Deployment

Deployment was planned in the working and steering groups. It involved the installation of the equipment into the clinical areas and was when the midwives started using FetaLink.

‘We hit the ground running. […] The day that it went live was the day that the clinical staff got their hands on it’ –Cerner Project Midwife

Staggered deployment

Deployment was staggered between the two labour wards, with one going live about a week and a half before the other. Roll-out was scheduled over 3 days at each ward, the main driver of which was the cost of support from the Cerner team from the US.

In the first labour ward, which was using computers and monitors on trolleys rather than wall-mounted, equipment was installed on a room-by-room basis while it was running as usual. This was due to delays in the delivery of equipment that meant it couldn’t be set up beforehand. This presented a challenge in coordinating the various people involved in the set-up and testing, along with patients using the rooms. The equipment for the second ward, which was mainly using telemetry and wall-mounted monitors, was set up in the week prior to go-live, allowing for a more seamless roll-out.

Limited but effective support by the Cerner technical team

Ideally, the go-live date would have been pushed back due to the delayed equipment, however due to the cost and time constraints of the Cerner technical team, this was not possible.

Despite the limited availability of the Cerner team, their support was extremely useful, as they helped ICHT to effectively deal with several “bugs” that arose during deployment. Staggered deployment allowed both sites to benefits to this “hands-on” support by Cerner, which would have not been possible had go-live been simultaneous.

Association and disassociation of the patient to the device was the biggest anticipated risk

From a software perspective, the deployment went well – clinical staff were able to use FetaLink as intended and there was adequate support. There were a few anticipated issues around the change in workflow, for example the staff forgetting password and locking themselves out.

The biggest anticipated risk was around the association of the patient to device, without first disassociating the previous patient. This would cause data to be stored in the wrong patient record, however there were no incidents of this during roll-out.

Clinical staff liked the new system

Overall, the clinical staff like the new system, as it makes handover easier and there is less admin i.e. scanning the paper traces.

Key lessons

Ensure equipment and infrastructure is in place and tested beforehand. This was not possible due to equipment delivery delays, and as a result there were a number of initial issues with connectivity and equipment set-up that could have been avoided.
Plan estates involvement. It would have been useful to have more flexibility and responsiveness from the estates team, which was needed for wall mounting equipment, providing plug and network sockets etc.
A staggered go-live was preferred over a big-bang approach. This meant the same deployment and support team members could be present at both wards making it safer, rather than having to split resources.
Consider whether to keep the ward running at deployment. At ICHT, go-live occurred while the labour ward was still running, which presented a challenge in getting into rooms to set up equipment. It may have been easier to close one side of the ward and do all the rooms in one go, rather than the stop-start approach as rooms became available.

‘Going live in a clinically active area is hard. It’s achievable, but you have to factor that in in terms of time and staff.’ – Clinical Lead Obstetrician

Supporting evidence

The key lessons that emerged during the interviews with key stakeholders involved in implementation resonate with the literature of NHS innovation efforts. As mentioned in the planning and testing sections, organisations like the King’s Fund (2018) and the Health Foundation (2015) argue that poor planning, lack of appropriate testing and inadequate physical infrastructure are among the biggest barriers to the spread of innovation within the NHS.

In terms of the choice of staggered go-live over a big-bang approach, it must be borne in mind that the specific organisational structure of the trust, along with equipment readiness and the level of support available (both from estates and from clinical and IT support teams) will determine the most suitable deployment strategy. It is important to ‘adapt’ not only innovations but also implementation strategies to the specific needs of the recipient organisation (The King’s Fund, 2018).

References

The Health Foundation (2015). What’s getting in the way? barriers to improvement in the NHS. The Health Foundation: London. Available here.(accessed 19/02/19)

King’s Fund (2018). Adoption and spread of innovation in the NHS. King’s Fund: London. Available here. (accessed 20/02/19)