Idyllwild Clinic: Post-Operative Messaging System to Prevent

Readmission
 
Hanna Sahagon and Sarah Schoenfeld 
May 2, 2022

University of San Diego © 2016. All Rights Reserved.

Document Control
Document Information

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©

Document Id 1
Document Owner Hanna Sahagon and Sarah Schoenfeld
Issue Date 02/28/2022
Last Saved Date 04/04/2022
File Name HCIN542_StakeholderAnalysis_v6.docx.

Document History

Version Issue Date Changes

Page 1, Sections 1.1 and 1.2 by Sarah Schoenfeld and Hanna
1.0 02/28/2022
Sahagon
Pages 1-6, Sections 1.3 through 2.1 by Sarah Schoenfeld and
3.0 03/22/2022
Hanna Sahagon
4.0 04/04/2022 Page 7, Section 3 by Sarah Schoenfeld and Hanna Sahagon
5.0 04/18/2022 Page7, Section. 4 by Sarah Schoenfeld and Hanna Sahagon
6.0 05/02/2022 Page 7, Section 5 by Sarah Schoenfeld and Hanna Sahagon

Document Approvals

Role Name Signature © Date

Project Sponsor
Dr. Berkovich

Sarah
Project Manager
Schoenfeld/Hann
a Sahagon

i
Table of Contents

1 PLANNING BASIS..................................................................................................1
1.1 PROJECT CHARTER.........................................................................................................................1
1.2 SCOPE........................................................................................................................................1
1.3 MILESTONES................................................................................................................................1
1.4 PHASES.......................................................................................................................................2
1.5 ACTIVITIES..................................................................................................................................2
1.6 TASKS........................................................................................................................................ 3
1.7 EFFORT.......................................................................................................................................4
1.8 RESOURCES.....................................................................................................................................4

2. PROJECT PLAN.....................................................................................................6
2.1 SCHEDULE (GANTT CHART)..............................................................................................................6
2.2 DEPENDENCIES.............................................................................................................................6
2.3 ASSUMPTIONS...............................................................................................................................7
2.4 CONSTRAINTS...............................................................................................................................7

3. WORKFLOW ANALYSIS..........................................................................................7
4. STAKEHOLDER ANALYSIS.......................................................................................7
5. RISK REDUCTION.................................................................................................7
6. EVALUATION........................................................................................................7
APPENDIX A. PROJECT CHARTER...................................................................................9
APPENDIX B. WORK BREAKDOWN STRUCTURE...............................................................12
APPENDIX C. WORKFLOW ANALYSIS............................................................................13
APPENDIX D. STAKEHOLDER ANALYSIS.........................................................................14
APPENDIX E. FAILURE MODE EFFECTS ANALYSIS............................................................18
APPENDIX F. POST IMPLEMENTATION EVALUATION.........................................................19

ii
1 Planning Basis

1.1 Project Charter

The Idyllwild Clinic is an outpatient surgical clinic focused on same-day surgeries. To perform more post-
operation check-ups on patients, the leadership team has decided to implement an automated text-messaging
system. This system will not only allow for automated patient check-ups, but it will also allow nurses to spend
less time contacting patients post-surgery. If a patient’s responses are concerning, it will prompt a flag in the
patient’s EHR chart, which will notify the nurse to contact the patient. Patients can also request a call from the
nurse if they have any questions about their recovery.

Please see Appendix A. for the Project Charter.

1.2 Scope

The Idyllwild Clinic is implementing an automated “check-up” process once a patient is discharged from the
clinic. This will help alleviate nurses from taking time away from patients in the clinic but still being able to
check up on others. This will be done by writing a code that sends text messages in 12 hours post operation, 1
day post operation, 3 days post operation, 5 days post operation, and 7 days post operation interval. If a patient
indicates a response that is concerning, their chart will be automatically flagged, and the nurse will be notified to
call that specific patient. At the end of the automated survey, the patient will also be able to request a call from a
nurse. All the information from the survey responses will automatically be logged into the patient’s chart. This
process will result in more checkups and being proactive with the nurse’s workday and schedule. It will also
allow nurses to have more time to do administrative work such as charting or prepping for other surgeries. The
implementation has a six-month timeline and will cost $50,000. The $50,000 is from a loan written by the
CARES Act, Paycheck Protection Program, and the Healthcare Enhancement Act. The leadership team
allocated the $50,000 for the entire project. 

1.3 Milestones

Milestone Description Delivery Date

Charter approved The Business Case has been documented and was 06/15/2022
approved by the Project Sponsor.
Project team appointed The project team was selected. 06/25/2022
Work Break-Down WBS approved. 06/30/2022
Structure(WBS)

Successful integration of The App has been successfully integrated into the 08/01/2022
new application within EHR system.
EHR
Training All staff will complete training to learn how to 09/01/2022
utilize the new EHR application. Nurses will be
trained on how the EHR system will alert them if a
patient’s responses are out of the “normal” range.
Nurses will also be taught on how to find a
patient’s responses within the EHR system. The
project team will begin pilot testing the application
with a small population of patients. Patients and
nurses will be able to provide feedback before Go-
Live.
Final System Testing The project team is performing final system testing 9/15/2022
to ensure the system will be ready by Go-Live. 
Go-Live The application will officially begin being utilized 10/10/2022

1
 by the clinic.
Post Go-Live Evaluation The team will perform their evaluation of the new 11/01/2022
application and the project.

1.4 Phases

Phase Description © Sequence

Project Initiation
Project Planning
Project Execution
Project Closure
Defining the project by developing a Project Phase # 1
Charter as well as recruiting the project team.
The team will develop the Work Break-Down Phase # 2
Structure(WBS) and quality plan. .
The team will successfully integrate the new Phase # 3
application into their existing EHR system. They
will also perform all system testing. They will also
plan and coordinate training days for the clinic
staff. They will train all staff on how to utilize the
new EHR application. The new application will
“Go-Live”.
They will evaluate the success of the project based Phase # 4
on the project metrics and how well they follow
their project plan.

1.5 Activities

Phase Activity Description © Sequence

Project Develop Business case was developed and approved First step of the project
Initiation Business by the project sponsor.
Case
Project Project Team Select and organize the team members who After project was approved
Initiation Appointed will be involved with implementation. by the sponsor but before the
development of the quality
plan
Project Develop Develop a work break-down structure to After the project team is
Planning WBS guide the project timeline and necessary appointed but before the
tasks. quality plan is developed
Project Develop Produce a document describing Quality After the Project Plan but
Planning Quality Plan Assurance and Quality Control and process before the formulation of
review activities to be undertaken. supplier contracts
Project Contact EHR If the EHR vendor has software that can After the development of the
Execution vendor to easily be added to the system, obtain quotes quality plan but before the
discuss new and timelines for integration. If they do not, integration of the application
application discuss costs for developing application. into the EHR system.
proposal
Project Integrate Integrate application into existing EHR After the EHR vendor has
Execution Application system (to be performed by the EHR vendor). been contacted but before
into existing system testing.
system
Project System See if the EHR system can handle the new After the application was
Execution testing application seamlessly. integrated but before
training.
Project Training Train members of the staff to use the new After system testing but
Execution EHR application. before final testing.
Project Final testing Use feedback from training to fix any bugs in After training but before go
Execution before Go the application before go live. live.
Live.

2
 Project Go Live New application is live on EHR system. After final testing but before
Execution project evaluation.
Project Post Go Live Evaluate Project based on project metrics. After Go Live.
Closure Evaluation

1.6 Tasks

Phase Activity Task Sequence

Project Develop Identify gaps in the current EHR system 1st
Initiation Business Write Proposal 2nd
Case
Project Project Team Reach out to various clinicians to 1st
Initiation Appointed participate in project
Select team based on clinicians that are 2nd
available and willing to participate
Project Develop Identify project timelines 1st
Planning WBS Identify project goals 2nd
Identify project metrics 3rd
Project Develop Identify Quality Targets 1st
Planning Quality Plan Identify Quality Assurance Techniques 2nd
Identify Quality Control Techniques 3rd
Document Quality Plan 4th
Project Contact EHR Contact EHR vendor 1st
Execution vendor to Determine if EHR vendor can produce 2nd
discuss new proposed application
application Determine hardware upgrades necessary 3rd
proposal Determine necessary contracts 4th
Project Integrate Perform software updates 1st
Execution Application Identify new workflow with added 2nd
into existing application
system
Project System Perform system testing 1st
Execution Testing Determine if hardware upgrades were 2nd
successful
Determine if application or hardware 3rd
require further updates before training
begins
Project Training Develop training materials 1st
Execution Coordinate training schedules basic on 2nd
clinic’s schedule
Coordinate clinic early closures or late 3rd
starts if necessary
Meet with super-users 4th
Train all clinic staff 5th
Project Final Testing Perform any last checks and testing before 1st
Execution Before Go- Go Live based on clinician’s feedback after
Live training
Project Go Live New application goes live 1st
Execution
Project Closure Post Go Live Project team evaluates the project based on 1st
Evaluation the project metrics and milestones
Project team delivers report on project to 2nd
clinic leadership with proposed plans for
long-term evaluation

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1.7 Effort

Task © Effort
Identify gaps in the current EHR system 7 days
Write Proposal 7 days

Reach out to various clinicians to participate in project 5 days

Select team based on clinicians that are available and willing to 3 days
participate

Identify project timelines 4 days

Identify project goals 5 days
Identify project metrics 5 days

Identify Quality Targets 4 days

Identify Quality Assurance Techniques 4 days
Identify Quality Control Techniques 4 days
Document Quality Plan 4 days
Contact EHR vendor 2 days
Determine if EHR vendor can produce proposed application 7 days
Determine hardware upgrades necessary
3 days
Determine necessary contracts
2 days
Perform software updates 14 days
Identify new workflow with added application 7 days
Perform system testing 14 days
Determine if hardware upgrades were successful 3 days
Determine if application or hardware require further updates before
2 days
training begins
Develop training materials 14 days
Coordinate training schedules basic on clinic’s schedule 2 days
Coordinate clinic early closures or late starts if necessary
1 day
Meet with super-users
Train all clinic staff 1 day
3 days

Perform any last checks and testing before Go Live based on 7 days
clinician’s feedback after training
Go Live 1 day
Project team evaluates the project based on the project metrics and 7 days
milestones
Project team delivers report on project to clinic leadership with
proposed plans for long-term evaluation

1.8 Resources
For each task identified, list the resources allocated to complete the task.

Task © Resource
Identify gaps in the current EHR system Clinician’s time; Clinic
Write Proposal Data to analyze past
metrics; Clinician’s time
to write report;
Clinician’s knowledge of
HIT and new application
implementation.

4
Reach out to various clinicians to participate in project Clinician’s time;
Select team based on clinicians that are available and willing to Knowledge of clinician’s
participate past experiences working
with HIT; Utilizing
leadership skills to
promote project
management roles to
clinic staff
Identify project timelines Prior knowledge of project
Identify project goals management theories and
Identify project metrics skills; Knowledge of
evidence-based practice
related to new HIT
program being propose;
Previous experience in
implementing new EHR
application; Knowledge of
clinic’s culture and patient
population; Time to write
out project timelines,
goals, and metrics
Identify Quality Targets Knowledge of quality
Identify Quality Assurance Techniques assurance and control
Identify Quality Control Techniques techniques; Prior
Document Quality Plan experience in developing a
quality plan; Time to write
quality plan
Contact EHR vendor Experience working with
Determine if EHR vendor can produce proposed application EHR vendor; Prior
Determine hardware upgrades necessary working relationship with
Determine necessary contracts EHR vendor;
Understanding of HIT,
hardware, and software;
Knowledge of budget;
Clinician’s time
Perform software updates Experience working with
Identify new workflow with added application EHR vendor; Prior
working relationship with
EHR vendor; Knowledge
of clinic culture;
Knowledge of workflow
related to new HIT
application; Knowledge of
evidence based practice;
Clinician’s time
Perform system testing Experience working with
Determine if hardware upgrades were successful EHR vendor; Prior
Determine if application or hardware require further updates before working relationship with
training begins EHR vendor; Knowledge
of clinic’s hardware and
software; Knowledge of
product testing;
Clinician’s time
Develop training materials Knowledge of clinic
Coordinate training schedules basic on clinic’s schedule culture; Knowledge of
Coordinate clinic early closures or late starts if necessary clinic’s operations and
Meet with super-users schedule; Knowledge of
Train all clinic staff clinician’s past
experiences; Knowledge
of training ideologies;

5
 Experience in training
new HIT applications;
Lost staff time who will be
away for training;
Clinician’s time
Perform any last checks and testing before Go Live based on Feedback from staff after
clinician’s feedback after training training; Clinician’s time
Project team evaluates the project based on the project metrics and Knowledge of project
milestones evaluation principles;
Project team delivers report on project to clinic leadership with Time to write report; Time
proposed plans for long-term evaluation to analyze effectiveness of
new application; Time to
perform any necessary
analytics.

2. Project Plan
2.1 Schedule (Gantt chart)

The project is expected to be completed within the 6-month project period. However, some delays
may occur due to the small number of project team members, who also have other responsibilities and
roles at the Idyllwild clinic.

Refer to the Appendix B. Work Breakdown Structure for a detailed project schedule.

2.2 Dependencies

Activity Depends on © Dependency Type

Set-up Project Office Appoint Project Team Finish-to-start

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 2.3 Assumptions
[List any planning assumptions made in an unordered list.]

2.4 Constraints
[List any planning constraints identified in an unordered list.]

3. Workflow Analysis

A workflow analysis allows the reader to see a sequence of tasks that is done between
humans, systems, or both. The workflow map starts with the patients being discharged and
ends with the end of the automated messages. A majority of the workflow is repetitive in
nature but is done throughout a week’s time.

Please see Appendix C. for the Workflow Analysis.

4. Stakeholder Analysis
Identifying stakeholders is critical to the success of any project. As change is being
implemented, managing that change is crucial. It allows perceptions and expectations of the
stakeholders to be understood and for ongoing “check ins” to be set up.

Please see Appendix D. for the Stakeholder Analysis.

5. Risk Reduction
To reduce risk, a failure mode and effects analysis was used to identify potential failure
modes and get to the root cause. To make sure risk is reduced, the surgery center care
teams need to create a standardized meaning of what responses are concerning for patients
responding to the automated text messages. This can be done via tier system or
categorizing it.
The risk priority is making sure doctors either submit follow up appointments or talk to the
patient and send them additional information. This can be corrected by having a department
dedicated to scheduling, so the care team does not have to stress about doing that. The
next priorities include requesting a follow up appointment and scheduling the follow up
appointment. The failure mode effects analysis goes more in depth about other risk factors
and how to correct them.

Please see Appendix E. for the FMEA.

6. Evaluation
[Add a short paragraph summarizing the post implementation evaluation]

[Internal hyperlink to Appendix G. Post Implementation Evaluation

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8
 Appendix A. Project Charter

Post Operation “Check-Up” Text Automation in an Outpatient Clinic

Project Charter 
A.    General Information 
Project Sponsor: Dr. Barbara Berkovich

Project Hanna Sahagon

Manager:

Prepared by: Sarah Schoenfeld

Date: 02/28/2022 
The organization is a small 20 bed clinic that provides outpatient surgery. Some examples of the surgeries
performed include tonsillectomies, hernia repairs, gallbladder removals, some cosmetic surgeries, and cataract
surgeries. The clinic is the largest outpatient operating center in its area and receives the most referrals from
various primary care providers (PCPs) in the surrounding area. The organization currently assigns one nurse to
check-up on patients who were discharged from the previous day. This often takes this nurse away from seeing
patients for about 1-2 hours. The organization also wants to increase the frequency patients are checked-up on;
however, they do not have enough nurses to perform the daily screening. The organization has decided to
implement an automated text message system that will screen patients after they have been discharged from the
clinic. The responses will automatically be recorded into the patient’s electronic medical record (EHR). If there
are any responses that are concerning, it will flag the patient’s EMR and notify a provider, and a nurse will
personally call the patient to check on their status. Patients will also be able to request a “nurse call” if they have
additional concerns that were not addressed in the automated survey. 

B.    Purpose
The purpose of this project is to automate the “check-up” process once a patient has been discharged from the
clinic. The goal of the project is to allow more check-ups on patients after they have been discharged without
having to dedicate more nurse time or hire more nurses. Patients will also be able to self-report, which will
allow for more collection of data in the event of nurses being unable to reach patients during business hours. 

When a patient is discharged, the nurse will notify the patients that they will receive a series of automated text
messages about their recovery post-surgery. The text messages will ask about patients’ symptoms and specific
recovery questions depending on the surgery the patient underwent. Text messages will be sent at the following
intervals: 12 hours post operation, 1 day post operation, 3 days post operation, 5 days post operation, and 7 days
post operation. If a patient indicates a response that is concerning, their chart will be automatically flagged, and
the nurse will be notified to call that specific patient. At the end of the automated survey, the patient will also be
able to request a call from a nurse. All the information from the survey responses will automatically be logged
into the patient’s chart. 

C.    Constraints and Assumptions

Assumptions to this project include fear that the system will need to be updated to send out automated messages.
The assumptions could be related to threats that workflow might be interrupted, or it will create vulnerabilities
within the system where attacks could occur. It is also assumed that the go live will not be successful due to
leadership not knowing how to implement a successful program. Constraints to this project include costs to
build the code and have discharge orders trigger the automated messages. Standardization is another constraint. 

D.    Project Scope Statement

The Idyllwild Clinic is implementing an automated “check up” process once a patient is discharged from the
clinic. This will help alleviate nurses from taking time away from patients in the clinic but still being able to
check up on others. This will be done by writing a code that sends text messages in 12 hours post operation, 1
day post operation, 3 days post operation, 5 days post operation, and 7 days post operation interval. If a patient

9
indicates a response that is concerning, their chart will be automatically flagged, and the nurse will be notified to
call that specific patient. At the end of the automated survey, the patient will also be able to request a call from a
nurse. All the information from the survey responses will automatically be logged into the patient’s chart. This
process will result in more checkups and being proactive with the nurse’s workday and schedule. It will also
allow nurses to have more time to do administrative work such as charting or prepping for other surgeries. The
implementation has a six-month timeline and will cost $50,000. The $50,000 is from a loan written by the
CARES Act, Paycheck Protection Program, and the Healthcare Enhancement Act. The leadership team
allocated the $50,000 for the entire project. 

E.    Resource Requirements

 The required resources are: 
Loan from CARES Act funding
Employees’ salaries from the Paycheck Protection Act 
$50,000.00 from Idyllwild Clinic budget
IT experience
Labor: Informatics team needs to write the code
Hardware: Computers to write code and have discharge orders trigger messages
Nurses: Time to learn how to navigate new messaging system within EHR
Project Team: Time to plan and implement the new messaging system
Patients: Must have access to a cellphone

F.     Risks
Budget
If more funding becomes available, this could allow the hospital to hire or contract more coders or
informaticists, which could allow the project to finish earlier than expected. If the hospital realizes that it cannot
integrate this feature within their EHR, it could exponentially drive up costs as the organization may need to
consider upgrading their EHR system. 

Coders’ Capabilities 
If the coders are unable to successfully create and integrate the coding, they may need to hire additional data
scientists or informaticists, which can increase both the budget and timeline for this project. 

G.    Success Metrics: Criteria for Evaluating Project Success and

Milestones
Success Metrics of Messaging System 
1. 90% of patients will respond to the survey at least once;
2. 80% of patients will respond to the survey three times; and 
3. 95% of “Request for Nurse Calls” will be responded to within 2 hours or sooner.  

F.     Key Stake Holders

Dr. Grant, clinic owner and medical director (*Key stakeholder)
Dr. Montague, physician and clinic partner (*Key stakeholder)
Mrs. Miller, physician's assistant (will function as project team member)
Mrs. Vallejo, MSN, NP (project team member)
Mrs. Jones, clinic director (*Key stakeholder)
Ms. Hillock, front office clerk (project team member)
Mr. Dupont, back office medical assistant (project team member)
Mr. delaCruz, clinic accounts and billing (project team member with IT experience)

F.     Executive Summary
Idyllwild Clinic is a 20 bed clinic with an outpatient surgery center. It is the largest outpatient surgery center and
serves surrounding communities. Surgeons perform anything from elective to life saving procedures at the
center. Due to the high volume and low staffing, it is difficult for nurses to step away and do quick check ups on
patients. Check ups can total 1-2 hours a day, all of which can be spent on performing tasks for patients heading
into surgery or administrative work such as charting. The Idyllwild Clinic leadership has allocated $50,000
dollars to implement a new program to help improve the clinic. The key stakeholders decided that an automated

10
text “check-up” system would be the best way to improve efficiency and make sure that the nursing staff is
effective in their day-to-day operations. The check up system will send automated text messages to patients post
op at five different intervals with options to call a nurse or if a response is concerning, a notification will be sent
to the nurse so they can call and check up on the patient via phone call. 

11
Appendix B. Work Breakdown Structure

12
Appendix C. Workflow Analysis

13
 Appendix D. Stakeholder Analysis
PROJECT STAKEHOLDER ANALYSIS

The purpose of stakeholder analysis is to inform the Project team who the stakeholders are,
how those stakeholders should contribute to the project, where barriers might be to project
success (from the stakeholder’s perspective and their potential impact) and the actions that
need to be taken to ensure stakeholders needs are met.  Depending on your project the
stakeholder analysis could be performed informally but more complex projects that involve:
multiple departments, agencies, or disciplines may require an extensive analysis.  Keep in
mind that stakeholders are not always obvious and requires interviewing and discovery.
Taking time to understand the stakeholders and how they can contribute to the success of
the project warrants a formal analysis.

The identification of stakeholders will also assist in determining if an advisory board for the
project is necessary (this is not always the case) and what the concerns of the stakeholders
are. 

CONTENTS
Purpose 1
Stakeholder Analysis 2
Stakeholder Interview 2
Influence / Interest Grid 3
Guidance notes 4

Identify the key stakeholders (both internal and external) in your project and determine their
interests or requirements from the project; what the project needs from them, any perceived
attitudes and/or risks the stakeholders may have and the actions to be taken to achieve
this.  

This may require a series of meetings or workshops in order to complete the Interview Sheet
below.

From your list of stakeholders you may determine more easily how they fit into your Project
Organization. The majority of whom will fit into the Advisory Board or Business Community.

Category Name Objectives/Questions

Topics to Cover (adjust as necessary):
◻ Special Interests
◻ Influence
◻ Dependencies
◻ Critical Timelines / Risks
◻ Actions required
Non clinical Staff Front Office  Special Interests: Less frantic
(could be listed by Manager/Receptionist phone calls from patients
department or since they can directly
agency) communicate post-operative
concerns with nurses
 Dependencies: N/A

14
  Influence: Influenced by clinic
leadership
 Actions Required: May need
to assist patients with
submitting questionnaire
answers via the automated
system; they should have
minimal training. 
Clinical staff (could Nurses  Special Interests: Ability to
be listed by check in on all patients in a
department or time efficient manner; Spend
agency) more time on patients who
need additional help post
operation; Less fatigue
attempting to contact patients
post operation
 Dependencies: Need Nurse
“buy-in” and willingness to
learn new EMR function
 Influence: Influenced by
doctors and clinic leadership
 Actions Required: Mandatory
training on new EMR features

Admin staff(this Medical Director  Special Interests: Nurses will

might include your be more available to assist
practice manager with patients in office vs.
and medical spending time attempting to
director) contact post-operative
patients
 Dependencies: Funding to
ensure purchase of new EMR
software is fruitful
 Influence: Efficiency of clinic
staff and nurses
 Actions Required: Develop
training and instil “future state”
mindset 
Outside personal or N/A N/A
agencies 
Vendors EMR Vendor  Special Interests: New
business contract with clinic
who needs new EMR featured
integrated
 Dependencies: Funding from
clinic to pay for system
upgrades
 Influence: N/A
 Actions Required: Develop
messaging system to meet
the needs of the clinic
Patients  Special Interest: Direct line of
communication to nurses
post-operation; ability to

15
 contact nurse if concerns;
detailed tracking of post-
operative concerns and
symptoms
 Dependencies: Need to know
how to use messaging system
 Influence: Nurse or clinical
staff involved in discharge
stress importance of tracking
post-operative symptoms (or
lack thereof)
 Actions Required: Train
patients how to use
messaging system before
discharge
Misc. N/A N/A

External to Clinic Primary Care Doctors  Special Interests: Increased

(this could be (PCP) Who Refer Patients commitment from Idyllwild
outside to Idyllwild Clinic for Clinic to the patient, which
organizations like surgical procedures increases trust and likelihood
practices that have of referral to clinic for patients
a contract for that are in need of outpatient
referring patients) surgery. 
 Dependencies: N/A
 Influence: If the PCP feels
their patients will recover
better from their surgeries due
to the increased follow-up,
they will be more likely to refer
them to Idyllwild Clinic. 
 Actions Required: Clinic will
need to develop informative
brochures and talking points
to persuade PCPs to choose
their operating center over
others. 
Finance In-clinic Finance   Special Interests: A decrease
in readmission to the clinic
post-operation usually means
the clinic will receive more
reimbursement for ensuring
quality care from agencies like
CMS. 
 Dependencies: If the clinic
does decrease readmission
rates, they will increase
revenue due to the increased
reimbursement from insurers
and CMS. 
 Influence: If the new
messaging system is
successful, they will be willing

16
 to increase clinic revenue. 
 Actions Required: Educate
clinicians on the financial
benefits if program is
successful; Provide bonuses
after successful integration of
new EMR feature if
intervention is fruitful. 

Once the key stakeholders are identified, plot their position on the grid below.  Please refer
to the ‘Guidance Notes’ below for reference.

KEEP SATISFIED MANAGE CLOSELY

Nurses EMR Vendor

Medical Director 
Patients
Clinic’s Internal Finance Dept. 

MONITOR  KEEP INFORMED

(MINIMUM EFFORT)
Front Desk Staff
Referring Primary Care
Doctors

17
Appendix E. Failure Mode Effects Analysis

18
19
Appendix F. Post Implementation Evaluation

20