Chapter 6 System implementation and support

Strategies to greater organization acceptance and use of a new system Organizational factor Provide adequate training

Both before the go live date and after the system is upgraded and changed Different training methods for different user groups

Major activities of a implementation project Communication

Have an effective plan for communicating progress Aids members of the implementation team and communicating and coordinating their activities Identifies how progress is communicated to the key constituent groups Current data

Major activities of the implementation projects System installation

Install hardware software and network infrastructure to support the new information system Build necessary interfaces IT staff play a crucial role in this phase Pilot the system in a unit or area before rolling out enterprise-wide

Pool of trainers

Will be trained by the vendor but will be knowledgeable about the entire system and can rotate through the entire organization to directly train all staff

Fundamental activities that should occur during any system implementation

Organize the implementation team and identify system champion Clearly define the project scope and goals Identify accountability for the successful completion of the project Establish and institute a project plan

Organizational factors

Allocate sufficient resources Provide adequate training Establish a strong relationship with the vendor

Strategies to greater organization acceptance and use of a new system Organizational factor Allocate sufficient resources

Adequate technical staff expertise Reliable and secure IT infrastructureand security

IT manager

Is the senior IT person assigned to the project

Types of staff training

Train the trainer Pool of trainers

System implementation

Begins once the organization has acquired the system and continues through the early stages following the go live date

Extrinsic incentive

Bonuses a promotion awards etc.

Team responsibility to identify accountability for the successful completion of the project 4 roles important in the management of large Healthcare Information and System projects

Business sponsor Business owner Project manager IT manager

Unintended consequences

Can be positive negative for both depending on one's perspective

Leadership an Aspect of managing change

Change must be led Often in the form of a committee leaders Chaired by an appropriate senior leader If the change is focused on a specific area the most senior leader would be the chair if it affects the entire organization the CEO should chair the committee Define the nature of the change Communicate the rationale and approach to change Identify procure and deploy necessary resources Resolve issues and altar direction as needed Monitor the progress of the change initiative

Planning implementing and iterating an Aspect of managing change

Change must be planned Tasks must be allotted resources Accountable staff for task performance must be determined When problems occur iteration and adjustment is necessary

ImplementationTeam responsibilities

Clearly define the project scope and goals Identify accountability for the successful completion of the project Establish and institute a project plan

Behavioral factors

Create an appropriate environment user expectations vary Clear and effective communication is key Do not underestimate use her resistance Understand the culture BEFORE you make the investment User acceptance occurs when see or realize the value of the HCIS brings to their work and the patient they serve

Several strategies that may lead to greater organizational acceptance and use of a new system

Create an appropriate environment one in which expectations are defined met and managed Know your culture and do not underestimate user resistance Allocate sufficient resources including technical support staff members and IT infrastructure Provide adequate initial and ongoing training Manage unintended consequences especially those known to fact implementation such as CPOE / EHR systems Establish strong working relationships with vendors

major activities of an implementation project conversion

Convert the data from the old system to the new system "Cleaned"the data before converting Complete accurate and current data before converting it to new system Once converted Run data through a series of validation checkpoints to insure accuracy of conversion Test system unit test functional test integrated test end to end test

Failing to plan for and manage the fundamental activities that occur during your system implementation can result in

Cost overruns Dissatisfied users Project delays System sabotage

Strategies to greater organization acceptance and use of a new system Organizational factor Establish a strong relationship with the vendor

Define expectation resource needs timelines Have open honest and candid conversations when problems arise or differences in expectation occurs

If no technical support is in house

Devoting a significant portion of an employee's time to training so that he or she may assume a support role Partnering with a neighboring organization that uses the same system to share technical support staff members Contracting with local computer for them to provide the needed assistance

Implementation team

First step in planning for the implementation of a new system is to organize this Primary function is to plan coordinate budget and manage all aspects of the new system implementation

During system Installation reasons to pilot the system in a unit or area before rolling it out

Evaluate system effectiveness Address issues/concerns fix bugs Apply lessons learned to other units

Intrinsic incentive

Excitement over the change fear of what will happen

Business owner

Generally has day-to-day responsibilities for running a function or department Ex.director of radiology director of pharmacy A project may need the involvement of several of these

Team responsibility to define project scope and goals

Goals need to align with the organization and need to be clear and concise To broad of goals leads to scope creep Goals should be specific measurable attainable relevant and timely Goals should define the organizations criteria for success Teams first item of business

Project manager responsibilities

Identify and obtain needed resources Deliver the project on time on budget and according to specification Communicate progress to sponsor stakeholders and team member Ensure that diligent risk monitoring is in place and appropriate risk mitigation plans have been developed Identify and manage the resolution of issues and problems Maintain the project plan Manage project scope

Major activities of the implementation projects Workflow and process analysis

Identify ways to improve workflow simplify tasks, eliminated redundancies, improve quality, improve user satisfaction Avoid simply automating outdated and inefficient processes ( by NOT evaluating current business processes) Gajn initial buy-in by involving users during the redesign process Observe the current information system and use if there is one Review and evaluate the existing workflow or business processes analyze and evaluate current processes and procedures Identify opportunities for improvement and as appropriate effect those changes Identify sources of data including interfaces to other systems Determine location and number of workstations needed Redesign physical location as needed

Strategy to greater organizational acceptance and use the the new system Know your culture and do not underestimate use your resistance

If you don't have sufficient medical staff Biane and support hospitals on staff or committed to the project you run the risk of encountering user resistance and system failure because of inadequate use

Major activities Of an implementation project staff training

Important to introduce fundamental or basic concept first and enable people to master of these concepts before moving onto new ones Timing of the training is important

Informal communication

Is less structured but can be equally important it is important that all staff members day evening and night shift be made aware of what is happening The method for communication may be varied but the message should be consistent and the information presented up-to-date and timely for example do not rely on email communication solely only to discover later that your organization nurses do not regularly check their email

A physician champion

Is usually the system champion in most cases.Particularly when the organization is implementing a system that directly or indirectly effects how physicians spend their time Serves as an advocate of the system assumes a leadership role in gaining by and from other physicians and user groups Make sure that positions have adequate input into the decision making process Having a system champion from each division when implementing clinical applications that span numerous clinical areas is helpful in gaining buy-in and facilitating communication among staff members . they will assume a pivotal holes in ensuring that project milestones are achieved and celebrated

Managing change has several aspects

Leadership Language and vision Connection and trust Incentives Planning implementing and iterating

Team responsibilities Establish and institute project plan components

Major activities( AKA tasks) Major milestones Estimated duration of each activity Any dependencies among activities (sequential tasks) Resources and budget available (including staff members time allocation) Individuals or team members responsible for completing each activity Target dates Measures for evaluating completion and success

Project manager

Manages the project Provide stay to day direction setting conflict resolution and communication needed by the project team Maybe an IT staffer or a person in the business or function benefiting from the project

Formal communication

May include everything from regular updates at board and administrative meetings to written briefings and articles in the facility newsletter The purpose should be to use as many channels and mechanisms as possible to ensure that the people who need to know are fully informed and aware of the implementation plans

Connection

Means that leader ship takes every opportunity to present the vision throughout the organization

Incentives In aspect of managing change

Members must be motivated to support significant change If the other person will support the change you will deliver some thing that is of interest to him or her for example space extra staff members a promotion May also take the form of awards plaques dinners for two to staff members who go above and beyond the call of duty during the change effort

Manage unintended consequences bahavorial factor

More work or new work ( more steps) Workflow ( alter improve or slow complicate) System demands Communication Emotions New kinds of errors Powershifts Dependence on the system

Connection and trust And aspect of managing change

Must achieve connection We just may use department head meeting medical staff forms one on one conversations in the hallway internal publications an email to communicate the vision to keep communicating the vision vision Communication must invite feedback criticism and challenges most should be done in person The members of the organization must trust the integrity intelligence compassion and skill of leader ship The members must also trust that leaders have thoughtfully come to the conclusion that the difficult change has excellent reasons behind it and represent the best option for the organization

Language and vision An aspect of managing change

Must understand the nature of the change Must know the world will look like when the change has been completed How their roles and work life will be different Why making the change is important Absence of this vision or failure to communicate the importance of the vision elevates the rest of the staff members will resist the change and cause a change to grind to a halt Language you "should" instead of "must" "we" instead of "you"

Major activity of an implementation project Preparation for go live How to determine the go live date

On a day when the patient census is low After staff have been trained When the IT staff are available to monitor assess system problems

Support and evaluation

Problems will be detected and changes will be needed IT staff should correct the problem or work with the vendor The vendor may detect glitches and develop upgrades or patches Optimizing use of the system Additional training Revised workflows Getting new features are Using data from the system for quality improvement initiatives Is reasonable to expect that the hardware software network will likely need to be replaced within 3 to 10 years as advances are made in technology organizations goals and needs changes in the healthcare environment changes

Train the trainer

Relies heavily on the vendor to train selected members of the organization who will then serve as super users and train others in their respective departments units or areas

Business owner responsibilities

Representing their department or function at steering committee and project team meetings Securing and coordinating necessary business and departmental resources Removing business obstacles to meeting the project timeline and producing deliverables as appropriate Working jointly with the project manager on several tests

Trust

Requires that leaders act in the best interest of the staff and the organization and that leaders listen and respond to the organizations concerns

Major activities of an implementation project System downtime procedures

Scheduled and unscheduled downtimes exist Downtime procedure should be communicated before go live Dry runs or practice sessions for downtime should be reviewed with staff before and after the go live

Business sponsor duties

Secures Funding/ needed business resources ex. Commitment of peoples time to work on the project Has final decision making and sign off accountability for project scope resources and approaches to resolving project problems Identifies and supports the business owner(s) Promotes the project internally and externally and obtains the buy-in from business constituents Chairs the project steering committee and is responsible for steering committee participation during the life of the project Helps define deliverables objectives scope and success criteria with identified business owners and the project manager Helps remove business obstacles to meeting the project timeline and producing deliverables as appropriate

Composition of implementation team should include

Some of the same people involved in selecting the system A Project leader (a strong project leader and the right mix of people is critical) System champion Key individuals from the clinical administrative areas that are the focus of the new system Vendor representative IT professional For large or complex projects a person skilled in project manager principles

System champion

Someone who is well respected in the organization sees the new system as necessary to the organizations achievement of its strategic goals and is passionate about implementing it

Qualities of a System champion

Strong communication interpersonal listening skills Should be willing to assist with pilot testing to train and coach others and to build census among user groups

Go live date

The date when the system is put into general use for everyone

Business sponsor

The individual who holds overall accountability for the project and represents the area of the organization that is the major recipient of the project Their management or executive level should be appropriate to the magnitude of the decisions and the support that the project will require

Team responsibilities Establishi and institute project plan Major activity

The order of the activities should be determined by the organization in accordance with its needs resources Workflow and process analysis Staff training Conversion Communications Preparation for go live date System downtime procedure

Major activities of an implementation project Preparation for system go live ImplementationTeam should ensure

The system is ready through testing Staff members are trained Appropriate procedures are in place Disaster recovery plans are in place IT staff in place to monitor and assess system problems and errors

Key challenges to train the trainer

The training process depends on the vendor the trainer may be ineffective training takes time away from the trainers primary duties

Strategy to greater organizational acceptance and use of a new system Create an appropriate environment Expectations

They come from what people see and hear about the system in the way they interpret what the system will do for them or for their organization Can be formed from a variety of sources: They may come from a comment made before a vendor presentation A question that arises during training a visit to another site that uses the same system attendance at a professional conference or a remark made by a colleague in the hallway The main criterion used to evaluate the systems value or success depends on the individuals expectations and point of view When managing it can be enormous Lee helpful to conduct formative assessments of the implementation process in which the focus is on the process as well as the outcomes System metrics need to be chosen and success criteria defined to determine whether or not the system is meeting these

Main purpose of testing

To simulate the live environment as closely as possible and determine how well the system and accompanying procedure work Running the old and new systems in tandem for a period time until the evidence that the new system is operating effectively may be advisable Or if not feasible or appropriate the organization may opt to implement a system using a phased approach

IT manager responsibilities

representing the IT department Has final IT decision making authority and sign off accountability removes IT obstacles to meet timelines and producing deliverables Promotes the project internally and externally and obtains buy-in from IT constituents