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System updates: Prepare by putting users first

A large non-profit health system was about to undergo a double upgrade of their electronic medical records system. The key to success was a rigorous accounting of workers’ actual needs.

Amit Shah | December 18, 2017

Does this sound familiar? A major system change is rolled out, on time and under budget. Hooray! The IT department celebrates. But for actual users, it’s a different story. They’re confused and demoralized. The IT people are bewildered by the backlash. They defend themselves by citing their success metrics. And that’s the problem: metrics that focus solely on budgets and deadlines and ignores the needs of the end users. A project shouldn’t be considered a success unless it also rigorously delivers a satisfying user experience.

“The IT view of the world isn’t wrong, just incomplete.”

This can’t be an afterthought. The needs of the users should be front and center. Look at the project through the eyes of the customers rather than the eyes of IT technicians, who are governed by a different view of reality. The IT view isn’t wrong, just incomplete. To make it complete, develop an operational readiness playbook for a repeatable process, centered on the needs of users, that can be updated as organizational needs change and users provide further feedback.

You should also beware of implementation plans based on best-case scenarios, and be ready for when things go wrong. For example, what will you do if the estimate of server capacity is wrong and the application begins to run slowly? Or a large number of users missed training and are struggling with the new system?

Getting users on board early is also crucial, especially those inclined to oppose the new system. Don’t be derailed by complaints before you even start. Take measures to reduce how negative views might affect perception of the project. And make sure supportive stakeholders feel empowered and informed.

Case study: Doctors vs. IT

A large, well-known health system was facing a double upgrade of their electronic medical record (EMR) —two simultaneous major releases—and users were nervous. The last two upgrades had created tremendous disruption. The CEO of the health system called on his chief of innovation and IT leaders to make the new upgrades more satisfactory for users.

The chief innovation officer challenged the team to go beyond satisfactory. All agreed that given the pervasive lack of confidence in the IT team, this would be a stretch goal. After interviewing stakeholders, it was clear the past problems were caused by customers and IT having different measures of success. Customers described being unprepared for the changes, and even unaware of what the changes were. In addition, informatics leaders found there were skills gaps in both clinical and technical problem solving, as well as in managing large organizational change. Leaders sought the help of Slalom to fill the skills gaps and assist the clinical informatics leader in developing a plan that included operational readiness and organizational engagement. In other words, they put users first.

One of the first steps was to change the perception of the project from an IT-driven one, to an operations-driven one: Operational executives took the lead and were held accountable. Success was measured by operational metrics. IT was assigned the role of assisting with the upgrade, not driving or controlling it.

These are the areas in which the team provided support to ensure the upgrades put users first:

  1. Helped create a “super user” program of 450+, with a sustainability plan for post-go-live
  2. Created a multi-disciplinary operational steering committee to oversee the project
  3. Identified stakeholders, and for each assessed how much influence they had, and how much impact they would feel
  4. Provided regular updates to senior leaders to ensure their engagement
  5. Analyzed over 5,000 upgrade changes to assess their impact on workflow and training
  6. Established a pain scale: Superusers gave feedback to leaders on the level of pain the organization was experiencing, and were given information needed to implement interventions
  7. Designed an operational command center for quick reaction during the go-live process
  8. Created workflow-based visio diagrams
  9. Interviewed leaders from high-impact service lines, and identified 165 critical pain points
  10. Created governance for the intake, prioritization, and implementation of future optimizations
  11. Created a communication process for operational downtime incidents
  12. Adjusted workflows using Epic Systems to increase efficiency and reduce redundancy
  13. Developed a detailed communications plan
  14. Slalom used its Decision Lab survey technology to quantify pre- and post-go-live concerns from 15,000+ employees
“It was clear the past problems were caused by customers and IT having different measures of success.”

Results: Stunning

The team managed a go-live that was described by staff and leaders as “utterly night-and-day from our last” and the “smoothest go-live” they’d ever been part of. Using the go-live pain scale of 1–10 with 10 being maximum pain, the go-live scored a 1.5.

Slalom was able to help provide a new governance paradigm focusing on the 10 most impactful service lines, ultimately generating 33 optimized future state workflows. Using Slalom’s Decision Lab technology, the team created surveys for 15,000+ employees to quantify pre- and post-go-live anxieties and aptitudes. This allowed the creation of a base metric for future upgrade planning. The new operational playbook focused on instilling a new culture from the leadership down to the last employee.

The number of steps involved in such a users-first approach to a system upgrade may seem daunting, especially for large organizations. But our case study shows that the payoff—a happy, efficient organization, and the restoration of employee trust—is more than worth the effort involved.

Amit Shah

Amit Shah is a healthcare consultant in Slalom’s Houston office. Amit has been a healthcare business and technology advisor for payers, providers, vendors, and associations in delivering solutions for over 11 years.

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