group assignment final ppt

[Audio] Good morning/afternoon, Dr. George and everyone. We are Chinaemerem, Laxmi, Marzieh, Pranisha, Varsha, and Tripdeep. Today we present our proposal for introducing an Electronic Health Record system at UCMS, a tertiary-level hospital in Nepal. Our focus is leadership: how a leader guides people through this change so that it is safe, ethical, and fair, not just technically successful..

[Audio] UCMS currently runs on paper-based patient records. That creates everyday problems: files get misplaced, retrieving information takes too long, documentation is time-consuming, and staff have concerns about whether records are accurate (Andresen, 2023). These problems affect patient care. When information is missing, clinicians work without the full picture. Staff end up documenting the same thing twice, and communication between teams gets delayed. Our proposed change is to introduce an EHR system. The goals are better access to information, less duplication, stronger communication, and safe, high-quality patient care (Woodend et al., 2022). Note the word proposed. We are not promising a perfect fix. We are planning a careful, evidence-guided change..

[Audio] No leader can implement an EHR alone, so we start with people. Our sponsors and key decision-makers are hospital leadership, clinical leaders, IT leaders, and patient safety and privacy leaders. They provide authority, resources, and direction. Our frontline stakeholders are the people who will use the system daily: nurses, physicians, allied health staff, administrative staff, and patients. Next is who trusts whom. Staff are more likely to listen to trusted clinical leaders, experienced nurses, and respected physicians than to a memo from management. We would use these people to explain the changes and to encourage colleagues to share concerns and feedback. We would also build on existing relationships among leadership, clinical staff, IT, and managers to support training, communication, and problem-solving. Finally, gatekeepers. Administrative and operational staff control schedules, training logistics, communication channels, and access to information. If they are not on board, even a great plan stalls (George, 2026; Dickson & Tholl, 2020)..

[Audio] We grouped the barriers into four types and paired each with a response, drawing on Kotter's (2012) work on leading change. Structural: The paper workflow may not fit the EHR process. Our response is to map the current workflow, identify where the EHR changes it, and test the new workflow in a small pilot. Relational: There may be communication or cooperation gaps between leadership, clinical staff, IT, managers, and administrators. We would involve representatives from each group early and use trusted clinical staff to support communication. Cultural: Staff may be comfortable with paper and hesitant to change routines or speak openly about problems. We would involve frontline staff in the design and pilot, and encourage no-blame reporting of problems. Resource: Staff may lack time for training, coverage may be hard to arrange, and technical support and equipment may be limited. We would plan protected training time, identify staffing needs, make technical support available, and phase the implementation. The point is that each barrier is anticipated and has a leadership response..

[Audio] Readiness comes from Weiner's (2009) theory, which has two parts: change commitment and change efficacy. Commitment asks whether people want this change. We would gather feedback from nurses, physicians, and administrators about perceived benefits and risks. Staff may see the advantage of finding information faster, but they may also worry about how an EHR affects clinical routines. Efficacy asks whether people are able to make it work. Do they have time, equipment, practical training, and technical help? For example, can nurses attend training without leaving patients uncovered? One important point: we will not label UCMS as fully ready or unready until we have collected staff feedback, reviewed documentation workflows, and assessed training and resource capacity. Readiness is something we measure, not something we assume (Seere et al., 2026)..

[Audio] Ethics must guide this change from the start. Day-to-day access to patient data must be handled with care, and chart notes must stay accurate and up to date. On privacy and confidentiality, we would tie access permissions to job roles, review access records on a set cycle, set clear access rules before the pilot, and train staff on their privacy duties and how to report concerns (Banks et al., 2021). On leadership integrity and accountability, leaders should not sell the EHR as a fix for every charting problem. They should be honest about what might go wrong, report progress directly, and base decisions on evidence (Dickson & Tholl, 2020; Kotter, 2012). And patient safety must lead, even if go-live takes longer than first thought. We would rather be late and safe than fast and harmful..

[Audio] Fairness means recognizing that people learn differently. Some pick up computers quickly and others need more time. Staff should not be left to start the EHR alone. They need hands-on practice, direct guidance, and support after go-live. At UCMS, leaders should plan in-person sessions for each shift, and a technical staff member should stay on site during testing. Staff should also feel safe raising concerns when something looks wrong, including near misses, so problems are caught early. We included two examples. First, if wrong details are entered because training did not cover enough, the hospital should correct the record, include the staff member in the process, and retrain with simpler steps and plain explanations. The response is support, not punishment. Second, if a patient's drug allergy is typed in wrong, the hospital should verify the entry, fix the chart, and document what was changed. That protects both the patient and transparency (Dickson & Tholl, 2020; Woodend et al., 2022)..

[Audio] This canvas brings the plan together on one page, adapted from Dr. George's lecture (2026), with Kotter (2012), Woodend et al. (2022), and James Cook University as supporting sources. The problem is paper records that may be misplaced, delayed, or hard to maintain. Our approach is to pilot in one department before wider rollout. The switch trigger is that we pause for serious safety or privacy risks. For readiness, we check staffing, training, equipment, and IT support. We address barriers in workflow, trust, culture, and resources. Our coalition includes leaders, nurses, physicians, IT, and privacy staff. For communication, we use shift briefings, demos, updates, and feedback loops. Our measures cover accuracy, retrieval time, training, EHR use, safety, and equity. Finally, the 90-day win is to prepare for the pilot and proceed only when safety and readiness criteria are met. Success in the first 90 days is a safe, well-prepared pilot, not full rollout..

[Audio] We use Donabedian's (1988) quality framework and add equity. Outcome measures are documentation accuracy, record retrieval time, and misplaced records. Process measures are training completion, EHR use, and staff confidence. Balancing measures make sure we are not causing harm elsewhere: technical problems, delays, documentation time per patient, privacy events, and documentation-related events. Equity measures ask whether everyone has a fair chance to succeed: access to training across day, evening, and night shifts and across roles, plus working workstations and technical support on every shift. Targets are provisional until we collect baseline data. A weekly reporting working group will report on a dashboard at days 30, 60, and 90..

[Audio] Before go-live, we collect baselines over 30 days using timed record retrieval and an audit of paper records. Our proposed targets are documentation accuracy 10 points above baseline, retrieval time 50% faster by day 90, 100% of staff trained before go-live, and 80% or more EHR use by day 90. We use a simple traffic-light system. Green means on track. Amber means below target, so we take corrective action within two weeks. Red means a confirmed privacy violation, an EHR-related safety incident, or failure to resolve a critical problem. If red occurs, the pilot is paused. Expansion is recommended only if outcome and process measures are green and no red event has occurred. These are clear rules, and they keep us accountable (Donabedian, 1988; Weiner, 2009)..

[Audio] Our key takeaway is that a successful EHR is not measured by how quickly a hospital goes digital, but by how safely, confidently, and fairly its people use the system to care for patients. Our commitment at UCMS has four parts. We put people at the centre of change. We protect every patient's safety and privacy. We measure progress and learn from the pilot. And we expand only when staff readiness and safety evidence support it. Thank you. We would be happy to take your questions..

References. Andresen, K. (Ed.). (2023). Leading change in health systems: Strategies for RN-BSN students. University of West Florida Pressbooks. Banks, G. C., Fischer, T., Gooty, J., & Stock, G. (2021). Ethical leadership: Mapping the terrain for concept cleanup and a future research agenda. The Leadership Quarterly, 32(2), 101471. https://doi.org/10.1016/j.leaqua.2020.101471 Dickson, G., & Tholl, B. (Eds.). (2020). Bringing leadership to life in health: LEADS in a caring environment: Putting LEADS to work. Springer Nature. ISBN 978-3-030-38535-4 Library link Donabedian, A. (1988). The quality of care: How can it be measured? JAMA, 260(12), 1743–1748. George, I. (2026, September 8). [Week 2 Lecture notes]. Trinity Western University Moodle platform. https://www.twu.ca James Cook University. (2024). Communication skills for health professionals. Pressbooks. Kotter, J. (2012). Leading change. Harvard Business Review Press. ISBN 978-1-4221-8643-5 Library link Seere, A., Suhonen, R., & Wiisak, J. (2026). Prerequisites for ethical leadership in health and social care: Integrative review. Nursing Ethics, 33(1), 6–25. https://doi.org/10.1177/09697330251366593 Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67 Woodend, K., Thibeault, C., Lemonde, M., & McCabe, J. (2022). Leadership for nurses in clinical settings. eCampusOntario.