Planning

Given the wide range of teams involved in this project (including ICHT maternity, ICT and estates teams, and Cerner), it was important to dedicate sufficient time to planning to ensure a successful and smooth implementation.

Project oversight

The steering group consisted of all the key decision makers from maternity; there was also a smaller working group that included the key stakeholders for the FetaLink project. Decisions were made in the working group and then fed back to the steering group, which acted as the project board.

Pre-implementation engagement

The project had good buy-in to start with, since ICHT had already gone live with other Cerner maternity functionalities. To aid engagement across maternity, the most senior midwives were appointed as clinical champions to build commitment to the project

‘I think we had really good buy-in, because we had already gone live with the documentation part earlier on, and we knew this was going to happen. We knew we were going to have centralised monitoring and it would make it much easier to do things. We had really good enthusiasm to make it work.’ – Clinical Lead Obstetrician

Data collection forms

The project started with a launch meeting with Cerner, after which ICHT started working through the ‘data collection worksheets’ provided by Cerner. These forms helped gather the information that was needed to complete each stage of the project and were useful in informing decisions around workflow and build requirements.

Key role of the change lead

The Change Lead was responsible for changing workflows, working with clinicians to determine requirements and collaborating with the training team to assess training needs and design support strategies for cutover. In addition, they engaged with clinicians to decide on build specifications and collaborated with the lead obstetrician to establish communication channels to the wider maternity group.

Data correction meetings

The planning process was aided by weekly data correction meetings in which performance data to be externally published was routinely reviewed. These meetings were for the entire Cerner Maternity build and deployment, not just for FetaLink, and in the context of FetaLink implementation planning, they served to provide information on where staff may need extra support with workflows or build.

Risk assessment

To ensure safety, a formal risk assessment was also performed as part of this planning exercise.

‘You need to ensure that there is a thorough understanding of the environment you are going into, because the smallest things will catch you out” – ICT Project Manager

Key lessons

Appropriate information gathering is key to inform decisions around training requirements, workflow/build requirement and to identify areas in which staff might need extra support.
Collaboration with the vendor (Cerner) can be useful to design strategies to gather all the necessary data and support the change lead.
Estates should have been involved in the planning stage from the beginning, as room layout and the wider physical infrastructure (e.g. availability of plugs) will have a huge impact on device mounting and kit requirement. In retrospective, the project Team at ICHT agrees that they should have involved this team sooner.

Supporting evidence

The key lessons around planning that could be extracted following interviews with key stakeholders are in accordance with evidence from other innovation projects within the NHS and implementation of electronic foetal-monitoring systems abroad. In an analysis of recent technology adoption initiatives within the NHS, the King’s Fund (2018) stresses the importance of exhaustive information gathering and planning to ensure a successful implementation, particularly in the case of technologies which, like electronic foetal-monitoring systems, involve multiple clinical and non-clinical teams and require a change in clinical workflows in environments where decision making needs to be speedy. At ICHT, engagement with the vendor (Cerner) was instrumental in this information gathering stage, as they provided the ‘data collection worksheets’ that guided this process. The importance of engagement with the supplier in the implementation is also stressed in other case-studies of electronic foetal monitoring implementation, such as that at Cork University Maternity Hospital, where the vendor and the IT leads worked together improve the digital skills of the clinical teams, thereby ensuring that the new system could be successfully adopted. Finally, in terms of physical infrastructure, there is evidence that other trusts have benefitted from the involvement of the estates team from the outset of the project. For example, Island Health (British Columbia, Canada) underwent a room upgrade prior to the introduction of this technology to ensure that the room layout and the electrical/network installation could support it.

In summary, exhaustive planning and information gathering, alongside engagement with the vendor and involvement of the estates teams, are necessary to facilitate a smooth implementation.

References

eHealth Ireland (2018). Enterprise Case Study: Using IT to Improve Ireland’s Public-Sector Healthcare. Available here. (accessed: 18/02/2019

King’s Fund (2018). Adoption and spread of innovation in the NHS. King’s Fund: London. Available here. (accessed: 18/02/2019)

Ministry of Health of British Columbia and Ernst and Young (2017). Review of Island Health’s IHealth Electronic Health Record System. Available here. (accessed: 19/02/2019)

Next: Software configuration