The contract award phase of any shared care record programme is quite exhilarating as customer and supplier, already working as a team, work through the final stages of commercials and contract – a process that is often the culmination of years of hard work. Supplier side, sales and solutions teams high five, there are firm handshakes with the customer team, ready for the difficult journey ahead (shared care records are not easy projects, they are difficult journeys) and then it’s into the kick-off meeting!
But let’s look at the tale of two example projects. One of the projects is positively thriving, growing, going from strength to strength with a great user base, strong adoption and a clear roadmap. Really exciting to see transformation happening! The other is gasping for breath, there is no consistent team to engage with and work has ground to a halt.
The backdrop for the two projects is interesting:
- The challenge they were trying to solve was the same, shared care record as a means of delivering better population health management, avoid unnecessary admissions, informed decision making, health and social care integration
- The technology proposed was the same
- The integration challenge was comparable (admittedly not identical, but it never is)
- The delivery teams involved were similar
- They had a similar budget
So what’s the difference, in a nutshell? Well, it is clear that the basics of any change programme apply – leadership, clear vision, case for change, transition roadmap, aligning systems and processes, etc. Of these, it really is the programme leadership and leadership from the representatives and champions of the user community that stand out. The latter group, the clinical users, consultants, nurses, local authority representatives make a huge difference if they have committed time to focus on spreading the word, staying engaged with progress and development of the project, articulating and repeating the vision and the “why” over and over to bring their community along.
I was speaking to a surgeon at an event and he said, “that shared care record – it seemed exciting at the time and everyone was buzzing about it, but we heard about it so long ago and haven’t heard anything since and, to be honest, I’ve forgotten what they said it would do!”. Thriving projects won’t have this problem. There will be a noticeable demand and plenty of requests for demos to remind people of the system and it’s potential, reminder events for particular stakeholder groups will be organised and there will be exchanges with other exemplars to explore lessons learned and best practice. The community will feel part of the programme, connected to it, motivated to change. The fittest programmes reach out for discussion on engagement strategies, benefits examples, branding and marketing approach, typical roadmaps, international examples and explore longer-term horizons with research and innovation potential. C-level executives will be engaged and will reinforce their commitment, providing support when tensions rise, as they often do in a change programme.
The programme lead seems to be an incredibly important choice. They will normally be experienced and well-known individuals in the regional health and care domain. They tend not to be contractors (sorry contractors, just replaying it as I’ve seen it) and they use their existing relationships well. They are experts in setting the right expectation and they are careful with their use of language and who to involve, and when. When rowing in the same direction, the programme lead, end-user champions, executive sponsors and supplier are a formidable force, strong enough to row against the tide at times and settling into a rhythm that works.
Then there’s the system itself and what it does, the purpose it serves and knowing whether it is working. The roll-out strategy is incredibly important. One of the most successful projects we have been involved in globally is the Northern Ireland Electronic Care Record, the NIECR. Their approach involved a period of limited production roll out as a proof of concept, to get feedback and understand the needs. Clinical engagement was as strong as any project I have ever seen, and there is a lot to be said for the individual personalities, a group of like-minded clinical champions from different disciplines who were simply determined to make it work, backed by supportive executives and an incredibly strong core programme team. The programme lead often talked about how much they learned in those days of initial use, limited use, subtle tweaks and important points related to realities of clinical practice were fed back and were able to be incorporated into their eventual full system procurement and roll out. The team measured the use and adoption in the pilot, the utilisation of individual features, documenting this and publishing it. They solicited lots of end-user feedback and studiously documented anecdotes and positive stories. They spoke to systems all over the world to understand what could be achieved. Their clinical steering group had expertise across a broad range of disciplines, they were respected clinical leaders who brought in other senior evaluators to be part of the process. It was a masterclass in delivering a national integrated electronic health record, and they have won multiple, well-deserved awards as a result. We used to go to meetings that the Northern Ireland team had arranged to discuss their plans, and at times it was standing room only. You could feel the appetite for change in the room.
The Northern Ireland ECR exceeded their 7-year business case target for adoption in 2 years and the records of over half of the population have now been accessed in this system during an episode of care.
So the message would be to speak to the vanguard and understand the wider considerations of a full change and transformation programme. Whilst there is no magic bullet, those basics of delivering a change programme aren’t a bad place to start!