Implementation in the ED

SuesquatchRN, BSN, RN · Sep 19, 2008

Is leadership actually throwing up roadblocks, or are they just apathetic? If the latter you may be able to circumvent them by putting them on a review committee of some sort so their authority is left intact and putting together a working committee of clinicians who are excited about the project.

rninformatics, DNP, RN · Sep 20, 2008

So who is the sponsor of the ED implementation? The primary sponsor should be the division head of the department that the implementation will occur in. The hiarchy of most acute care facilities is - the VP of Patient Care (or the CNO) is the division head for the ED department. The ED Director and Manager report to the CNO. The CNO reports to the CEO or the CFO or the COO.

So the CNO would be the primary sponsor of the ED project whether it be a new construction project or an information systems implementation. There can also be more than one sponsor of a project - the CNO, the CIO and the CFO. These are the sponsors and champions of the project. So if the Director and or Manager of the ED are demonstrating a "lack of interest" the sponsors should address that. It is the responsiblity of the sponsor(s) to communicate the importance of the project. Any pressure for the ED to start documenting electronically would come from the sponsors down to middle managment and then to the staff.

Do we know the reasons why the "ED leadership" seems less than enthusiastic?

Do they have valid issues that need to be documented as potential risks? Sometimes you want to court the nay sayers, bring any potential concerns out into the open, develop solutions and move on.

You asked about suggestions on how to ensure the project is successful. Have the project outcomes/goals been documented? Do you and the team know exactly what the sponsor's consider constitutes a successful project? Measurable metrics should be documented prior to the start of the project - suchs as: 95% of the physicians orders generated in the ED will be entered electornically, there will be a 50% increase in lost ED charges post implementation, all clinician documentation (excluding RRT and Code Blues) will be entered electronically, etc

To the staff and ED manager "success" may look very different. Success can be very subjective. Related to HIT project outcomes "success" needs to be extremly specific and measurable!

The sponsors, ED leadership and ED staff must take ownership of the project, in order for it to be a "success".

Good Luck

Early in this project, I have noticed and utter lack of interest from the ER leadership. the ER staff have been open and participatory and in some cases almost enthusiastic at the thought of getting "off the paper': Leadership has been the absolute opposite.
My fear is that this project will fail due to lack of participation and interest by the ER management. Does anyone have any suggestions or thoughts as to how to ensure the project is successful.
By the way, inpatient nursing has been documenting in the computer for 5 years. There is some pressure from the hospital system for the ER to start.

mydesygn · Sep 21, 2008

Thank you so much! your insight is appreciated. My personal opinion is that the apathy is rooted in "this is something that the IT dept wants mentality". It is the hardest mentality to get around.

We performed a " Research " project over the summer where we documented requirements and evaluated whether the hospital's current system (Meditech) met those requirements. I set up meetings with leadership to evaluate requirements. Only 1 person even looked at the requirements (and that person was an educator not a manager).

We setup "hands-on " demo sessions. Not one of the managers or director attended, only staff. Our chief Nursing officer would be sponsor for an implementation, but as an executive, she would not be directly involved in a Build/ implementation.

I fear that as the clinical analyst that I will be making most of the decisions and if those decisions "aren't right" then I will be spending a lot of time re-building and fielding a lot of complaints.

I feel like there should be some "ownership" of this process since it is so important to their everyday work. I am also not sure if the fact that I am a nurse might somehow give the impression that I can make decisions for them and they don't need to bother. Previously, one of their managers handled "all the computer stuff". That person no longer works there. One of the educators has assumed that role. I still don't think that the management should discard any involvement, however.

SuesquatchRN, BSN, RN · Sep 21, 2008

BTDT, mydesygn.

Find someone in the ED with an interest in what you're doing. Anyone.

And do not go live without the higher-ups in the clinical areas signing off on what you did and saying, with their signature, that they reviewed and approved it.

Good luck.

loricatus · Sep 22, 2008

I feel like there should be some "ownership" of this process since it is so important to their everyday work. I am also not sure if the fact that I am a nurse might somehow give the impression that I can make decisions for them and they don't need to bother. Previously, one of their managers handled "all the computer stuff". That person no longer works there. One of the educators has assumed that role. I still don't think that the management should discard any involvement, however.

Although I am not in Informatics (not for the lack of trying), can I suggest that you use some psychology on the management? Ask for their written advise of what they would like to see in a system. Once you have their concerns, you can open the door to communication. I do suspect, however, that their concerns will be different from staff; but, if you can make them feel that the system will make their job easier, you may just get the cooperation you are seeking.