Date post: | 05-Jun-2015 |
Category: |
Healthcare |
Upload: | mfolkard |
View: | 393 times |
Download: | 4 times |
#CCIO
Moving from why to how:CCIOs and the power of collaboration
#CCIO
Dr Colin Brown CCIO, University Hospitals of
Morecambe Bay NHS Foundation
#CCIO
Leadership support requirements during a significant system
implementation
#CCIO
Dr Colin Brown CCIO University Hospitals of Morecambe Bay Kings Fund - 26th November 2013
Leadership Support through a System Implementation
Single Patient Record Agenda
Dr Colin Brown – Nov 13
INSERT AN IMAGE / IMAGES INTO HERE
Shape of a System Implementation
A Process – Not a Single Go-Live Event
Leadership Support through a System Implementation • Describe Morecambe Bay journey • Lorenzo EPR as a core component of our
Single Patient Record strategy • Interoperability / Portal Capability • Leadership
• Clinical Engagement • Change Management
Morecambe Bay Locality
Morecambe Bay Locality
• 1000 square miles • 320,000 residents (400,000 activity base) • 98% GP registered • 95% of all patient activity at local Trust • 3 Hospital sites (2 Acute) with 900 beds
and 2 community treatment centres • 12M visitors to the lakes each year (2 x
Scotland)
Background Leadership 1990’s to 2007
• Longstanding Single Patient Record Vision • Head of Health Informatics since 1992 • Generational change in consultants • Strong Executive leadership • Full visibility at Trust Board level (3 successive
TB’s)
• Organisational transformational project (NOT IT)
Step 3: Develop a change vision Simplifies many decisions Inspires / motivates Coordinates actions Imaginable, desirable, feasible, focused, flexible, Communicable
Multiple
Journey My Start
1996 2013
Labour Government
Treatment and Cancer Access Targets
Reduce to 2 Acute Sites
FT Status
Dr Foster High Mortality
Trust Breach of FT Authorisation
Bettercaretogether
MBHT 3 Way Trust Merger
Patient Records in the 21st Century
Step 1: Create a sense of Urgency
50% fail – underestimate how hard it is to make people change Overestimate success Lack patience
ver
Lorenzo Regional Care Management • Go-Live in June 2010 • Clinical Documentation (forms, notes and letters) • Care Management (PAS function)
• ADT’s, Access Planning, OP management
• Resulting • PACS viewing • Sequential capability • TTO prescribing (Nov 11) • Advanced Bed Management (Nov 11) • Emergency Care (Jun / Nov 12) • Test Requests (Sept 13)
Transrectal ultrasound biopsy of prostate clinic using clinical note and CDC forms
single Patient Record (sPR)
0
500
1000
1500
2000
2500
3000
3500
4000 Immediate Discharge Summaries
Created in Lorenzo Jan 2011 - Sept 2012
single Patient Record (sPR) Step 6: Generate Short-term wins Long term change needs short –term wins within 14-26 months Visible and clear wins Reward change agents Reduce credibility of cynics and resistors Convert neutrals to weak supporters, then to strong supporters
R&R: Inc. External Report
R&R External Report (Gastroscopy)
GP Summary Care Record
Clinical Problem Recording
EPR Implementation Process
• High-level Project life cycle
Project Initiation
and Deploy
Go-Live and early
life support
3000 users introduced to a new system Well run
Project with good governance and controls
Stability by November 2010
Adoption
System and SOP familiarisation
UHMB Trust Board sign off Jan 2011
Acceptance
Process and content becomes irresistible
Patient Records in the 21st Century
Risk Management Crossing the system transfer void
• Good Communications • Good Governance • Good Project Management • Proactive management of the risk envelope
– Don’t attempt too much, keep it manageable and credible – Change process before cut over or after not on the day – Engineer break points, Emergency Department? – Keep the big in big bang as small as possible – Keep the data migration as tight as possible – Look for a good day
Process of Clinical Engagement
Informatics-led to Clinically engaged to Clinically-led Informatics
Go Live
Newly appointed Clinical Lead for Informatics
IDS go live TTO go live EC go live
New Clinical Directors in post
Establish CCIO
Clinical priority setting
Step 2: Create a guiding coalition Position power Expertise Credibility Leadership
Clinical Engagement 1
• Hearts and minds, hearts and minds • Good communications • Small wins
• Infection Control Team • Surgeons CPD
• Reward supporters • Hardwire systematic change through “red
line” steps
Clinical Engagement 2
• Mandated red line steps • Possess a smartcard (March 2011) • View NP referral letters on screen (June 2012) • “Training Workshops” - 228 of 230 consultants
(Sept to Nov 2012) • Adopt IDS as sole discharge communication with
GP’s - Dec 2012 (83 % within 24 hours) • “Paperlite” outpatient project (April 13 to June 14)
Step 4: Communicate the vision for buy-in Most companies underestimate communications by factor of 10 Stalls transformation Comm’s – vivid, simple, repeatable, invitational Leaders – “Walk the Talk”
Requirements
Work Package & Plan – sign off
Sign off train,
Start Finish
5 weeks
Content built
Dry run Pilot
* Technical enablement of diagnostics ** Train technician/clinician
7 weeks
Treatment Function - High Level Plan
“Paperlite” Outpatients Project
Step 8: Make it stick – Incorporate change into new culture Change norms of shared values and behaviour Inertia can be maintained by longstanding staff, need to overcome Prove new way is better than old Success is visible and communicated May lose some people in process Reinforce new norms / values with incentives and rewards Reinforce new culture with every new employee
Morecambe Bay Future EPR Developments -1
• Complete Paperlite Outpatient Project June 2014
• Inpatient Paperlite Care – Rollout Test Requesting – In Patient Prescribing and Meds Admin (IPPMA) – Documentation (inpatient and ED) – Observations – ICP’s – Theatres
Step 5: Empowering broad-based action Reduce layers of management Align to customer (user and patient) needs Devolve responsibility Excellent communications Remove troublesome supervisors, honesty, change or remove
Morecambe Bay Single Patient Record Development • Interoperability
• GP Systems – Documents, Messages, Reciprocal Summary Views
• Medical Devices • Community Services , Social Services (Strata)
• Connect up an e-Health Economy • Local Trusts (Blackpool, Preston, Blackburn) • Support whole patient pathways
• Empower Patients view and interact with records
Step 7: Never letting up Consolidate gains / produce more change Maintain critical momentum Drive new behaviours and practice into embedded culture Needs concerted effort, new projects, new people recruited, Do not declare victory Leaders steer for the long term
Morecambe Bay Single Patient Record Development
• Has Morecambe Bay been successful ?
Not yet (goals keep changing) Healthcare is evolutionary It is all part of a journey