Project Charter

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Project Charter Use this exemplar (sample) as an example of what might be possible for your Project Charter. This can serve as an example and guide as you complete Parts 1 (due at the conclusion of Assessment 1), Part 2 (due at the conclusion of Assessment 2), Part 3 (due at the conclusion of Assessment 3), and Part 4 (due at the conclusion of Assessment 4) of your Project Charter. Remember to focus on one specific “gap” that is measurable for your project.

Part 1 Project Overview

Project Name Caring for Cultures at Hillside Community Health Center

Gap Analysis

Hillside Community Health Center has experienced monthly declines in patient/client visits since the clinic opened in January. The opening month, the clinic had 700 visits. The past month, the clinic had 400 visits. The identified gap between the desired state (700 visits) and the current state (400 visits) is 300 visits. The primary focus of this project will be to address this gap in patient/client visits.

It is important to identify contributing factors to the reduction in patient visits as there is limited health care options in the community. A survey was sent to patients who did not reschedule a repeat visit or missed appointments. Issues related to cultural competency and feeling welcomed were identified. Hillside Community Health Center can serve as a source of health promotion, prevention, education, and a point of access to care for this underserved community.

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Gap Analysis

Current State

Desired State Identified Gap

Methods used to identify the Gap

Implications/Relevance to Identified Population

400 clinic visits per month

700 clinic visits per month

300 clinic visits per month

Clinic records of visits per month, follow-up survey for patients who missed appointments or did not schedule a follow-up appointment

It is important to identify contributing factors to the reduction in patient/client visits as there is limited health care options in the community. The clinic can serve as an access point to health care services, prevention, education, and health promotion and connection with the community, which is underserved

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Evidence to Support the Need

Providers’ cultural competency is cited as one of the factors that influence person-centered care and communication in the 2021 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality, 2021). Cultural differences between healthcare staff and patients/clients can lead to mistrust in the system, miscommunication, low satisfaction, and disempowerment. On the other hand, when staff members are culturally competent, there is greater satisfaction, better sharing and seeking of information, and treatment adherence (Jongen et al., 2018).

Health care teams that mirror the communities they serve have a positive significant relationship with improved community relations, quality and effectively addressing health disparities. Persaud (2020) found that culturally relevant care is associated with better patient outcomes and the ability to meet the needs of the community served. Diversity in health care appears to benefit the community and the healthcare organization, establishing a deeper connection between the organization and the community. Implementation of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) can provide guidance to the clinic’s mission of serving the population and increasing patient visits (U.S. Department of Health and Human Services, 2013).

Problem Statement

The decline in patient/client volume observed at the center since inception is attributed to issues related to cultural competency and feeling unwelcomed at the clinic based on survey responses. This has impacted residents’ utilization of health-care services at the center, resulting in suboptimal health promotion, prevention, and treatment activities.

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SMART Objectives

Specific The target population for the project comprises the residents in the neighborhood, specifically patients/clients for the clinic. Measurable The patient/client volume as measured by the observed visits per month will increase from 400 to 700 by the end of Year 1 in December. Achievable

All the necessary resources for the project’s operation are available for training for the staff, hiring of representative staff, and staffing patterns to serve 700 visits per month. The clinic has access to grants and external funding for training, outreach, and marketing. There is an independent source of funding related to serving vulnerable groups via a private foundation

Relevant

• The project is directly aligned with the mission of the center which is to serve the community and offer health care services

• The center can serve as a source of health promotion, education, prevention and a point of access to care for the community. The center can serve as a model for actions related to the provision of culturally competent and patient/client centered care

Time The Center will see an increase in patient visits from 400 to 700 by the end of Year 1, December.

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Project AIM

Cultural responsiveness is an ongoing focus for Hillside Community Health Center. As the center strives to serve more meaningfully in the underserved and culturally diverse neighborhood, an immediate and important aim for the center is to see an improvement in the number of patient/client visits per month. Eken et al. (2021) found that the development of a culturally competent approach is critical in connecting with patients and establishing a rapport for continuity of care.

The aim of the project is to achieve the expected average patient/client visits per month to the center (700) by December of Year 1 by implementing relevant and effective training for the staff related to cultural competency and patient/client centered care.

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References (APA format)

Agency for Healthcare Research and Quality. (2021). 2021 National healthcare quality and disparities

report. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr.pdf

Eken, H., Dee, E., Powers, A., & Jordan, A. (2021). Racial and ethnic differences in perception of provider

cultural competence among patients with depression and anxiety symptoms: A retrospective,

population based, cross sectional analysis. The Lancet, 8(11), 957-968

https://doi.org/10.1016/S2215-0366(21)00285-6

Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: A

systematic scoping review. BMC Health Services Research, 18(1), Article 232.

https://doi.org/10.1186/s12913-018-3001-5

Persaud, S. (2020). Diversifying nursing leadership through commitment, connection, and

collaboration. Nursing Administration Quarterly, 44 (3), 244-250. https://doi.org/

10.1097/NAQ.0000000000000422.

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U.S. Department of Health and Human Services. (2013). National standards for culturally and

linguistically appropriate services (CLAS) in health and health care.

https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf

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Part 2 Project Team

Title Department Role

Executive Sponsor

Clinic Director Administration

• JA is the chief liaison between the Hillside Community Health Center and Hillside Hospital, the center’s parent organization. The clinic director represents the organization in the medical community. • JA will provide project access to the contacts she developed while

resolving the initial staffing and infrastructure issues at the center. These contacts will aid in the community outreach aspect of the project. • JA initiated the surveys with the community leaders that led to the discovery of the issues related to cultural competency and patient/client centered care. Therefore, she has a keen interest in ensuring the success of the project. • JA provides access to financial resources as she approves all projects undertaken at the center and sanctions budgets related to the project. • JA demonstrates calmness under pressure and was instrumental in quelling staff resistance that arose related to policy changes in the first year of the clinic’s inception. She has developed a strong relationship with members of the staff since then and is in a unique position to tackle resistance to the project from the center’s staff and high level administrative sources.

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Team Members

Clinic staff and external advisors

The team members for this project were chosen from different levels and positions within the center and include those directly involved with the project. The team includes members who are familiar with the clinic and its system. The team will include the DEI educator who will implement the training program related to cultural competence and patient/client centered care. In addition to the healthcare staff, the team must also include champions who can disseminate information to and generate enthusiasm for the project among fellow healthcare providers and staff at the clinic. The team members for this project come from different backgrounds with diverse knowledge, values, traditions, and beliefs. These differences can be sources of innovative approaches and solutions, especially in the case of unexpected hurdles that can arise through the course of the project.

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Team Members

Title/Depart ment and/or Affiliation

Rationale for Selection/Contribution to the Project

Clinic healthcare providers

• Clinic healthcare providers interact with patients/clients, team members, and providers from other specialties to ensure that health conditions are accurately diagnosed and that care provided is based on the patients’/clients’ clinical histories and their unique social and cultural needs.

• Healthcare providers provide medical oversight for policy or protocol changes developed in the project that impact patient/client care at the clinic.

• Healthcare providers work with the diversity educator to identify and eliminate instances of implicit bias in interactions with patients/clients and one another

• Healthcare providers will incorporate the knowledge and skills from the cultural competency training into practice. They will also be involved in the implementation of best practices and improvement plans resulting from the intervention.

Clinic nurses

• The nursing staff at the center interact with patients/clients and their families as part of their regular operations. They are in a unique position to educate and guide patients/clients and their families on prevention efforts and following healthy practices according to their unique social and cultural needs.

• The nursing staff at the clinic will be involved in implementing any action items resulting from the analysis of the survey data. Their participation in this part of the project will help the nursing staff gain a deeper understanding of the importance of cultural competence, thereby reducing the chances of staff resistance to the project.

• The nursing staff will incorporate the knowledge and skills from the training into practice. They will also be involved in the implementation of best practices and improvement plans resulting from the intervention.

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Community Engagement Specialist (SA)

• SA is a well respected member of the Hillside community and has over 12 years of experience working with the neighborhood served by the center and Hillside Hospital.

• SA has well-established connections with prominent community leaders. • SA will set up the diversity advisory committee comprising the diversity educator

and community leaders. The committee will be involved in the project plans and operations.

• SA will oversee the creation of a team of community outreach volunteers who will carry out surveys in the neighborhood for the clinic.

• SA will act as a bridge between team members, sponsors, and stakeholders by communicating updates and relevant information.

• SA will focus on improving collaboration, resolving conflicts, and reducing informational deficiency.

External Diversity Educator

• The external DEI educator has experience working with underserved communities and will provide the training/education for the staff on aspects of care for patients/clients with unique social and cultural needs.

• They will work closely with the clinic healthcare providers, nursing staff, clinic administration, clinic staff, and community leaders to create and implement training modules.

• They will analyze the survey data to fine-tune training and assessment efforts. They will also assist with data analysis to determine the cultural competency of the center’s staff after completion of the planned intervention (training/education programming) as well as individual improvement through the course of the training.

• They will work with the outreach advisory committee to incorporate specific inputs into the training and best practices.

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Team Leader Clinic

Administrator (GL)

GL oversees patient/client and community engagement. She focuses on staff development and collaborations that are aimed at providing continuous and quality health care. GL is an authentic leader who is self-reflective and sincere. She is guided by a set of core ethical values aligned with the organization’s vision and mission. She builds relationships and inspires trust and mutual respect. In the past, she has been effective in handling disagreements by helping both parties find common ground. She leads by example to foster ethical behavior among the staff (Wong & Walsh, 2019). This leadership approach is suitable for teams that are interprofessional in nature, such as the team working on this project. The ability to inspire trust and loyalty among the staff and the residents of the community is crucial to the project. As an authentic leader, GL is honest and fair with team members and can set expectations regarding roles and responsibilities effectively. GL uses principles of servant leadership, which involves facilitating the well-being and development of her followers. This sometimes involves stepping in and out of the leadership role, which allows each team member to take on leadership responsibilities when their professional expertise or specific knowledge becomes relevant in providing the most effective outcome (Mostafa & El-Motalib, 2019). In the project, this would mean strategically delegating leadership responsibilities such as partnering with the DEI educator for the creation of training materials and community outreach. Individual team members can display leadership behaviors and utilize opportunities to make decisions that help them achieve the aim of the project and their own leadership development. This leadership approach emphasizes improved patient/client outcomes over bottom-line financial decisions (Smith et al., 2018). This can lead to a more positive perception of the center by the residents of the neighborhood and promote community engagement. GL will make the policy decisions for this project and oversee their implementation. GL has high emotional intelligence and the ability to understand people. This ability is very important in leadership, and it influences cooperation among team members and encourages healthy working relationships. A leader with a high emotional intelligence effectively creates a work environment that supports problem-solving, promotes a high

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degree of self-awareness among followers, fosters trusting relationships, and encourages creativity and self-improvement (Skrzypczyńska, 2020).

Stakeholders

Title/Role or Affiliation

Connection to the Project

How Affected/Impacted by Project? Contribution to the Project

All health care providers, nurses, and clinic staff

Internal Stakeholders

The healthcare providers, nurses, and staff will improve their ability to provide effective and culturally competent care to patients/clients.

This implementation of training for the staff may require additional time and changes in staffing

The healthcare providers, nurses, and staff will undergo training to align the care they provide with culturally and linguistically appropriate services (CLAS) standards.

The clinic staff will make up most of the project team and will carry out any changes that result from the project.

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Administration and the Board of Directors

Residents of the communities that the project’s interventions aim to benefit

Internal Stakeholders

Improvement in the cultural competency of the staff at the center will result in increased visits to the clinic, which is the aim of the project. Improving access to care for the residents of the neighborhood aligns with the organizational mission and can help improve the clinic’s eligibility for public and private grants. The center and hospital administration can then use this financial support for future expansion plans.

The administration and Board of Directors will provide financial support and access to other clinic resources.

The administration and Board of Directors will provide the approvals necessary for the completion of project tasks.

External Stakeholders

The success of the project will lead to increased consistent use of and access to health care for the residents of the neighborhood.

Residents will provide the data for the project in the form of pre-and post- intervention surveys.

Representatives from this stakeholder group will also be part of the diversity outreach committee.

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Community Leaders External Stakeholders

The successful implementation of the project will result in increased access to health care for the members of the communities the leaders represent. This may include better health outcomes, an increase in health promotion activities, and improved health status for the community at large

Community leaders will contribute to the project as part of the diversity outreach advisory committee.

Community leaders will provide culture- and language-specific inputs to diversity educators during the creation of training modules.

Community leaders will help to interpret survey responses based on their understanding of the lived experiences of residents.

Community leaders will work with community engagement specialist, on matters of community engagement and volunteer recruitment as needed.

Community leaders will serve as representatives and advocates of the targeted community

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Communication Plan Internal Communication: At the project inception, a formalized process will be instituted consisting of weekly meetings for the project team on a specified day and time. In some instances, remote access may be needed. An online message board will be developed for the project team to communicate between weekly meetings as issues or challenges arise. The team leader will be copied on messaging for transparency and open communication. The team will utilize concise and respectful communication between members and solicit feedback and different perspectives as issues arise related to the planned intervention, staffing, resistance to training, implicit bias, and outcomes. The Team Leader, who has high emotional intelligence, will be instrumental in managing change and conflict resolution as the planned intervention is implemented (Cavaness et al, 2020). The Team Leader will also be the designated communicator with the Executive Sponsor and will provide biweekly updates. The use of evidence and data related to the number of employees who have completed training, scores on the cultural awareness survey, patient/clinic visits, and community outreach and survey efforts will be presented to the Executive Sponsor.

External Communication: The Team Leader will act as the liaison between the Project Team and the Stakeholders. The stakeholders should be representative of the community served and their interests. Effective communication is related to trust and in understanding the values, emotions, and culture of the community (Bourmaud & Chauvin, 2021). The objective is to partner with the stakeholders and communicate the outcomes of the improvement work, generate interest, and share successes (UNC Institute for Health Care Improvement, 2022).

Different audiences require different methods and modes of communication. The Team Leader will meet with the designated stakeholders monthly and present the status, updates, and other relevant information related to the project using written and visual (graphs, tables, charts) methods. The Team Leader will solicit feedback from the stakeholders related to education and training programs, cultural norms and practices, language assistance, and changes in community perceptions as the training is implemented and completed. The Stakeholders will be considered equal partners in the change opportunity, with a focus on the health of the community population, the development of trusting relationships, and the provision of culturally competent health care.

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References (APA format)

Bourmaud, A., & Chauvin, F. (2021). Which communication strategies can improve interventions aimed at tackling social

inequalities in organized cancer screening in France? Global Health Promotion, 28(1_suppl), 89–92.

https://doi.org/10.1177/1757975921989505

Cavaness, K., Picchioni, A., & Fleshman, J. (2020). Linking emotional intelligence to successful health care leadership: The Big

Five Model of Personality. Clinical Colon Rectal Surgery, 33(4),195-203. https://doi.org/10.1055/s-0040-1709435

UNC Center for Healthcare Improvement. (2022). Communication plan.

https://www.med.unc.edu/ihqi/resources/communication-plan/

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Part 3 Intervention Planned Intervention

According to the survey sent to patients/clients who missed appointments or did not schedule a second visit, the declining patient/client visits are associated with decreased cultural competency of the staff and feeling unwelcomed at the clinic. The planned intervention will focus on the training and education of the clinic staff related to culturally competent and patient/client centered care, which could result in the clinic achieving its goal of an average of 700 patient/client visits per month.

• All current clinic employees will undergo a series of trainings related to the provision of culturally competent care aligned with the target population. The training will focus on promoting cross cultural awareness.

• Training will be initiated within 14 days of the project start and all staff will complete the

trainings within three months. New staff will undergo the training as part of orientation/on boarding.

• After completing the trainings, the staff will be administered a cultural awareness assessment with an expected score of 90% or higher. If the score does not meet the set threshold of 90%, the training will be extended, and the assessment repeated within 30 days

• The training will be supervised by the certified Diversity Educator or representative who initially will be contracted by the clinic to deliver the training. If the planned intervention is successful, an “in house” person will be trained, certified, and designated to deliver the training on a regular basis

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Measurement: Proposed Outcomes

Develop outcome, process, and counter/balancing measures for your project

Outcome Measure • What is the desired outcome in

measurable terms?

Process Measure State 1-2 process measures that address:

Counter/Balancing Measure As you are not implementing the project, develop counter/balancing measures that might be anticipated if the planned intervention is implemented

The clinic will achieve the expected average of 700 patient/clients visits per month by the end of Year 1 (December) by implementing relevant and effective cultural competency training for the staff

• All clinic staff will complete the series of trainings related to cultural competence and patient/client centered care within three months of program inception

• 90% of the staff who complete the training will score 90% or greater on the cultural awareness assessment post training

• Staff who do not meet the 90% threshold will be offered additional trainings and will repeat the assessment within 30 days once the additional training is completed

Due to the planned intervention, the following might be potential counter/balancing measures:

• Reduced appointment availability due to training schedule

• Increase in overtime or temporary staffing costs to cover staff undergoing training

• Resistance of some staff to training and/or choose to leave the clinic versus undergoing the training

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Data Collection & Management

Use the table below to develop a plan for the collection, management, and stewardship of the data you will collect for your Project Charter. Use at least one source/citation to support your data collection plan.

Data Collection Data Collector Collection Timeline Data Storage/Protection Diversity, Equity, and Inclusion

• The number of patient/clients visits each month

• The number of missed appointments each month

• The number of patients/client s who did not schedule a second or follow up appointment

• Staff will be trained to code number of clinic visits per month (including missed appointments or non scheduled follow up) by auditor

• Data will be collected by auditor who is proficient with electronic heatlh records (EHRs) and data analysis

• Data collection begins Day 1 of the program initiation and concludes at the end of Year 1

• Data collected monthly by the auditor and categorized by completed visits, missed visits, and non scheduled follow up visits

• Data will be stored in password protected EHRs with access limited to designated personnel per HIPAA reguations

• Data will be de- identified by name but will retain other demographic information useful for the analysis

• Any authorized access will be reported and monitored via the EHR system

• Demographic information will be collected and analysed per missed appointments or non scheduled follow up for patterns and trends

• Demographic data will be used to address issues related to staff interactions, cultural competence, and the provision of patient/client centered care

• Issues such as language barriers, transportation and other factors which may impact access and utilization will be assessed

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Ethical Leadership Health care organizations such as Hillside Community Health Center, have a duty to provide culturally competent and equitable care that serves the needs of the community. The improved cultural awareness and competency will benefit the clinic staff, the patients/clients and the community and lead to increased clinic visits. The Quadruple Aim incudes the patient/client experience, the health of populations, reducing per capita costs, and ensuring the wellbeing of the workforce. The Quintuple Aim includes equity as the fifth component (Nundy et al. 2022).

From this framework, the staff will be better prepared to serve the community, understand the social and cultural needs, and provide quality care that optimizes outcomes and community relationships. They will have a better understanding of the cultural norms and practices and be able to tailor messaging, communication, and practices that are culturally congruent while establishing a connection with the community served. Establishing relationships with patients/clients and their families and participating in practices that lead to better health increases job satisfaction and a sense of purpose.

The patients/clients will have access to more culturally aligned health care, may feel more “understood” and respected and will be less hesitant about visiting the clinic, keeping appointments, and establishing relationships with providers. This may lead to increased access to affordable care, decrease costs associated with poor health, health promotion activities and a better understanding of prevention and contributing factors to illness and chronic conditions (Bau et al., 2019).

Although the intent of the training is to better prepare the staff for this work, the additional time for training, potential staffing issues, and increases in patient/client load may lead to additional stressors and burnout. Ethical leadership will include providing the needed resources for clinic staff as they undertake this fundamental and rapid change with resources related to work life balance.

Despite the clinic’s effort to meet the needs of the community, there may be groups within the service area that are marginalized due to numbers or other factors such as immigration status.

As the leader of this project, a commitment to the Quadruple/Quintuple Aim and the provision of culturally competent and patient/client centered care must be embedded in the organization. This includes a commitment to resources for training, education, hiring, representation, and on-going opportunities as part of the organization’s commitment to diversity, inclusion, and health equity. Addressing the multifaceted health care needs of a culturally and ethnically diverse population requires creative leadership approaches (Shenoy, 2021).

The Team Leader uses a combination of servant and authentic styles of leadership to address issues related to culture and inclusion. As an ethical leader, GL leads by example. The Team Leader displays genuine care and concern for the health-care staff as well as for the local community. At the core of GL’s leadership principles is the willingness to evolve and adapt to changes. GL constantly

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encourages the staff to identify issues and work toward solving them. GL ensures that the work environment is ethical, safe, and governed by a set of ethical rules rather than politics or profits. The Team Leader often stresses the importance of treating patients/clients with respect. By analyzing and understanding the social and cultural determinants that lead to health inequities, the training of the staff may be focused on meeting patient/client needs and providing access to culturally competent care and the needed resources. The Team Leader, the team, and community stakeholders have partnered to develop community initiatives to educate and build rapport with the community and establish trusting relationships. Collectively, the center’s staff along with the members of the community can strive to reduce health disparities and improve health equity by promoting ethical leadership (Kryzanowski et al., 2019).

SWOT Analysis

Strengths

The center has executive level and organizational support for the implementation of the training program focusing on cultural competence and patient/centered care. This includes resources for training, extra staffing, and community outreach. The clinic has also partnered with community stakeholders, who have a vested interest in the success of the training and the increased use of the clinic, which will contribute to the health and wellbeing of the neighborhood population.

Weaknesses

Resistance to the training related to time, energy, staffing patterns, implicit bias or interest may be a potential weakness. Staff may be experiencing burnout and difficulty with work life balance. The lack of diversity of clinic personnel and leadership within the organization may also be a limitation. Another potential weakness is the quality of the training provided, especially if the cultural awareness scores do not reach the set threshold.

Opportunities

The planned intervention may result in increased use of the clinic and its resources. This might allow for the hiring of additional personnel, including a person to conduct the trainings, and opportunities for increased representation as well as assuming leadership roles. This may also lead to opportunities for community partnerships to partner with local groups and serve as a model for the delivery of culturally competent and patient/client centered care.

Threats

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The time, energy, and staffing needed to implement the training sessions may impact the ability to serve current patients/clients and retain staff. The training may not result in improved cultural competence and patient/client centered care. Another possible threat is the inadequate bandwidth of the center’s staff to do justice to the project’s initiatives and to incoporate the training into practice and address work life balance.

References (APA format) Bau, I., R. A. Logan, C. Dezii, B. Rosof, A. Fernandez, M. Paasche-Orlow, & W. F. Wong. (2019.) Patient centered,

integrated heatlh care quaity measurse could improve health literacy, language, access and cultural

competence. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.

Kryzanowski, J., Bloomquist, C. D., Dunn-Pierce, T., Murphy, L., Clarke, S., & Neudorf, C. (2019). Quality improvement

as a population health promotion opportunity to reorient the healthcare system. Canadian Journal of Public Health, 110,

58–61. https://doi.org/10.17269/s41997-018-0132-8

Nundy, S., Cooper, L., Mate, K. (2022). The Quintuple Aim for health care improvement: A new imperative to advance

health equity. JAMA, 327(6), 521–522. https://doi.org/10.1001/jama.2021.25181

Shenoy A. (2021). Patient safety from the perspective of quality management frameworks: A review. Patient Safety in

Surgery, 15(1), Article 12. https://doi.org/10.1186/s13037-021-00286-6

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Part 4

Poster Presentation

Presenting information to an audience is a common skill that is needed for leaders who work in health care today. At some time in your career, you might attend a conference in person or virtually to share information about a project. Many health care conferences now include virtual poster presentation sessions.

Use the Poster Presentation Template PPTX file located in Assessment 4 or develop your own to create a poster that presents what you learned while developing the Project Charter in Parts 1–3. Be sure to review the assessment description and scoring guide before you begin work on your design.