Child Health BC Technology Enabled Access

to Care for Children (TEACC)

PROJECT CHARTER

EXECUTIVE SPONSOR: Maureen O’Donnell PROJECT MANAGER: Karen Waite DOCUMENT DATE: March 10, 2014

  

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DOCUMENT CONTROL

PRINCIPAL AUTHORS Pat MCarron and Karen Waite, Healthtech

EXECUTIVE SPONSOR Dr. Maureen O’Donnell, Executive Director, CHBC

IMITSSPONSOR Barry Rivelis, Chief Information Officer, PHSA

REVIEWERS

Mary Lou Matthews, Provincial Lead, Network Operations, CHBC Bev Mitchell, Director Telehealth and Primary & Community Information Services

 DOCUMENT HISTORY

VERSION AUTHOR DATE NOTES REVIEWERS 0.1 Pat McCarron 2014-01-13 Populate Draft Karen Waite

0.2 Karen Waite January 23, 2014 Populate Draft Pat McCarron

0.3 Pat McCarron January 27, 2014 Populate Draft Karen Waite

0.4 Karen Waite January 27, 2014 Populate Draft Pat McCarron

0.5/0.6 Karen Waite/Pat Mc Carron

January 28, 2014 Populate Draft Mary Lou Matthews Bev Mitchell

0.7 Karen Waite February 6, 2014 Revisions based on Mary Lou Matthews and Bev Mitchell’s review

.8 Karen Waite February 6, 2014 Added signature line, page #s

Mary Lou Matthews Bev Mitchell

.9 Karen Waite February 9, 2014 Added ‘Strategic Alignment’ language

Mary Lou Matthews Bev Mitchell Maureen O’Donnell

Final Karen Waite March 10, 2014 Minor edits and signatures.

Confidentiality Warning: The information in this document is intended for internal CHBC/PHSA/VCH/PHC use only. It may contain information that is privileged and confidential. If this document is sent to you in error, then take notice that any use, dissemination, distribution or copying of its contents is strictly prohibited.

 

   

APPROVAL & SIGN-OFF (Internal) This project charter has been reviewed and approved by the following sponsors as listed below and made FINAL on March 10, 2014. All Executive Stakeholders and Sponsors have a common understanding of and agree with the goals, objectives, scope, deliverables and project organization as described within this document.

EXECUTIVE SPONSOR

Signature: __________________________________ Dr. Maureen O’Donnell, Executive Director CHBC

Date: March 10, 2014

CHBC NETWORK OPERATIONS

Signature: __________________________________ Mary Lou Matthews, Provincial Lead, Network Operations

Date: March 10, 2014

PHSA TELEHEALTH

Signature: __________________________________ Bev Mitchell, Director Telehealth and Primary & Community Information Services

Date: March 10, 2014

PROJECT MANAGER

Signature: ________________ Karen Waite, Healthtech

Date: March 10, 2014

TABLE OF CONTENTS 1.  Background and Rationale ............................................................................................... 3 2.  Project Definition .............................................................................................................. 4 3.  Project Scope .................................................................................................................... 7 4.  Project Approach .............................................................................................................. 8 5.  Project Organization & Governance .............................................................................. 14 6.  Project Budget ................................................................................................................ 21 7.  Risks ................................................................................................................................ 22 8.  Assumptions, Constraints, & Critical Success Factors .............................................. 24  

 

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1. BACKGROUND AND RATIONALE

1.1. Background

 Child Health BC (CHBC), an initiative of BC Children’s Hospital, is a provincial network linking the health authorities, the three child serving ministries and many provincial organizations, with a mandate to improve health status and health outcomes of BC’s infants, children and youth by working collaboratively to build an integrated and accessible system. An initiative to assist with this mandate is to develop, within a provincial context, regional access to paediatric specialty and sub-specialty services through mechanisms such as telehealth, regional outreach clinics, and other enhancing technologies such as m-health. This initiative is being conducted in close collaboration with the PHSA Telehealth Program, and other key stakeholders and will include the development of an implementation plan for this ‘Technology Enabled Access to Care for Children’ (TEACC) project. This initiative also includes the design of an overarching framework, service delivery plan, scan of provincial workflows, and the identification and implementation of up to three priority projects which will serve to meet the goal of enhanced access to paediatric specialty and sub-speciality services. The initiative will require the collaboration with CHBC leadership and telehealth personnel in PHSA (and others, such as Clinical and Systems Transformation) and the Regional Health Authorities for the integration of technology and telehealth into the service delivery planning and implementation for paediatric specialty services and eventually, other child health services. The enabling solutions are anticipated to include clinical, educational and administrative applications but will focus on enabling, expanding and supporting the processes required to design, implement and evaluate services.

1.2. Current State Gaps have been identified in equity of access to specialist and subspecialist services across BC’s vast geography. Child Health BC is interested in further enhancing access to specialist and subspecialist services across the province. Telehealth and other consumer health solutions have the potential to increase access, however, there has not, to date, been a comprehensive provincial strategy or service map neither developed nor implemented that focused on the access needs of BC’s infants, children and youth to specialist and subspecialist care. Nor have targeted pilot projects been funded to test the impact of telehealth on increased access to paediatric services in BC, although benefits analysis has been conducted elsewhere in Canada and internationally have indicated that telehealth has a positive impact on access to care and services. There has been significant progress made in the development of infrastructure and capacity for telehealth within the regional health authorities, however, there has not, as yet, been significant adoption of telehealth or other enabling technology on a broad, provincial scale for paediatric services. Along with the implementation of a ‘tiers of service’ model for the coordination and delivery of care and services across the province, there is an opportunity to integrate telehealth and enabling technology to build capacity and bring specialist and subspecialist care to those who have more limited access currently.

1.3. Strategic Alignment

The TEACC initiative supports CHBC’s mandate to work collaboratively to build an integrated and accessible system of health services for children and youth. This initiative will facilitate extending the reach of services to families and providers living and working throughout BC, an objective that is in alignment with strategic directions of PHSA, BCCH and UBC Department of Pediatrics.

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PHSA Telehealth is developing a strategy outlining the need for provincially focused and integrated Telehealth services. PHSA Telehealth is collaborating in the TEACC project, as PHSA Telehealth has responsibility for the delivery of Telehealth Solutions across PHSA and plays a key role in helping to manage projects relating to the delivery of provincially scoped telehealth solutions.

1.4. Desired End State In the desired future state there would be:

• an overarching access framework that would provide direction for health authorities and providers in the integration of telehealth and enabling technology to service delivery;

• an evaluation report that documented demonstrated success in the use of telehealth and enabling

technology to: • Provide specialist and subspecialist services in underserved areas; • Decrease wait times for service; • Increase efficiency of health care practitioners providing services; • Decrease the burden of travel for those travelling to receive services and those travelling to provide

services; and • Strengthen health human resource capacity in areas outside of the lower mainland through use of

telehealth and enabling technology for knowledge and skill transfer;

• a sustainable integrated service delivery mechanism leveraging telehealth and enabling technologies;

• technical and human infrastructure to support widespread adoption, utilization and support for the technical integration; and

• recommendations/lessons learned that would inform the future development of paediatric services through telehealth and enabling technology and the further development of telehealth and technical infrastructure to support service delivery and knowledge transfer.

PROJECT DEFINITION

 1.5. Project Purpose

The purpose of the TEACC Project is to:

• develop an overarching framework and infrastructure to support the sustainable integration of telehealth and other enabling technology into paediatric clinical service delivery across the province;

• identify opportunities to improve access to paediatric specialist and subspecialist services across the province;

• identify up to three priority projects which will demonstrate the potential for enabling technology to assist in improving access to care; and

• implement and evaluate the impact of the priority projects on access to paediatric care. Child Health BC and PHSA Telehealth are co-leaders of this project which runs from December 2013 through October 31, 2014. The project will be led by the Child Health BC Core Working Group co-chaired by CHBC and PHSA Telehealth. The CHBC Steering Committee will provide guidance and support for the initiative. The BC Telehealth Development Committee will provide support and expertise for the telehealth aspects of the overarching initiative and priority projects. The project will be supported by external consultants with expertise in telehealth and project management.

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1.6. Project Objectives

Overarching Project Objectives include: 1.0 A benefits evaluation will be completed for each of three priority projects by October 31, 2014, which will

demonstrate the impact of telehealth and enabling technology as introduced in three priority projects. 2.0 Improvement in access of up to three speciality/subspecialty areas as further delineated in the priority project

mini-charters and documented in the benefits evaluation. 3.0 Patient/family satisfaction in the use of telehealth and/or enabling technology will be rated as at least 80% by

patients/family members participating in the priority projects. 4.0 Provider satisfaction in the use of telehealth and/or enabling technology will be rated as at least 80% by

providers participating in the priority projects. 5.0 Awareness of the potential for use of telehealth and other enabling technology for service delivery will

increase amongst referring clinicians. 6.0 Awareness of the potential for use of telehealth and other enabling technology to provide services will

increase amongst consulting clinicians. In addition to the above objectives, each priority project may develop objectives specific to the project.

1.7. Project Benefits The project benefits are expected to include seven of the eight benefit categories as set out below. Benefits will be more fully described for each of the priority projects once they have been confirmed.

BENEFIT

CATEGORY DEFINITION PROVINCIAL ACCESS INITIATIVE

BENEFITS Quality

System Quality Type of feature/functionality of solution; accessibility and responsive of solution; security features of system

The project is expected to inform requirements for further strengthening of telehealth and enabling solutions infrastructure and applications suited to initiatives with a provincial scope.

Information Quality Ability of system to correctly reflect the required (e.g. patient) information

Service Quality Responsiveness of service related to system, such as user training or technical support

The project is expected to inform the training and service support requirements for a broad base of clinical users of telehealth and enabling technology. The project may inform the service requirements for system support for clinical services which may be delivered on an urgent or emergent basis.

User Interaction

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Use User frequency, duration, pattern, flexibility of actual usage

The project is expected to increase user frequency and duration of use for telehealth and enabling technology.

User Satisfaction Competency of user on system; user friendless and ease of use of system

The project is expected to improve the competencies of a broader base of clinical users.

Net Benefits Quality of Care Patient safety; appropriateness/effectiveness of

system; health outcomes The project’s main objective is to improve access to specialty and subspecialty care and therefore is expected to improve patient safety and health outcomes. It is also expected to improve the effectiveness of service delivery by reducing the need for travel on the part of clinicians who currently travel for outreach purposes. It is also expected to result in knowledge transfer and capacity building in regions where availability of specialists and subspecialists is currently limited.

Access to Care Ability of patient to access services quicker and more efficiently; patient and caregiver participation in their own health

The project is expected to result in improved access to specialist and subspecialist services. See Quality of Care above. There is also the potential to lay the foundation for a consumer health solution or solutions that would assist patients and families to participate/manage their health care.

Productivity Improved efficiency; improved health system management capability; improved continuity of care, improved care coordination; cost savings

The project is expected to generate an increase in the productivity of health care providers.

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Indicators will be developed for each of the Priority Projects and will be expressed in the ‘Benefit Indicator Format’ as per the example below.  

BENEFIT INDICATORS

INDICATOR REALIZATION BASELINE 2014/15 2015/16 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

System Quality <Indicator> <Term> <%> <%> <%> <%> <%> <%> <%> <%> <%>

Use <Indicator> <Term> <%> <%> <%> <%> <%> <%> <%> <%> <%>

Net Benefits <Indicator> <Term> <%> <%> <%> <%> <%> <%> <%> <%> <%>

2. PROJECT SCOPE 2.1. In Scope • Selection of priority projects

• Development of mini-project charters for each

• Development of the overarching access framework

• Development of service maps

• Stakeholder engagement and communication activities as they relate to the overarching project and the priority projects

• Development of the implementation plan and evaluation plan for the priority projects

• Support for the implementation of the priority projects (the PHSA telehealth implementation leads)

• Development of a sustainability plan

• Evaluation of the priority projects

2.2. Out of Scope • Sourcing for any funding that goes beyond the professional consulting services that have been retained

for the initiative

• Any potential priority projects that don’t fall within the mandate of CHBC

• Meeting gaps in physical readiness or technical readiness that cannot be feasibly met within current budget/time constraints

• Any potential priority project that may have an anticipated lead time that exhausts the length of the project

• Any potential priority project that would require physician billing code that is not currently in place

• Any potential priority project that would include out of province activity

• Any potential priority project that does not include a telehealth application or enabling technology

2.3. Related Projects

• Child Health BC Tiers of Service

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• BC Children’s Site Redevelopment Project

• Clinical Systems Transformation Project

• FNHA Telehealth Expansion Project (30 First Nations communities)

• iScheduler Project

• Others may be identified as the project progresses   

3. PROJECT APPROACH 3.1. High-Level Approach and Methodology

Standard project management methodology will be employed for the project including project initiative, planning, execution, monitor, control and roll out. Project reporting tools consistent with the IMITS tools will be used for project methodology. The consultant will conduct the engagement in five phases: 1) Project Initiation

In the project initiation phase, a project kick-off meeting will be conducted and the project scope, schedule, and deliverables will be confirmed. A stakeholder map, project governance structure and terms of reference for a project executive advisory committee and core working group will be developed. Information requirements will be identified, and information sourced to inform the development of the project charter, selection criteria for priority projects and for the development of a selection process. Knowledge transfer between CHBC and PHSA will occur and there will be targeted meetings with key external stakeholders to gather information and develop an overarching Project Charter. (December 2013/January 2014) 2) Project Planning: Priority Project Selection During this phase of the project, the priority project selection criteria will be finalized as well as an inventory of potential opportunities. Further information about the potential opportunities will be gathered; the project selection criteria will be confirmed and applied to the potential opportunities. Based on the analysis against project criteria, high potential projects will be identified and will be confirmed through a stakeholder engagement process. Mini-charters for the project will be initiated and the priority project structures will be developed. (January/February 2013) 3) Project Planning: Priority Project Implementation Plan Development The second part of the planning phase will see the approval of the mini-charters and the striking of Priority Project Teams. The teams will contribute to the development of Priority Project Implementation plans. These plans will include:

• Service mapping of clinical service for the priority areas reflecting tiers of service approach and the referral mechanism, and how CHBC specialty and sub-specialty services are integrated with regional service plans. A service plan will be developed. (March 2014)

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• Determination of the service plan (March 2014)

• Development of implementation plan, including a risk management log in conjunction with telehealth team (April 2014)

• Development of a change and communications strategy and plan (April/May 2014) 4) Execution/Monitoring and Control Implementation

During the implementation phase, PHSA Telehealth, Priority Project Teams and stakeholders, will work closely to implement the plans. The engagement/communication plans will be executed, any clinical protocols or communication systems will need to be developed, the infrastructure technical plans will be implemented and a training plan will be developed and executed. Site specific and integrated test plans will be developed and implemented. The findings will be documented and any adjustments will be made. The projects will then be readied to ‘go live’ and the project evaluation plan will be implemented. The projects will be monitored – weekly status reports will be prepared and any risks/issues escalated as required. (Implementation to begin as soon as charters complete/approved - pilots to ‘go live’ by June 11th. Evaluation data to be collected from project inception through end of September.) 5) Project Close Out

The Project Lead and consulting team will conduct a ‘lessons learned’ activities and ensure that all participants (both internal and external) have an opportunity to participate. A ‘Lessons Learned’ project close out report will be developed and reviewed with the project sponsor.

APPROACH

PURPOSE ACTIVITIES MILESTONES DATE MAJOR DELIVERABLES

Phase 1: Project Initiation December - January

• To establish the project structures and processes and ensure all participants understand the direction and their roles.

• Develop project charter, confirm roles and responsibilities, develop project governance structure and establish project plan

Complete Project Charter

Jan 31, 2014

• Project Governance Structure

• Core Working Group ToR

• Stakeholder Map

• Project Charter • Project

Schedule

Phase 2: Project Planning: Select Priority Projects February 2014

• Determine Priority Projects

• Develop and confirm project selection process including inventory, selection criteria

• Approve Selection Process

Feb 28, 2014

• Project Selection Process

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and opportunity profile • Gather information regarding

projects – engaging with stakeholders (e.g. Health Planners and members of the CHBC Steering Committee)

• Apply selection criteria, rate projects

• Recommend Priority Projects

and Criteria

• Approve 3 Priority Projects

• Project Inventory

• Project Selection Criteria

• Draft Mini-Project Charters

Phase 3: Project Planning: Priority Project Implementation Plans March/April 2014

• Develop plans necessary to successfully execute the Priority Projects

• Develop implementation plan • Strike Priority Project

Teams/working groups • Develop engagement, change

and communications strategy and plan

• Develop risk management log • Develop evaluation

methodology • Begin execution of projects

• Priority Project Implementation Plans Complete

Apr 11, 2014

• Priority Project Team ToRs

• RACI Charts • Evaluation

Plans • Communication

Plans • Implementation

Plans • Risk/Issues

Logs Phase 4: Execute Monitor and Control April to October 2014

• Implement Priority Projects, Monitor and Control

• Roll out stakeholder engagement/communication plan

• Develop clinical process flow • Identify any clinical protocols

required and develop process and tools

• Confirm technical infrastructure requirements/changes and procure/execute

• Confirm any physical plant changes required

• Confirm human resource requirements and source as required

• Train all participants • Plan and conduct site-specific

and integrated test – remediate any issues

• Priority Projects ‘Go Live’

Jun 11, 2014

• Communication materials

• Clinical Protocols

• Training Plans and materials

• Test scripts/templates

• Evaluation raw data

APPROACH

PURPOSE ACTIVITIES MILESTONES DATE MAJOR DELIVERABLES

Phase 5: Project Close-Out October 2014

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• Conclude Project • Develop Overarching Access Framework

• Develop Project Evaluation Report

• Conduct Project Lessons Learned Sessions

• Communicate key project findings and recommendations to key stakeholders.

• Project Close Out Meetings and sign off on final deliverables

Oct 31, 2014

• Overarching Access Framework

• Project Evaluation Report

• Project Lessons Learned Report

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3.2. Project Work Plan The following represents the baseline project work plan.

Dec 2013 January 2014 February 2014 March 2014 April 2014

Phase 1: Project Initiation

CHBC

 Provincial A

ccess Initia

tive

December 16th 2013Project Kickoff

Phase 3:  Project Planning Priority Project Implementation Plans

• Gather and review relevant material• CHBC Orientation/PHSA Orientation• Develop Stakeholder Map• Develop Project Governance Structure/Terms 

of Reference• Develop overarching project charter• Develop priority project selection 

criteria/selection process (assume three projects)

• Review with CHBC Steering Committee

• Develop implementation plan• Strike  Priotity Project Teamsworking

groups• Develop a engagement, change and 

communications strategy and plan• Develop Risk management log• Develop evaluation methodology• Begin execution of projects

February 7th CHBC Steering Cmte  Mtg

• Meet with Health Planners• Gather and review relevant 

material• One on one meetings with key 

stakeholders• Complete project 

inventory/opportunity documents

• Apply project selection criteria to high potential projects

• Identify proposed priority projects

• Confirm with relevant stakeholders

• Develop draft mini‐charters• Obtain CHBC approvals

Phase 2: Project Planning: Priority Projects Selection

February 28thPriority Projects Selected

April 11Priority Project Implementation Plans Complete

• Regional Engagement• Service mapping of clinical 

service for priority areas• Determination of the service 

plan• Confirm project charters

 

 

 

 

 

 

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May 2014 June 2014 July 2014 August 2014 September 2014 October 2014CH

BC Provincial A

ccess Initiative

Phase 4:  Priority Project Execution/Monitoring/Control

October 31 Project Close Out

Priority Project 1

• Roll out stakeholder engagement/communication plan

• Develop clinical process flow• Identify any clinical protocols 

required and develop process and tools

• Confirm technical infrastructure requirements/changes and  procure/execute

• Confirm any physical plant changes required

• Confirm human resource requirements and source as required

• Train all participants• Plan and conduct site‐specific 

and integrated test – remediate any issues

Priority Project 2

Priority Project 3

October 17 Draft Evaluation Report  and Framework Delivered

Phase 5:  Project Close Out

June 11All Priority  Projects ‘live’

• Roll out evaluation • Gather evaluation findings • Gather evaluation findings

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PROJECT ORGANIZATION & GOVERNANCE  

3.3. Organizational Structure The following represents the CHBC Project Governance Structure. The project is being funded and sponsored by CHBC and reports via the Project Executive Sponsor, Dr. M. O’Donnell to Lesley Arnold, President, BC Children’s Hospital and Sunny Hill Health Centre. As the project and priority projects have a technical component, PHSA’s Chief Information Officer will be kept apprised of the project and will be brought into an Executive Advisory Committee meeting to assist in addressing any project related technical risks/issues as required. In addition, there may be other individuals who are invited to the Executive Advisory Committee at the call of the Executive Sponsor. The project is supported by a Core Working Group which consists of representatives from CHBC, PHSA Telehealth, BC Children’s and Sunny Hill Health Centre Physician group, University of British Columbia Department of Paediatrics, and representatives from the regional Health Authorities. Priority Project Teams will be struck to provide a planning and coordination function for the priority projects once selected.

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3.4. Roles & Responsibilities

COMMITTEES & ADVISORY GROUPS

GROUP NAME RESPONSIBILITY MEMBERS MEETING FREQUENCY

Executive Advisory Committee

• Receives project status reports;

• Provides support, guidance and direction as required to ensure project success;

• Responds to project risks and issues as escalated by the Core Working Group, Priority Project Teams or individuals with the responsibility for leading the project and producing project deliverables;

• Authorizes release of formal reports and information communication about the project.

• Reviews any information being distributed to health authority executives.

Dr. M. O’Donnell Barry Rivelis Ad hoc as required

At the call of Dr. M. O’Donnell

Core Working Group

• Directly contribute to the initiative by providing input into:

o The planning of the CHBC Provincial Access Initiative including the development of the project charter, selection of priority projects;

o The execution of the project including the development of project-related deliverables;

o The evaluation methods and tools;

• Monitor project

• Mary Lou Matthews (CHBC) - Co-chair

• Bev Mitchell (PHSA Telehealth) – Co-chair

• Val Ashworth (PHSA Telehealth)

• Michele Fryer (CHBC) • Dr. Maureen O’Donnell • Liz Santos (PHSA

Telehealth) • Jennifer Scarr (CHBC) • John Jacob (UBC

Department of Paediatrics)

• Physician BC Children’s Hospital/Sunnyhill Health Centre Physician

Twice per month – second and fourth Thursdays

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progress and assist with resolving project related risks/issues and escalating as appropriate to the Project Executive Steering Committee;

Representative – TBC • Health Authority

Representative(s) - TBC • Ad hoc members as

required to fulfill the group’s responsibilities

 CORE PROJECT TEAM

ROLE PRIMARY RESPONSIBILITIES Project Executive Sponsor – Maureen O’Donnell

Chairs the Executive Advisory Committee Participates in the Core Working Group when available Receives project status reports and regular briefings on the project Supports the project by providing expert guidance and direction and assisting to resolve project risks/issues escalated by the Core Working Group, Project Manager or sponsors. Approves project artifacts Reviews any communication material intended for Health Authority Executives Acts as a champion for the project

Project Sponsor - CHBC – Mary Lou Matthews

Co-Chairs the Core Working Group Works with the Project Sponsor - PHSA and the Project Manager to provide oversight for all project activities Receives project status updates Provides guidance and direction from the perspective of CHBC Reviews draft project artifacts and recommends for approval to the Project Executive Sponsor Contributes to the development of project work products/artifacts Acts as a champion for the project

Project Sponsor – PHSA Telehealth - Bev Mitchell

Co-Chairs the Core Working Group Works with the Project Sponsor - PHSA and the Project Manager to provide oversight for all project activities Receives project status updates Provides guidance and direction from the perspective of PHSA Telehealth Reviews draft project artifacts and provides feedback – informs PHSA CIO of any impacts or potential impacts to IMITS Contributes to the development of project work products/artifacts Acts as a champion for the project

Project Manager – Karen Waite – Healthtech

Provides leadership for the secretariat functions for the Core Working Group Responsible for developing the Project Charter Ensures work products and deliverables developed on-time and on-schedule and are of a high quality Compiles regular status reports and updates Arranges and leads regular project status meetings Manages Healthtech Project Resources

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CORE PROJECT TEAM ROLE PRIMARY RESPONSIBILITIES

Leads Project Risk/Issue identification and management Escalates any issues that cannot be resolved at the account management level Develops strategy and approach for identifying/confirming clinical priorities Develops strategy and approach for identifying/confirming integration with regional service plans Develops change management strategy and provide input into the implementation/tactical plan and materials. Develops communication strategy including identifying target audiences and objectives for each audience. Develops evaluation framework and provide input into and oversight for development of evaluation tools and processes. Conducts project close out activities

Project Operational Lead – Pat McCarron – Healthtech

Develops structure and process for integration of service plans Conducts research into and implements the strategy for identification and mapping the services to available resources (may include reading material, interviewing, analyzing referral patterns, etc) Develops draft implementation plans for priority projects including activities, resources, time- lines Develops risk log and documents risks for priority projects Develops change management implementation/tactical plan and associated methods and materials Develops a communication tactical plan, associated communication materials and execute on the plan Develops draft evaluation tools and processes

Project Business Analyst – Jon Rabeneck – Healthtech

Provides project supports as required/assigned

Project Team Members Actively participates in project working group and task team meetings Receives project status reports Contributes to and reviews draft project work products and artifacts, providing feedback/input Conducts activities as required to contribute to the success of the project and priority projects Acts as champions for the project and priority projects

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3.5. Stakeholders

Stakeholder Mandate/Role Interest in Project

Child Health BC An initiative of BC Children’s Hospital and is a network of health authorities and health care providers committed to excellence in delivery of care to infants, children and youth in BC. Project Sponsor/Lead and Funder.

Interested in creating solutions for improving access to child and youth health services across the province. Interested in improving family satisfaction by having more local access, at least partially, to specialized services. Interested in ensuring success of project and value for dollar in project expenditures. Interested in demonstrating leadership/ success in innovative paediatric service delivery at a national level through participation in CAPHC and CPS connections.

Provincial Health Services Authority - Telehealth

Provides Telehealth Services and consulting to PHSA Agencies, VCHA and Providence Health Care. Provides leadership for scheduling using deploying and managing iScheduler (Telehealth Connect) for BC as the provincial platform to manage the scheduling of telehealth events. Project Partner/Co-Lead

Interest in supporting clinical access to paediatric care using enabling technologies. Interested in further development and implementation of a strategic approach to provincial telehealth services to catalyse the adoption and use of telehealth service delivery across the province.

BC Children’s Hospital Foundation

BC Children's Hospital Foundation is united with its donors by a single, simple passion - to improve the health and the lives of the young people who enter BC Children's Hospital. One of three stated priorities for a fundraising campaign called ‘Campaign for BC’s Children’ includes: •Child Health BC, a BC Children's Hospital initiative that is building paediatric care capacity throughout the province. Funder of CHBC, and therefore indirectly project funder.

Interest in ensuring that project outcomes have a positive impact on infant, children and youth health and that ‘success stories’ can be used to support the Foundation’s mandate.

BC Children’s Executive and Management Teams

BC Children’s Hospital and Sunny Hill Health Centre for Children, agencies of the

Interested in enabling the excellence in delivery of paediatric services and ensuring most appropriate/efficient means for delivering services.

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Stakeholder Mandate/Role Interest in Project

(Including Site Development and Clinical Transformation Teams)

Provincial Health Services Authority, provide expert care for the province’s most seriously ill or injured children, including newborns and adolescents. Based in Vancouver, BC Children’s and Sunny Hill reach across the province with vital health services that may not be available anywhere else in B.C. Provide specialized training in paediatric health care and work with renowned researchers to achieve better health for children and youth. As academic health centres, BC Children's and Sunny Hill are affiliated with the University of British Columbia, Simon Fraser University, Child & Family Research Institute, and other education and research institutions. Project role – provide support/champion initiatives.

Also interested in building paediatric capacity across the province. Interested in evaluation component of the project to assess impact of telehealth services on family and provider satisfaction and on whether there is a reduction in trips to BCCH ambulatory care programs. Interested in building paediatric capacity through networking and education/training opportunities with paediatric providers.

Regional Health Authorities (Clinical Leadership, Health Planners, Telehealth Leads, Technical Leads)

Have a mandate to provide leadership for their own Health Authority. The regional health authorities are responsible for:

• Identifying regional healthcare needs;

• Planning appropriate programs and services;

• Ensuring funding and appropriate management of these programs and services; and

• Information gathering and data collection.

Project role – participate in project planning and implementation.

Will be interested in the opportunities for enhanced access to services as well as operational and budget impacts. Interested in improving access to children within their Health Authority and planning for same. Will consider the implementation of the Tiers of Service (TOS) in their Health Authority and as part of provincial planning. May be interested in using telehealth to provide service in their own Health Authority, and will support access to services only available through BCCH teams. Some will have subspecialty services whose access can be increased through telehealth.

BC Telehealth Development Committee

Focused on the identification, development, implementation, and evaluation of operational policy, standards and guidelines necessary to facilitate the expansion of Telehealth within

As per the Health Authorities’ – Telehealth Leads/Programs – however, may collectively be interested in contributing to endorsing any proposed province-wide protocols/standards that will have an impact.

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Stakeholder Mandate/Role Interest in Project

BC to enhance and improve access to health services. Project role – support initiative

First Nations Health Authority

The mandate of the FNHA is to plan, design, manage, deliver and fund the delivery of First Nations Health Programs in British Columbia. FNHA works with BC First Nations, government partners and others to improve health outcomes for BC First Nations people. (taken from their web site) Project role – participate actively on the CHBC Steering Committee. May be opportunity for collaboration on initiative.

Interested in accessing speciality and subspecialty services for First Nations (potentially on reserve). May be interested in leveraging PHSA Telehealth technical and operational infrastructure. Alignment with their own strategy for access.

Provincial Government (including Ministry of Health, Ministry of Child and Family Development, Ministry of Education)

The Ministry of Health works in collaboration with B.C.’s health authorities to provide quality and timely public health and other healthcare services to British Columbians. The Ministry sets province-wide goals, standards and performance agreements for healthcare delivery by the health authorities. Project role – participate actively on the CHBC Steering Committee

May be interested in providing input into the prioritization of initiatives. Will be interested in the impact to paediatric service delivery. Will be interested in the evaluation of outcomes of initiatives.

3.6. Communication

Each of the stakeholders identified in the Stakeholder Map (Section 3.5 above) are considered to be target audiences and therefore a ‘communication approach’ has been associated with each of them. The methods for communication may be one or more of the following:

• The stakeholder or representative attends one or more project specific meetings (e.g. Core Working Group, Pilot Project Team meeting), receives information and carries it back to their colleagues;

• A member of the Provincial Access Initiative Core Project Team attends regular meetings and will provide regular project updates which will be supported by a ‘one pager’ which will be updated monthly (e.g. BC Telehealth Development Committee; Health Planners Group;

• Targeted communication will be developed and circulated at key project milestones (e.g. a communiqué developed for sites participating in the Priority Projects); or

• Will have access to updates posted on the CHBC website. Key messaging at the project outset will include:

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• The overarching project and priority projects are intended to be collaborative initiatives – led by CHBC and PHSA Telehealth and supported by a broad stakeholder base.

• The key objective is improving access to specialist and sub-specialist services.

• The priority projects selected will have potential for aprovincial-wide impact. Method, frequency and key messages will be dependent on the nature of the Priority Projects and therefore a detailed communication plan or plans will be developed once the Priority Projects have been selected.

3.7. Decision Making Project Executive Sponsor will have the authority for project related decision-making. When appropriate and/or required, the Project Executive Sponsor will consult with others who have responsibility for or who are subject matter experts in the particular area under consideration. The Project Executive Sponsor will keep PHSA Senior Executives and Child Health BC Steering Committee informed of the status of the project at regular meetings as appropriate. The members of the Core Working Group and Priority Project Teams may provide input/recommendations to the Project Executive Sponsor from time to time. Key decisions taken will be documented as part of meeting notes or in the project status report as applicable. A RASCI chart will be developed for each of the Priority Project Teams.

3.8. Change Control Proposed changes to the scope, schedule, or budget as agreed to in this Project Charter will be reviewed by the project Executive Sponsor who will determine whether to approve the proposed changes. Approved changes will be documented and included in an appendix to the Charter.

4. PROJECT BUDGET The project budget has been set out and is being monitored through CHBC’s operational processes.

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5. RISKS

RISK LOG Project:  Project Manager: Date Last Updated:  

RISK IDENTIFICATION  RISK ASSESSMENT  RISK MITIGATION STRATEGY STATUS 

ID  RISK DESCRIPTION  Low  Medium  High  MITIGATION STRATEGY  COMMENTS 

1 

Risk that project human resources are insufficient for the stated deliverables and timelines. 

  √   

Through the priority project selection process, identify potential in‐kind resources that may be applied towards project activities. Ensure activities undertaken are value‐add for the project. 

  

  

2 

Risk that priority projects with the highest potential impact/chance of success will require operating or capital equipment funding which is currently not budgeted. 

  √   

Select sites that already have telehealth capacity as early adopter sites. Identify potential budget requirements as early in the project as possible. 

  

  

3 

Risk that there are too many priority projects that stakeholders want to see moved forward.   

√     

Develop selection criteria in collaboration with key stakeholders. Ensure potential projects rated against criteria. Ensure stakeholders aware of constraints.             

  

  

RISK IDENTIFICATION  RISK ASSESSMENT  RISK MITIGATION STRATEGY  STATUS 

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ID RISK DESCRIPTION 

Low  Medium  High  MITIGATION STRATEGY  COMMENTS 

4 

Risk that specialists/sub‐specialists will not be incented to provide services through telehealth. 

√     

Ensure specialists/subspecialists involved in the project selection and project planning. Ensure projects selected have billing codes. Develop systems/processes to ensure ease of implementation. Allow opportunity for publication/other options to allow for visibility. Consider sessional compensation for low volume activity until volumes MSP fees appropriate. 

  

  

5 

Risk that due to the number of stakeholder groups and individuals that key stakeholders will not be kept abreast of the project and therefore will not be supportive. 

√     

Develop stakeholder engagement and communication plan tailored to key stakeholder groups and develop easily accessible communication vehicles. Include key stakeholders in project organization structure. 

  

  

6 

Risk that adoption and utilization will be low if priority projects are focused on small patient populations. 

  √   

Ensure that all priority projects have potential for provincial scope. 

  

  

7 

 Priority projects may not be supported to continue beyond the scheduled project end date. 

   √     

Develop a sustainability plan in collaboration with project stakeholders. 

  

  

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6. ASSUMPTIONS, CONSTRAINTS, & CRITICAL SUCCESS FACTORS

6.1. Assumptions .

• The budget for professional services related to this engagement as outlined in this document is predicated on the following assumptions:

• That during the course of this professional consulting services engagement there will be projects identified, scoped and planned which may require additional capital or operating budgets which may include but may not be limited to:

o Establishing and maintaining network connectivity (may include network deployment, network drops, wireless network installation, network gear, wireless usage, internet usage);

o Telehealth end-point; o Licensing for software (e.g. scheduling, electronic stethoscope, PC or mobile-based

videoconferencing, learning content management system); o Support desk and technical service personnel costs; o Long distance telephone and videoconference studio costs; o Stipends for physicians to participate in planning; o Potential travel costs for stakeholders to participate in planning and implementation activities;

and o Potential legal fees for the review or development of legal agreements. o The procurement of the above goods and services may require the preparation of and

execution of procurement vehicles such as requests for quotes and requests for proposals and associated evaluation processes.

o Travel on the part of the consultants (one based in Toronto, one based in Ottawa and one based in Victoria) will be required to engage and involve regional stakeholders in the planning and execution of projects.

• that PHSA Telehealth will take a leadership role in the implementation of the Telehealth aspects of the project;

• that organizations participating in a Priority Project will be required to contribute ‘in-kind’ resources that may include those with administrative, technical, or clinical roles who will sit on a Priority Project Team or work group, take on work associated with the implementation or ongoing support of a Priority Project and/or support a Priority Project;

• that if funds are required to implement the project that those involved/advocating for the project will work collaboratively to address; and

• that individuals with expertise in evaluation who currently have roles within CHBC or PHSA Telehealth or one of the Health Authorities may be available to assist in reviewing the proposed evaluation methodologies and draft tools.

6.2. Constraints

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Constraint / Barrier Impact on Project Success (Schedule, Cost, Scope, Quality, Other)

Project runs from December 2013 to October 31, 2014 (and includes the July/August holiday period)

This timeline is short given the deliverables and the complexity of implementing a telehealth project therefore, there may be an impact on quality, scope or schedule (depending on the priority projects selected).

Funding requirements are not yet identified for purchase of end-point equipment, licenses nor end-point staffing.

There may be an impact on scope/schedule.

There are multiple Health Authorities involved, each of which has structured and supported telehealth slightly differently.

This means that there may need to be time spent on harmonizing protocols or processes to ensure that there is consistency across a provincially scoped initiative. There may be an impact on schedule.

Availability of suitable enabling solutions.

There may not be an effective solution to meet a project requirement which may have an impact on scope, schedule.

6.3. Critical Success Factors

Key success factors include but are not limited to:

• Strong, visible stakeholder support for the overarching initiative and for the priority projects will be required to assist in overcoming any project barriers;

• A ‘solutions oriented approach’ on the part of project participants will be required in order to ensure that all come to the table ready and willing to resolve any potential issues;

• A collaborative approach with a focus on the ‘greater good’ will be required as in telehealth initiatives, often those contributing resources are not the same organizations receiving the benefits; and

• Strong leadership from CHBC, PHSA Telehealth and Health Authorities will be required to address project risks and issues that may arise.