Change and Optimisation


By Gaelle Fertil

Published 4 March 2021

Change & Optimisation:
6 steps to making go-live the
beginning of the journey

Preparing for an EPR go-live is a complex and consuming task, everything is planned around that all important go-live date. The date is the focus; it drives deadlines, plans, risks and all activities to ready the staff.

But with so much effort being put on arriving at this huge event, it is easy to lose sight of what happens after. In the frantic preparations for the big go-live there is often lack of bandwidth to discuss and agree how and also who will continue the work after go-live.

The reality is that go-live is just the beginning of the journey. Go-live brings a basic system online, optimisation turns on the intended benefits.

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Success lies in having the steps in place ahead of time to assure that optimisation is planned early on with resources, budget, governance and change plans. Key to this is to consider the go-live as the start to a long transformation journey.

Here are 6 steps to achieve this:

1. Shift from stabilisation to optimisation

Once the EPR is live there is a period of stabilisation whilst everyone gets to grips with the new system and recovers from such a large change. This period of time can feel like a low ROI with a decrease in productivity, staff discontent, inefficiency or even patient complaints – planning for this will help manage expectations.

Go-live support efforts are focused on reaching that “stable” sweet spot as quickly as possible. It is at this point that the EPR optimisation team should start to take over to understand the users’ needs and the value of the optimisation. Users complaints soon turn into questions about ways the system could support further improvements of workflow efficiencies, it is key at that point to capitalise on the momentum and engagement achieved.

This is also the opportune time to ensure all aspects of the implementation are duly completed – for example that downtime procedures are well communicated throughout the Trust and embedded into the organisation’s SOPs.

2. Realign resources to support optimisation

During go-live it is “all hands on deck”, it’s hard to see or think beyond the burning issues at hand. It is therefore important to have given some thought as to how resources will be re-aligned to optimisation and what criteria will be used to do so, prior to go-live.

Part of the plan should be to assess the team and identify those who will continue past the stabilisation and go into the optimisation team – key is to continue to have the appropriate skills involved (training, communication, change analysts, configuration analysts) as well as operational leadership involvement.

For example, the training team should move from catch-up training to establishing advanced training – they will do this by analysing the way users are interacting with the system, identifying good practice and putting in place mentoring opportunities to share best practice. They may also deliver tailored training courses based on departments or functionality, for example Order Management, that are identified as requiring additional training to drive efficiency.

3. Set up strong governance and change control

This step is often forgotten or not dealt with, but it is actually the most important if any optimisation programme is to succeed. A strong governance structure ensures that:

    • Leadership involvement is used effectively.
    • Correct leadership is engaged. For example, if part of the vision is to increase clinical quality, the governance committee should include leadership from quality assurance and clinical representatives.
    • Projects are aligned with the organisation’s overall mission
    • Priorities are balanced out – at times tough decisions may need to be made and user requests may result in a “no”.

Strong governance is supported by a change control process providing structure, guidance, rules and overall consistency.

4. Realise those benefits (eventually)

After all the planning and visualising of benefits, now comes the time to measure them. If a strong benefits realisation plan exists the relevant benefit owners will have been identified and measurement reports will have been agreed. If not, it’s now time to prioritise this activity although pre go-live baseline metrics will no longer be possible. Some benefits will take years to realise so ownership and tracking must be embedded in the SOPs and tied into the BAU governance.

Although it’s important to measure those benefits identified in the business case, chances are new previously unidentified benefits will start appearing – these should be measured and communicated as part of the post go-live communications plan.

5. Engage and communicate

Change management, communication, marketing, PR – these disciplines are key to a successful go-live but continue into optimisation.

Champions, superusers, leaders, ambassadors etc should continue to be engaged with and involved in decision making as part of the post go-live governance structure. Their journey in shaping the EPR is only commencing at go-live and the governance structure should ensure that they continue to be heard.

Communication in the optimisation phase should help to drive adoption and maintain momentum by sharing the positive effects that the changes have had on patient care and for the organisation. Tell the users’ experiences, find good news stories to shout about, but also talk about how people are overcoming difficulties – whether specific to individual teams or relevant to the organisation as a whole.

6. Sharing within the healthcare system

With the NHS priority on creating strong partnerships between NHS organisations, local government and private sector partners should look at how their EPR implementation could be leveraged to support the ICS digital agenda (if it’s not already so).

This could take many shapes and sizes from sharing the lessons learned of a large digital transformation, to exploring the possibilities offered by the technology to support better sharing of data. In all cases, supporting wider digital transformation will involve a level of change and therefore further optimisation should be part of the organisation’s optimisation plan.

Implementing an EPR is a marathon not a sprint, but when does it end? Does it ever? A programme brings together a large number of resources to achieve a common vision, however that vision does not come to life at go-live.

Key to a successful optimisation is first to plan for it – by anticipating the resourcing needs and preparing stakeholders. Eventually, like any programme, it requires clarity of purpose, engagement and a strong governance structure. An effective optimisation programme can truly deliver that “Transformation” leading to streamlined access to data, increased clinical engagement, improved workflows and clinical outcomes.

About the author

Gaelle Fertil is Client Services Director for Ideal Health and leads their Change and Benefits Management practice.

Gaelle has over 25 years’ experience managing large complex digital health transformation programmes across the UK, Australia and Singapore.

She is passionate about digital transformation in healthcare and has delivered multiple health system implementations across primary, community and acute sectors.

Gaelle has particular experience with Change Management and was the Director for Change and Training for Singapore Ministry of Health’s largest and most ambitious programme – implementing a single National Electronic Health Records System. She led the change and training activities for implementing Epic to over 41 institutions and 27,500 frontline users and was responsible for the delivery of clinical, operational and operational readiness events.


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