Telehealth System Implementation: Nursing Informatics Project

Introduction and Rationale for Project Tracking

This second part of the nursing informatics project concerns itself primarily with the tracking of project progress. Project tracking is a crucial undertaking insofar as the successful implementation of the project is concerned. Gunduz and Almuajebh (2020) observe that project tracking ought to be perceived as "the process of monitoring and measuring the progress of all activities that together compose a project" (p. 57). As those authors further indicate, the overall objective of tracking is to ensure that progress made synchronizes with the project plan as initially conceptualized. With this in mind, the current activity is especially critical for ensuring that the project is not derailed by factors that can be addressed in good time. Furthermore, there is a need to ensure that resources are managed prudently and that all crucial tasks and roles are executed by those persons deemed essential to the success of the project.

There is a need to ensure that the various key tasks are executed as per the initial plan. Relevant modifications may, however, be made going forward in efforts to ensure the successful achievement of all milestones as well as successful project delivery.

a. Proper Utilization of Resources. There is a need to ensure that the various organizational and human resources are being put to proper use. Tracking project progress will help lower the chances of delays, task dependencies, and resource deadlocks.

b. Enhanced Risk Control. By tracking the progress of the project, it becomes possible to have a better understanding of diverse scenarios and to eliminate the probability of "black swan" events. Any adverse outcomes identified can be dealt with through the application of a well-considered plan.

c. Team Motivation. There is also a dimension of team motivation whose relevance to the overall success of the project cannot be overstated. Fewer drawbacks and the ability to stick to the project schedule will motivate all those responsible for the various tasks — as identified in the RACI chart — and ensure that they remain intrinsically motivated and committed to achieving positive project outcomes.

d. Better Coordination. Tracking of project progress will also be instrumental in ensuring that all stakeholders are informed about the milestones achieved. Furthermore, all those involved will have an opportunity to deliberate on various tangibles and intangibles of relevance to the project. This results in better coordination of tasks and project undertakings going forward.

Alignment with Project Scope

The present project's scope has been identified as instrumental in ensuring the successful execution of the project, particularly in helping to ensure that there is no misalignment between the identified project objectives and project elements. Detailed assessment of the relevant project parameters indicates that the project remains within scope with respect to all aspects, including: scope description, project deliverables, criteria for acceptance, exclusions, and constraints.

a. Scope Description. The project adheres to its mandate to deliver a telehealth system that will help reduce both the occurrence and 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 is being made toward the successful implementation of a virtual platform to connect healthcare providers with patients.

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

iii. Progress is being made toward ensuring a significant reduction of in-person or "onsite" visits by patients.

d. Project Exclusions. There is sustained awareness of the following out-of-scope aspects: (i) all aspects of in-patient operations, and (ii) all aspects of lab work and radiology.

e. Project Constraints. There is sustained awareness of the following project constraints: (i) time limitations, (ii) resource limitations, and (iii) personnel limitations.

Current State vs. Future State: GAP Analysis Findings

In the first part of this undertaking, a GAP analysis was instrumental in identifying the various factors or deficiencies that the organization ought to focus on in its efforts to achieve the target state — which is the delivery of a telehealth system that will help reduce both the occurrence and the frequency of physical interactions between patients and healthcare providers. A total of four factors were identified through the development of a fishbone diagram. These factors are as follows.

i. Staff Shortage. It was established that, like other organizations in the healthcare sector, the organization has been affected by the negative consequences of a retiring workforce — a national concern (Iriarte and Bayona, 2020). Over the last 12 months, the facility lost 15% of its workforce to what is now referred to as "the retirement drain." More specifically, at the end of 2020, the facility employed a total of 27 registered nurses; by the end of 2021, four nurses from that original cohort had retired. Although no direct connection between this drain and patient mortality has been established, further assessment indicated that the retirements have resulted in increased workload for remaining nurses and decreased motivation among the workforce. It was also established that the facility lacks skilled nurses in certain specific areas, particularly geriatric nurses, pediatric nurses, orthopedic nurses, and oncology nurses — a concern further compounded by the retirement drain.

ii. Overcrowding (Outpatient). Patient overcrowding was found to be a direct consequence of the increased need for care and the size of the hospital relative to the population being served. With respect to the increased need for care, the COVID-19 pandemic triggered a threefold increase in the number of people seeking treatment for the condition or related concerns, particularly during the first year of the pandemic. Utilization of healthcare services did, however, decrease during 2021 and 2022, following the implementation of 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 that has not been accompanied by a corresponding increase in the number of healthcare facilities. The facility therefore presently serves the needs of a community whose population has almost tripled, inevitably overstretching available resources.

iii. Onsite COVID-19 Measures. Various measures have been put in place by the government and individual institutions to contain the spread of the COVID-19 pandemic, including social distancing, limitations on overcrowding, and appointment-based visits. At this facility, particular emphasis has been placed on social distancing and proper ventilation, which effectively limits the optimal utilization of facility resources.

iv. Facility Procedures. A wide range of procedures and initiatives have historically been deployed to promote efficiency and improve patient outcomes. The two initiatives identified as placing the greatest strain on facility resources are nosocomial infection minimization strategies and patient engagement strategies.

Traditionally, nosocomial infection minimization strategies have included the implementation of hand hygiene procedures and the use of proper protective equipment. More recently, the facility has sought to educate all personnel about approaches to minimize healthcare-associated infections and has implemented additional environmental infection control measures. These inevitably require the deployment of additional organizational resources in the form of personnel (for education purposes) and tools and materials.

With respect to patient engagement strategies, the facility recognizes that such engagement is critically important for promoting positive outcomes in clinical settings. A number of measures have therefore been deployed with the overall goal of ensuring that patients are actively incorporated into the care experience. These strategies include shared decision-making between patients and healthcare providers, and patient education. Both may be considered "add-on" undertakings that also require commitment of organizational resources.