By Jennifer Dunne
Published 25 March 2021
Act early in 5 key areas to avoid delays
Mobilisation is a strange phase that sits somewhere between the “action” of procurement/business case approval and recruiting, preparing, designing, building, and everything needed to start implementing on the right foot.
An electronic patient record (EPR) solution is one of the biggest investments an NHS Trust will ever make. As well as the software and infrastructure, the cost of the programme team is significant, delays during implementation can be extremely expensive, both from reputational and financial perspectives.
Mobilising effectively lays the foundation for a successful, delay-free implementation and ultimately creates an environment in which anticipated benefits can be realised.
Here are five key areas that require focus in this phase;
1. Transition from procurement/business case phase
It is important there is continuity and transition between the procurement and business case phase into the implementation phase of an EPR programme. A way to achieve this is to recruit an EPR Programme Director who will be in post from procurement through to implementation and will bring in the programme management expertise for each stage where required. The assignment of a Senior Responsible Officer (SRO) who is empowered to move the programme along and engage with clinical and operational team, is vital to creating and building momentum.
When this transition or continuity is not clear, it can lead to loss of context of decisions that were made to influence the EPR Programme. The procurement phase will likely have included a detailed requirements gathering exercise and ideally and a detailed understanding of how clinical and operational teams work today. This will likely have involved various clinical and operational stakeholders who will trust the information provided is shared and therefore will not be asked for again, and again, and again.
2. Importance of strong governance
Effective, active and visible leadership by the Executive Team is the number one determinant of success of any organisation-wide change programme. It is vital that the Executive Board is invested in the EPR programme and prepared to steer, guide and support the implementation programme regularly and on an adhoc basis as and when required. Getting the governance right at the start of the mobilisation phase is critical to ensuring effective leadership and buy-in for the remainder of the implementation and beyond.
3 ways to achieve strong governance:
1. Identify the appropriate clinical and operational sponsors. It is ok to have multiple sponsors as long as the responsibilities are clear.
2. Ensure the SRO is empowered to manage the budget and third-party contracts (such as the EPR vendor)
3. The organisation chart on the right shows the minimum governance required (this will expand over time to include a technical design authority and change control board as examples) and highlights the three key workstreams all EPR implementations need to include.
The EPR Programme Team size and structure will usually be informed by the EPR Vendor. This should be considered the minimum required for a successful implementation. The deployment of an organisational readiness team, necessary to lead change management, communications, benefits workstreams (as examples) would need to be resourced by the Trust. Given the majority of benefits will be delivered as a result of people changing the way they work, it is important not to underestimate the scale of change and the skilled resources needed to lead organisational readiness.
It may be tempting to expect existing staff to be shared across their business as usual (BAU) or other projects and the EPR programme. This is a challenge to get right, as sometimes BAU issues are higher than expected and sometimes the skill set is not totally in line with what is required.
To address these issues, engaging an experienced Programme Director, Integration Architect, Transformation Lead (Change Manager) and Communications Manager during the mobilisation period will ensure the programme leadership team is in a strong position from the start. They will also be responsible for supporting the procurement of a specialist implementation partner or individual roles required to complement the existing team, and through effective skills and knowledge transfer, can begin creating alignment in the delivery of a successful implementation. This is not an overnight process, recruiting and establishing a strong team, equipped to fully mobilise
3. Engaging key stakeholders early
There is an African proverb, “It takes a village to raise a child”, it is certainly accurate to say it takes a whole organisation to implement an EPR.
An EPR supports clinical and operational processes. Clinical and operational processes are operated by staff across the Trust. Therefore, if the processes are going to change, it follows that involving staff across the Trust is essential.
Whilst staff are a critical stakeholder group, there are many others to consider. A stakeholder matrix will need to be created and will map the level of influence each stakeholder or group will have on the programme and also the level of change that the stakeholders and groups will need to adopt.
The diagram on the right is an example list of stakeholder groups. This list is not exhaustive but rather to highlight the range of different stakeholder groups that will need to engage in the implementation for it to be successful.
It is never too early to engage with stakeholders. This may have started in the procurement and business case stage when the requirements and benefits work was undertaken.
4. Preparing your communications approach and consideration for branding
Once the stakeholders have been mapped, the communication strategy can be developed. It is recommended for most Trust’s that the EPR be branded for ease of visualisation of communication and also to highlight that the EPR is made up of more than the core EPR solution, i.e. setting the vision for the EPR’s transformation.
Without clear internal and external communication, the collaboration between all parties will begin to diminish which could lead to incomplete process and people change and therefore to fragmented workflows in the enabling solution. Lack of communication could also negatively affect engagement from the organisation and eventually support at go live and adoption beyond. Poor adoption has a direct result on realising the benefits which could impact on the financial position of the Trust, depending on the funding source and arrangements for the return on investment.
Investment in a specialist communication lead who will align with the Trust Communication Team at the mobilisation stage will stand the programme in good stead.
5. Ensuring collaboration from the start
Finally, it is worth highlighting how imperative it is to enter into an EPR Programme in a collaborative way. Collaboration is formed with the wider Trust and external stakeholders, the EPR Vendor and any downstream system providers to be integrated with.
Starting with a ‘one team’ approach will alleviate tension later if or when things don’t quite go to plan and reduce the number of delays caused by a ‘them and us’ situation or the introduction of a classic blame culture.
In summary, it is my personal experience leading EPR implementations that if the investment and effort is not made at the mobilisation stage, it will almost certainly lead to delays later. Continuity, strong governance, the right level of expertise and experience, stakeholder engagement and transparency of information are the catalysts to creating a feeling of ‘we’re in this together’, which if done well at the mobilisation stage will set the tone for a successful implementation and user adoption.