Like the human heart, a hospital’s information system provides a vital function: every beat transmitting important messages along one of the many integrated pathways in a synchronized operation. It also collects, stores and manages a vast amount of clinical, financial and operational data generated by the hospital, all designed to maintain a healthy infrastructure. The implementation of a new system, therefore, is not to be taken lightly.
Two years ago, a member hospital I work with made the momentous decision to replace its aging, out-of-date hospital information system (HIS) with a new one that would more fully integrate all of its operations.
To prepare for the change, we developed a detailed, 14-month timeline and contracted with experienced implementation consultants to support our efforts. We created more than a dozen business and clinical teams to represent their respective areas, all overseen by both a senior IT team and senior leadership to serve as the project’s executive sponsors. A substantial financial commitment was dedicated to the effort and we were confident our approach would result in a successful system implementation.
We launched the system in four phases. First, we documented how the outgoing system worked and applied that understanding to how the hospital’s processes could be accomplished in the new system. Next, we conducted intensive training with each team and worked with vendors to ensure each department was fully prepared. Third, we conducted months-long system testing, running scenarios based on routine operations as well as non-routine functionality for each department. Finally, at go-live, we turned the system on one department at a time in logical order.
It should have worked perfectly, but it didn’t.
While we could admit patients, request patient procedures, order and receive supplies and medications, document results and discharge those patients, other scenarios surfaced. What we experienced at go-live were staff who didn’t know how to use the new system, the not unimportant issue of bills that couldn’t be finalized and problems documenting portions of the hospital’s financial statement.
How did our fail-proof plan let us down? There were issues — some that we could have anticipated but many we could not. I offer these lessons learned in hopes that they are helpful to any organization undertaking a similar hospital-wide implementation.
1. Set up a command post: Plan to staff a command post 24/7 for several weeks following go-live with key hospital decision-makers and representatives from both the implementation consulting team and the system vendor. Unforeseen issues and/or problems will surface immediately upon go-live which will require quick investigation, decisive remedies and solution implementation that can be communicated to the entire organization. This is especially critical for the night shift, where many system problems may interfere with patient care and can’t wait until the morning to be fixed.
2. Ensure you have a “Plan B”: You have patients to take care of and having system glitches is not an acceptable excuse for delaying or compromising their care. Learn – and practice – downtime procedures so everyone is well-versed in automatically transitioning into manual “Plan B” in the event of a system disruption.
3. Be prepared to change: Your efforts should be focused not on simply transitioning your current way of doing things into the new system, but on enhancing how those things are done. This will likely mean that some staff and/or departments will need to learn a different way of accomplishing certain familiar tasks, and this change may not always be welcome. Take advantage of any available resources provided by the implementation consultants to help smooth the way.
4. Plan for schedule gaps during training: When your employees are in system training, they are not available to perform their regular duties. While this is unavoidable, planning and flexible scheduling can help mitigate some of these difficulties. Where necessary, particularly on the clinical side, extra staff or temporary personnel helped ease this burden during our training.
5. Coordinate staff training: If the time between an employee receiving system training and actual implementation is beyond several months, it’s likely they will have forgotten much of what they initially learned but haven’t used since. This could result in a nasty surprise when you go live and they don’t remember exactly how to accomplish a task that seemed so easy in training. If possible, schedule departmental training in a phased manner to coincide with the timing of the go-live. If possible, plan for some additional time and expense for staff retraining.
6. Revisit daily operations three months post go-live: Once the hospital has had the opportunity to manage its daily clinical and business operations in the new system, it will become apparent what impact the new system has had on accomplishing these tasks. The system may allow staff to complete their activities in an enhanced manner, and everybody will be grateful for that. However, there will undoubtedly be many cases where the new system has slowed things down or created new roadblocks that had not been previously identified.
Be prepared for the need for additional system tweaks. Be on the lookout for the always used but unofficial “workarounds” that staff develop on their own. Be sensitive to the fact that hospital staff may be tired and perhaps frustrated once they actually use the system and find certain aspects of it to actually be more complicated; and for some tasks to take longer to complete than what they were used to.
It may not be possible to conduct a problem-free system launch, given the enormous complexity of automating and integrating every single activity of a hospital. However, by devoting a serious effort to preparing for, and anticipating, the impact of a new system implementation it’s possible to minimize these concerns and help ensure that everything flows efficiently, keeping your hospital vital and strong.
