“It’s so important that training and change work together” Ideal on EPR training and reducing the productivity slump at go-live

At HTN Now, we were joined by Ideal Health’s director of training and change, Nick Robertson, to discuss reducing the productivity slump at go-live; planning an EPR training rollout; and embracing learning as a continuous journey.

Understanding the challenges of training deployment

“Let’s start with the end in mind,” Nick said. “What is our target? By go-live, your staff should be confident to use and embed the system as part of their new ways of working. They should have the competence to execute tasks on the system following the approved workflows, and committed to using the system as designed and in real-time.”

Nick highlighted the Kübler Ross change curve, which shares a “predictable reaction and a set of behaviours around change”: shock or surprise at the event, frustration that things are different, a low period with lacking energy, initial engagement with the new situation, learning how to work with the new situation, and finally integration of the changes.

Rather than let people’s approach to the change take the sudden dip with low mood and frustration, Nick said that the key is to “shallow the curve” – to be clear about how the work is going to take place to lessen the shock and to help people transition through the change.

Training is often relegated to the last spot on agendas as people tend to think that it is a simple process that happens towards the end of the implementation, Nick noted. “My advice there is to put training at the top. Without a voice, things can get delayed in the training workstream which can be detrimental to the end result.” There is a lot to think about when it comes to training, he added, such as staff engagement, lesson plans, incentives, reporting, training format and lots more.

Planning the training rollout 

“If you haven’t already rolled out, the best thing I would recommend is to do a training readiness assessment,” Nick said. “The first thing I always like to understand is what the leadership and organisational culture is like. Do they value training, do they invest in it?”

Other questions to ask include what the current training team looks like in terms of size and scale; facilities, infrastructure and IT capability; and training communications, with regards to what methods are being used, how they are received, attendance rate and participant feedback so that this can feed into the EPR delivery.

The next step is to move onto a training strategy, Nick explained. On what the strategy should include, Nick suggested ascertaining user groups that will be impacted; the IT proficiency of the organisation and any necessary upskilling; and the training interventions as far as they are known, such as instructor-led training, e-learning, virtual delivery, and one-to-one support. In addition, the strategy should cover the facilities and resources that are required, stakeholders and suggested communication methods, and insight into the learning management system – namely whether there is already one fit for the job, or whether the organisation should look at sourcing a third-party LMS.

At this point, Nick said, you should have an idea of the current risks and issues. “There are some standard ones; vendors usually have pre-populated risks and issues surrounding the training workstream – things like staff not attending,” Nick explained.

Once the strategy is signed off, the team can begin to work on the plan, taking detail from the strategy and expanding on it. For example, where the strategy identified the user groups, the plan should provide the numbers included in those user groups. “We should know the training interventions by now, so we can start talking about a blended approach – how we’re balancing e-learning and instructor-led learning. And because we know our approach, we know the facilities and resources that will be required, what needs to happen with the LMS. We should also be able to formulate communications – what’s the frequency? What are the key messages?”

The risks and issues should also be evaluated at this point, Nick noted, and there should be mitigations in place.

“The strategy, once signed off, is a static artefact. But the training plan is a living document. You can keep adding to it as information becomes available and it grows throughout the programme. At the very end, it gets closed down and saved as an artefact – it’s a very useful piece of documentation for the future.”

The training plan then leads to the project plan, in which all the tasks that need to be completed get included as line items to be ticked off. The project plan should be reviewed with the programme management office at least once a month initially, Nick said, and then once every two weeks as activities start to gather pace.

From there, it moves onto task-to-role mapping. “This is typically done in a spreadsheet – we have all the roles down one side of the spreadsheet and then across the top we have all the tasks that can be carried out in the EPR given the scope. We use that to build up a picture of who is going to be using the system for what. Then we can look at the course-to-role mapping; are there some roles that are doing similar things, in which case they can come onto one training course?”

Learning is a continuous journey

“I think sometimes, it’s thought that training is just something that happens at the very end, about ten weeks before go-live, and doesn’t require a great deal of effort between the start and that point,” Greg said. “But we need to understand what’s coming, what it’s going to look like, how it’s going to impact people. We want to build up a learning journey throughout the programme.”

Nick shared an example of the training journey, from the vision (including the need for leadership to create the vision of why an EPR is being put in place; to ensuring visible and active leadership promoting; undertaking roadshows to increase visibility the EPR and its benefits; developing informal learning opportunities; identifying and training super-users; and end-user training. “This shouldn’t be the first time that the end-users have seen the system,” Nick said. “We should have done enough work upfront that they come along and have some understanding already – this end-user training is a chance for them to have a go with it in a practical sense and develop their confidence.”

Then the journey reaches go-live, with Nick saying: “Of course, we need lots of support here. We have those super-users; if they have been properly trained and there’s been investment in them, they will be very useful at go-live. We’ll have at-the-elbow support, typically through floorwalkers. We’ll also have quick reference collateral. It’s really important that during training we tell people where that support collateral is and they test their access and familiarise themselves with it.”

Looking at post go-live, Nick said, there will be a period of “mop-up training”, and then it is a case of transitioning to business-as-usual. “Keep using the super-users here,” Nick advised. “They’re not just for the first couple of weeks after go-live. They are the voice of the organisation coming back to you. They’ll tell you what is going well and what isn’t, what people like versus what they don’t like.”

Nick also raised the importance of maintaining the collateral, moving forwards. “At go-live, there will likely be some issues and fixes. There will be some slight changes in functionality. Maintaining your collateral is an ongoing activity that takes resource and time.”

Next, Nick moved on to discuss alignment with change. “It’s so important that training and change work together,” he said. He emphasised the need for collaboration between the programme training team, the programme change team, programme workstreams, and the advisory board, which Nick described as “where the change requests are analysed and approved or deferred.” Working collaboratively with these different groups will help to ensure accurate training content, he added, and helps spread understanding as to the reasons that decisions are made.

A typical training workstream

Nick shared an example of a typical training workstream, split into three key sections: align, engaged, and optimisation.

The tasks under ‘align’ include bringing the training manager on board, creating and reviewing the training strategy, and creating the training plan.

Under ‘engaged’, tasks include bringing senior trainers on board; starting to develop materials; training admin; building the LMS; recruiting super-users; developing e-learning; domain loading and testing; onboarding trainers; plotting courses; publishing the schedule; signing off on materials; training the domain; training super-users; publishing e-learning; and ending user-training.

Then, after go-live, ‘optimisation’ includes mop-up training, transitioning to business-as-usual, and providing optimisation coaching and support.

“Investing in training is really important,” Nick concluded. “It’s not only about getting staff to be confident and competent in time for go-live. There should be improved clinical outcomes, as EPRs typically come with clinical decision-support. It supports organisational reputation – that’s why it’s good to make information visible to the public, so they know that you’re investing money in an EPR to make sure that you can get the best care possible. There’s also an impact on staff retention; if they’ve got a system that they enjoy using, they are going to be happier and they’re going to stick around.”

Finally, Nick said, “The EPR brings an increased patient satisfaction and patient outcomes. At the heart of all this, everyone should take a step back and remember that. It’s all about the patient.”

Many thanks to Nick for joining us.