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.
Ridge View Regional Medical Center — Organizational Chart
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.
Staff Survey Results
Conducted by HR and Quality Improvement | n=187 respondents | Anonymous
| Survey Item | Agree | Neutral | Disagree |
|---|---|---|---|
| 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
Marcus,
I'll be honest with you because I don't think anyone else will. The memo from Dr. Marsh this morning is not describing the hospital I work in.
My physicians are logging in, yes. But logging in is not using the system. Half of them are doing what I call 'documentation theater' — they enter just enough to satisfy the timestamp, and the real clinical thinking happens on paper or in their heads. You'd never know it from the login rates.
The order-entry workflow is the main culprit in the ED. What used to take 45 seconds now takes three minutes when the census is high and the system is slow. That's not a training problem. That's a design problem. And no one from HealthBridge seems interested in hearing it.
I am not the enemy of this rollout. I want it to work. But I need someone to actually listen to what's happening at the ground level before we declare victory.
— Theo
Theo,
Thank you for this. I needed to hear it directly.
The login rate data was the number Dr. Marsh asked for, so it's the number we reported. But you're right — I've been uncomfortable with it for weeks. It doesn't capture whether people are actually using the system the way it was designed.
Can I come shadow your team for a shift this week? Not to audit anyone — I just want to see what you're seeing.
Also: the medication reconciliation issue keeps coming up. I want to look at whether there's a workflow configuration that hasn't been surfaced yet.
— Marcus
Marcus,
To answer your question: the 89% training completion figure counts anyone who completed the initial four-hour onboarding module. It does not differentiate between staff who completed it in Month 1 versus those who just finished it last week. It also doesn't capture staff who completed the module but scored below 70% on the assessment — we count them as complete because they sat through it.
I'm flagging this because I think the number is being interpreted as more meaningful than it is.
Between us: I've been doing EHR implementations for eleven years. The medication reconciliation module in HealthBridge Pro is genuinely one of the more complicated ones I've seen. I've passed this feedback to our product team twice. I haven't heard back.
I want this to succeed too. If there's a way I can be more useful to you beyond running training sessions, let me know.
— Denise
All-Hands Clinical Staff Meeting
Quality Metrics Report
Source: Quality Improvement & IT Analytics, Months 1-6
| Metric | Baseline | Month 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 |
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.
Dr. Theo Vasquez
Sandra Okafor
Keisha Monroe
Dr. Theo Vasquez
Sandra Okafor
Keisha Monroe
Your Decisions
Your decisions will appear here as you progress.
Simulation Complete
Your feedback report is below. Review it carefully before your discussion session.