Case Study

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.

PROBLEM STATEMENT

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.  

PROJECT MISSION STATEMENT

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.

PROJECT GOALS, OBJECTIVES AND STRATEGIES

Project goal

The goal of the project is delivering an electronic records management system for Mount Pleasant Hospital.

Project objectives

The following are the objectives of the project:

1. Define the patient records management problem at Mount Pleasant Hospital and prescribe a solution to it.
2. Design, develop, and maintain the proposed electronic medical records system.
3. Conduct staff training on the new system to ensure its effective use.
4. Present the project brief and deliverables to the Executive project staff

Project strategies

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

Objective 3: Conduct staff training on the new system to ensure its effective use.

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

DELIVERABLES

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:

1. Problem statement
2. Scope of project statement
3. Work breakdown structure
4. Risk analysis and contingency plan document
5. Required project resources statement
6. Project budget and cash flow document
7. Staff training module/ plan/ documentation
8. Fully functional electronic records management system

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

RISK AND CONTINGENCY 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:

1. Project delay

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.

2. Changes in scope of the project

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.

3. Key stakeholder turnover

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.

4. Communication overhead

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.

5. Inaccurate or conflicting expectations by users/ stakeholders

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.

Table: Risk assessment

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

PROJECT RESOURCES REQUIRED

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

PROJECT MANAGEMENT STRUCTURE

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.

1. Project manager: They will be in charge of the overall project. They will appoint the project administrators and other project staff
2. Project administrators: They will be in charge of coordinating specific units of the project such as hardware deployment, software development, software installation and user training.
3. Other project staff: They include the technicians who will do the actual development or customisation of the software and hardware installations.
4. Mount Pleasant Hospital management representatives: They are the clients and project initiators. They will specify the system's functional requirements.
5. Mount Pleasant Hospital junior staff: They will be the main system users after the project is completed. They will provide the non-functional requirements of the system.

6. BUDGET AND CASHFLOW

   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

COMMUNICATIONS AND REPORTING

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

 

Appendix

Budget

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

• Budget assumptions

1. Project plan is developed in three weeks, project is proposed to be developed in three months
2. Average hourly rate is AUD 50 for the project manager and administrators; and AUD 40 for the other project staff
3. Work is done on a regular shift eight hours a day, five days per week.
4. Employer contributes 5% of pay to superannuation
5. Saturday and Sunday are not working days