Part 1: Planning
Quality projects and initiatives are essential for improving care quality via implementing evidence-based practices and protocols in nursing practice. As DNP-prepared nurses, we play a vital role in leading evidence-translation efforts to support these improvements. This paper discusses a proposal for developing and expanding telehealth into psychiatry at the correctional facility I currently work at, guided by project management tools. The components of the project included in this paper are the SWOT analysis, gap analysis, a work breakdown structure, a timeline of activities, a change management plan, and a risk management plan. Documentation of the project implementation plan and an evaluation of its progress is also provided.
Background of the Nursing Informatics Project
Telehealth use has rapidly expanded significantly in the last few years as various healthcare institutions rushed to adopt this technology in response to the Covid-19 pandemic. This expansion has been facilitated by the growing body of evidence indicating that telehealth is an effective intervention with similar quality of care as face-to-face interactions. Telehealth is also associated with several benefits, including better delivery of patient care, enhanced quality, and lower costs of care delivery (Mahtta et al., 2020). In addition, telehealth has been described as having the potential to address several disparities and challenges today. In mental health, telehealth or telepsychiatry has also improved access to mental healthcare services, particularly in areas with accessibility issues, such as remote areas, and promoted flexibility (Gude et al., 2021). With these benefits, telehealth is expected to continue playing a major role in the delivery of mental healthcare services.
Prisons and correctional facilities are known to face many challenges, one of them being related to the delivery of healthcare services. Latifi et al. (2021) reported that the delivery of care services is complex, expensive, and lacks uniformity. This is further complicated by the fact that prisons have one of the highest degrees of disease burden since over% of inmates have multiple chronic conditions (Latifi et al., 2021). Furthermore, inmates with mental health issues often lack access to essential mental health services, a challenge that can be partly addressed by telehealth. Telepsychiatry for prisons and correctional facilities is an effective care delivery model that addresses several challenges faced in this setting. For example, telepsychiatry offers unique advantages, including facilitating better access to mental health services, lowering the costs (i.e., compared to transporting an inmate to an outside psychiatric facility), and eliminating exposure to the prison culture and bureaucratic protocols (Kaftarian, 2019; Latifi et al., 2021). For these reasons, telepsychiatry for correctional facilities is a sensible and attractive option with many potential benefits.
Communication with the Nurse Leader
Nurse leaders are recognized as catalysts for improving quality because of their unique position to influence many aspects of quality improvement, including amassing resources, creating a supportive culture, engaging nurses and other stakeholders, and leading change (Stanley et al., 2008). For these reasons, I engaged the nurse leader to obtain feedback about the proposed project and guidance on how to proceed. The nurse leader liked the idea of implementing a telehealth project in the facility.
The nurse leader was aware of the general trend that access to healthcare services in correctional facilities has generally been low and challenging due to the several multifaceted constraints, including security, culture, and resources. She described some of these challenges as safety concerns among the healthcare professionals and traveling costs which often deter and increase the opportunity costs of providing mental care for inmates. She also pointed out that while the facility has a dedicated psychiatrist who visits the facility twice weekly, the large and increasing number of inmates requiring psychiatric services has made it difficult for the psychiatrists to provide comprehensive care. As a result, psychiatrists mainly provide minimal therapy, which is inadequate. Therefore, according to the nurse leader, telepsychiatry was a good idea for the facility.
Besides the nurse leader, I also spoke with one of the facility’s management representatives, one of the captains, who was also receptive to the idea. This captain also appreciated how telehealth could improve care for inmates. She gave an example of how increasing access to mental health for inmates at the facility would reduce altercations with guards or other inmates while incarcerated. She also pointed out the likelihood that inmates who received psychiatric services would likely be more productive members of society. According to this captain, she had heard of another larger facility that implemented a similar project and was convenient and with minimal risk compared to transporting the inmate out of the facility or bringing in a specialist to the facility.
The above views indicate the acceptability of telehealth in correctional facilities. Previous studies have also established that inmates and providers generally accept teleconsultations via video consultations (Senanayake et al., 2018). These teleconsultations often entail screening, diagnosing, counseling, disease management, and telepsychiatry (Senanayake et al., 2018). This systematic review also reported that inmates preferred telepsychiatry consultations, especially for sexual-related concerns (Senanayake et al., 2018).
In terms of what is needed for this project, we discussed the resources needed, particularly new infrastructure such as a telehealth provider, physical infrastructure such as computers and a private room, and securing a contract with additional providers who will provide the teleconsultations. However, the nurse leader voiced a concern that while these resources are readily available, some were a bit costly. However, this cost would be justified by the potential benefits of implementing this project, as discussed above.
SWOT Analysis
A SWOT analysis is beneficial when determining the potential opportunities for starting a new project. It is a strategic planning process that allows the identification of internal and external strengths and threats and allows the organization to utilize its strengths to mitigate threats and establish short and long-term goals to attain competitiveness (Garcia-Dia, 2019). This tool is essential in project planning because it helps highlight some issues that must be closely monitored (i.e., the combination of weaknesses and threats) (Garcia-Dia, 2019). The following is a SWOT analysis of the correctional facility with regard to implementing a nursing informatics project.
Appendix A contains the SWOT analysis chart. Clearly, there are several strengths of implementing the telehealth project to facilitate virtual mental healthcare services in the facility. Some of these benefits include increasing access to care and possible cost-savings for the facility; proven effectiveness of this intervention in correctional facilities, good acceptability, and potential to eliminate several barriers that often maintain challenges faced in delivering care in prisons (e.g., prison politics, local institutional mood, and heavy restrictions) (Kaftarian, 2019). Besides enhancing accessibility, this project also has the chance to bring the much -needed quality care to one of the most underserved populations.
Despite these benefits, several issues threaten the project. The first weakness is the unique prison culture, which, in many cases, prioritizes security and safety over other issues. These protocols will likely limit how telehealth spaces will be organized (Kaftarian, 2019). Additionally, since the facility was constructed several years ago when telehealth was not included in the designs, obtaining appropriate space that ensures adequate confidentiality can be challenging. Furthermore, this project requires significant capital and resources to purchase physical infrastructure such as monitors, internet, and/or procure telehealth software from vendors. Telehealth providers will also require competitive retainers. A cost-benefit analysis of all these costs would be developed to justify why this expenditure is necessary. There are several threats to the implementation of this project as well. The main threats include the overall prison culture, shortage of providers, and legal provisions. For instance, the prison culture, which is often characterized by a survival mindset, along with the challenges above related to confidentiality, may threaten the value of this project, particularly after implementation.
Gap Analysis
A gap analysis was also performed to determine and identify the gaps that must be bridged in order to move the organization from the current state to the expected state (Sipes, 2020). This analysis was completed by identifying the current characteristics of mental health care in the correctional facility, the desired features of this care, and the steps needed to achieve the desired state. This process is summarized in Appendix B.
Overall, the current state of the facility reveals several issues that affect the quality of mental health care at the facility. For example, the mental healthcare provider sees patients on specific days of the week. Providers are subjected to “standard” security checks, which restrict what to bring to the treatment setting (Senanayake et al., 2018). Furthermore, psychiatrists may be affected by the “local prison mood, and providers may be at risk of immediate physical danger, which may affect their focus. Because of these reasons, mental healthcare providers face increased pressure when providing care at prison facilities. On the contrary, implementing telehealth could address most of these issues. For example, telehealth will allow healthcare providers to see patients more frequently while experiencing no fear related to their safety, thus allowing them to focus better on their work (Senanayake et al., 2018). Additionally, telehealth will allow providers to provide care independently without the influence of prison politics (Senanayake et al., 2018).
Work Breakdown Structure (WBS)
The WBS is a tool used to outline the details of the specific tasks and activities of the project (Sipes, 2020). This document also shows and helps organize tasks into a roadmap or interrelated tasks to be executed by the project team. The project leaders, with input from other project team members, are usually responsible for creating the WBS. Creating this tool is essential to enable the project team to know areas where things can go wrong, avoid repeated plans, and facilitate clear work assignments (Burghate, 2018). Appendix C outlines the key milestones and respective deliverables for the current project.
Project Timeline
The project timeline or schedule, together with the WBS, helps provide a quick overview of the project. It includes the major milestones and tasks and the expected time that each will be completed based on the complexity of the task (Sipes, 2020). Although the project timeline is developed early at the onset of the project alongside the WBS, it should be reviewed regularly to validate whether the project is on track. The project timeline also established project-related expectations for each task in order to meet the project targets. It is also important to keep the timeline realistic (Garcia-Dia, 2019). Generally, a high-level project schedule with an identifiable start date, end date, and key milestones and deliverables is useful in providing updates and communicating the project’s progress.
The timeline in Appendix D depicts the key milestones to be accomplished at a certain date. As per this schedule, the project is expected to be completed within a timeframe of three months. The project is expected to go live in the second week of May 2023. A copy of this timeline will be given to the key stakeholders, including the nurse leader and the facility management, to ensure that all stakeholders are up to date.
Responsibility Chart
Also known as the responsibility assignment matrix (RAM), the responsibility chart is a tool used to assign all the tasks listed in the WBS to individuals or teams tasked with completing them (Sipes, 2020). The goal of this tool is to clearly identify and state those responsible for certain tasks, those charged for ensuring that the task is completed on time, and to keep everyone aware of their roles. The benefits of developing the RAM include ensuring the project runs efficiently by avoiding duplication, minimizing confusion, and promoting accountability (Garcia-Dia, 2019). The RAM also ensures that work is distributed evenly and the team can make quick decisions given that they know whom to consult.
The RACI table in Appendix E outlines four key stakeholders with critical influence on the project. These include the facility management, the project team, nurse leadership, and external stakeholders. Overall, the project team will be responsible and accountable for most of the project tasks and activities from initiation to implementation. For example, the project team will be responsible for creating the project charter, schedule, budget, and scope during the initiation phase. In the planning phase, the project team is responsible for developing the plan, conducting status meetings, creating new workflows, and initiating conversations regarding other issues with other stakeholders. Other roles the project team will be responsible for include implementing the project, performing preliminary analyses, and performing evaluations. The project leader will be accountable for ensuring that all these tasks are completed appropriately and on time. The nurse leader will be consulted when undertaking most of the project activities. The facility management will be consulted and informed of how various tasks are progressing. While the external stakeholders, such as vendors, will be informed of the project’s success from time to time, vendors will be responsible for providing training modules and installing the infrastructure.
Change Management Plan
Implementing change is likely to cause anxiety among certain members or stakeholders. This anxiety, if not managed early, can grow into resistance and opposition that may affect or delay the course of the project. Resistance may also arise due to dissenting or diverging opinions related to the project. As a result, a change management plan allows the project leader to identify possible barriers to the project and develop proactive approaches to address these issues. Although several models of change can facilitate change management, they all have many things in common; these commonalities will guide this project. Some of these interventions include engaging all stakeholders through routine and open communication, celebrating small wins, seeking input and feedback from stakeholders and integrating when making decisions, and facilitating a participative culture (Sipes, 2020).
Overall, Kotter’s 8-step model was chosen to guide the change management processes. This model outlines eight key steps, which include creating a need for change, forming a powerful project team, creating a vision for change, communicating the vision, empowering others to act on the vision, planning for and creating small wins, consolidating the change, and institutionalizing the change(s) within the organization’s culture and/or policies (Sittrop & Crosthwaite, 2021). Collectively, these steps ensure an effective change management process because they identify the key success factors that underpin a successful change process. For example, Kotter’s model outlines some of the key change processes, such as stakeholder engagement, obtaining buy-in from stakeholders, continuously engaging stakeholders, and using project champions (Sittrop & Crosthwaite, 2021).
Communication Plan
Ongoing communication with all stakeholders is essential for successful project completion (Sipes, 2020). In the current proposed project, the project leader and the project team will communicate routinely with several stakeholders. For example, ongoing consultations and coordination with the nurse leader will be necessary since the nurse leader is involved in making various decisions related to the project. Some of these decisions relate to the project’s budget, workflow changes, securing appropriate technology to facilitate telehealth, going live, and project assessment. The project team will also communicate with the facility management on various occasions to rationalize various decisions about the project. Furthermore, ongoing communication and discussion with a number of external stakeholders, including the technology vendors, would also be necessary (Garcia-Dia, 2019). These discussions will center on negotiating the contract, consulting the vendors when installing or piloting the new system, and other pertinent areas. Besides, good communication among the project team members is vital for success. Additionally, good communication facilitates better stakeholder management.
For these reasons, a communication plan is crucial to facilitating good communication. Appendix F outlines the key stakeholders, the how, and the frequency of communication with them. Overall, the project’s communication plan shows that the project team will communicate information related to project updates on a weekly basis via email with all stakeholders, while project reports will be communicated virtually and via video conferencing with the facility management. Change requests will be communicated in person as they arise to members of the project team, while performance reports will be disseminated monthly via emails and monthly reports to all stakeholders. Appendix F provides a more detailed communication plan.
Risk Management Plan
Risks, defined as anything that can impact the project positively or negatively, are common and typically part of the project. Since risks are unavoidable, a risk management plan is vital. A risk management plan helps identify the potential internal and external risks, prioritizes the risks based on the likelihood of the risk happening and the severity of impact, and identifies the possible interventions to mitigate or eliminate the risk. Risk management is usually a continuing process since risks usually change with changes in the project dynamics., hence it is important to continuously monitor the identified risks. According to Sipes (2020), constant and frequent (weekly) review, especially before and after the implementation. The goal of the risk management plan is to identify and document all risks, thereby enabling the project leader to keep a look at them and develop proactive measures to address these risks (Sipes, 2020).
Appendix G outlines the potential risks and respective risk mitigation strategies. In general, the major risks associated with implementing a telehealth system at a correctional facility include limited resources due to budget and space constraints, security issues due to safety restrictions, lack of stakeholder/management support, and poor communication. These risks carry a low to high likelihood of occurrence and are likely to result in medium to high impact.
Rationale
Explain how the set of tools you developed will be applied to your project.
Several project-management tools developed herein are vital to ensuring successful project implementation. In particular, each of the tools offers crucial information needed to support and implement the project. For instance, the gap analysis helped identify why the change is needed to optimize operations at the facility. The SWOT analysis helped identify the internal and external tools as well as issues to address when planning to implement the project. Other tools, such as the work breakdown structure and stakeholder maps, helped identify crucial stakeholders needed to support the project. Collectively, each tool developed above contributed an incremental benefit toward the success of the project.
The proposed technology is not new, but the organization has been slow to implement this technology. As mentioned above, some of the reasons that could have contributed to the slow adoption of telehealth include the unique protocols and priorities at the correctional facility, which emphasize safety and security.
In what way has this changed with the onset of the pandemic, if at all? What were the changes?
Elsewhere at the industry level, the adoption of telehealth was significantly influenced by the Covid-19 pandemic. At the onset of the pandemic, new public health protocols such as lockdowns meant that few individuals were able to access healthcare. As a result, in order to overcome this challenge, many healthcare organizations implemented telehealth services as an alternative to enabling individuals to access care while observing the public health protocols. Many organizations that have implemented this technology report a positive impact on the technology on various healthcare delivery outcomes, including access, quality, and costs (Gajarawala & Pelkowski, 2020).
Are health information system/application upgrades scheduled or planned?
At this point, the current project is planned as discussions regarding the project, such as the resources, the vendor, and other necessary requirements, are still ongoing. Additionally, the process of obtaining approval from the facility’s management to implement this project is still ongoing. Unfortunately, because the project requires significant resources, including a need to make physical modifications to accommodate the new system, more time will be needed to actualize the project plan. Therefore, the implementation of a telehealth system at this correctional facility will remain a plan.
Part II: Implementation
All the plans and activities undertaken during the project design and planning phases culminate in the implementation phase, where the plan is put into action and all the planned activities are actualized. Besides implementing the planned activities, other key activities and tasks undertaken by the project team include monitoring project control processes and budgets, reporting progress, managing problems as they arise, and engaging other stakeholders. Other tasks include training the team, gathering the necessary resources, and testing the new system. The special considerations during this phase include ensuring that all stakeholders and the project team work together to facilitate a smooth transition and adoption of the new technology, providing relevant training to users at various levels, and prioritizing and escalating issues (Garcia-Dia, 2019).
Change Management
Many individuals are usually excited to move forward with the execution phase following months of planning. However, introducing the change may face many challenges because of user resistance and other challenges during adoption. For example, the implementation of any new system is expected to cause a significant change in work practices, power balance, and value (Garcia-Dia, 2019). Therefore, it is important to implement several components of change management to ensure successful adoption. Some key change management processes and tasks that will be implemented include early and adequate engagement of end-users, continuously communicating the upcoming change, and utilizing project champions. As part of the change management process, the project team will also identify the project champions who will lead the adoption of the new system. Working with the project champion will help create a trusting environment and influence system adoption, particularly by obtaining buy-in from stakeholders at the managerial level.
The change management plan developed is guided by Kotter’s 8-Step model. So far, many of the change management steps outlined in this model have been accomplished. For example, the project team has been actively communicating how and what the project or the new system will solve the existing problems. The project team has also been working closely with other stakeholders, especially the facility’s leadership and management, to formulate the implementation plan and a thoughtful culture change. The remaining steps include creating small wins, consolidating the change, and institutionalizing the change. Some of the small wins that will signify that the project implementation is progressing as planned include securing a vendor for the new system and successfully making infrastructural modifications to support the project.
Communicating Change
Change communication is essential during system implementation. In the current project, the project team has created both formal and informal channels of communication to facilitate the delivery of targeted messages to all stakeholders. Based on the communication plan developed in the planning phase, the project team has been informing the stakeholders of how the project is progressing. Some of the issues that have been communicated to the relevant stakeholders include the training needs of users, expectations of what the project will achieve, the status of the project, and the roles and contributions of each stakeholder. As the project progresses, the expected go-live date, training needs, system deployment plans, and expectations will be communicated to all stakeholders. The channels of communication include routine updates with relevant groups such as facility leadership and vendor, one-on-one conversations with project team members, and short announcements to all stakeholders. Continuous and constant communication with all stakeholders is expected to build up anticipation, prepare all stakeholders for the upcoming change, and create a positive implementation environment. Open communication is also expected to enable stakeholder feedback and offer an opportunity to respond to stakeholder concerns and anxieties. In the end, this should minimize resistance to change.
Training and Testing
As a new system, training will be essential to ensure that all stakeholders are aware and have a detailed understanding of the moving parts of the project during the go-live. The training modules will depend on the system requirements (Garcia-Dia, 2019). When implementing telehealth systems, the important training components will be tailored for healthcare providers in the facility and will entail how to engage with patients via telehealth, getting acquainted with the new software, components for clinical usefulness, compliance issues, how the new system will address current challenges, and any new or changes in administrative processes to support the new system/technology. Training on how the system works, and any administrative measures associated with the new system will also be provided to the facility’s management as well as other essential non-clinician stakeholders. The training modules are currently being tailored to specific stakeholder needs.
After the training, system testing will be performed. Consequently, the present project will be a pilot project to test the viability of a telehealth program at the facility. The program will target patients with specific conditions, such as mental health conditions, that usually require patients to be transferred to an outside facility for comprehensive evaluation.
Evaluation
The last phase of any project implementation evaluation. The aim of evaluating is to determine if the project goals and objectives were attained and whether the change resulted in the desired outcome or not, as per the scope of the project. Ordinarily, continuous monitoring and reporting of progress and impact of the project are essential components of the evaluation phase. This often entails discussing the findings with all the stakeholders with the aim of identifying if the project goals were met and the project needs to be institutionalized or if there are modifications that need to be completed. However, since this project has not been implemented at this point, the evaluation will focus on analyzing any changes in the project’s scope, timeline, and budget. This evaluation will also focus on evaluating the extent to which the tools developed in the planning phase have been implemented.
Is the project staying within scope? (Scope)
The project is staying within the scope. The goal of the project remains to implement a telehealth system at a correctional facility to promote and enhance mental health care at the facility. A few of the changes encountered during the project were able to be accommodated within the current project scope. One of the major changes was to implement this project as a pilot project at the facility, with a few patients that are eligible for referrals receiving telepsychiatry. Depending on the outcomes of this pilot project, a recommendation on whether or not to expand the scope to include all psychiatry sessions conducted via telehealth will be made.
Were all of the gaps identified?
The primary gap being addressed in this project is poor delivery and reduced access to mental healthcare in correctional facilities. Some of the issues identified as contributing to poor delivery and low access to mental healthcare in correctional facilities include the prison security rules and protocols that limit the frequency and how mental healthcare services and internal issues that affect how providers interact with patients. In light of these issues, telehealth was identified as a sensible option to address these gaps. However, while most gaps related to the delivery of mental healthcare in correctional facilities were identified, it is possible that other gaps in the provision of mental healthcare in correctional facilities were overlooked because of the current project’s focus (improving access and quality of mental healthcare).
Is the project following the timeline?
The project is also following the timeline. At this point, the key project activities being undertaken relate to pre-implementation activities, such as developing the training programs, securing a telehealth system from the vendor, developing new workflow toolkits, and identifying eligible patients. However, going forward, the project is likely to take longer than planned because some activities, such as making internal modifications are yet to be completed.
If you had a budget, is it on track?
This project also required significant budget funding to finance the purchase and installation of the new system as well as making infrastructural modifications. However, securing this funding has been a challenge for the facility because the facility’s funding is usually pre-budgeted. A communication from the facility’s management indicated that the funding requests would need to be included in the next budget statement.
Were all of the work activities correctly assigned?
According to the WBS developed, many project activities, from planning to implementation and evaluation, were assigned to the project team. Some of these activities include developing the project plan, carrying out the training, and implementing the project. A few other tasks, such as installing the system, were assigned to the vendor because this stakeholder has more expertise in relation to this task. The nurse leader and the organization’s management would be consulted throughout the project implementation process. The project leader would be accountable for ensuring that each activity is implemented and/or done appropriately. Therefore, the responsibilities were assigned correctly considering that the project team is charged with implementing the project.
Are team members responsible?
As mentioned above, most tasks were assigned to the project team. The team has performed well in several activities, including developing the project plan, initiating negotiations for funding, and continuously engaging other stakeholders. The team has also consulted the management and the nurse leader from time to time. Therefore, all team members have demonstrated responsibility and accountability.
Did the project start on time, in line to meet the due date?
The project started on time as planned, with a conversation with the nurse leader to explore a quality improvement opportunity at the organization. After securing the support and endorsement of the nurse leader, an implementation plan was developed and presented to the facility management on time. However, as mentioned above, securing the funding needed to make the needed modifications and purchase a telehealth system has been challenging because of the limited budgets. Because of this, project delays will be witnessed. Accordingly, the project is expected to not be completed as per the scheduled due date.
Are you holding weekly status meetings and documenting all activities? Are all team members in attendance and communicated with?
The project team has been providing routine updates regarding the project’s progress. The team has also held two status meetings to discuss the project’s requirements and make preparations and arrangements for how the project will be completed. Another meeting will be reconvened to discuss how the project will continue once the funding is secured.
Are all changes approved and documented?
No changes have been documented at this point as the system is yet to be implemented. However, notable recommendations or changes approved by the project team included identifying a viable system vendor and initiating conversations regarding the acquisition of the system.
Are all risks identified, prioritized, assigned an owner, and a mitigation plan developed?
Several risks, including cost limitations, lack of stakeholder support, security limitations, and poor communication, were identified as the possible risks with the highest likelihood of occurrence and greatest impact. As it turns out, lack of funding has resulted in project delays. The nurse leader was identified as the owner and has been assigned the responsibility of pushing for funding and identifying alternative funding sources to facilitate the project’s completion. The nurse leader is also in charge of negotiating with the management to address any security-related challenges and engage all stakeholders as the project champion.
Lessons Learned: What went well and what needs to be updated and revised
The present project intends to implement a new telehealth system to increase mental health care access and quality at a correctional facility while minimizing costs. Several aspects of the project went well. The first is the project planning. According to Serrador (2013), project planning is associated with overall project success and project efficiency. This was evident in this project. For example, the documents prepared during the planning phase were crucial in creating a detailed outline of what to expect, highlighting various key needs, identifying stakeholders, and creating proactive measures to address the expected challenges. The project plan was also useful when presenting the proposal to the organization’s management. For instance, it was much easier to convince the management why the project was necessary with the availability of supporting documents and a comprehensive plan in place.
Securing the support of the nurse leader is another thing that went well in the project. According to Laukka et al. (2020), healthcare leaders such as nurse leaders can assume one or more of the following roles when implementing/adopting a new health information technology: project supporters, change managers, advocates, project managers, facilitators, and project champions. In the present project, obtaining buy-in from the nurse leader was essential since she played a vital role in spearheading many processes and addressing many issues related to the project. For example, the nurse leader helped communicate why the project was necessary and provided how the care delivery process would significantly improve with the adoption of telehealth. The nurse leader also acted as the project champion and helped engage all the stakeholders, thus ensuring that the project progressed as planned.
However, one issue that needs to be revised relates to the project timeline. The challenges faced in this project highlighted the need for flexibility, particularly when it comes to resource allocation and time. Flexibility enables the project manager to easily ensure project success by allowing him/her to make relevant modifications in light of limited resources (Lima et al., 2019). Furthermore, flexibility is an important tool for project managers that allows them to effectively manage projects under uncertainty, leading to better control of the project schedule and, subsequently, the deadlines and costs (Lima et al., 2019). In light of this, flexibility in the scheduling of the current project, such as indicating a time range when the project should be completed should unforeseen issues arise, should be integrated into the project to ensure that possible deviations are taken into account.
Conclusion
Project management concepts and tools are essential in quality improvement initiatives. They offer guidance and enable the project leader to manage the change process better. This paper discussed a proposal to implement telehealth technology at a correctional facility to facilitate telepsychiatry sessions. Previous literature indicates that telehealth interventions are associated with a number of positive outcomes, including increased access to care and better quality of care. In the present correctional facility, implementing telehealth is expected to increase access to and quality of mental healthcare and lower the costs of care.
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Appendix A
Fig. 1: SWOT Analysis
| Strengths
· An innovative approach to providing psychiatric care with several potential benefits, e.g.: o Facilitates increased access to care o Lower costs · Eliminates key barriers to psychiatric care in correctional facilities · Good acceptability by both providers and inmates |
Weaknesses
· Unique prison environment with security and safety being a priority · Cost of the project · Privacy issues o Finding confidential space may be challenging |
| Opportunities
· Bringing healthcare to one of the most underserved populations · Enhance the quality of care |
Threats
· Prison culture · Shortage of personnel, particularly healthcare providers · Legal provisions |
Appendix B
Fig. 2: Gap Analysis
| Current State | Desired state | |||
| · The mental healthcare provider sees patients on specific days of the week.
· Providers are subjected to “standard” security checks (They are restricted on what to bring to the treatment setting). · Psychiatrists may be affected by the “local prison mood.” · Providers may be at risk of immediate physical danger, which may affect their focus. · Care providers may be facing increased pressure on prison politics. |
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· Mental health care providers should be able to see patients more frequently.
· Providers should not experience any fear related to their safety, allowing them to focus better on their work. · Providers should be able to independently provide care without influence from outside forces. |
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| Intervention: Telehealth | ||||
Appendix C
Table I: The Project WBS
| Project Phase | Milestones |
| 1. Initiation | 1.1 Conversation with the Nurse Leader & Project Request
1.2 Developing Project Charter & Approval 1.3 Developing the Project Scope 1.4 Budget Creation 1.5 Gap Analysis 1.6 Kick-off Meeting |
| 2. Plan | 2.1 Identify the Project Team
2.2 Developing and Approval of the Project Plan 2.2.1 Requirements 2.2.2 Develop the WBS 2.2.3 Responsibility Chart 2.2.4 Risk Management Plan 2.2.5 Change Management Plan 2.2.6 Cost Management Plan 2.3 Communication Plan 2.4 Status Meeting |
| 3. Implementation | 3.1 Engaging the Stakeholders
3.2 Implementing the Telehealth Service 3.3 Team Performance Assessment 3.4 Hold Status Meeting |
| 4. Monitoring and Evaluation | 4.1 Project Performance Report
4.2 Variance Analysis 4.3 Lessons Learned 4.4 Formal Acceptance |
Appendix D
Figure 3: Project Timeline
Appendix E
Table II: The RACI Table
| Facility Management | Project Team | Nurse Leadership | External resources | ||
| Project Phase | Activity or Deliverable | ||||
| Initiation Phase | – Create Project Charter | C | R/A | C | I |
| – Create Schedule | I | R/A | C | I | |
| – Develop Budget | C | R/A | C | C | |
| – Conduct a Gap Analysis | I | R/A | C | I | |
| – Kick-off Meeting | I | R/A | A | I | |
| Planning Phase | – Develop the Project Plan | I | R | A | I |
| – Develop Communication Plan | I | R/A | C | I | |
| – Create Workflows | C | R/A | C | C | |
| – Secure Appropriate Technology | C | R/A | C | C | |
| – Status Meeting | I | R/A | I | I | |
| Implementation Phase | – Train Stakeholders | I | A | C | R |
| – Implement the Project | C | R/A | C | C | |
| – Perform Preliminary Analyses | I | R/A | I | I | |
| – Status Meeting | I | R/A | I | I | |
| Evaluation Phase | – Conduct Project Assessment and Write Report | C | R/A | C | I |
| – Report Lessons Learned | I | R/A | I | I | |
Appendix F
Table III: Communication Plan
| Type of Information | Goal(s) | Frequency | Owner/ Prepared by | Channel | Target audience |
| Project status and update | Report the progress of the project, including key accomplishments, emerging issues, and any deviations. | End of weekly | Project leader | The project team and key stakeholders | |
| Project high-level reports | Keep the management informed of the progress of the project and any need for escalation. | As needed | Project leader and Nurse Leader | Virtual via video conference & email | Facility leadership |
| Change requests | Ensure that every team member is aware of their updated roles | As needed | Project manager | Face-to-face/ virtual conference | Project team members |
| Performance review reports | Report outcomes of project review and announce any new adjustments that may follow | Monthly | Project leader | Email and face to face | All key stakeholders |
Appendix G
Table IV: Risk Management Plan
| Version 1 | Date: April 1, 2023 | |||||
| Risk Description | Triggers | Impact | Risk or occurrence | Impact severity | Possible interventions | |
| 1 | Cost – Equipping various spaces could be expensive | Most of which may be non-existent and require conversion of other spaces. | Project delays | Medium | High | Engage with the facility management early to identify possible spaces that support telehealth (considering privacy and cony and confidentiality) |
| 2 | Security – Restrictions in correctional facilities may affect the acceptability of telehealth services | Security protocols prioritizing safety and security | Undesirable project outcomes | High | Medium | Work with the management to identify acceptable compromises |
| 3 | Lack of stakeholder support | Poor stakeholder buy-in and a potential increase in public budgets | Poor project progress | Low | High | Engage stakeholders more closely |
| 4 | Poor communication | Communication disconnects among stakeholders (due to different systems) | Delay in project | Medium | Medium | The project leader ensures each communication is successful via routine follow-ups. |
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