Scholary Project Synthesis Paper NCory

7/30/2019 Scholary Project Synthesis Paper NCory

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Running head: SCHOLARLY PROJECT SYNTHESIS PAPER 1

Scholarly Project Synthesis Paper

Nicole Cory

Ferris State University


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SCHOLARLY PROJECT SYNTHESIS PAPER 2

Abstract

This paper summarizes and analyzes a project managed and completed by this student during the

summer semester of 2013. The scholarly project is an opportunity for the student to learn and

understand the role of the informatics nurse specialist (INS) through experience. According to

the ANA, within the INS role the key responsibility is often implementation. During this project

a mobile application was developed and implemented which will be used at Pine Rest to collect

feedback and other data related to patient care. Also in this paper, the evidence to support the

project are described and analyzed. An evaluation of the experience performed by the student

and preceptor is also included.

Key words: project, informatics nurse specialist


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Scholarly Project Synthesis Paper

Managing and completing a project provides an opportunity for a student to gain

knowledge and skills that may not be attainable through study and research alone. The

experience requires the student to apply knowledge gained during the program as he or she

immerses herself in a common role of the informatics nurse specialist (INS), as project manager.

Project management is a highly desired and utilized skill for the INS (ANA, 2008). Project

management is such an important part of the INS role that it has been recommended that colleges

begin to integrate information technology project management into the informatics curriculum

(Sockolow & Bowles, 2008). Managing a project is a difficult task, and much is learned by the

student while under the guidance of a preceptor with project management experience.

As a student I was able to perform the majority of tasks the project with only supervision

from my preceptor. I was involved in analyzing current practices related to a paper process

described as cumbersome and time consuming (S. Koons, personal communication, June 19,

2013). I helped to identify technology that could replace the paper process and improve the ease

of data collection at Pine Rest. I worked with the information technology (IT) department to

obtain a quote from a software development company outsourced by Pine Rest and obtained

approval of the budget by leadership. I helped to develop job aids, guidelines, and policies

related to the use of the new technology as well as to safeguard the data collected by clinicians. I

performed training on the use of the technology and assisted in expanding the use of the

technology to other types of data collection beyond the InfoProject.

This paper will describe a project performed by this student at Pine Rest Christian Mental

Health Services with Pam Hietbrink, RN-MSN, an experienced INS. The goals and objectives

related to this project are described. The paper also discusses personal and professional


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accountability as it relates to the project. There is also a comprehensive description and analysis

of project outcomes and a detailed discussion of adherence to legal, ethical, nursing, and

organizational standards. An evaluation is included in this paper with copies of the evaluation

performed by the student, preceptor, and several project stakeholders found in Appendix A. The

paper then provides recommendations for future implementation of similar projects.

Description of scholarly project

The project involved the development and adoption of a software or application. The

technology will be used by the clinical service managers to collect feedback from patients for the

info project. The goal of the info project is to get patients involved in their care and make sure

their voice is heard. The development and implementation of informatics solutions that can be

utilized to automate processes and support clinical decision making can drastically improve

patient outcomes (Amarasingham, Plantinga, Diener-West, Gaskin, & Powe, 2009). This

technology would improve the process in place at Pine Rest.

The use of paper forms to collect data often resulted in delayed data analysis and decision

making (S. Koons, personal communication, June 19, 2013). The paper forms also introduce

potential for lost forms and missing data. Utilizing technology, we hoped to prevent these

occurrences. Innovative technology has been cited as a tool for improving the quality of

healthcare (Institute of Medicine [IOM], 2012). The use of information technology in

healthcare has been shown to reduce mortality, complications and costs in some organizations

(Amarasingham et al, 2009). As of February 2010, there were over 6,000 mobile apps related to

health and healthcare (Sarasohn-Kahn, J., 2010). This is evidence that mobile technology has

become common enough that Pine Rest might reconsider this policy and consider the potential

that mobile technology has to positively affect patient care. The use of technology in this


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instance could improve patient outcomes and satisfaction by providing actionable data on a

concurrent rather than retrospective basis.

Project Goals

The goals and objectives of this project revolve around the overall goal of implementing

a technology solution to improve an informatics related issue. The goals were to evaluate the

current state at Pine Rest to identify a situation where technology could improve practice.

Another goal was to understand the technology at Pine Rest in order to select and implement a

solution compatible with their current framework. Then we sought to obtain approval of the

solution and a budget for the development of the solution by leadership. The next goal was to

demonstrate the solution for the end-users and gain feedback in order to address any potential

issues with the build. The final goal was to educate and prepare the clinical services managers

on the use of the solution.

Project Objectives

One objective of the project was to identify problems related to the process of collecting

information for the info project at Pine Rest. According to the ANA (2008), standard two for the

INS includes the assessment of informatics related problems, needs, or issues. To do this we met

with the quality department analysts and the lead clinical service manager to discuss the info

project. This was identified early-on as a process that might lend itself to the use of technology.

Our analysis resulted in findings of lost data, potentially skewed data due to being collected by

staff instead of management, and late data receipt.

Another reason for selecting this project as our focus was the enthusiasm of several of the

end-users in changing the process from paper to technology. This enthusiasm pointed out the

willingness to change among some of the stakeholders of the project. According to Kurt Lewins


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change theory, ongoing staff involvement is essential to the phase of unfreezing, which may not

be accomplished if staff doesnt agree that there is a need for change and that the change will

improve their work (Kristonis, 2004).

The next objective was to perform an analysis of the technology in place at Pine Rest in

order to support the selection of compatible informatics solutions. Through meetings with

information technology (IT) staff and a survey of the clinical service managers we were able to

identify a couple of potential solutions. The INS must be able to navigate the complex

relationship between computer science and nursing science (ANA, 2008). The development of a

mobile application from scratch was identified as a potential option, but due to our limited

knowledge of mobile app development and lack of confidence in the security of data collected

using a mobile app we chose to investigate a software application that was already in use in the

IT department that could be scaled to a mobile screen and accessed via a link on any mobile

device through the hospitals intranet.

Another objective was to identify potential solutions to previously identified issues, and

research the cost and benefits of each solution. We had already decided that we would

investigate the technology identified by Dallas Thiel in IT and had considered this to be the most

cost-efficient option as it had already been in use and would require minimal modification. We

also looked at Info Path form development and the use of the survey templates that came

standard with the hospitals version of the Sharepoint software already in place at Pine Rest. We

decided that these were not user-friendly, customizable, nor did they come with adequate

graphing capabilities. InfoPath and Sharepoint were limited as they only allowed the user to

export the data to excel and manually manipulate the data into charts and graphs.


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The next objective was to demonstrate the technology to the end-user and collect

feedback. In three meetings the survey tool was demonstrated to the clinical service managers

and the quality department analysts. I took notes on their reactions and questions and we sought

to obtain answers from IT on any questions we were unable to answer on our own. There were

some questions around the customization of the surveys and the security of the data.

Another objective was to develop a project proposal and use it to gain the approval of the

solution and a budget for the solution. During the semester I worked on a proposal to submit to

the nursing leadership and quality department director. The proposal was submitted to the

individuals and utilized to seek approval of the technology. The proposal identified that I would

perform education and training on the use of the technology as well as submission of requests for

new surveys. The proposal described who would be responsible for the technology post-

implementation and a plan for the evaluation of the technology after 2 weeks of use, one month

of use, and three months of use. The Health Information Management Systems Societys

technology adoption framework talks about defining team roles and responsibilities early on in a

project (Health Information Management Systems Society [HIMSS], n.d.). It is imperative to

include this information in your written proposal which serves as a guide throughout the project.

Our final objective was to educate the end-user on the use of the solution and implement

the solution. I showed the clinical service managers how to use the tool and provided support as

they first attempted to collect information using the tool. I also provided them with job aids with

step by step instruction and screen shots to assist them in using the survey when they were on

their own. Job aids are part of the training and education stage in the technology adoption

framework (HIMSS, n.d.). I also showed them how to submit a request for the survey and

described the types of surveys that would be appropriate.


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Professional and Personal Accountability

In order for successful project completion one must demonstrate personal accountability

for the deliverables assigned to them. Accountability is a major factor in the success of any

project, large or small. The project manager must work to instill a sense of accountability within

the project team in order to get the deliverables completed (Simon & Canacari, 2012). Without

accountability among the project team it is impossible to deliver a product within the projected

timeframe for completion.

Part of personal accountability is in the communication among the project team.

According to the Project Management Body of Knowledge (PMBOK) (2008), communication is

required to ensure timely project completion. They state that project managers spend much of

their time communicating with individuals both internally and externally to the organization.

Personally I committed to communicating regularly with those involved. When things change or

decisions are to be made, communication is extremely important. As the project manager, I

made myself available via phone or e-mail and always respond to questions, e-mails, or phone

calls within the same day. During this project we spoke face to face, held phone conversation,

and sent e-mails.

Collaboration with other disciplines is an essential part of the INS role. Several projects

cite collaboration as a critical success factor. An implementation of a barcode medication

administration system utilized teams of nurses, pharmacists, information technologist, vendors,

and respiratory therapists (Ross, 2008). Collaboration among multiple disciplines was cited as

an integral component of the project and shared responsibility and effort had a positive impact on

the outcome of the project.


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Another way I made myself and others accountable was by developing and committing to

a project timeline. This project was dependent on feedback from others. We did not obtain a

quote from SpringThrough until one of the final few weeks of the project. This did not meet our

timeline. Luckily this was not detrimental to the project as we were able to move forward with

several other deliverables as we waited. I believe this happened because we did not set

expectations with the software company by giving them a date we expected to receive the

information requested.

I was personally responsible for many of the deliverables during this project and was able

to maintain project deadlines when I wasnt waiting on another individual. The development of

job aids, request forms, and a policy rough draft were also completed by me with assistance of

my preceptor. My preceptor also held herself accountable and was available during the hours we

had assigned to the project and attended all meetings to which she had committed.

Description and Analysis of Project Outcomes

The outcome of this project was an electronic method of collecting survey data. The

survey can be accessed through the hospitals intranet or a link sent to an individual or group via

their internal e-mail. There were several issues, concerns, and challenges related to the

development of a new technology for use at a behavioral medicine facility. These concerns

included, HIPAA, team human resource management, end-user resistance, and organizational

policy concerning the use of mobile devices.

The first major concern was the security of the data collected using the new technology.

The Health Insurance Portability and Accountability Act (HIPAA) requires that certain

safeguards are in place in order toprotect the privacy of patients health information

(Department of Health and Human Services [HHS], n.d.). We discussed privacy at length with


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the IT representative for this project as well as the software vendor. They assured us that

because the survey is accessed through the intranet and not truly housed on a persons mobile

device, the information would be secure. We also decided that in this survey, the only

information collected related to the patients identification would be the patients initials and the

room and bed they were in at the time of the data collection. This would further safeguard the

data.

Current policy at Pine Rest prohibits staff from utilizing mobile devices on any of the

units within the hospital. Pine Rest will need to adopt a bring your own device policy (BYOD).

BYOD is a concept some organizations have become accustomed to and for which policies have

been developed. Pine Rest has yet to utilize mobile technology in practice, therefore there is a

policy in place banning staff from using smart phones on the inpatient units in order to prevent

workers from checking their social networking sites and texting on the units during work hours.

Bring your own device (BYOD) policies exist in many organizations today. The BYOD

policy seeks to regulate the types of devices used and the ways they are being used in the

workplace including prestigious organizations such as the Pentagon (Armando, Costa, Merlo, &

Verderame, 2012). Most BYOD policies include a way to prevent a person from introducing

malware and viruses into the system and also contain and protect any sensitive information

related to that organization (Armando et al., 2012). This often includes implementing additional

security on the personal device as well as to register the device with the organizations system so

it is recognized.

Pine Rest is in a position to reconsider this policy as mobile technology is beginning to

emerge as a valuable tool for the clinician. Major organizations like Johns Hopkins have

deployed mobile technology to support physicians and nursees, (Wierz, Kurliand, Christina,


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Collins, & Martin, 2013). Birmingham Childrens Hospital is using mobile technology to

receive feedback from patients and families (McLoughlin, 2013). Jane Phillips Medical Care

developed a mobile app for nurses to use during their shift to document medication

administration and review plans of care (Williams, 2012). UPMC is using an eVisit app to

assess patients and determine if they really need to come and see a physician for their ailments

(Williams, 2012). We worked with information technology from the beginning of the project.

We discussed this issue in the first meeting with the IT representative who stated the policy

could be modified to allow for the use of mobile devices in certain situations. I also drafted a

revision of this policy for their use in order to allow for the implementation to occur without

violating policy.

Team management and development in this project was imperative to its success. When

implementing or developing technological solutions, the INS must be sure to collaborate with IT

professionals as well as the end-user in order to develop usable solutions (ANA, 2008). A major

aspect of project management is managing human resources (Project Management Institute

[PMI], 2008). The team is comprised of many members who need to be assigned roles and

responsibilities. Selection of appropriate team members is imperative to the project success.

During this project, we were able to involve several enthusiastic and committed individuals.

Without their commitment to the project, we would not have been able to implement the

technology successfully.

Selection of an appropriate solution for an informatics related issue is a major aspect of

an informatics project. Having excellent clinical and IT knowledge can assist the INS in

selecting the best solutions for the end-user (ANA, 2008). The INS has to be able to speak both


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languages in order to convey the needs of the end-user; he or she must be able to speak

knowledgably among clinicians as well as information technology staff members.

It is imperative for the INS to advocate for improved practice and to monitor for

problems caused by or exaggerated by informatics solutions. According to the Joint

Commission, over-reliance or under-reliance on information systems in healthcare can cause

harm to patients (Mitka, 2009). This is an issue that must be monitored and managed by the

INS. Sometimes technology is the key to improving the efficiency of work in healthcare and this

is something I also noted during the practicum semester. During the analysis and discussion

around the patient rounding process it became evident that technology could reduce the time it

took to round and improve the consistency and speed of which the information was shared. It

also will provide data more quickly in order for leadership to review for compliance with this

practice which is an organizational goal. Even so, it is important in this role to realize that

technology is not always the answer, and to be careful to remain open-minded when selecting

informatics solutions.

Another potential issue for this project was the potential for resistance to the use of the

technology by the end-user. Lewins change theory has been utilized as a framework for the

implementation of change in many different organizations and projects (Cashin, Fowler, &

McGarry, 2012). Lewin states that for change to take effect it must be the result of collaboration

with the group. Therefore, the end-users of the proposed technology were involved throughout

the project. We held meetings with them and demonstrated the product as soon as we had

something to show them. We asked their opinion and attempted to answer any questions that

came up during the project.

Evaluation of Project


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The first goal was to evaluate the current state at Pine Rest to identify a situation where

technology could improve practice. This was completed and an appropriate solution was

identified. The next goal was to understand the technology at Pine Rest in order to select and

implement a solution compatible with their current framework. Through collaboration with the

IT department, we were able to complete this goal early on. Then we sought to obtain approval

of the solution and a budget for the development of the solution by leadership. This goal was met

as we submitted our proposal for the project to the leadership and the quality department

accepted ownership and budget for the technology costs. The next goal was to demonstrate the

solution for the end-users and gain feedback in order to address any potential issues with the

build. This was completed through demonstrations held at the clinical service manager and

quality department meetings. The final goal was to educate and prepare the clinical services

managers on the use of the solution. This was completed through one to one assistance and

discussion.

There were some things I had wished to accomplish or that I had hoped to gain

knowledge of during this project. The original plan for the project was to take our IT knowledge

and resources and complete the development of the mobile solution ourselves. This would have

been a valuable experience and would have provided invaluable opportunity to delve further into

the standard of knowledge of information technology. However, due to constraints in time,

resources, and knowledge, it was decided that developing a mobile application from scratch was

not an attainable goal.

An evaluation tool for this project has been included in this paper (see appendix B). The

tool was developed using a Likert scale which appropriate for this evaluation because it is mostly

used to assess an attitude or belief on a certain topic (Losby & Wetmore, 2012). The Likert scale


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uses a declarative statement that supplies a negative or positive attitude which is used to obtain a

response that is definitive. This tool uses a 5-point Likert scale with responses starting with

strongly agree to strongly disagree which provides the rater with an opportunity to respond

either positively or negatively (Losby & Wetmore, 2012).

The TIGER initiative makes recommendations for informatics competencies that were

utilized in guiding the development of questions for this survey. The recommendations were

developed in relation to the push for nurses to become adept at using technology to document

and perform patient care tasks (TIGER, n.d.). The knowledge that some nurses, due to their age,

may not have received formal training in the use of computers or other technology, while other

younger nurses have grown up with technology (Tiger, n.d.). The TIGER recommendations

were used as a guide toward the development of this evaluation tool. See appendix B for the

evaluation tools completed by the student and the preceptor for the project.

Recommendations for Future Implementations

In future implementation projects I will be sure to do a couple of things differently. First

of all, I will always develop a project timeline and communicate clear expectations with all

stakeholders on a regular basis. This time we did not provide the technology vendor with a

deadline and he did not deliver within what I would consider a timely manner. Had we set clear

expectations and deadlines with all parties, this may not have been an issue.

I will definitely utilize the HIMSS Technology Adoption Framework and the PMBOK as

a guide in project management in future implementations. These two resources served as a

wonderful guide to all the different aspects of managing a project. Using the PMBOK, I was

able to develop a project plan, or project charter if you will, that was utilized throughout the

project to keep on task. The project charter is a document that serves several purposes. The


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charter is used to formally authorize the project including the budget, stakeholders, plan, and

major deliverables and responsibilities among the project team (PMI, 2008).

The definition of project scope using a project charter actually decreases the incidence of

project failure, or delays because it prevents scope creep. Scope creep is results from adding

deliverables to a project without being authorized or managed (PMI, 2008). To control this

phenomenon, all changes and additions are added to the project charter and reviewed and

approved or disapproved by all stakeholders and modifications to the project timeline, deadlines,

and budget are made as needed. Without this control, the timeline can remain the same, but the

deliverables increase until it is impossible to complete the project on time or within the

previously allotted budget (PMI, 2008).

The technology adoption framework is a useful tool for project managers as it is able to

incorporate both technical aspects of project management as well as change management

methodologies (HIMSS, n.d.). This framework talks about defining scope as well as team

repsonbilities, but also describes the steps to plan for change management. This includes

developing a change management plan, workflow analysis, and stakeholder analysis. End-user

resistance is to be anticipated when change is attempted (McCarthy & Eastman, 2010). Because

of this phenomenon, these techniques, incorporated within the traditional project management

strategies, allow for a more successful project because they consider the need for managing the

change and preparing the organization for the change.

One thing that I feel we did right was to be conscientious when you are making decision

in the project and recognize when decisions are for your own benefit, versus the benefit of the

organization. The INS has responsibility to By choosing to expand the use of the technology

already in place we lost the opportunity to learn about mobile application development, but the


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organization saved money and time and the end-result is just as effective. We also avoided

project failure by utilizing the resources available to us, rather than embarking on a project with

unobtainable goals which may have been the case had we stubbornly adhered to the original goal

of developing a mobile application from scratch. During the decision-making process Pam

assisted me in seeing that the safer bet would be to adapt the existing technology, rather than

gamble on developing an application that might not be widely adopted.

Conclusion

Completing this project provided me with experiences with the competencies related to

project management which is an imperative skill for the INS. The hours I spent at Pine Rest with

Ms. Hietbrink will provide a foundation for completing many projects for the duration of my

future in the INS role. I will continue to learn and expand upon the knowledge gained from

working with my preceptor and hope to gain project management professional (PMP)

certification in the near future. This was a valuable experience as I was able to experience the

different stages of a project first-hand.

By assisting in the selection, development, and implementation of a technological

solution to an informatics related issue, I gained experience with the competency of

implementation. Through involvement in this project I have become more comfortable with

managing implementation type projects. Because I was involved in all stages, I will be able to

take this experience and implement it into my practice. I have a strong suspicion that many

organizations could benefit from translating their paper processes to technology, even to mobile

technology where real-time collection is appropriate.

Because of my knowledge of and belief in Kurt Lewins change theory, we chose to

involve the end users in the analysis of the issue, and brought them in to help evaluate the


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proposed technology. This gave us feedback and information from those who would be tasked

with utilizing the technology in practice, and also gave us a realistic expectation of the adoption

of the technology by those groups. The technology adoption framework provided a guide to the

steps required to move from the current state using paper to the future state using technology.

I have come to believe that it is my responsibility, as the INS, to assist in the

development of solutions that are not disruptive to the workflow of the clinician, and only

implement change when the benefits are clear and measurable. What was helpful in this project

was that we had a survey to demonstrate for the end-user early on, and we were able to request

the ability to modify the technology after the software development company turned the reigns

over to us. This gave us opportunity to modify and tweak the product as time goes on and things

change. Through the use of gained knowledge from theory and research I was able to

successfully complete a project that will improve my practice as an INS, and this experience has

prepared me to fulfill the role of the INS after graduating from Ferris State University.


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References

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revolutionizing healthcare, use case study: The Johns Hopkins Hospital. Retrieved from

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Appendix A

Screen Shots of Survey Tool


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Appendix B

Completed Evaluations

Evaluation for Clinical Scholarly Project Summer 2013

Student: Nicole Cory Preceptor: Pam Heitbrink, MSN Nursing Informatics Specialist

Evaluation completed by __Nicole Cory__________________________

1= Strongly agree 2=Somewhat agree 3=neutral 4=somewhat disagree 5=strongly disagree

1. This student demonstrates understanding of the importance of information management

to clinical practice.

1 2 3 4 5

2. The student understands regulatory standards and guidelines and their relationship to

information management.

1 2 3 4 5

3. This student demonstrated understanding of the importance of privacy and security of

information systems.

1 2 3 4 5

4. The student demonstrated personal and professional accountability for the project

completion.

Comments: I have learned many different ways that information can affect clinicalpractice. The use of information management extends beyond the documentation

of clinical practice and is also used to support organizational decision making and

the goals of meeting business and regulatory goals and standards.

Comments:

Comments: Knowledge of regulatory standards and guidelines is an ongoing

learning experience. I understand that the INS must be aware of the guidelines and

know when he or she needs to seek the assistance of other more knowledgeable

team members.


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1 2 3 4 5

5. The student demonstrated the ability to work with multidisciplinary teams to accomplish

information management work.

1 2 3 4 5

6. The student demonstrated the ability to utilize different technologies and systems to

manage information.

1 2 3 4 5

7. The student demonstrated understanding of change management methodologies.

1 2 3 4 5

Reference

Technology Informatics Guiding Education Reform (TIGER) (n.d.) Informatics competencies for everypracticing nurse: Recommendations from the TIGER collaborative. Retrieved from

http://www.tigersummit.com/uploads/3.Tiger.Report_Competencies_final.pdf

Comments: During the project we explored more than one type of technology that

could be utilized to manage the same information.

Comments: We worked with IT, nurse managers, and quality during this project to

accomplish our goals. The experience was valuable in solidifying my

understanding of the need for collaboration in the practice of the INS.

Comments: I was able to complete the deliverables to which I was committed

within the time frame previously defined.

Comments: Change management is very difficult and I believe it would take years

of experience to become a successful change manager. I hold a novice amount of

knowledge related to change management.


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Evalutation

Preceptor for Student Nicole Cory


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Documents

Scholary Project Synthesis Paper NCory