M5 Elevate | Simulation

Elevate Activity

NUR6210 | Module 5 | Leadership & Implementation

Start

Simulation | Elevate

“Worsening Chronic Disease in a Rural Population”

You will continue to play the role of a NP/DNP Digital Health Implementation Leader in this simulation. This simulation will take place in a Tennessee Rural Health Network clinic.

Begin Simulation

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Scenario Details

Currently, the clinic has access to software that enables appointment calendars, but some still use a paper appointment book that requires staff to thumb through to find appointment times. There is no consistent triage system for prioritizing patients needing care. Staff at the front desk verify insurance verbally but risk not getting the most up-to-date coverage information. On intake, patient vital signs and medications are sometimes noted on a paper form and sometimes charted in the computer. The provider must flip through handwritten notes and check the computer to see any health trends. Previous lab results are filed in a different section in the paper chart and in the computer, requiring a brief search.

Scenario Details

Orders for new interventions are handwritten and faxed. The computer has not been set up to send labs or prescriptions to external facilities. This means lab orders go to an external facility and medication orders must be taken by the patient to a pharmacy. The clinic is not able to track labs. Education material can be printed but the staff is not able to personalize it to particular patients. Post discharge calls are expected but there is no designated flow process that makes this happen. In general, the clinic must practice reactive care rather than proactive.

Scenario Details

This can cause hospital admissions or readmissions for poorly managed care, missed follow-up appointments, duplicated care, unclear communication among staff, inefficiencies and lack of reimbursement due to faulty or skimpy documentation, limited if any ability for the clinic to establish a “value-based” model where providers and staff focus on patient-centered, efficient and effective, coordinated and integrated care.

In addition to the fairly recent patient portal, the clinic has a very basic electronic health record but has been “too busy” to learn its use. They also have computers that include Microsoft Office software. Currently they use the software to enter some patient data—allowing them to track some trends.

Prompt 1

Prompt 1: You will need to decide what to implement based largely on existing resources. As is typical in change implementation, a few staff members and one provider are “early adopters,” using all the new tools they have access to. The bulk of staff are still somewhat resistant but showing some interest. There are a few hold-outs who are firmly entrenched in their beliefs that the “new-fangled” tools will take too much time away from patients.

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Prompt 2

Prompt 2: How will you address the integration and consistent use of technology?

As the implementation begins the third week, providers begin skipping or delaying documentation related to care coordination. Data shows care plan documentation drops from 55% to 48%. Staff report duplicate work and frustration. “We’re already working crazy hard. This just adds one more step.”

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Patients are not responding to follow-up messages or telehealth invitations.

Data:

• Portal use remains at 35%
• Telehealth sign-ups drop to 44%
• Engagement gap widens due to social drivers

Patients say they don’t have internet at home, internet is unreliable, or they do not know how to use the clinic systems.

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Nurses and front desk staff are resistant to changing their work processes. They voice dissatisfaction with the idea of new technology, complaining that it won’t work for their patients, that they will have to drag a computer into an exam room or sign on to the computer every time they see a patient. Consider how you would lead change strategically while recognizing the pattern of resistance - early innovators, early adopters, early majority, late majority, and laggards.

Roger's Adoption CurveConsider how it would apply to this scenario.

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Care Coordination Workflow Map

Now it's time to create a care coordination workflow map. Redesigning a workflow is more than just moving boxes on a page—it is a leadership strategy to eliminate friction. To ensure the implementation of this new care model sticks, you must visualize how data, people, and patients move through the system without creating 'technology abandonment' risks. Your map should reflect a system that is resilient, not just functional. Please view the next slide for more details about map requirements. Consider using these tools to create your map: Lucid, Monday, Miro, SmartDraw, or PowerPoint.

Care Coordination Workflow Details

Example Care Coordination Workflow Map

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Care Coordination Workflow Map

For this activity, you will draft a Care Coordination Workflow Map. Your map must show:

• Action Points: Where can staff training and use of technology be consistently implemented in a normal workday?

• Information Flow: How is patient info shared between team members to avoid data silos?

• Back-up Plans: What is the "Plan B" if a patient struggles with technology or a staff member resists the change?

• Review Steps: When will the team meet to discuss what is working (and what isn't) during the pilot phase?

‼️Remember to add your share link or embed your flowchart in your Word Companion guide - so your instructor can review and provide feedback.

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Interdisciplinary Role Assignments

Implementation fails when roles are ambiguous. As a leader, your task is to leverage 'Cognitive Flexibility'—assigning responsibilities that match the expertise of your team while addressing potential staff resistance. By clearly defining 'who owns what,' you build the organizational readiness necessary for a successful transition.

Interdisciplinary Role Assignments

For this activity, you will create an Interdisciplinary Role Assignment Matrix connected to this simulation scenario. Focus on how these roles support the adoption of the new care model:

• The Lead (FNP/Project Lead): Define how this role will practice 'Intentional Presence' and lead the communication plan for the staff.
• The Change Champions (Nurse/Pharmacy): Identify the specific tasks these roles will manage to mitigate peer resistance and assist with 'Staff Training.'
• The Support Liaison (Social Work/Admin): Detail how this role manages the 'Patient Communication and Education Plan,' specifically for patients with digital literacy concerns.
• Risk Mitigation Ownership: Assign which team member is responsible for monitoring 'Technology Abandonment' risks during the first 30 days of implementation.

✨Note: Please add roles as needed to your created matrix.

Please use the provided Word Companion guide as you navigate this simulation. This is the same guide used in the Explore activity.

Great work!

You have navigated the Elevate phase of this simulation, “Worsening Chronic Disease in a Rural Population.” Make sure you respond to the prompts provided in the Companion Guide. Next, you will move to the Evaluate phase of the simulation.

Deliverables:

• Please submit your Companion Guide after you complete this simulation.
• You will submit your Word Simulation Companion Guide Workbook twice in this module.
• First Submission: After this Elevate Activity
• Second Submission: After the Evaluate Activity

Want to review the activity again?

RETURN TO HOME TO RESTART THE ACTIVITY