Many of you have been through a major EHR implementation and go-live. I’ve been through them before as well. The teamwork of a go-live is like nothing else I’ve ever experienced.
There is the overnight cutover period that was practiced numerous times as “cutover dry runs” with the goal of making sure it goes smoothly and can be done in the shortest time possible. After all, you are asking a hospital to go to downtime procedures until you can bring up the new system.
There is the excitement as others gather for the proverbial “flip-the-switch” moment. The applause and high fives for people who have been working hard toward this moment for many months. The appreciation from operations leaders on hand.
There is the wait for the first user calls and tickets to roll in. The wondering if all the planning for the command center and support structure was on target.
There is the settling in as ticket volume increases, teams start working them, and tickets start getting resolved.
There are the periodic reports from operational leaders who are rounding on the floors. They report on the pulse of staff who are dealing with a new system while trying to care for patients. They report on the issues that seem most problematic.
There is the dashboard monitoring to see which teams are getting the most tickets and whether adjustments in staffing need to be made. There’s the ongoing review of tickets to ensure they are prioritized appropriately.
There are the huddles throughout the day where each area reports on their major issues and the roll up to the end of day executive huddle. And the daily communication to all users that goes out with updates and tips.
After the first two days of our Wave 1 Epic go-live at the University of Vermont Health Network, we are in decent shape and have closed over 60 percent of the tickets opened. And we are hearing generally positive attitudes from everyone in spite of the significant changes involved.
Some of my key takeaways and lessons to share at this stage:
- Operations leadership engagement. Having their visible onsite support speaks volumes. We say these aren’t IT projects. While IT staff are taking the calls and fixing the problems, it is truly an IT and operations partnership.
- Complimentary leadership roles. We have an overall command center lead, a physician lead, a nursing lead, and someone summarizing the issues/trends from the huddles. We keep it fluid and work together as a team.
- Undefined roles of IT leaders. Beyond the scheduled shifts, it’s about being available, checking in on and thanking staff, and keeping in touch with operations leadership.
- Monitoring. Dashboards with data are invaluable. But monitoring also means watching and listening to how things are going for different teams and making adjustments/improvements where needed.
- Multi-tasking. As a leader, what seems important to follow-up on one minute may be quickly forgotten when someone else comes to tell you about another issue. It takes a certain level of personal organization to track the conversations and follow-ups.
- No heroes. Leaders need to know when to send people home who have worked too long, especially from cutover night into Day 1 of support. People need to stay healthy and come back fresh for their next shift.
- Learning new tools. If I’d been shown how to do everything in our ticketing system before go live, I would have forgotten most of it. When I had to start using it, the just in time training worked. And those of us new to certain functions were proudly showing each other how to do things. The old “see one, do one, teach one” approach.
- Underlying support systems. Bottom line, they must work. We had an issue with our ticketing system hitting a limit on outbound emails Day 1 but were able to resolve it within a few hours.
- Camaraderie. It is defined as “mutual trust and friendship among people who spend a lot of time together.” So true at go-live time.
As of this posting, Day 3 has just started. There is a full surgery schedule and all ambulatory practices are open. And in true northern fashion in November, anywhere from 6-12 inches of snow is expected overnight. Plans are already being made to accommodate this so that people can get to and from work safely for their command center shifts.
I continue to be impressed with everyone on “Team Epic” — the hundreds of people involved in this network-wide effort and I feel privileged to be a part of it. I will miss them all when my interim CTO engagement ends.
Stay tuned for more reports from the field…