'Big Bang Live' is DOA without proper implementation
By Adam Nason, August 27, 2013
Thinking about launching multiple software systems simultaneously? Think twice.
With meaningful use coming at hospitals like a meteor headed straight for Earth, some hospitals are starting to panic. As with any “The sky is falling” panic, there are companies out there offering "salvation," promising to free hospitals from the tremendous undertaking of bringing their record keeping and data management systems into the 21st century. The solution offered by such companies that more and more hospitals are buying into is “Big Bang Live,” a strategy in which multiple new software systems are implemented at the same time. Is this the right choice for every hospital, or does it open up a whole new host of issues?
This firsthand account from a multi-system live launch in Los Angeles in early 2013 might hold the answer:
"Consultants from any company willing to answer questions were being summoned for immediate assistance with a system that went live four days earlier. The hospital was dangerously short on resources that weren’t covered by the firm responsible for the implementation. It was 7 a.m. when I walked into the ER for my assigned support shift, the fourth day after the new system was implemented at the hospital. Having experience with working in a busy emergency room, I was accustomed to hustle and bustle. But there was something different today. I found staff extremely agitated as they stood in front of their computer carts. Nurses could be seen crying from frustration and fear that they could be harming their patients from their inexperience in the new system. Most of the doctors had flatly refused to use/learn the new program. The staff was overwhelmed to the point of turning patients and ambulances away from the emergency room."
The cause of this frightening scene was a Big Bang Live during which four new systems were introduced on the same day. To further complicate matters, the emergency department staff received an hour or less of training on all four systems combined before the systems went live. The hospital staff was severely limited and was quickly overwhelmed as soon as the system activated. Everything they were familiar with disappeared. The IT staff was quickly overwhelmed, as well. Perhaps we can learn from their misfortune.
As providers of healthcare software continue to advance their programming, their systems are becoming increasingly dynamic. The advances of the last five years alone have been truly groundbreaking with regard to patient safety and staff efficiency. No one can deny that new systems are helping reduce costs and improve care when properly implemented. To truly get optimal functionality, however, the systems require a great deal of building, rigorous testing and retesting, and efficient training before activation. Only through this process can software providers create a solid foundation for successful implementation.
With a Big Bang Live scenario, a solid implementation process is often overlooked. There are timelines that need to be followed, and this results in cut corners. Amazing functionalities that new systems can provide are regularly overlooked – and sometimes omitted entirely. Often, departmental input is not considered in the design, as this input could lead to delays. System building focuses on the quickest pathway method, favoring time over improved function to accommodate the user. It isn't discovered until after implementation that these omissions create major deficiencies and inefficiencies, requiring more money and time to fix than addressing issues up front would have taken.
Education is a must. Improper training leading up to Big Bang Live can ultimately cause undue stress for the staff that will be using these systems every day. Hospitals already run at minimum staffing. Asking anyone to attend an eight- to 16-hour class is a challenge, often resulting in shortened classes that provide basic familiarity but fall short when it comes to functional knowledge of the system. Imagine learning Windows, iOS and Linux operating systems in one to two hours total and then watching your trainer assume you've reached an operational level. Then imagine being expected to use all three systems cohesively while a patient’s life is dependent on your efficiency and care. No health professional can be expected to excel, let alone function, under such stressful circumstances.
Alongside the horror stories of Big Bang Live implementations gone wrong, there are also success stories. Many healthcare software providers and consulting firms hire highly trained and qualified professionals who are driven to see your hospital meet its goals for meaningful use. Some offer solutions such as an aggressive staggered rollout of a new system every three to four weeks or on a new unit every week. These rollouts allow staff to build on their knowledge of the previous system, reducing the overwhelming burden of learning several new systems at once. Another option that has been utilized is to buy your success in a Big Bang Live through overstaffing. In certain cases, hospitals have brought in hundreds of outside consultants, resulting in a 1:1 and even 2:1 consultant-to-staff ratio during the Big Bang Live. This hands-on approach with staff virtually guarantees success, but it may not be a realistic option for many hospitals.
It is easy to see the allure of a Big Bang Live. All your software is operational at once. Initial costs can be lower due to a severely aggressive and truncated timeline. There is excitement in seeing your team working feverishly together toward a common goal. And with a proper implementation strategy, a Big Bang Live can be done successfully. However, when assessing the risks and benefits of a Big Bang Live, hospital administrators must ask themselves:
- What is the doomsday scenario in your personal world?
- What if it were your sky that was falling?
- What if it were your spouse, parent or child in the back of that ambulance that was being told to go somewhere else because the hospital staff felt unable to help?
And all of this because of a hurried decision to implement multiple new healthcare programs on the same day. Weigh your options on what is best for the hospital, staff and – most importantly – the patient before they all become weighed down by your decision.
About the author
Adam Nason, senior consultant, MedSys Group, is a nationally certified pharmacy technician with over 10 years of healthcare experience, most of which has been within healthcare informatics. With a specialty in pharmacy and nursing healthcare systems, Nason has worked with hospitals across the country optimizing systems with both patient safety and fiscal savings in mind. Learn more at www.medsysgroup.com.
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