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MHA CAPSTONE PROPOSAL

Expansion on Telehealth at Dallas Presbyterian Hospital

J. Doe

University of Phoenix

MHA/599: Capstone: Leading the Organization Through Change

Dr. Coralene Quimby-Worrell

May 2025

In response to growing healthcare access disparities and the need for innovative care delivery models, this capstone project proposes a comprehensive business development strategy to expand telehealth services at Dallas Presbyterian Hospital. The initiative aims to address critical operational challenges, including reducing avoidable emergency room visits, minimizing patient no-shows, and enhancing care access for older adults and individuals in rural or underserved areas. By leveraging strategic partnerships with local insurance providers, healthcare professionals, and telehealth technology vendors, the project seeks to improve digital access to both primary and specialty care. Furthermore, it prioritizes compliance with CMS telemedicine reimbursement guidelines, cost-effective care delivery, and elevated patient satisfaction. This proposal aligns with Dallas Presbyterian’s long-term vision of delivering affordable, accessible, and technologically advanced healthcare solutions.

The plan to create a business development strategy and expand telehealth services at Dallas Presbyterian Hospital is the main focus of my Capstone project. The initiative addresses important challenges such as reducing non-essential visits to the ER, reducing no-show appointments, and improving access to the healthcare system for older and rural populations.
The purpose is to create a complete strategy that improves digital access to primary and specialty care. Those who live in underserved areas with limited options for in-person care, have older age, or limited mobility, are among the target groups. The purpose of this project is to guarantee compliance with CMS guidelines for telemedicine reimbursement, improve patient satisfaction, and reduce the cost of providing care.
We will work with local insurance companies, health professionals, and telehealth vendors to meet these goals. Through these collaborations, Dallas Presbyterian will be able to improve the visibility of digital health services, guarantee a successful rollout, and complete a steady integration with current hospital operations. The scheme is in line with the long-term goal of the hospital to innovate and provide access to affordable, technologically advanced health services.

SWOT Analysis

Strengths: We’ve got a lot going for us. The hospital’s got a great reputation—people trust us, and that’s huge. Our IT systems are already in a good spot to handle this kind of digital upgrade. Plus, we have a talented team of healthcare pros ready to make telehealth work and keep it running smoothly.

Weaknesses: That said, there are some hurdles. A lot of our older patients aren’t super tech-savvy, which could make it tough for them to jump on board with telehealth. The upfront costs for new tech and training staff are pretty steep, too. And let’s be real—some of our team might push back on changing how things are done, which could slow us down.

Opportunities: There’s a ton of potential here. CMS is expanding telehealth reimbursement policies, which is basically a green light for virtual care. People in rural and underserved areas are clamoring for remote healthcare options, and we’re in a prime spot to deliver. Teaming up with telehealth tech companies and insurers could really level up what we’re able to offer.

Threats: Of course, there are risks keeping an eye on. Because no one wants their data to be compromised, cybersecurity is important. We also have to stay on top of HIPAA rules to avoid any trouble. Plus, virtual-first clinics are popping up everywhere, and the rules around telehealth funding can be a bit of a wild card, which might make things tricky down the road.

This is placeholder text to be replaced with the text of your report; use in-text citations as needed.

Bashshur, R., Doarn, C. R., Frenk, J. M., Kvedar, J. C., & Woolliscroft, J. O. (2020). Telemedicine and the COVID-19 pandemic: Lessons for the future. Telemedicine and e-Health, 26(5), 571–573. https://doi.org/10.1089/tmj.2020.29040.rb
The function of telemedicine during the epidemic and its quick uptake are highlighted in this article. It highlights the need for reliable infrastructure and legal adjustments to support telehealth's future growth.
Dorsey, E. R., & Topol, E. J. (2020). Telemedicine 2020 and the next decade. The Lancet, 395(10227), 859. https://doi.org/10.1016/S0140-6736(20)30424-4
In order to future-proof healthcare delivery, this study highlights long-term trends in telemedicine and promotes proactive investment in virtual platforms.
Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open, 7(8), e016242. https://doi.org/10.1136/bmjopen-2017-016242
The need of this expansion plan is further supported by a thorough assessment showing high levels of patient satisfaction with telehealth because of its accessibility, effectiveness, and convenience.

Uscher-Pines, L., Sousa, J., Raja, P., Mehrotra, A., Barnett, M., & Huskamp, H. A. (2020). Suddenly becoming a “virtual doctor”: Experiences of psychiatrists transitioning to telemedicine during the COVID-19 pandemic. Psychiatric Services, 71(11), 1143–1150. https://doi.org/10.1176/appi.ps.202000250
Examines the shift of mental health practitioners to online platforms, highlighting obstacles and effective tactics related to Dallas Presbyterian's staff development and digital transformation.

The purpose of this Capstone project is to implement a structured, comprehensive plan for expanding telehealth services at Dallas Presbyterian Hospital. Several pressing challenges are addressed in this expansion and they include, disparities in healthcare access for vulnerable populations, avoidable emergency department utilization, and gaps in continuity of care for patients in rural and underserved regions. This initiative supports strategic goals related to innovation, affordability, and population health improvement as the hospital seeks to modernize in order to align with broader national healthcare priorities. This expansion also reflects the hospital’s long-term mission of offering equitable, high-quality care through accessible, patient-centered solutions.

The overall goal of this project it to enhance improve access to primary and specialized healthcare services through virtual care delivery to be particular among older adults, individuals with limited mobility, and patients in remote or medically underserved communities. During the first 12 months after deployment, the initial goal is to increase the use of virtual care by 35%. Reducing non-urgent emergency room visits by 20% is the second objective and this is through the use of tele-triage and video consultations during the same time frame. In order to ensure accountability and compatibility with Dallas Presbyterian's values and strategic plan, these goals are made to be both measurable and reachable.

Projects with a greater purpose—beyond financial gain or technological efficiency—have a much higher chance of succeeding, according to Nieto-Rodriguez (2021). He encourages a series of "why" questions until the fundamental goal is revealed. The deeper reason for this project is not merely to introduce telehealth capabilities but is to increase access to timely, patient-centered care that will improve population health and reduce long-term costs for both patients and the healthcare system.

The planned growth of telehealth will produce a number of important deliverables that guarantee both short-term operation and long-term viability. The most important of them is the establishment of a safe, HIPAA-compliant telehealth platform that is completely linked with the hospital's current electronic health record (EHR) interface. Communication between patients and providers will be allowed by this platform since it enables comprehensive virtual visits, remote monitoring, and follow-up care. All clinical and administrative personnel involved in the provision of telehealth services will get comprehensive training modules from the project concurrently. Platform usage, virtual patient communication, regulatory compliance, and best practices for documentation will all be covered in these modules.

The patient-facing resources, including as instructional videos and multilingual manuals, are another deliverable that helps patients use the telehealth system. For those for whom English is not their first language or who have poor levels of computer literacy, these will be especially crucial. In addition, the hospital will create an outcomes dashboard in order to track performance indicators such as usage rates, patient satisfaction ratings, no-show decreases, and emergency department diversion metrics. When taken as a whole, these deliverables will guarantee the expansion's technical, strategic, and operational success.

Dallas Presbyterian Hospital's telemedicine service growth is a creative and enterprising endeavor. Innovation is reflected in the projects through the use of advanced technology to bridge gaps in care delivery, streamline provider workflows, and improve patient engagement. The project's approach, which involves partnering with outside technology providers and health insurance providers to reduce upfront expenses and increase scalability, incorporates entrepreneurial thinking. Additionally, these partnerships will allow co-investment in infrastructure development and value-based reimbursement plans.

Dorsey and Topol (2020) argue that telemedicine represents one of the most transformative trends in modern healthcare and they also claim that organizations investing in these models now will be better prepared to meet patient expectations over the next decade. This idea additionally aims to increase operational efficiency and create new revenue streams by utilizing underutilized resources, such as administrative space and provider downtime." The hospital will not only position itself in the quickly changing healthcare industry but also modernize its service delivery model.

The community will greatly benefit from this proposal, mostly the populations who have historically had limited access to consistent, high-quality healthcare. So many barriers’ patients face when attempting to access care will be eliminated through Dallas Presbyterian Hospital expanding telehealth services such as long travel times, mobility issues, and limited provider availability. This is particularly true for people who reside in rural areas, where they might not have access to transportation or reside in locations that have been classified as medically underserved. Moreover, elderly individuals and those with chronic illnesses will get frequent check-ins and proactive disease management that have been enabled by virtual care.

The critical part of delivering community value is through addressing cultural, linguistic, and technological barriers. Multilingual support, starting with English and Spanish, and availability to interpreters will be features of telehealth services. In order to account for varying levels of internet access, educational materials will be available in both digital and printed formats. Patients like telehealth services for their ease and capacity to alleviate logistical burdens, especially when efforts are made to enhance accessibility and communication (Kruse et al., 2017). This project is designed to intentionally meet those needs and maximize the community’s benefit.

The project will repurpose existing administrative office space into a centralized telehealth operations hub. And the area will house virtual consultation rooms equipped with soundproofing, secure internet access, and video conferencing equipment. A small area will be allocated to technical support staff and training sessions. Since no new development is required, the facility needs are minimal. However, infrastructure upgrades will include dedicated servers or cloud-based storage for telehealth data, improved Wi-Fi coverage, and additional cybersecurity layers to ensure data protection.

The telehealth initiative's implementation needs to comply with a number of important governmental and regulatory requirements. The project will adhere to the Centers for Medicare & Medicaid Services (CMS) telemedicine reimbursement guidelines, which have been developed to promote virtual care, especially in underserved areas. Additionally, it will be in compliance with the Health Insurance Portability and Accountability Act (HIPAA), which requires that patient health information be handled securely when visiting virtually. In addition, telehealth service providers need to be licensed in Texas and follow the rules established by the Texas Medical Board.

The COVID-19 pandemic hastened the regulatory adoption of telehealth and encouraged providers to be aware of evolving reimbursement schemes (Bashshur et al., 2020). At Dallas Presbyterian, internal legal counsel and compliance officers will work with clinical teams in order to ensure that licensing, documentation, and billing procedures comply with all relevant legal requirements. This includes updates to clinical policies and provider credentialing processes.

Technology forms the basis of the implementation approach for this project. A secure, cloud-based telehealth technology that seamlessly connects to the current EHR will be implemented by the hospital. Clinicians making virtual visits will have access to additional hardware, such as dual monitors, headsets, and HD webcams. A user-friendly web portal and mobile app will be among the patient-facing tools, enabling users to make appointments, participate in virtual consultations, and access educational resources.

Making decisions and keeping track of performance are roles that will be played by the data analytics. Patients’ outcomes, satisfaction, and cost savings will be tracked by real-time dashboards. For enterprises looking to grow and prove their worth to payers and regulatory bodies, data-informed telehealth systems are essential, as stated by Dorsey and Topol (2020).

The expansion of telehealth depends on staffing. A single full-time program director who will be in charge of supervision and assessment must be hired and trained for the project. Three primary care physicians and two specialty providers will be included by the clinical staffing and their work will be to rotate virtual appointments with in-person care. Additionally, four registered nurses will help with patient education, follow-up care, and remote triage. Scheduling, technical assistance, and documentation will be managed by three administrative employees.

Estimated patient demand and industry-recommended ratios for virtual care delivery are used to determine staffing levels. When transferring professionals to telehealth, Uscher-Pines et al. (2020) stress the significance of thorough training. As a result, Dallas Presbyterian will offer onboarding courses that address culturally sensitive care, telemedicine protocol, platform usage, and legal compliance. Ongoing performance evaluations will be based on patient satisfaction scores, adherence to protocols, and clinical outcomes.

Expanding telehealth at Dallas Presbyterian Hospital is more than a tech upgrade; it represents a transformation in how we approach healthcare delivery. It shifts the focus from traditional in-person visits to smarter, more accessible, and flexible care that aligns with the expectations of modern patients. This change is not just operational but also cultural and systemic. The goal is to reimagine care for individuals who have historically been underserved, such as older adults, rural residents, and those facing logistical barriers to in-person care. Telehealth bridges those gaps and enables care that is timely, digital, and patient-centered (Dorsey & Topol, 2020). It also positions the hospital to stay competitive in an increasingly virtual healthcare environment. This initiative supports Dallas Presbyterian’s mission by delivering accessible, equitable, and high-quality care, while preparing the organization for a future where virtual health is an essential standard of care. There will be a plan to organize departmental trainings, in phases, to ensure everyone is in consensus when implementing these new transitions. I will begin with departments that will use telehealth the most, and then expand to others. All trainings will be customized to each department’s role.

Implementing telehealth at scale requires a strong and proactive change management approach. To guide the transition, the project will follow Kotter’s 8-Step Change Model, which includes creating urgency, forming a powerful coalition, and generating short-term wins to build momentum (Kotter, 2012). The strategy focuses on engaging all stakeholders—clinicians, administrators, IT teams, and patients—through a structured rollout. Some staff may feel unsure about using new technology or concerned about losing the personal touch in patient care. To address this, the hospital will provide hands-on training, mentorship opportunities, and clear communication to build trust and competence. Research by Uscher-Pines et al. (2020) showed that mental health professionals who received structured support were more confident when transitioning to telemedicine during the pandemic. That insight informs this project’s emphasis on preparation, responsiveness, and inclusivity in managing change.

Culture plays a critical role in how well any innovation is adopted. At Dallas Presbyterian, a culture of innovation, adaptability, and collaboration already exists and will serve as the foundation for this initiative’s success. This project reinforces that culture by emphasizing open dialogue, shared goals, and professional growth. Staff will be encouraged to ask questions, offer feedback, and engage with new workflows in a supportive environment. Leadership will model this mindset by embracing telehealth and reinforcing how it aligns with the organization’s mission. According to the American Hospital Association (2022), hospitals that align innovation with their core values tend to see greater buy-in and better outcomes. The project also prioritizes inclusivity and equity. Support will be provided to help patients and staff with varying levels of digital literacy and comfort with technology. These cultural considerations ensure that the transition to telehealth is thoughtful, human-centered, and sustainable.

Clear, consistent communication is key to making this project successful. The hospital will implement a communication strategy that includes newsletters, team huddles, live trainings, and digital updates to keep everyone informed and aligned with the project goals. Staff will have opportunities to provide feedback throughout the rollout, and their input will shape ongoing improvements. Interdisciplinary workgroups will help coordinate tasks, ensure representation across departments, and avoid siloed decision-making. For patients, Dallas Presbyterian will offer multilingual educational resources, instructional videos, and access to support services. These efforts aim to make telehealth easy to understand and use, especially for those unfamiliar with digital tools. As Nieto-Rodriguez (2021) explains, when teams understand the deeper purpose behind a project and feel involved in the process, engagement and long-term success are more likely. By prioritizing honest dialogue, inclusive facilitation, and shared ownership, this project ensures that communication supports both implementation and long-term growth.

This is placeholder text to be replaced with the text of your report; use in-text citations as needed.

Complete the table by adding the estimated capital expense to the second column.

Then, calculate the total projected capital expense.

These capital expense items will be used for multiple years and will be depreciated or expensed over 5 years. The total capital expenses must be divided by 5 to calculate annual depreciation expense. Calculate annual depreciation expense and place it in the last row of the table.

Determine how many physicians, nurses, and staff are needed to operate the program in the second column and enter their annual salary in the third column.

Complete the table by multiplying the number of staff by the annual salary projection of those positions to obtain the total salary projection in the fourth column.

Calculate the totals for the number of staff, annual salary projection, and total salary projection at the end of each column.

Benefits expenses are estimated to be 25% of salaries. The benefits expense should be added to the total salary projection from the table above to calculate total salaries and benefit expense.

Complete the table by placing the correct calculation in the second column.

Consider all of the operating expense categories in the first column, then place the estimated operating expenses for each category in the second column.

Calculate the total annual operating expenses and place it in the last row of the table.

Consider all of the following sources for income, funding, and/or cost-sharing in the first column, then place the total for each category in the second column.

Calculate the total revenue or funding and place it in the last row of the table.

Total Annual Expense Projections

Note: If desired, for patient-related programs, divide the total annual expense projection by net patient reimbursement to calculate the number of patients that would need to breakeven. The total number of annual patients for breakeven may then be divided by the total number of days the operation will be open to estimate the daily patient volume for breakeven.

Refer to the total annual expense type listed in the first column, then place the total of each in the second column.

Calculate the total annual expense projection and place it in the last row of the table.

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American Hospital Association. (2022). Telehealth: A Path to Virtual Integrated Care. Retrieved from https://www.aha.org/telehealth

Bashshur, R., Doarn, C. R., Frenk, J. M., Kvedar, J. C., & Woolliscroft, J. O. (2020). Telemedicine and the COVID-19 pandemic: Lessons for the future. Telemedicine and e-Health, 26(5), 571–573. https://doi.org/10.1089/tmj.2020.29040.rb

Dorsey, E. R., & Topol, E. J. (2020). Telemedicine 2020 and the next decade. The Lancet, 395(10227), 859. https://doi.org/10.1016/S0140-6736(20)30424-4

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Nieto-Rodriguez, A. (2021, October 11). Does your project have a purpose? Harvard Business Review. https://hbr.org/2021/10/does-your-project-have-a-purpose

Kruse, C. S., Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7(8), e016242. https://doi.org/10.1136/bmjopen-2017-016242

Nieto-Rodriguez, A. (2021, October 11). Does your project have a purpose? Harvard Business Review. https://hbr.org/2021/10/does-your-project-have-a-purpose

Uscher-Pines, L., Sousa, J., Raja, P., Mehrotra, A., Barnett, M., & Huskamp, H. A. (2020). Suddenly becoming a “virtual doctor”: Experiences of psychiatrists transitioning to telemedicine during the COVID-19 pandemic. Psychiatric Services, 71(11), 1143–1150. https://doi.org/10.1176/appi.ps.202000250