Question: Leadership Case Study (25 Points): There are three case studies located in Appendix A of your book (Pg 441- 445) under the Donald Bradshaw section. Choose one of the three case studies, read the leadership challenge and how Dr. Bradshaw dealt with those issues of the chosen case. In 4-6 (double spaced) pages, answer the following questions:
• Describe the Marco and Micro forces influencing this situation, as if you were completing an environmental scan prior to solving the issue.
• What leadership model, or elements from leadership models, did Dr. Bradshaw deploy as he worked through this issue? Support your answer with reference to the text and one other reference.
• Describe the power and influence Dr. Bradshaw, or any leader dealing with this issue, is needed in this situation?
• Describe the decision making model Dr. Bradshaw employed in this situation.
• Do you agree with Dr. Bradshaw's approach? If so, why? If not, why? What makes him an effective or ineffective leader, in your opinion?
Back up your opinion with concepts that you learned from the text throughout the course.
Leadership in Practice: Bradshaw Case 1
Implementing an Information System: Electronic Health Record
Describe the leadership challenge of your case.
Our task was to implement an outpatient electronic health record (EHR) within our health system, which consisted of multiple, geographically separated clinics and a community hospital. We were part of a vertically integrated, staff-model, worldwide healthcare system; the EHR was developed by our parent organization, and the training package was centrally contracted. Because we were early in the process of implementing the EHR, important leadership roles were to capture strengths, weaknesses, and lessons learned concerning the EHR system. The greatest challenge was to use the EHR implementation to evaluate the entire care process and not just take our present processes of information flow, patient flow, and staff communication to the electronic record, but improve the efficiency, effectiveness, and efficacy of the care processes utilized.
Discuss how you met and dealt with the leadership challenge, and discuss the outcome or resolution of the challenge.
We addressed this challenge in several areas by utilizing a situational assessment that included an analysis of the following areas:
1. Equipment and infrastructure (e.g., computers, printers, bandwidth, classrooms).
2. Patient flow. After this analysis, we reengineered patient flow while determining the scope of practice and duties of providers and staff; we then modeled changes caused by or necessary to support EHR implementation.
3. Staffing implications for EHR implementation (not only the trainers and information management/information technology staff, but also additional support staff in clinics, appointment and admissions sections, shifting duties among present staff, dealing with labor unions, and other relevant issues).
4. Implications for reimbursement/compensation caused by decreased patient care during implementation (salary versus workload-driven compensation models).
5. Adequacy of the centrally contracted trainers compared to our organization's needs: If additional local trainers are required, how do we find, hire, and train those local trainers?
In essence, moving to an EHR across the entire system required changing our existing models of delivering care. Leadership issues in change management included the following points:
1. Developing a vision, message, and communication plan for the EHR implementation.
2. Identifying champions (physicians, nurses, support staff) for each area of the system.
3. Identifying early adopters who would stimulate change and "anchors" who were resistant to change.
4. Determining the appropriate implementation model (rapid change for the entire organization over several weeks versus clinic-by-clinic implementation over several months).
5. Determining the appropriate training model (large groups with individual follow-up versus one-on-one, over-the-shoulder, on-the-job training), structure (in groups by function versus by clinical team), and time lines. Because central contractors were deemed adequate only for the initial training, we needed additional trainers for maintenance training.
Leadership imperatives for the implementation of the EHR included the following needs:
1. Ensuring synchronization of equipment, training, and staffing
2. Ensuring adequate training, both initially and then over the long term (refresher, new employees, and revisions); scheduling; and the ability to modify training and scheduling based on individual needs and unexpected events (e.g., staff or trainer illness, system downtime, local surge in illness or demands)
3. Creating incentives for using the EHR system and publishing results
4. Developing a system to ensure rapid response to questions, suggestions, and needs
5. Celebrating success
The results of the EHR implementation were successful. Over a 9-month period, an implementation plan was developed, training was completed, and the necessary changes were implemented with a marked improvement in effectiveness and efficiency of care. After implementation, more than 95% of patients had records available at clinic visits (baseline was less than 70%), documentation vastly improved in legibility, records were linked to electronic prescriptions with improved safety, and health promotion and preventive measures were facilitated through systematic reminders and ease of tracking. Additionally, improved staff satisfaction with their new or changed roles, due to reengineering, was realized.
Over the 4 months of initial implementation, we did see 15% less productivity (e.g., more training time, slower patient flow, longer visits required, patient education) in outpatient clinics. Implementing a single EHR for primary care and specialty clinics was challenging: The EHR was developed for primary care, so specialty care applications for drawing, scanning, and other needs had to be developed. Also, EHR continues to be a challenge owing to issues related to ongoing training, accuracy of coding, and some provider dissatisfaction with movement through the electronic record (multiple screens, slow response, and multiple logins).