How to Build a Sustainable TSAM® Implementation Plan

Implementing a new clinical orientation model is about more than introducing a different set of competencies. It requires an organization to reconsider how new clinicians learn, how preceptors guide their development, how leaders evaluate progress, and how readiness for independent practice is determined.

The Tiered Skills Acquisition Model provides a structured, competency-based approach to that transition. However, achieving sustainable results requires more than adopting the framework. Healthcare organizations need a clear TSAM® implementation plan that connects the model to their people, workflows, technology, and long-term workforce goals.

The strongest implementation plans do not treat TSAM^® as a temporary initiative. They establish the leadership support, operational structure, and continuous improvement processes needed to make the model part of everyday clinical practice.

Begin With a Clear Case for Change

Before determining timelines or building competencies, leaders must establish why the organization is implementing TSAM^®. What problems should the new approach solve? Depending on the organization, those challenges may include:

• Inconsistent orientation experiences across units
• Overreliance on time-based orientation schedules
• Difficulty determining readiness for independent practice
• Excessive administrative work for preceptors and educators
• Unnecessary variation in how competencies are taught and validated
• New-hire dissatisfaction or early turnover
• Limited visibility into orientation progress and outcomes

A shared case for change helps leaders communicate that TSAM^® is not simply a new form or technology. It is a different approach to building competence during the transition into clinical practice. Organizations that are still exploring the framework can begin with CHCI’s overview of what the Tiered Skills Acquisition Model is.

Build the Right Implementation Team

Sustainable TSAM^® implementation cannot rest with one nursing professional development practitioner or project leader. It requires participation from the people who influence clinical orientation throughout the organization.

The implementation team may include representatives from:

• Nursing executive leadership
• Nursing professional development
• Clinical education
• Unit leadership
• Preceptors
• Human resources
• Quality and patient safety
• Information technology
• Point-of-care clinical practice

Each representative brings a different perspective. Executive leaders can remove barriers and reinforce accountability. Educators can guide competency development. Unit leaders and preceptors can identify workflow realities that may affect adoption. Technology partners can ensure documentation supports the model instead of creating additional work. The team should also establish clear decision-making authority. Everyone does not need to approve every detail, but everyone should understand who owns each part of implementation.

Assess the Current Orientation Environment

An effective implementation plan begins with an honest assessment of the current state. Before designing the future process, examine how orientation operates today:

• How are competencies currently organized?
• Are expectations consistent across units?
• How is progress documented?
• Who determines whether an orientee is ready to advance?
• How are preceptors prepared and supported?
• Where do delays or communication gaps occur?
• What data are currently available?
• How often is orientation extended, shortened, or repeated?
• How do orientees and preceptors describe their experience?

This assessment establishes a baseline and helps the implementation team distinguish between practices that should be preserved, redesigned, or eliminated. It also prevents organizations from transferring an inefficient paper process into a digital environment without addressing the underlying problem. If warning signs are already present, CHCI’s guide to identifying a healthcare competency tracking problem can support this evaluation.

Define What Success Will Look Like

A TSAM^® implementation plan should identify measurable goals before the first pilot begins. Without baseline measures and agreed-upon outcomes, it becomes difficult to determine whether implementation is creating meaningful improvement. Organizations may choose to monitor:

• Average orientation length
• Time to independent practice
• Orientation extensions
• Preceptor and orientee satisfaction
• New-hire retention
• Completion and progression rates
• Variations among units or learner populations
• Preceptor workload
• Competency documentation completion
• Leader confidence in readiness decisions

Not every measure will change immediately. Some indicators can be evaluated during orientation, while retention and workforce outcomes require longer-term monitoring. The goal is not simply to prove that the organization launched TSAM^®. It is to understand whether the new process is creating a more consistent, supportive, and competency-driven transition to practice.

Align Competencies and Tiers With Clinical Practice

Once the implementation team understands the current state and desired outcomes, it can begin aligning clinical competencies with the TSAM^® framework. This work requires thoughtful collaboration. Competencies must reflect organizational standards, patient populations, regulatory expectations, specialty requirements, and the realities of each clinical environment.

Teams should consider:

• Which competencies apply across the organization?
• Which are specific to a specialty or unit?
• Which foundational skills must be demonstrated first?
• How should competencies progress from less complex to more complex practice?
• What evidence will demonstrate competence?
• Who is qualified to validate each competency?
• What circumstances require additional education or reassessment?

For a closer look at how tiers and competency categories work together, leaders can review the components of TSAM^®.

The purpose of this phase is not to create a larger checklist. It is to build a meaningful progression that allows clinicians to advance based on demonstrated competence.

Prepare Leaders, Educators, and Preceptors

People support what they understand. Before implementation begins, everyone involved should understand not only what is changing, but why. Leadership preparation should address:

• The purpose and principles of TSAM^®
• How progression differs from a fixed orientation calendar
• Expectations for unit-level implementation
• How leaders should respond when progress varies
• How implementation outcomes will be monitored

Preceptor preparation should be equally intentional. Preceptors need to understand how to guide tiered progression, provide feedback, document performance, and recognize when an orientee is ready for greater responsibility. This is also an opportunity to invite questions and concerns. Preceptors who participate in the transition can identify practical barriers early and become credible champions for the new process.

Start With a Purposeful Pilot

A pilot gives the organization an opportunity to test workflows, strengthen communication, and learn before expanding implementation. Choose a pilot environment with:

• Engaged unit leadership
• Experienced preceptors
• Sufficient orientation volume
• A willingness to provide honest feedback
• Workflows that are representative enough to inform expansion

Avoid selecting a pilot unit solely because it appears to be the easiest. A successful pilot should produce useful lessons, not just favorable results. Before launch, define the pilot’s scope, timeline, participants, support structure, success measures, and process for resolving concerns. Schedule regular check-ins so issues can be addressed while the pilot is active.

Use Technology to Support the Workflow

Technology should make TSAM^® easier to operationalize and sustain. It should give orientees, preceptors, educators, and leaders appropriate visibility into progress without creating unnecessary documentation.

An integrated platform can help organizations:

• Organize competencies into progressive tiers
• Document observations and validation
• Monitor individual progress
• Identify delayed or incomplete requirements
• Improve communication among stakeholders
• Compare implementation across units
• Analyze orientation and workforce trends

The platform alone, however, does not create successful implementation. Technology must be paired with sound methodology, stakeholder preparation, and expert guidance.

CHCI combines its comprehensive workforce development platform with the education and consulting needed to help organizations put TSAM^® into practice. CHCI is the only legally authorized platform and provider of educational consulting services for implementing the authentic TSAM® framework. This strategic partnership helps organizations move from initial planning through implementation, evaluation, and continued improvement.

Learn From the Pilot Before Expanding

After the pilot, implementation leaders should review both quantitative results and participant feedback.

Ask:

• Did orientees understand the progression?
• Could preceptors use the workflow consistently?
• Were competency expectations clear?
• Did technology support the process effectively?
• Where did participants require additional guidance?
• Did leaders receive the information they needed?
• What should change before the next phase?

The purpose of the pilot is learning. Adjusting workflows after receiving feedback is not a sign that implementation failed. It is evidence that the organization is treating implementation as an improvement process. Expansion should occur in manageable phases. Specialty requirements, unit cultures, leadership readiness, and staffing pressures may differ throughout the organization. A phased approach creates room to adapt while protecting the essential principles of TSAM^®.

Create a Plan for Long-Term Sustainability

Implementation does not end when every unit has launched the model. Without ongoing ownership and evaluation, even a strong initiative can gradually lose consistency.

A sustainability plan should identify:

• Who owns TSAM^® after rollout
• How new leaders and preceptors will be educated
• When competencies and tiers will be reviewed
• How users can report workflow concerns
• Which outcomes will be monitored
• How often implementation data will be reviewed
• How improvement decisions will be documented and communicated

Organizations should also establish a routine for checking implementation fidelity. Units may need flexibility, but local adaptations should not undermine the model’s competency-based structure. Sustainability depends on keeping TSAM^® visible as part of the organization’s broader workforce strategy, not allowing it to become another orientation document that is reviewed only when a problem occurs.

A Platform and Partnership Built for Sustainable Change

A sustainable TSAM^® implementation plan connects methodology, people, processes, and technology. It begins with a clear organizational need, builds shared ownership, prepares the people responsible for implementation, and creates a structure for learning over time.

CHCI is more than just a technology provider. We serve as a strategic workforce development partner, pairing the MyCHCI platform with the exclusive TSAM^® education and expert consulting organizations need to hit the ground running and sustain meaningful change.

From initial planning and competency alignment to platform implementation and continued optimization, CHCI helps healthcare organizations build a structured approach that works in practice and remains accessible anytime, anywhere.

Schedule a demo to learn how CHCI can help your organization plan, implement, and sustain TSAM^®.

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