario
10.3.3. Patient Input
10.3.3.1. Performed an anonymous written survey of 100 veterans of which 63 responded
10.3.3.1.1. Found results to vary significantly for most of the questions however the question regarding feeling more comfortable talking to other veterans over civilians was unanimous
10.3.3.1.2. 93% of respondents stated they would use an app that helped the techniques taught by their providers
10.3.3.1.3. 89% of respondents stated they would like the chat feature to be able to chat with their group members outside of group
10.3.4. 2010 National Survey of Veterans
10.3.4.1. Survey is completed by a third party to evaluate the access to and quality of care provided by the VA
10.3.4.1.1. Survey responses for why veterans never accessed care at the VA (VA, 2010)
10.3.4.1.2. Will utilize statistics surrounding lack of knowledge of benefits, how to apply for benefits, and not considering the VA within the app to ensure that this information is included for veterans who download the app seeking help prior to speaking to anyone about their concerns