For a recent HTN Now panel discussion we welcomed experts from across health and care, including Sally Mole, digital programme manager at The Dudley Group NHS FT, Fhezan Ashraf, clinical configuration manager at The Dudley Group NHS FT, Stacey Spence, EPR programme manager at Medway NHS FT and Hayley Grafton, CNIO at University Hospitals of Leicester NHS Trust.
The discussion began with wider introductions, where each of our experts gave an overview of their own go-live projects before moving onto post go-live best practices, exploring key learnings and challenges when it comes to engaging the workforce and measuring adoption.
Key learnings and processes
“This was in the making for many years,” Hayley began as she spoke about the enterprise EPR deployment in her previous role at Royal Marsden Hospital in London. She attributed the “relatively well” go-live to a number of different elements, including “working with a supplier that already had a tried and tested implementation methodology,” while also highlighting the “great endorsement from the leadership team and CEO” as well as “ownership from all areas, not just digital” as instrumental to the success of the project.
Going into further detail about the programme, Hayley explained, “we had operational readiness groups which were jointly chaired by our operational clinical leads,” which included a nursing director and a medical director. During the implementation process, Hayley noted that there was “a lot of planning around business continuity” which led to their bronze, silver and gold group structure, indicating the different stages of the process from operational readiness through to command and control.
Next, Stacey outlined key learnings from their go-live success story at Medway NHS FT, based on their initial EPR deployment back in 2021, which she said was “a pivotal change” for the trust. “It’s not just an IT project,” Stacey added, “it’s a joint shared partnership across the whole organisation.” Giving some background, she explained how Medway was completely hybrid before the EPR deployment, with a “number of independent systems that were in place alongside a lot of paper records,” noting that the transition from paper was “really difficult in those initial conversations.” In order to tackle this, Stacey highlighted how the trust began with a “really strong communication and engagement plan that was clinically and operationally led” and like Hayley’s team, they also had a range of staff members taking on these roles.
The trust ended up going live with their adult inpatients instead of the entire hospital and have since learned a number of lessons from this, with Stacey highlighting one key lesson in particular around sign-in access. “We didn’t have single sign-on in place before our go-live,” she explained, “we had everyone log in through their own windows account which meant that 80 per cent of our issues were around people not being able to get logged on.” Since experiencing this challenge, Stacey noted that the trust has now “implemented a single-sign on tool” which has led to the continued success of other deployments.
Finally, despite having had 88 go-lives since 2022 at The Dudley Group, Sally focused on one in particular, taking us through their EPR upgrade, which she noted as one of their “biggest deployments” over the last six months. This involved five major releases going live at the same time, which included moving infrastructure from on-premise to the cloud with a large focus on “operational management and working with the clinical teams to make sure everything was clinically safe.”
Speaking on the lessons learned, Sally emphasised the importance of letting staff know what they’re getting into, having the same processes and methodology for projects and “engaging with clinical teams, the clinical safety officer, the CNIO, the CCIO and all of the teams on the floor.” From Sally’s perspective, “planning, setting expectations and taking clinical teams on the journey with you” are core elements to success.
Measuring success
From a configuration perspective, Fhez outlined early end-user engagement as the key success factor within The Dudley Group, which he said was all part of “really understanding and anticipating behaviours” to make sure they didn’t get “too many surprises” when figuring out what needs to change. He noted how this should always be done from the design phase, as “making small changes in any process can have a huge impact if not carefully thought about.”
On measuring this impact, Fhez used pathology as an example, “where we can very easily track the update of a solution just by looking at backend data. Look at how the number of orders placed has increased since making the update and that’s how you can see the impact of change.” As well as quantitative data, he also highlighted qualitative data as a key indicator, allowing you to “really see if a piece of configuration is doing the trick” because “you get to see people using the system and giving good feedback” adding how that is “probably most powerful” when it comes to measuring success.
Benefits of support networks
Hayley then went on to speak about the benefits of having support in place during and after the go-live stages, stating, “we’re expecting extra issues to come through, so having that back office support is fundamental.” However, Hayley also noted challenges with some of these service desks as being “a bit convoluted when it comes to getting your issue across” because you have to “go through a thousand questions before you can submit your query.” Hayley highlighted how this led to her team “scaling it right back” to one, easy to find phone number for staff to call and then “branching it off” into different categories such as equipment and EPR system fixes etc.
Sally mentioned how her team often do technical go-lives before the systems go live to the user, adding that “you wouldn’t think that it’s so important, but actually it means we can filter out all those user issues and security issues before they go live.” She then asked Hayley if she had the same processes in place within her team, with Hayley stating, “we went live two weeks before the full go-live for our users,” however this meant they were managing appointments on dual systems during that time. Hayley highlighted one key benefit to this though, adding, “it meant that once we went live, everything was up to date” at the time of go-live.
Strategies for engaging the workforce
“We ran a number of face-to-face workshops with our supplier,” Stacey explained, highlighting how difficult this was during COVID but emphasising the importance of bringing the staff along on the journey, stating, “I think the experience wouldn’t have been so positive if we hadn’t brought people along.” She noted how important it was to clearly explain what the EPR system could do for staff, how the transition would work and what it would mean for the day-to-day.
Stacey highlighted the accessibility of the workshops and how they were “open to all staff regardless of whether they were actively involved in patient records or patient care,” allowing them to “see the system and talk about the system design.” This was combined with a multi-phased approach in which Stacey would partner with the clinical leads and attend focused meetings where the doctor would explain the clinical change before Stacey would come in with the “technical side and the reality of going live”.
Expanding on how the face-to-face approach and floor walking gave a “real appreciation” for the clinical perspective, adding, “I’ve worked in digital healthcare for eight years, but I’m not clinical-first, so it’s really important for when I’m managing the project delivery that I understand how the clinicians are working.” For Stacey, this meant getting clinicians involved in the conversation so that she could learn “what their pressure points are, their biggest issues and how an EPR system can actually support that.”
When asked about digital champions, Stacey insisted that “there absolutely is a role for them” when it comes to EPR implementation and that her trust would have “shifts dedicated to staff to be digital champions.” Stacey explained how this was key to the success of the deployment, as it meant they were able to have more “people on the ground supporting our end users.” Stacey also outlined her “work with ward managers for the nursing groups to see who was more confident with clinical systems” as well as looking at those with good leadership skills to become the “dedicated super users of the system” on that ward. “They work really well,” she added “and we still use them with all our deployments.”
Big bang approach vs modular approach
“I think if I had to choose, I’d pick big bang every day,” Hayley said when asked which approach she’d prefer, however she also recognised that “you need to have the investment to do that. And not just the financial investment, but the resource investment as well” in order to make that approach successful.
“I don’t think there’s a clear-cut answer,” Hayley went onto say, “it all depends on where the organisation is and what you’re trying to achieve.” She then reinforced this by speaking about the more modular approach taking place in her current role at Leicester, stating, “it equally has a lot of benefits. You have the ability to test things out through smaller, incremental deployments” as well as having more “influence on what the system looks like,” which she said “works much better” for the team at Leicester.
Overcoming challenges
Next, Sally noted adoption as one of the key challenges to going live, outlining how you will “get that anyway with all digital solutions” but that it can be “resolved throughout the project lifecycle as long as the project is delivered correctly.” Echoing what Stacey had to say, Sally touched on workshops as one way to engage the workforce and help with adoption, but also mentioned the need to “create a really good product at the end of it,” which you can only do “with the clinicians that are going to be using it.”
Sally then mentioned future proofing as an essential part of overcoming challenges, stating, “we don’t just look at the digital solution as it stands at the moment, but also what it will look like when it goes live, what we need to do from the perspective of new starters and whether it needs to be included in mandatory trading.” She said the key is to “make sure it’s embedded in processes across the organisation” and to understand that there might be a drop in performance at the go-live point. “We’re not expecting them to start using the system and be absolutely amazing from day one,” Sally said.
Referring back to the discussion on digital champions, Sally highlighted this as key for tackling some of the challenges going forward, noting, “we’ve had lots of great deployments but they could go a lot smoother if we had digital champions across the network.”
Speaking on things that could have gone better, Hayley highlighted how much of an impact digital transformation can have on an organisation, having spoken to members of staff who “didn’t feel like they were ready to take on this technology” and “felt their jobs were at risk because their jobs were changing so much.” In order to address this challenge, Hayley emphasised the value of staff training and awareness, as well as the need to “seek out those people and make sure they’re well supported and recognise that not everyone is going to be as excited about it as we are.”
Stacey echoed this sentiment on staff training, highlighting the importance of getting this up and running sooner rather than later. When looking at what didn’t work well for her team, Stacey explained how they had a “training trajectory based on a numerical value that we had identified early on” however, they ended up being behind this trajectory four weeks before the go-live date. “We did actually hit way over our target by the time we went live,” Stacey said, but highlighted how the slow uptake at the start added “constant operational pressure.” Since then, the team have changed their approach and Stacey noted how this has helped to “improve all of our other deployments.”
We’re like to thank the panel for joining us and sharing their expert thoughts and learning on their go-live experiences.
