Telehealth System Nursing Informatics Project

Nursing Informatics Project: Telehealth System

Part 2

Implementation

A: The Need for Tracking

This second part largely concerns itself with the tracking of project progress. It is important to note that this is a crucial undertaking in as far as the successful implementation of the project is concerned. Gunduz and Almuajebh (2020) make an observation to the effect that project tracking ought to be perceived as “the process of monitoring and measuring the progress of all activities that together compose a project” (57). As the authors in this case further indicate, the overall objective on this front happens to be seeing to it that the progress made synchronizes with the project plan as initially conceptualized. With this in mind, the current activity is especially crucial for this particular project in efforts to ensure that it is not derailed by factors that can be addressed in good time. Further, there will be need to ensure that resources are in this case managed prudently and that all the crucial tasks and roles are executed by those persons deemed crucial for the success of the project.

There is need to see to it that the various key tasks are executed as per the initial plan. The relevant modifications could, however, be made going forward in efforts to ensure successful achievement of all the relevant milestones as well as successful project delivery. Prior to the conduction of an examination on how to apply the various tracking documents developed in the first part of this undertaking, there would be need to come up with a rationale for this particular undertaking.

Rationale

a. Proper Utilization of Resources

There will be need to ensure that the various organizational as well as human resources are being put to proper use. Thus, tracking project progress will help lower the chances of delays, task dependencies, as well as resource deadlocks.

b. Enhanced Risk Control

In seeking to track the progress of the project, we shall be able to have better comprehension of diverse scenarios and eliminate the probability of ‘black swan’ events. In this case, any adverse outcomes identified so far can be dealt with via the application of a well thought out plan.

c. Team Motivation

I am also convinced that there is a dimension of team motivation whose relevance when it comes to the overall success of the project cannot be overstated. In essence, fewer drawbacks and ability to stick to project schedule will motivate all those responsible for the various tasks, i.e. as identified in the RACI chart, and ensure that they are intrinsically motivated and committed to achievement of positive project outcomes.

d. Better Coordination

Tracking of project progress will also be instrumental in efforts to ensure that all stakeholders are informed about the milestones achieved so far. Further, all those involved will have an opportunity to deliberate on various tangibles and intangibles of relevance to this particular project. This results in better coordination of tasks and the relevant project undertakings going forward.

B: Alignment with Project Scope

The present project’s scope has been identified as being instrumental in seeking to ensure that the execution of the project is successful. This is more so the case given that it helps ensure that there is no misalignment between the identified project objectives and project elements. Detailed assessment of the relevant project parameters indicates that it is still within the scope. This is in relation to all the aspects of the scope including; scope description, project deliverables, criteria for acceptance, exclusions, as well as constraints. These will be further assessed below;

a. Scope description

The project sticks to its mandate to deliver a Telehealth System that will help in efforts to reduce not only the occurrence, but also the frequency of physical interactions between patients and healthcare providers.

b. Project deliverables

i. The creation of a digital information and technology platform to connect healthcare providers with patients in virtual settings is on track

ii. The development of a resilient system capable of handling high volumes of data, so as to minimize the probability of downtimes during periods of increased utilization is on track.

c. Criteria for Acceptance

i. Progress being made towards the successful implementation of a virtual platform meant to connect healthcare providers with patients

ii. Progress being made towards ensuring that that the operation of the system is seamless

iii. Progress being made towards ensuring that there is significant reduction of in-person or ‘onsite’ visits by patients

d. Project exclusions

There is sustained cognizance or awareness about the following ‘out of scope’ aspects of the project:

i. All aspects of in-patient operations

ii. All aspects of lab work and radiology

e. Project Constraints

There is sustained awareness about the following project constraints:

i. Time limitations

ii. Resource limitations

iii. Personnel limitations

C: Assessment of Progress in terms of Current State vis-à-vis Future State

It is important to note that in the first part of this undertaking, GAP analysis came in handy and was instrumental in the identification of the various factors or deficiencies that the organization ought to focus on in its efforts to achieve the target state – which in this case happens to be the delivery of a Telehealth System that will help in efforts to reduce not only the occurrence, but also the frequency of physical interactions between patients and healthcare providers. A total of four factors were identified via the development of a fishbone diagram. The said factors are;

i. Staff shortage

It was established that like other organizations in the healthcare realm, our organization has been impacted by the negative effects of a retiring workforce. Indeed, this happens to be a national concern (Iriarte and Bayona, 2020). Over the last 12 months, the facility has lost 15% of its workforce to what we now refer to as ‘the retirement drain’. To be more specific, it should be noted that at the end of 2020, the facility had in its employ a total of 27 registered nurses. At the end of 2021, a total of 4 nurses had retired out of the original tally of nurses. Although we have not established any connection between the said ‘drain’ and patient mortality, further assessment indicated that this has resulted in increased workload for nurses and decreased motivation among the remaining workforce. It was also established that the facility lacks skilled nurses in some specific areas. This is especially in relation to geriatric nurses, pediatric nurses, orthopedic nurses, and oncology nurses. This is a concern further complicated by the ‘retirement drain.’

ii. Overcrowding (Outpatient)

It was established that patient overcrowding was as a direct consequence of the increased need for care, and size of the hospital relative to the population being served. In as far as increased need for care is concerned, a finding was made to the effect that the COVID-19 pandemic triggered a 3-fold increase in the number of people seeking treatment for the condition or other related concerns. This was especially the case during the first year of the pandemic. There was however decreased utilization of healthcare services during the years 2021 and 2022. This was more so the case following the implementation of the nationwide social distancing and stay-at-home regulations. It should also be noted that over the last two decades, the community in which the facility is located has experienced a surge in population. This has not been accompanied by a corresponding increase in the number of healthcare facilities. It therefore follows that the facility presently serves the needs of a community whose population has almost tripled. This inevitably overstretches the resources of the said facility.

iii. Onsite Covid-19 Measures

As has been stated elsewhere in this text, there are various measures that have been put in place by the government as well as individual institutions in efforts to rein in the spread of the COVID-19 pandemic. The said measures are inclusive of, but they are not limited to; the implementation of social-distancing, limiting of overcrowding, appointment-based visits, etc. In our facility, we have specifically been keen on social distancing and proper ventilation. This effectively means that the optimal utilization of facility resources is largely limited.

iv. Facility Procedures

In the past, a wide range of procedures and initiatives have been deployed in efforts to promote efficiency and improve patient outcomes. The two initiatives that have been identified as having the greatest strain on facility resources are nosocomial infection minimization strategies and patient engagement strategies. Traditionally, nosocomial infection minimization strategies that have been largely utilized are inclusive of implementation of hand hygiene procedures and utilization of proper protective equipment. On the other hand, in the recent past, the facility has sought to educate all personnel about the various approaches that ought to be used to minimize healthcare-associated infections. Further, the facility has also implemented additional environmental infection control measures. These inevitably require the deployment of additional organizational resources in the form of personnel (i.e. for education purposes) and tools/materials.

When it comes to patient engagement strategies, the facility recognizes that the relevance of such engagement cannot be overstated in efforts to further promote positive outcomes in clinical settings. For this reason, a number of measures have been deployed with the overall goal of ensuring that patients are roped into the care experience. The said strategies are inclusive of; shared decision making between patients and healthcare providers, and patient education. These could be considered ‘add-on’ undertakings that also need the commitment of the various organizational resources.

D: Adherence to Project Timeline

In essence, there are a total of 5 project tasks that were identified as requiting completion so as to attain the overall project goal of delivering a Telehealth System that will help in efforts to reduce not only the occurrence, but also the frequency of physical interactions between patients and healthcare providers. The five project tasks are;

a. Planning

b. Software/hardware selection

c. System prep and training

d. Implementation

e. Evaluation

To have a better perspective of the project schedule, a Gantt chart was developed. In this case, the various crucial project elements were assigned start and finish dates. As Bannerman (2008) indicates, the Gantt chart happens to be one of the most instrumental tools in not only the scheduling, but also the management and monitoring of a project’s resources and tasks.

In summary, of the five tasks, one has been completed in good time and within budget. The other task has commenced and is on track. The other three tasks are yet to commence – as depicted in the project schedule. A screenshot of the project schedule has been included below for ease of reference.

Figure 1: Gantt chart

a. Planning

Start: 4/4/22

End: 4/19/22

All the 5 phases of project went on as planned. The said phases have been described in greater detail below;

i. Initiation of the project

In this phase, the project was broadly defined. More specifically, it was at this point that the scope was described. It was established that the project was feasible after the various key stakeholders were engaged and ‘green light’ given for the project to commence.

ii. Conceptualization of the project

Following the determination of feasibility, the plan-do-check-act (PDCA) cycle was employed so as to come up with a proper definition of items in the ‘plan’ quadrant. Ika (2009) indicates that this happens to be an instrumental tool in project management as it serves as a checklist of sorts in change implementation as well as process improvement efforts. One of the checklist items that was included in the present context is deliverables identification. A total of two project deliverables were clearly highlighted; as the creation of a digital information and technology platform to connect healthcare providers with patients in virtual settings is on track, and the development of a resilient system capable of handling high volumes of data, so as to minimize the probability of downtimes during periods of increased utilization is on track.

iii. Project team formation

An able and competent team was formed to advance the project agenda. Those assigned responsibility for the various tasks were: Robert Strapp (planning), Andrew Clifford (software/hardware selection), Alex Jung (system prep and training), Robert Williams (implementation), and Joanna Garner (evaluation).

iv. Tasks identification and sequencing

The identification of crucial tasks to inform successful achievement of project objectives was undertaken. Towards this end, tasks identified on this front were; planning, software/hardware selection, system prep and training, implementation, and evaluation.

v. Budget preparation

The development of a budget happens to be one of the most crucial activities in as far as the successful formulation and implementation of a project is concerned. Indeed, Ward and Chapman (2003) are categorical that “a budget is the lifeblood of the project” (99). In this case, the projected costs required for the successful completion of this project were defined. To a large extent, estimates were based on historical data (specifically recently implemented projects of this nature in similar-size organizations), and expert assessment of costs. This was done so as to ensure that unnecessary pitfalls were avoided.

b. Software/Hardware Selection

Start: 4/19/22

End: 5/1/22

It is important to note that we recognized from early on that in an undertaking of this nature, there is no ‘one size fits all’ solution. For this reason, the software and hardware selected in this case had to align with the specific circumstances of the organization, i.e. with regard to the facility, resources available, size of community being served, etc. Several steps were followed in this regard:

i. Needs assessment/practice requirements (completed)

This largely involved a reassessment of the concern that required to be addressed and how the embrace of technology would be instrumental.

ii. Establishment of software/hardware specifications (ongoing)

iii. Vendor selection (pending)

iv. Negotiation of various contract terms with the vendor (pending)

c. System prep and training

Start: 5/11/22

End: 5/26/22

d. Implementation

Start: 5/11/22

End: 5/26/22

e. Evaluation

Start: 5/26/22

End: 7/10/22

NOTE: Thanks to the Gantt chart, we were able to identify the tasks that could be undertaken at the very same time. Further, tasks that could not be undertaken at the same time – and have to wait until some other tasks are completed - were highlighted.

E: Budget

The budget is on track and at present, there are no variations expected or foreseen. A breakdown of the most crucial cost elements has been given below. It is, however, important to note that the financial cost does not capture the labor hours that would be required throughout the implementation and evaluation process.

Upfront Cost

Yearly Cost

5-year Total Cost of Ownership (TCO)

Total system cost

Table 1: Entire system cost

Breakdown

a. Software

Estimate: $7,000

The need for software that could be deemed secure, safe, and simple was indicated. Further, the need for software that could be integrated with electronic health records (EHR) was highlighted. Key considerations on this front were Mend, Doxy.me., AMC Health, swyMed, and Teladoc.

b. Hardware

Estimate: $9,000

To complement the software, several items needed to be acquired. Thus, essential considerations on this front were inclusive of, but they were not limited to; tablets and laptop/desktop computers, carts, networking devices, etc.

c. Implementation Support

Estimate: $6,500

It was established that the implementation of the Telehealth system calls for the input of various players. Some of the said players are inclusive of developers, consultants, analysts, trainers, as well as the in-house team highlighted elsewhere in this text.

d. Training

Estimate: $4,500

Proctor, Powell, and McMillen (2013) make an observation to the effect that the relevance of staff training in change efforts cannot be overstated. This is more so the case in those scenarios that are rooted in information and communication technology – i.e. as is the case with EHR implementation and Telehealth system implementation. For this reason, we identified the need to support staff utilization of the Telehealth system by ensuring that ongoing training was budgeted for.

e. Ongoing Costs

Estimate: $2,000

There are inclusive of all those costs associated with ensuring the optimal performance of the Telehealth system as well as meeting emerging needs of the said system going forward. The ongoing costs that were identified in this case are inclusive of; training, hardware replacement, software maintenance, optimization needs, etc.

F: Task Responsibility Assessment

The need for teamwork was established from early on. Powell, McMillen, Proctor, Carpenter, Griffey, and Bunger (2012) are of the opinion that a project’s chances of success are largely dependent upon collaboration between team members, and the extent to which each player is committed towards the overall project success. In the present scenario, responsibility for the tasks was indicated using the RACI matrix. Flottorp et al. (2013) indicate that “a RACI chart organizes your project so that everyone knows what’s happening” (11). It therefore follows that this particular tool came in handy in our efforts to establish the team members responsible, accountable, those to be consulted, as well as those who ought to stay informed. The tool was especially instrumental in the accomplishment of five principal functions;

a. Effectively define project roles

b. Promote synergy

c. Reduce miscommunication

d. Enhance coordination

e. Increase productivity

It is important to note that one project activity (planning) has been accomplished and one other activity is ongoing (software/hardware selection). The three other activities (i.e. system prep and training, implementation, and evaluation) are pending. For this reason, there would be need to assess the responsibility of team members in relation to planning and software/hardware selection – within the RACI framework. The table below has been developed for this particular purpose.

In basic terms, it should be noted that of the four factors factored into the RACI framework;

Responsible was meant to identify the team member(s) charged with the actual completion of a specific task

Accountable was meant to identify the team member(s) charged with decision making with regard to certain tasks

Consulted was meant to identify team member(s) to be reached out to about decisions touching on certain tasks

Informed was meant to identify team member(s) to be notified or brought up to speed about decisions touching on certain tasks.

Project Activity

Responsible

Accountable

Consulted

Informed

Planning

1. Project manager

1. Project manager

1. Application developer

2. QA test engineer

3. Physician advocate

4. Nurse advocate

1. Super users

Software/hardware selection

1. Application developer

2. QA test engineer

1. Project manager

1. Physician advocate

2. Nurse advocate

3. Super users

Table 2: Application of RACI framework to planning and software/hardware selection project activities

Assessment

In seeking to assess the performance of the team members indicated above, the 5-point performance rating scale was utilized. Items on this front were;

1-unacceptable

2-needs improvement

3-meets expectations

4-exceeds expectations

The performance of the three team members in as far as responsibility is concerned has been evaluated in the table below;

Planning

Software/hardware selection

Project Manager