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It’s like a puzzle: Executing proper implementation go-live

DanO'Connor

Dan O’Connor, Vice President, Client Relations, Stoltenberg Consulting

For small community hospitals or physician offices starting their EHR system implementations, or for those struggling with a current system, executing a proper implementation go-live can be a puzzle. Health information technology (HIT) projects are often very complicated, complex projects that span multiple divisions throughout a hospital or health system.

In these implementations, the best project managers are like the top coaches in sports – both of whom have the skills to appropriately assess the puzzles faced by their organization or team. They have the ability to evaluate people and their skills and put them in situations that maximize their talents. This holds true with individuals in sports or healthcare teams and is the difference between good and great project management.

In addition to strong managers, all HIT projects should include project charters with well-defined scope statements that outline not only the project phases but also the goals and success factors. With the complexity of both large and small-scale projects and the variability of the clinical and financial environments in healthcare today, implementations are difficult because you’re not only affecting workflow and technical processes, but also communication processes with varying levels of multidisciplinary collaboration.

Regardless of complexity or scale, defining the goals and success factors upfront and communicating these to the project team, providers and administrators will help ensure successful project implementations of any organizational size or HIT system.

Common early frustrations

As you evaluate projects, there are multiple challenges that can arise which may cause team frustrations and delay the go-live. One of the biggest frustrations is multiple priorities pulling team members in different directions or competing for their time. In best-case scenarios, you completely isolate a project team from their other outside responsibilities. Unfortunately, except for the largest projects, this is not possible most of the time. The ability to anticipate these potential influencers and distractions can be key in keeping a project on time and on budget while maintaining a project team’s positive morale. 

Another area that can cause problems or frustrations is “scope creep” where the goals of the project gradually expand beyond the original scope statement. This tendency can derail a project, causing missed deadlines, project-team dissatisfaction and budgetary issues. Strong project managers can manage scope without creating abrasion between team members or with outside groups or divisions looking for additions or changes to the project. While communication is always a key to managing projects, this is the area where both transparency and communication are vital.

From engagement to go-live

Communication is also an important element of the engagement strategy, particularly for physicians and other providers. However, it’s often difficult to pull those providers who are usually the busiest and have the most time dedicated to direct patient care to obtain their feedback and input on the design. Despite these challenges, provider end-users are instrumental in ensuring the usability and adoption of a new EHR system. While engaging these staff, make sure to involve not just the physicians, but also nursing, administrative and other staff integral to the clinical workflow.

Once engaged in the project, developing a training program and making sure everyone is well trained on how to use the new system is a tremendously important aspect of a successful implementation. Even prior to training, however, healthcare organizations need to develop a progress-reporting strategy. It is vital to consider the creation of the needed reports and specific dashboards with benchmarks early in the process to measure improvements and address deficiencies.

As projects advance, you may see increased anxiety and frustration as you transition through the testing and training phases into go-live preparation and the eventual go-live. Having detailed go-live plans with contingencies built in is important to project realization. The most effective projects have prepared for and created protocols for multiple potential problems and are staffed to maximum capacity. You can more easily reduce staffing needs during a go-live rather than increase them.

Consistent communication ensures adoption

Having strong consistent communication throughout the go-live phase helps keep team members focused and resolves any potential issues. The most successful projects are those that have consistent daily meetings scheduled with communications distributed to the project team and the healthcare community on a regular basis.

HIT implementation is a continuous process- and quality-improvement project that does not simply end with the go-live. Optimization following the implementation process is just as essential as the structure, focus and energy that went into the initial process. The best project managers understand this reality and that managing complex project puzzles takes organization, planning and attention to detail. Most importantly, well-selected teams maximize the skills and potentials of individuals as well as the group.

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