Support

Planning

The support structure was decided by the working and steering groups, and a rota drawn up. This support structure was altered and amended throughout the deployment and stabilisation period due to the requests and needs of the maternity wards.

Support at go-live

24/7 support was needed at deployment as the wards needed to keep running as normal. There were some expected teething problems, such as clinical staff forgeting passwords, but also some unexpected issues, such as the connectivity between equipment dropping out and lack of availibility of network ports, that needed a swift and effective response to ensure the wards were still able to function as normal.

The Change Lead, along with other members of the working group (including Cerner Project Midwives, Lead Obstetrician, ICT Project Manager), members of the training team, agency floorwalkers (2-3 per unit), a technical team from Cerner (formed by 3 members from Cerner US and 2 from Cerner UK) and part of ICHT technical team played a key role in providing support at go-live.

Floorwalkers

The floorwalkers were from an agency and were trained on FetaLink by the clinical systems training team. They were also trained by the ICT project manager regarding possible hardware issues and how to troubleshoot the system.

It was initially planned for them to be available 24/7 for the two weeks following go-live. However, owing to teething issues Maternity requested for them to be kept on longer. They stayed for three months in total.

The floorwalkers also new starters get set up on the system, in order to ensure there was a smooth transition.

Cerner technical team

Cerner provided a set number of days of ‘early life support’, so they were also available at go-live to fix bugs and other issues. However due to the delayed delivery of the equipment, this team wasn’t utilised as effectively as it could have been. The assistance was also short-lived, as this team was only available for three days following go-live.

Additional support

There was additional support from the ICT team, Cerner Project Midwives, obstetricians, Change Lead and other members of the working group. Support from clinical staff was important since the floorwalkers did not understand the clinical side of any issues.

Ongoing support structure

People tend to go to the Cerner Project Midwives with ICT problems, and the IT helpline can help with some issues, however problems with FetaLink specifically are referred to the ICT Project Manager involved with the project.

‘There is very little expertise, locally, to understand how things fit together, so we’ve had to pick all of it up ourselves…The trusts need to understand that the support of this environment is different – it’s not strictly IT and it’s not strictly medical engineering, there is an in-between that I don’t think anyone has actually defined yet. So there is a support role that needs to be defined and someone’s got to take it on.’
– Senior Clinical Project Manager

It took a year and a half to agree on the support process for FetaLink, and there is now a resource embedded within clinical engineering, which acts as a go-to regarding medical device integration to the EPR, intended to cover FetaLink and related applications.

Key lessons

Having more Cerner at go-live would have been useful. Due to equipment procurement issues, the Cerner technical team was not utilised as effectively as it could have been. However, since this team came from the US, it was not possible to push back the go-live date. It would have been useful to have a local team that could have provided more flexibility in this respect.
Good change lead was key: having a good change lead who was available to provide support on the day and in the period following go-live was key to success.
Don’t underestimate how long support will be needed. The original estimation of two weeks for the floorwalkers needed to be extended due to initial unanticipated issues.
Define the ongoing support role: Ongoing support will be needed in case of any issues in the long-term. The clinical staff need to know who to go to with problems regarding FetaLink.

Supporting evidence

The continuous, “boots on the ground” support provided by the IT Midwifery Leads, the Lead Obstetrician, the ICT Project Manager, the floorwalkers, the training team and the Cerner technical team likely contributed to the successful implementation of FetaLink at Imperial, ensuring patient safety and the integration of the new system into existing clinical workflows. This emphasis on supporting implementation well beyond deployment contrasts with the general trend within the NHS. The King’s Fund (2018) argues that the NHS spends too little money on the spread and adoption of innovation (less than 0.1 % of the total innovation budget), which markedly differs from the private sector, where sometimes more resources are spent on supporting adoption and scale-up than on the development of innovations. In light of this, organisations like the Nuffield Trust (2017), The Health Foundation (2015) and the King’s Fund (2018) recommend allocating sufficient resources to supporting the adoption of innovations not only during but also after deployment. This helps sustain change by integrating new systems or technologies into the organisational and cultural structures of the recipient organisations.

References

The Health Foundation (2015). What’s getting in the way? Barriers to improvement in the NHS. The Health Foundation: London. Available here. (Accessed. 21 March 2019)

Castle-Clarke, S., Edwards, N., and Buckingham, H. (2017) Falling short: Why the NHS is still struggling to make the most of new innovations. Briefing, Nuffield Trust. Available here. (Accessed. 21 March 2019)

King’s Fund (2018). Adoption and spread of innovation in the NHS. King’s Fund: London. Available here. (Accessed. 21 March 2019)

Next: Deployment