Dr. Neely's Learning Lab — Leading Change Simulation
Leading Change Simulation
Graduate Seminar — University of Tennessee Chattanooga

Before You Begin

Your role: You are Marcus Webb, Change Implementation Lead at Ridge View Regional Medical Center, a 280-bed community hospital in Chattanooga, Tennessee.

The situation: Six months ago, the hospital began a full migration to a new Electronic Health Record (EHR) system called HealthBridge Pro. The system went live on schedule. You are now at Month 6 of a planned 12-month rollout.

Your task: You will review documents, talk to key people, and make five decisions about how to lead this change effort forward.

Phase 1: Review the Situation

You are Marcus Webb, Change Implementation Lead at Ridge View Regional Medical Center. Review all six artifacts below to understand the situation before meeting with the characters.

0 of 6 artifacts reviewed

Ridge View Regional Medical Center — Organizational Chart

Dr. Carolyn Marsh
Chief Medical Officer (CMO)
Sandra Okafor
Chief Nursing Officer (CNO)
Paula Nguyen
Nurse Manager, ICU Night Shift
Dr. Theo Vasquez
Director of Emergency Medicine
Marcus Webb (You)
Change Implementation Lead
Denise Hartley
IT Systems Trainer, HealthBridge Pro
External vendor staff
Frontline Staff
~240 nurses, 85 physicians, 40 clinical support
Across 6 units
Note: Paula Nguyen does not report directly to the CMO. She reports through Sandra Okafor (CNO). She was not present at the Month 6 leadership review meeting. Consider why information from her unit may not have reached the CMO's office.
TO: All Department Heads and Clinical Leads
FROM: Dr. Carolyn Marsh, Chief Medical Officer
DATE: Day 1 of Simulation
RE: HealthBridge Pro — Six-Month Progress Update

It is difficult to overstate how proud I am of this organization's response to the HealthBridge Pro implementation. Six months ago, I asked a great deal of our staff — to embrace a new way of documenting, communicating, and coordinating care — and by every measure available to me, they have risen to that challenge.

Across all six clinical units, HealthBridge Pro is now the primary documentation system. Physician login rates have reached 94%. Our IT partner reports that training completion sits at 89% of all staff. I have personally walked the floors and spoken with nurses and physicians who tell me they are finding their footing with the new system.

I want to be honest: there have been bumps. Some staff have found the medication reconciliation module challenging. A small number of physicians have expressed frustration with the order-entry workflow. These are expected growing pains, and we are addressing them through ongoing training sessions.

I am writing today to ask each of you to recommit to this transition. We are six months in. The hardest part is behind us. What we need now is consistency — every clinician, every shift, every time. No workarounds, no paper backups, no parallel systems. HealthBridge Pro is our system now.

I have full confidence in our team. Thank you for your continued leadership.

— Dr. Carolyn Marsh, CMO

Staff Survey Results

Conducted by HR and Quality Improvement | n=187 respondents | Anonymous

Survey ItemAgreeNeutralDisagree
I feel confident using HealthBridge Pro during a busy shift. 31% 21% 48%
The EHR system improves the quality of care I provide to patients. 22% 29% 49%
I understand why this change was necessary for Ridge View. 54% 19% 27%
I have received adequate training and support. 38% 18% 44%
I currently use HealthBridge Pro for all required documentation. 39% 16% 45%
I sometimes use paper or workarounds when the EHR feels too slow. 61% 14% 25%
I feel my concerns about the EHR have been heard by leadership. 18% 22% 60%

Selected Open-Ended Responses

"I log in so the system shows I'm there, then I use my notebook. I'll enter it before the end of shift."
"No one has asked me what actually slows me down. They just send more training emails."
"The medication reconciliation screen takes me 4-5 extra clicks every single time. At 2 AM with six patients, that matters."
"Some of us figured out a faster way. But I'm not sure if we're supposed to do it that way or not."

All-Hands Clinical Staff Meeting

Conference Room B & Video Link | Day 1 of Simulation, 3:00 PM
Facilitated by Marcus Webb | ~34 in person, 18 on video | Edited excerpts
[Marcus Webb]: Thank you for making time. I know the agenda said 'progress update' but I want to be honest — I'm here because I think we have a problem, and I need your help understanding it. I'm going to ask you to be direct with me.
[Staff nurse, ED]: The system is fine when the census is low. When we're slammed, every extra click feels like a crisis. I know that sounds dramatic but it's true.
[Physician, Internal Medicine]: I want to know when someone is going to look at the order sets. We spent months customizing them before go-live and half of what we asked for didn't make it into the build.
[Marcus Webb]: That's on me to follow up. Can you send me the list?
[Physician, Internal Medicine]: I've sent it three times. But sure. I'll send it again.

[Paula Nguyen, ICU Night Shift Nurse Manager]: Can I say something? I've been waiting to see if anyone would bring this up.
[Marcus Webb]: Please.
[Paula Nguyen]: My team on the night shift had the same problems everyone is describing in Month 1 and 2. The medication reconciliation screen was killing us. We were adding eight to ten minutes to every admission workflow, and at 3 AM that's not sustainable.
[Paula Nguyen]: So we figured out a workaround. Not a paper workaround — we stayed inside the system. One of my nurses, Keisha, found that if you pre-stage the reconciliation tab while you're still in the admit screen, it pre-populates about half the fields. Then when you get to reconciliation it's already halfway done. It cut the workflow from about nine minutes to just over four.
[Marcus Webb]: How long have you been doing this?
[Paula Nguyen]: Since Month 2. I wasn't sure if we were supposed to. The training didn't cover it. But our documentation error rate has dropped — I think it's around 40 percent fewer reconciliation errors since we started.
[Staff nurse, ICU]: It's 38 percent. I track it.
[Marcus Webb]: Why didn't you report this?
[Paula Nguyen]: We didn't know it was reportable. We thought we might be doing something wrong. And honestly — no one asked.

[Physician, ED]: What actually happens after this meeting? Will anything change?
[Marcus Webb]: I don't know yet. But I'm going to find out what Paula's team is doing and figure out if it can work across units. And I'm going to tell you what I find, either way.

Quality Metrics Report

Source: Quality Improvement & IT Analytics, Months 1-6

MetricBaselineMonth 6
Physician EHR login rate N/A 94% (system access only)
Full documentation completion rate 91% (paper) 67% (EHR only)
Medication reconciliation errors — hospital-wide 4.2 per 1,000 admissions 5.8 per 1,000
Medication reconciliation errors — ICU Night only 4.1 per 1,000 admissions 2.5 per 1,000
Average documentation time per admission 12 min 19 min hospital-wide / 11 min ICU Night
Staff-reported workaround usage Not tracked 61% report using workarounds
Patient satisfaction — care coordination 74th percentile 61st percentile
Analyst Note: The ICU Night Shift data is not broken out in the standard dashboard. It was provided separately upon request. No other unit has submitted a comparable data request.

Phase 2: Talk to the Characters

Click on a character to begin a conversation. You must have at least 3 exchanges with each character before proceeding.

0 of 9 required exchanges completed
TV

Dr. Theo Vasquez

Director of Emergency Medicine
Blunt, data-driven. Frustrated that no one listened earlier.
0 of 3 exchanges
SO

Sandra Okafor

Chief Nursing Officer
Measured, careful, politically cautious. Privately skeptical.
0 of 3 exchanges
KM

Keisha Monroe

Staff RN, ICU Night Shift
Thoughtful, private. Found the workaround. Proud but uncertain.
0 of 3 exchanges
TV

Dr. Theo Vasquez

Director of Emergency Medicine
0 of 3 exchanges
Dr. Vasquez is typing...
SO

Sandra Okafor

Chief Nursing Officer
0 of 3 exchanges
Sandra is typing...
KM

Keisha Monroe

Staff RN, ICU Night Shift
0 of 3 exchanges
Keisha is typing...

Simulation Complete

Your feedback report is below. Review it carefully before your discussion session.