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Case Scenario/ Task
ELECTRONIC HEALTH RECORD NEW RELEASE AND EXPANSION OF FUNCTIONALITY –
CHANGE MANAGEMENT AND STRATEGY EXECUTION PROJECT PLAN FOR THE MOUNT
PLEASANT HOSPITAL
INTRODUCTION
You are the newly appointed manager of the hospital’s clinical redesign and education unit. You have
been recently approached by the management of your hospital about the new release of the software
for electronic health records. This release will involve significant new functionality to that which is
currently provided. There will be new software, hardware required as well as a large change
management requirement.
The new functionality in particular addresses requirements for some of the key specialties including
cardiology and respiratory. New pathways are also being built into the EMR to aid with the
management of stroke, cardiology and hip fracture in line with current guidelines. The new release of
software will expand the amount of information currently shared with polyclinics and community based
service programs.
In order to ensure that the implementation of the new software release is a success, the hospital
executive want to provide funding to your unit for a project. The project funding will assist with
preparing staff education, clinical pathways and any other necessary task that you identify as
necessary.
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The storage and retrieval of patient information, summed up as records management, is a crucial determinant of improving patient service delivery at the hospital. The current records management operations at the hospital are paper based. This means that all patient information is stored in paper files that are stored on shelves for future retrieval. First, we must acknowledge that with such a system of managing patient records, retrieving records is a task that requires relatively more effort and time. The Mount Pleasant Hospital is a big facility that serves many patients, which means that the scale of patient records management can be overwhelming. When a returning patient comes to seek medical services at the facility, their file has to be searched among thousands of physical paper-based files that are placed on shelves. Even with advanced library management skills, the challenge of delivering fast access to information on paper-based record management systems will persist (Svärd, 2013).
It is also nearly impossible to achieve fast and efficient information exchange with relevant stakeholders. We understand that sharing of medical records within the different departments of a polyclinic, or even among different health providers can immensely help improve service delivery and patient satisfaction. If such exchange of patient information should occur, it must be done securely – patient privacy is paramount in a health service system. However, if we exchange patient records through the paper files, we face a significant risk of having the information land in the wrong hands every time such a need arises. With these considerations, we can see that Mount Pleasant Hospital is facing a problem with delivering efficient and satisfactory services to patients as a result of the challenges that arise from manual handling of records at the hospital. The problem that Mount Pleasant Hospital faces with regard to managing patient records can be described as slow, inefficient and unsecured storage and retrieval of patient records.
The purpose of the project is to design and develop an electronic records management system for Mount Pleasant Hospital. It will deliver a system that will be an important and central part of improving patient experience and satisfaction.
The goal of the project is delivering an electronic records management system for Mount Pleasant Hospital.
The following are the objectives of the project:
Objective 1: Define the patient records management problem at Mount Pleasant Hospital and prescribe a solution to it.
Strategies | Key performance indicators | Outcomes |
Clearly identify what the records management situation is | A clear idea of the records management situation is available | A clear scope of the problem is established |
Properly define the problem | A specific problem statement is available | Scope of problems gets well identified |
Objective 2: Design, develop, and maintain the proposed electronic medical records system.
Strategies | Key performance indicators | Outcomes |
Develop a fully functional electronic medical records system | An EMR with all expected functionalities is available | Improved records management at the hospital |
Develop an intuitive records management interface to facilitate easy use of the system | An easy-to-use interface of the system is delivered | Faster records entry and retrieval |
Strategies | Key performance indicators | Outcomes |
Develop comprehensive documentation including a user manual for the system | User manual and relevant documentation available | Maximum use of the developed system |
Develop an intuitive records management interface to facilitate easy use of the system | A simple interface for entering or reading records is available | Improved patient satisfaction |
At the end of the project, we will deliver a fully functional electronic medical records management system that shall comprise of hardware and software systems and trained users. With this delivery, we can expect that Mount Pleasant Hospital will convert from manual to electronic management of records immediately. Along the development of the project, we shall be submitting progressive deliverables to the executive project staff. These deliverables will be made available at the end of every sub-stage of the development. The purpose of the deliverables will be to ensure that the project is working as scheduled. The following shall be the progressive and final project deliverables:
WORK BREAKDOWN STRUCTURE
Project plan section | Tasks involved |
Project initiation and system analysis | · Defining problem statement
· Defining the scope of the problem
· Establishing the mission of the project
· Collecting system requirements
· Defining project goals, objectives and strategies |
Requirements analysis | · Identifying functional requirements of the system
· Identifying non-functional requirements of the system |
Stakeholder analysis | · Identifying key project stakeholders
· Identifying stakeholder communication requirements |
Project resource requirements | · Identifying project resource requirements
· Estimating project budget |
Risk analysis | · Performing risk assessment
· Developing a contingency management plan |
As with every project, we are faced with potential risks that can arise in the course of the project and cause undesirable outcomes. A risk is an unforeseeable event which, if it occurs, will have a significant impact on the project. Project risks can be positive or negative depending on the impact that they are likely to cause on the project. If risks occur, there is a likelihood that the project may not be delivered as scheduled. Therefore there is a need to perform a risk analysis and develop a contingency plan for the identified risks. The risk analysis identifies potential risks and their impacts on the project. Efficient project risk management is an essential competency for every project manager (Gemünden & Aubry, 2015). The following are risks that are likely to occur in the project:
Project delays can result from an ill-defined scope (Hydari, 2015). An ill-defined scope can lead to significant delay of individual project tasks which is likely to affect the entire project schedule. If this risk occurs, it will cause undesirable outcomes such as an increased wage bill since project staff will work on the project for longer.
A change in scope of the project after the project has started is a common IT project risk (Teller, Kock & Gemünden, 2014). After project development has commenced, stakeholders may start seeing new possibilities that can be delivered by the system. They can subsequently request to add features to the functionality of the system. This risk can cause the project to overrun its budget and time schedule. It can also cause the final system to become loosely integrated since some functionality of the system may have not been defined in the core of the system but only as add-ons.
If an indispensable stakeholder such as the system administrator leaves while the implementation is still new at Mount Pleasant Hospital, the system support staff and other system users may experience massive difficulty running the new system. If this risk occurs, patient service delivery may get worse than it was before the introduction of EMR since they will have already developed a reliance on the system.
Although wide consultation is highly desirable in the project, when key project staff unconsciously spend most of their time consulting, they may eventually become unable to deliver their project tasks in time.
If the major stakeholders at Mount Pleasant Hospital who requested the development of the project do not have a clear understanding of how EMRs work, they might raise inaccurate expectations. If they raise inaccurate expectations, the project will be developed according to those expectations and the stakeholders may come to realize, only at the end of the project, that that is not what they wanted. At this point it might be too late to change the project.
Now that we have identified several potential risks, it would be appropriate to assess them. The table below shows the risk assessment for the above identified risks.
Potential risk | Causes | Chance | Impact | Contingency plan |
· Project delay | Ill-defined scope, | Moderate | High | Comprehensively define project tasks, properly define project scope |
· Changes in project scope | Lack of in-depth understanding of EMR systems functionality | High | High | Ensure that all stakeholders are broadly educated on the full functionalities of EMR systems |
· Key stakeholder turnover | Various reasons | Moderate | High | Follow well-know conventions so that final deliverable is a standard easily understandable system, Provide proper project documentation that any competent person can use to manage the system |
· Communication overhead | Unclear expectations | Moderate | Moderate | Extensively engage stakeholders and address all foreseeable issues before commencement of project |
· Inaccurate expectations | Lack of in-depth understanding of EMR systems functionality | Moderate | High | Educate the key stakeholders on what EMR systems can and cannot do |
We will need human, financial and technical resources to successfully develop and maintain the project. The following resources will be required to deliver the final product.
Resource | Quantity |
Project manager | 1 |
Project administrators | 3 |
Other project staff | 7 |
Computers and peripherals | 20 |
Stationery and office supplies | For 4 people |
Communication equipment |
To cover hospital radius |
The project will be headed by a project manager and a team of three project administrators. There will also be other stakeholders from the hospital fraternity including senior and junior staff representatives. The project management structure, with regard to communication and coordination, will be networked as opposed to hierarchical. The following are all the likely project stakeholders.
Project budget
Labour costs | Project manager | Project coordinators | Other project staff | Total |
Number of people employed | 1 | 3 | 7 | 11 |
Number of weeks employed | 15 | 15 | 12 | 42 |
Hourly rate of pay | 50 | 50 | 40 | 140 |
Hours per week employed | 40 | 40 | 40 | 120 |
Base pay | 30,000 | 90,000 | 134,400 | 254,400 |
Superannuation at 5% | 1,500 | 4,500 | 6,720 | 12,720 |
Sub total | ||||
Professional development | 200 | 200 | ||
Sub total | 31,500 | 94,500 | 141,320 | 267,320 |
Payroll tax at 5% | 1,575 | 4,725 | 7,066 | 13,336 |
Total labour costs | 64,575 | 193,725 | 289,706 | 548,006 |
Non-labour costs | Total |
Hardware equipment | 470,000 |
Safety equipment and training | 5,000 |
Meetings | 3,000 |
Communication (phone and Internet connection) | 4,300 |
Overhead costs | 2,000 |
Stationery and office supplies | 1,000 |
Total | 485,300 |
Total project costs | 1,033,306 |
NB: All costs are expressed in AUD
Project cashflow
July | August | September | October | Total | |
No. of days in the month | 31 | 31 | 30 | 31 | 123 |
Project total of 15 weeks (15x7=105) | 31 | 31 | 30 | 13 | 105 |
Days in the month as a percentage total | 29.5% | 29.5% | 28.5% | 12.4% | |
Project office first 3 weeks (3x7=21) | 21 | ||||
68% | 0 | 0 | 0 | ||
Project manager | 19,049 | 19,049 | 18,403 | 8,007 | 64,575 |
Project coordinators | 57,148 | 57,148 | 55,211 | 24,021 | 193,725 |
Other project staff | 85,463 | 85,463 | 82,566 | 35,923 | 289,706 |
Total labour budget | 161,660 | 161,660 | 156,180 | 67,951 | 548,006 |
Non-labour budget | July | August | September | October | Total |
Hardware equipment | 470,000 | 0 | 0 | 0 | 470,000 |
Safety equipment and training | 5,000 | 0 | 0 | 0 | 5,000 |
Meetings | 750 | 750 | 750 | 750 | 3,000 |
Communication (phone and Internet connection) | 1,000 | 1,300 | 1000 | 1000 | 4,300 |
Overhead costs | 2,000 | 0 | 0 | 0 | 2,000 |
Stationery and office supplies | 500 | 500 | 0 | 0 | 1,000 |
Total non labour budget |
July | August | September | October | Total | |
Total labour budget | 161,660 | 161,660 | 156,180 | 67,951 | 548,006 |
Total non-labour budget | 479,250 | 2,550 | 1,750 | 1,750 | 485,300 |
Total budget | 640,910 | 164,210 | 157,930 | 69,701 | 1,033,306 |
We will be holding periodical meetings with Mount Pleasant Hospital management representatives, who are the key stakeholders. At the meetings, we will be submitting the deliverables that were earlier identified to the key stakeholders. We will accept feedback from these stakeholders but the feedback will only be used to improve the remaining sections of the project. The deliverable meetings will be composed of the project manager, all the three project administrators and at least two key stakeholders from the hospital's management. The meetings shall be based on milestones and not on time. The following table summarizes the main communications required in the project.
Communications | Stakeholders involved | Frequency | Medium |
Presenting deliverables | Project manager, administrators, management representatives | Upon completion of deliverable as scheduled | Boardroom meetings |
Discussing milestones | Project manager, administrators, management representatives | Every fortnight | Online collaboration, boardroom meetings |
Emergency communications | Any stakeholders | As demand arises | Boardroom meetings, email |
Status updates | Project manager, management representatives | Every fortnight | Online collaboration |
Final project launch | All key stakeholders, users, staff | Upon completion of project | Launching event |
The project will require a one-time financing of a sum of AUD 752,420. The project will be exclusively financed by the management of Mount Pleasant Hospital.
Item | Cost estimates |
Project staff salaries | AUD 548,006 |
Hardware equipment | AUD 470,000 |
Safety equipment and training | AUD 5,000 |
Meetings | AUD 3,000 |
Communication (phone and Internet connection) | AUD 4,300 |
Overhead costs | AUD 2,000 |
Stationery and office supplies | AUD 1,000 |
TOTAL | AUD 1,033,306 |
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