Student Name

University

Professor

FPX 9100

Date

Project Charter

Part 1
Project Charter Information
Project Name	Provider Inbox Management Optimization (PIMO): Creating the Optimal Inbox
Project Site	Adelante Healthcare – Adult and Family Medicine
Contact at site	Name with credentials: Robert Babyar, MD, Chief Medical OfficerOrganizational Email: robert.babyar@adelantehealthcare.org Phone Number:877-809-5092
Preceptor	Name with credentials: Adita Flagg Email: adita.flagg@adelantehealthcare.orgPhone Number: 877-809-5092
Executive Sponsor	Chief Executive Officer (CEO) of Adelante HealthcareThe CEO is the key person responsible for the overall productivity and operation of the company. The CEO is instrumental in providing fiscal, political, and networking support.

Part 1
Project Charter Information
Gap Analysis	A January 2023 report pulled by analysts at the project site revealed 75% of patient messages are not reviewed or addressed in the first three days. The Quality Department identified this problem following an investigation into delayed patient responses, which stemmed from a collection of patient complaints. Currently, no response time policy, procedure, or guideline is in place for clinical staff to understand and adhere to best practices. The practice gap was first identified in May 2022 while working alongside a DNP graduate and medical director. The medical director explained the many challenges providers face, including time, duplication of efforts, and a lack of delegation or support. A root cause analysis was then conducted to identify additional challenges. Appendix A shows a Fishbone diagram for the practice gap. The practice gap was then discussed with the executive sponsor, R.B., and approval was given to begin a quality improvement project and address the issue. The desired state involves implementing an evidence-based intervention, in this case, a response time policy. A response time policy will support timelier patient-provider communication and reduce patient care delays.The response time policy will also promote delegation, collaboration, and interdepartmental support to respond to patient messages within a specified period.The 2023 National Patient Safety Goals published by The Joint Commission focus on improving patient safety in all aspects of healthcare. More specifically, goal number 2 is focused on improving communication among caregivers. With the newly published goals, the project site has a renewed focus on closing this care gap and adhering to evidence-based practice recommendations (The Joint Commission Requirements, 2023). Organizations devoting time to optimizing provider inbox management is proven to lead to information overload and has been found to be a leading contributor to job dissatisfaction and provider burnout (Murphy, Satterly, Giardina et al., 2019).A 2019 qualitative study conducted by Kaiser Permanente across 4 months found that consistently responding to patient messages saves time, as delayed responses inevitably generate more patient calls to the practice (Lieu, et al., 2019). An additional study by North et al. (2018) conducted a cohort study including 600 patients in which a response time policy was implemented. The response-time policy provided staff direction to respond to all patient messages within 24 hours, excluding holidays resulting in timelier responses to patient inquiries. The PIMO project aims to improve patient-provider

Project Charter Information

Evidence to Support the Need

Reviewing evidence-based interventions for inbox optimization, common themes emerged. Implementing a response-time policy demonstrated improved efficiency among clinical staff, higher patient engagement, increased involvement from non- provider clinical staff, and timelier messaging and results sharing with patients engaged in portal messaging systems. It is imperative that appropriate policies and procedures are developed and then implemented for governing patient online portal use. While patient portals offer healthcare providers numerous opportunities to communicate with their patients, policy improvements are needed, as these changes may ultimately lead to better use and uptake (Steitz et al., 2019). The need for policy improvements is corroborated in the study by Hefner et al. (2019), as the researchers describe how policies need to be either revamped or established that require healthcare providers to undertake adequate training and education. Similarly, the findings of Lieu et al. (2019) also support the need for policy improvements that are used to oversee physician-to-physician training, as there are many different strategies that can be employed to improve how physicians manage their inboxes and respond to patients. Reynolds et al. (2021) found that patient portals must offer virtual patient-provider interactions and contextualized medical advice. This means that policies may also need to be instituted that require healthcare facilities to upgrade the organization’s existing patient portals for the latest innovations. Through these initiatives of response time policy creation and implementation, staff training of the organization’s inbox portal, and training on policy requirements, staff will learn how to better manage this patient portal secure messaging to ensure that patients are being responded to in a timely manner. Similarities are seen with Reynolds’ and Lieu’s findings that identify employee training as a crucial component to support policy implementation. Huang et al.’s (2022) study showed differential patient-provider communication patterns across various care settings and practice roles. Findings from this study indicate opportunities for care teams exist to optimize their inbox messaging system, helping to balance the workload and promote optimal efficiency. Securing and implementing policy changes within healthcare facilities focusing on provider training and integrating the latest patient portal messaging systems significantly improves patient safety, treatment delays, and patient satisfaction. Continued implementation and widespread use of response-time policy and adherence to time management expectations

Project Charter Information
PICOT	For staff and providers (P), how does the implementation of a patient-provider response time policy (I) to respond to portal messages compared to the current state (C) affect response times (O) over a two-month period (T)?
Project Aim	The aim of the PIMO project is to improve patient-provider response times, achieving or exceeding the time measures as dictated by the policy and decreasing delays in care asmeasured by the policy description.
Part II
Stakeholders
Stakeholder	Identify the key stakeholders for your project. Think of key stakeholders (internal and external). This might include patients/clients, families, community leaders and organizations, health agencies, systems within the organization etc. List between 3-4 potential stakeholder members
Initials or fictitious name	Title, Role or Affiliatio n.	Connecti on to the project.	Potential impact (how affected).	Contribut ion to the project.	Barriers or anticipate d challenges if any

Project Charter Information
C.A.	Director of Nursing & Nutrition Services	Project Lead	Impact is had through direct involvem ent in project to support implemen tation across both nursing and non- nursing discipline s.	Project Lead. Will drive change, implemen tation, data collection, and analysis.	Potential challenge s may include schedulin g conflicts with colleague s and additional stakehold ers as well as potential staffresistance to change

Project Charter Information
A.F.	Director of Quality, Safety & Clinical Risk	Quality, Safety & Risk implicati ons	Impact is had through direct involvem ent in project to support implemen tation.	Support with implemen tation roll out in complian ce with project site policies, procedure s, and guidelines.	Apotential barrier to consider is increased workload or inability to prioritize another project.
S.A.L.	Regional Medical Director	Advance d Practice Provider and Physician involvem ent	Impact is had through direct involvem ent in project to support implemen tation through the lens of medical providers.	Support with implemen tation roll out in complian ce with project site policies, procedure s, and guideline s.	Apotential barrier to consider is increased workload or inability to prioritize another project.

Project Charter Information

Team Leader

C.A. will be the team leader for the quality improvement DNP project. Successful project implementation requires participation from a multitude of departments, teams, and leaders. Effective collaboration and detailed communication are crucial to driving successful outcomes. Approaching the problem through different frames and perspectives is also necessary to facilitate high-level communication strategies and to keep the project on track. Exhibiting emotional intelligence, drive, and organization emotionally intelligent, organized, and driven, making C.A. the right leader to drive a quality improvement project of this size.C.A. has an extensive background in nursing and leadership over the past 14 years and currently serves as the Director of Nursing at the project site. Relationship building, technical skill, and change advocacy experience offer opportunities to garner additional project support and allocate necessary resources for project implementation. C.A.’s leadership style is a mix of servant and transformational leadership foundations in which the focus is to develop the team members and push them to reach their utmost potential (Manning & Curtis, 2019). Utilization of the servant leadership style supports team empowerment and offers authority by way of nurturing, and empathic listening to help team members achieve their goals (Reynolds, 2021). Choosing a leader with these leadership styles is crucial to successful project delivery. Leaders who can express more flexibility in their leadership styles are more likely to see improvements and changes with less resistance, as they can communicate the same message in a variety of ways (Reynolds, 2021). Putting these values and styles into practice reinforces intentionality around diversity and inclusion, which can pay dividends before, during, and after project kickoff. C.A. will create a safe space for colleagues and employees to voice their opinions and weigh in on key decisions to successfully deliver on the project.In my personal life, adapting to team needs and modifying communication styles happens frequently. At the senior leadership level, leaders are faced with competing deadlines, priorities, and opinions. Leveraging my two leadership styles, I can pivot and reiterate a point to ensure comprehension across the team. An example of this includes the medical director wanting to make more superficial changes to the patient portal messaging system, rather than conducting a root cause analysis. My leadership approach required me to sit down with my colleague and listen to her perspective and

Project Charter Information
Team Members	Identify 4-6 team members (initials or fictitious name), department or affiliation and credentials or qualifications. Think about how a diverse set of individuals (demographics, disciplines, experiences, knowledge) will add to the team!Describe each team member’s title, department or affiliation, qualifications/credentials and the rationale for inclusion and how the person contributes to the project’s success.
Initials or Fictitious Name	Title	Department or Affiliation	Credentials or Qualifications	Rationale for selection/Cont ribution to theproject
N.V.	Data Analyst	Health Information Systems (HIS)	BS	N.V.’s skill set will be necessary to retrieve data before, during, and after project implementatio n to effectively measure outcomeefficacy.

Project Charter Information
S.K.	Informatics Director	Information Technology/H ealth Information Systems (HIS)	MSIT	N.V.’s skill set will be necessary for more advanced data mining before, during, and after project implementation. Large changes impacting the electronic medical record (EMR) will also require this level of approval.

Project Charter Information
E.D.P.	Project Manager	Transformatio n Office	BS	E.D.P.’stalents as a project manager will be useful during the implementatio n stage, ensuring all pieces are fully developed and vetted before deploying into a live environment.
S.A.L.	Regional Medical Director	Medical Provider Leadership	DNP, FNP, RN	Support with implementatio n roll out in compliance with project site policies, procedures, and guidelines.Will also share provider input to drive future decisions.

Project Charter Information
Develop a communication plan for each person associated with the Project Charter, e.g., Executive Sponsor,Stakeholders, Team Leader, Team members.
Team	Purpose	Frequenc	Method	Who is	Potential
Member/Stakehol	of	y and	of	responsib	challenge
der.	communi	timing of	communi	le for the	s/ barriers
	cation	communi	cation	communi	or assets
	(Inform,	cation.	(consider	cation to	with
	share,	(How	audience,	this	communi
	engage,	often,	method,	member?	cation
	solicit	specific	culture,	(Why is it	(barriers,
	informati	stages of	language,	important	language,
	on?).	project?)	inclusion)	who	culture,
			.	delivers	different
				the	discipline
				message?	s, best
				)	practices
					(cite the
					literature
					1-2
					sources
					as
					needed).

	Project Charter Information
	Executive Sponsor	The	The CEO	Email is	The	Time
		purpose	will	the	project	constraint
		of	receive	preferred	team	s on the
		communi	an email	method	leader is	CEO
		cation	at the end	of	responsib	create a
		with the	of each	communi	le for	potential
		Executive	project	cation for	providing	communi
		Sponsor	phase.	the CEO	updates	cation
		is to	This	as it	to the	barrier.
		inform	provides	creates a	CEO.	While the
		the	project	‘paper	The	CEO
		sponsor	status	trail’,	assigned	does
		on	updates,	which	team	utilize an
		project	current	supports	leader	open-
		status,	phase,	the team	will be	door
		share	and	in	responsib	policy,
		relevant	upcoming	recalling	le as they	his
		updates,	actions.	previous	have the	bandwidt
		and	The CEO	discussio	most	h is
		engage	will also	n topics	informati	limited,
		this	receive a	and	on to pass	and
		person in	final	informati	on to an	finding
		the	detailed	on.	executive	availabilit
		overall	report		stakehold	y to
		implemen	following		er. If any	discuss
		tation so	the final		changes	project
		they can	data		are	status
		serve as	analysis.		recomme	may
		an			nded or	prove
		additional			needed,	difficult.
		change			the team	Communi

	Part 1
	Project Charter Information
	Project Team	Provide	The team	Email is	The	Experien
	Members	relevant	will	the	project	ce and
		updates	receive	preferred	team	backgrou
		on	project	communi	leader is	nd in
		project	phase end	cation	responsib	different
		status and	emails as	method	le for	clinical
		discuss	each	for all	providing	discipline
		needs for	phase	team	updates	s have a
		individua	concludes	members,	to the	likelihoo
		l roles	.	however	CEO.	d to bring
		and	Additiona	additional	The	about
		departme	l emails	mediums	assigned	preconce
		nts.	and	that may	team	ptions.
			meeting	be	leader	Strong
			requests	utilized	will be	communi
			will	include	responsib	cation
			occur as	Microsoft	le as they	managem
			new	Teams,	have the	ent is
			needs	PowerPoi	most	needed to
			arise or	nt, Word,	informati	mitigate
			priorities	and	on to pass	this risk.
			shift.	SharePoi	on to all	The
				nt.	stakehold	leader
					ers and	planning
					participan	ahead for
					ts.	this and
						making
						adjustme
						nts so the
						frame of
						reference

	Part 1
	Project Charter Information
	Project	Provide	The team	Email is	The	Failure to
	Stakeholders	relevant	will	the	project	fully
		updates	receive	preferred	team	understan
		on	project	communi	leader is	d the
		project	phase end	cation	responsib	project
		status and	emails as	method	le for	scope is a
		discuss	each	for all	providing	concern
		needs for	phase	team	updates	as it may
		individua	concludes	members,	to the	drive
		l roles	.	however	CEO.	misconce
		and	Additiona	additional	The	ptions.
		departme	l emails	mediums	assigned	Clear,
		nts.	and	that may	team	concise
			meeting	be	leader	communi
			requests	utilized	will be	cation is
			will	include	responsib	needed to
			occur as	Microsoft	le as they	mitigate
			new	Teams,	have the	this risk.
			needs	PowerPoi	most	In
			arise or	nt, Word,	informati	planning
			priorities	and	on to pass	ahead for
			shift.	SharePoi	on to all	this, the
				nt.	stakehold	team
					ers and	leader
					participan	should
					ts.	check in
						frequentl
						y with the
						team.
						“Effectiv
						e

Part 1

Project Charter Information

Intervention and Measurement

Project Charter Information

Planned Intervention

Practice Change InterventionImplementing online portal messaging systems has become increasingly popular among healthcare providers. The systems allow patients to communicate with their providers via a secure online platform. However, one potential downside of these systems is that they may lead to delays in treatment such as treatment options, medication adherence, and chronic condition management. Additionally, the increased demands on medical providers to see more patients do not leave enough administrative time to meet patient needs. Patients are experiencing delayed communication, treatment, and decreased quality of care because of absent or delayed patient-provider response times and expectations (Sinsky et al., 2018).This information is corroborated by Lanham’s study (2018) in which 50% of patient- initiated messages were unresolved after three months. Another national example includes a study from Szilagyi, et al. (2022) in which a randomized trial across 53 primary care practices was deployed across 12 months and included patients ranging in age from 18 to 65 years old. This study found that out of more than 196,486 patients, 55.6% received follow- up to their initial communication, whereas the remaining 44.4% had no responses (Szilagyi, et al., 2022). Hence, the researchers found that the use of online portal messaging systems contributed to patient safety concerns such as delays in care (Szilagyi et al., 2022).Intervention # 1: Time-based response time policy implementation. Recommendations and progressions from the literature:In the article by Steitz et al. (2019), the researchers explored the policies and procedures that are in use at My Health at Vanderbilt (MHAV) patient portal use, an academic medical center. Data from MHAV was collected and analyzed, with eight categories made for patient portal activity: Appointment, Health Result, Medication, Immunization, Billing, Messaging, Document Access, and Genetics (Steitz et al., 2019). The operating policies for patient account activity, portal uptake, and function use over time were examined. Overall, the researchers in this study concluded that patient portals provide healthcare providers with many opportunities to communicate and engage with their patients, although an improvement in policies is needed and implementation of response time policies can ultimately promote use and uptake (Steitz et al., 2019).Intervention and operational logistics:

Project Charter Information
Improvement Model / Framework
The improvement model used in this quality improvement project is derived from an approach from the Institute of Healthcare Improvement (IHI, 2019) which includes the “Plan, Do, Study, Act” (PDSA) as a model for quality improvement projects. The PDSA cycle is designed to center around problems impacting various stakeholders. The PDSA model has been highly utilized and well documented in healthcare literature and will be an appropriate fit for this quality improvement project. This project is aimed at improving provider inbox management and decreasing patient care delays through the implementation of a response time policy.PDSA cycles will be implemented at the start of the project and then weekly until the project’s conclusion. Following these weekly PDSA cycles will allow the project team to assess real-time responses to new implementations as well as allow the team to adjust intervention strategies and drive towards the final outcome. Results will be compared against pre-implementation data and will be shared with the project team and executive stakeholders to inform future quality-based recommendations and implementations further.
Proposed Outcomes
Metric (What is being measured to determine success):	Outcome Measure (What is the desired outcome in measurable terms):	Process Measure (Are you doing the right things to get to the outcome? Are the steps in the process leading to the planned outcome?):	Balancing Measure (Are the changes being made causing problems in other areas?):

Part 1
Project Charter Information
Provider Response Times	Providers will respond to 85% of messages within the 24-business hour response time.Any messages requiring clinical intervention, such as triage, will be tasked to the assigned nurse in the unit. If the regularly assigned nurse is unavailable, a clinical supervisor will be contacted to ensure the patient receives the necessary care required. In the event a medical situation presents and cannot be properly addressed by a non-prover clinical staff member, escalation to the primary care physician, nurse practitioner, or physician assistant is required.	Provider response time to messages will be within 24-business hours.Messages received on a Friday, weekend, or holiday must reply by the end of the next business day.Data is collected pre- implementation and then weekly until project conclusion. Monthly data reports will be collected following successful implementation to ensure adherence to the policy. Calculation:Sum of total patient messages responded to within 24 business hours/total number of patient messages*100	Not Applicable

Part 1
Project Charter Information
	Clinical staff will open and review 90% of messages within the first 12 hours of receipt.	Clinical review of messages to be conducted within 12 hours of receipt.Messages received on Friday, the weekend, or a holiday must be reviewed by the end of the next business day.Data is collected pre- implementation and then weekly until project conclusion. Monthly data reports will be collected following successful implementation to ensure adherence to the policy. Calculation:Sum of total patient messages opened in 12 hours/sum of total patient messages*100
First Touch Times	Any messages requiring clinical intervention, such as triage, will be tasked to the assigned nurse in the unit. If the regularly assigned nurse is unavailable, a clinical supervisor will be contacted to ensure the patient receives the necessary care required. In the event a medical situation presents and cannot be properly addressed by a non-prover clinical staff member, escalation to the primary care physician, nurse practitioner, or physician assistant is required.		Not Applicable

Part 1

Project Charter Information

Part III

Data Collection & Management

Develop a plan for the collection, management, and stewardship of the data you will collect for your Project Charter.

	Part 1
	Project Charter Information
	Describe the data to be collected.   1. Data to be collected includes: total number of patient messages received total number of messages sent in response to patients total number of messages reviewed within 12 hours of receipt	Who will collect it?   Data Analysts from the Health Informatio n Systems (HIS) team	When will it be collected? Develop a timeline. All internal medicine and family medicine inboxes will be reviewed before, during, and after project implement ation. Baseline data was taken on January 2,2023. Data collected during implement ation will	How will the data be stored?   All collected data in relation to the project will be stored on an existing organizatio n laptop, secured by password, and organizatio nal virtual private network (VPN).	How will the data be protected? Who will have access?  All collected data will be stored and protected on an existing organizatio n laptop, secured by password protection and VPN safeguards.	Consider aspects related to diversity, equity, and inclusion. Is the data stratified by gender, race, ethnicity, age, disability, or socioecono mic status? How might this informatio n be utilized to address population health, equity and health disparities? Use citations as needed to support

Part 1

Project Charter Information

Data Analysis

The PIMO project is a quality improvement project designed to optimize various processes and outcomes and guide future practice and policy within the project site using evidence-based practice interventions. Primary Outcome Measures & Measure Analysis:Increased provider response times to patient messagesAnalysis: The agreement to provide patient responses within 24 business hours will be at least 85%. Data calculations involve taking the sum of total patient messages responded to within 24 business hours and dividing that number by the total number of patient messages, and then multiplying by 100 to get a percentage rate. Any messages requiring clinical intervention, such as triage, will be tasked to the assigned nurse in the unit. If the regularly assigned nurse is unavailable, a clinical supervisor will be contacted to ensure the patient receives the necessary care required. In the event a medical situation presents and cannot be properly addressed by a non-prover clinical staff member, escalation to the primary care physician, nurse practitioner, or physician assistant is required.Timelier first touch to incoming messages (opening and reviewing messages)Analysis: The number of messages opened and reviewed within 12 hours of notification will be at least 90%. Data calculations involve taking the sum of total patient messages opened in 12 hours and dividing that by the sum of total patient messages, and then multiplying by 100 to arrive at a percentage rate. Any messages requiring clinical intervention, such as triage, will be tasked to the assigned nurse in the unit. If the regularly assigned nurse is unavailable, a clinical supervisor will be contacted to ensure the patient receives the necessary care required. In the event a medical situation presents and cannot be properly addressed by a non- prover clinical staff member, escalation to the primary care physician, nurse practitioner, or physician assistant is required.Data collected during this project is an internal collection process conducted by the data analysts at the project site. No specific tool is being utilized in this quality improvement project, and thus, permission is not required.

SWOT Analysis and Business for Project

Part 1

Project Charter Information

Think about how this project benefits the target population, the organization, and those served. Complete the SWOT Analysis.

Strengths

Project strengths: What are the assets of the organization that will help it achieve a successful outcome, e.g., knowledge, support, resources, funding, etc.?The project team is comprised of individuals with extensive medical knowledge, background, and experiences such as leadership, operations, quality, nursing, and clinical informatics.Using an optimized provider inbox within the EMR will improve the quality of care provided to patients and enhance clinical staff satisfaction.Increased patient satisfaction can promote increased patient referrals and clinic visits, which improves revenue generation for the organization.

Weaknesses

Potential obstacles or challenges: What are the potential barriers that might interfere with success? In the past, what factors were aligned with lack of success, and obstacles to change?There is no guarantee that clinical staff and providers will continue to adhere to modified guidelines and processes following project implementation.The timing of project planning and implementation competes with the daily tasks and priorities of team members for this project. Setting aside dedicated project time may be a challenge.Clinical staff do not currently feel empowered to address messages and tasks at their levels without provider input.A lack of understanding of the root issue of the problem may require more resources initially than initially anticipated.

Opportunities

Opportunities to facilitate project success: What are the strengths? How might these translate into opportunities for change?Talent retention: improved patient-provider communications can benefit provider retention and employee satisfaction scores. Happier patients can lead to increased work satisfaction.May find an opportunity to provide patients with more timely results (labs and diagnostic results) without phone calls, messages, or in-person visits through the portal.Improving patient retention through advocacy and resource provisioning via inbox optimization.

Threats

Part 1

Project Charter Information

Potential threats: Identify potential threats to the success of the project, e.g., competition, factors beyond your control, etc.Staff turnover may increase and make implementation and training more challenging.System downtimes are routinely scheduled; however, unexpected downtimes may occur and impact all computer systems and, ultimately, this project.Clinical staff do not currently understand the process or problem; gaining buy-in may be a challenge.

References

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