Deployment Guide
for Clinicians
A one stop guide to clinicians
involved in deploying IT systems
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
WELCOME
This guide is intended as a one-stop resource
for clinicians who are involved in teams
deploying IT systems.
Who is this guide for?
The aim of the guide is to help clinicians who have
been asked to get involved in IT projects, or are simply
interested, understand how they can contribute
effectively and what roles and responsibilities they may
be asked to undertake.
Why is it needed?
With the NHS introducing more and more IT systems
there is a clear need for practical guidance to support
clinical staff involved in implementation.
The objective of this guide is to inform and empower
clinicians to take a more active role in supporting IT
deployments.
The guide includes explanations of core clinical activities
including engagement and safety and covers the other
key areas involved in the introduction of an IT system.
Jargon buster
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Deployment Guide for Clinicians
Introduction
ROLES AND RESPONSIBILITIES FOR CLINICIANS
INVOLVED IN IT DEPLOYMENTS
There are a number of key roles that require the help of
clinicians to ensure a successful IT deployment. Not all of
them are covered in this guide but in summary they are:
leadership and engagement
Clinical engagement
Clinical safety
overnance including safety, data quality and
g
information
setting standards and supporting change as required
stablishing the clinical content required for your
e
local project.
Deployment
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Deployment Guide for Clinicians
Introduction
CONTENTS
Clinical engagement
The step by step guide to making the clinical
engagement needed to successfully deploy
an IT system.
Pages
5 to 15
Clinical safety
Find out how to deploy an IT system
so that it is clinically safe.
Pages
16 to 33
Clinical safety
Deployment
All you need to know to deploy an IT system.
Pages
34 to 49
Deployment
Clinical engagement
Jargon buster
Jargon buster
Common terms used in IT deployments.
Page
50
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
The success factors of clinical engagement
linical engagement is key to the success of
C
information technology projects
c linicians who are asked to be clinical champions need
the time to do the job
t he role demands good communication skills and
credibility in the clinical community
Clinical safety
you do not need to be a IT expert to do the job
nalysing and planning how to reach stakeholders
a
is critical
Deployment
t here are some tools, techniques and tips to help
to achieve this.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Introduction
Why is clinical engagement important?
Clinical engagement is widely recognised to be a
critical success factor in IT projects in healthcare.
“Continuous engagement with healthcare
professionals from the outset is essential and
time-consuming, but must not be avoided.
If it is, it has bigger costs downstream.”
The specialist skills and experience that clinicians can
provide is crucial in all phases of IT projects, for example,
during the design phase in the development of a clinical
system.
Clinical safety
Deployment
Jargon buster
The socio-economic impact of interoperable
electronic health record (EHR) and ePrescribing
systems in Europe and beyond.
A lack of clinical involvement in this building stage
may result in a system that does not meet clinical needs,
is not fit for purpose and not accepted by the people
who are using it.
Final study report, October 2009.
LINK
The value of early and sustained clinical engagement
cannot be overstated as it prevents this from happening.
Clinicians working closely with colleagues in IT, project
management and business change promote a holistic
approach to system implementation. At the same time
it can provide an opportunity for personal and
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
Jargon buster
CLINICAL ENGAGEMENT
The role of the clinical champion
What does being a clinical champion mean and what
does it involve?
In a large clinical IT deployment, support from all staff
in the organisation is critical. The role of the clinical
champion is to secure the support from clinicians and
feed their concerns back into the project. Being a
clinical champion means getting out and about in the
organisation, letting people know what is going on and
telling others about the benefits of deploying a clinical
IT system. LINK
How much time will you need?
In order to fulfil this role it is likely you will need
protected time away from your clinical role. It is difficult
to be specific about the amount of time required as it
will depend on the type of system being put in place and
the amount of clinical use it will have. It also depends on
whether the role of clinical champion is combined with
that of clinical safety officer.
Who can be a clinical champion?
There is no set criteria, but the most important
characteristics are credibility within the organisation
and amongst clinical groups, together with good
communication skills.
Do you need to be an IT expert to be a clinical champion?
You do not need to be an IT expert. In fact, sometimes it
helps if you are not, as you are more likely to recognise
the questions other staff will ask and provide answers
that they will understand.
Large scale deployments do need a fair amount of clinical
resource to support the project and you may need at least
two to three days per week to undertake engagement
activities and participate in an advisory capacity in the
project. The clinical safety officer role often takes two
days per week but this can increase, as can engagement
activities, in the weeks leading up to the new system
being switched on. Other ways of undertaking these
activities include sharing across a team, but the clinical
safety officer role has specific responsibilities for sign off
that should not be delegated.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Identifying who is important
Who should you engage?
Get to know your clinicians. Start with the natural
innovators, clinicians who have a good reputation
and deliver on commitments outside their normal
clinical work.
Clinical safety
What are stakeholders?
Stakeholders are any people who will be affected by
your project, directly and indirectly.
In clinical engagement terms the stakeholders are all
those clinical staff who will be affected by the project.
Make sure you speak to all types of clinicians who could
be affected, not just one type of clinical professional.
In project management terminology, the process of
identifying and engaging with these professionals is
known as stakeholder management.
Sometimes you may also be asked to talk to staff who do
not have clinical roles but whose work has a direct impact
on clinical care such as ward clerks, secretarial staff, clerks
and coding staff.
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
The stages of stakeholder management
Why analyse stakeholders?
Taking a structured approach to assessing who your
stakeholders are helps you to identify who to influence
and the action to take.
You should work with your communications and benefits
leads to do this as it helps to ensure that stakeholder
engagement activities are integrated and undertaken in
a coordinated manner.
Clinical safety
Deployment
Planning: what is a stakeholder management plan?
A stakeholder management plan lays out how and when
you expect to liaise with stakeholders and who should
be prioritised depending on their level of influence or
power. For each group you should work out the best way
to engage and what messages you should be giving.
Remember: Stakeholders can change throughout the
lifetime of a project! Planning and engagement are
not a one-off exercise and will need to be repeated
continuously during the project.
This will help make your messages consistent and clear.
Understanding your stakeholders can help to make sure
your engagement activities are targeted correctly and
meet their needs.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder management: analysis
Mapping stakeholders
Top tips for stakeholder analysis
The objective of a stakeholder mapping exercise is to
identify the following:
1. U
tilising the tools available will help you to identify
those people that have an influence on, or are
affected by, directly involved, or interested in the
project.
who are our target stakeholders?
Clinical safety
re some stakeholders a higher priority than others?
a
e.g. who is likely to have the most interest and
influence on the project?
Deployment
issues such as whether we would also like to engage
with some stakeholders who are less likely to be
affected but who are politically important.
2. T
his information will help you to tailor the content,
timing and methods of your communications.
3. R
emember there will always be someone to ask so use
the resources available to you.
4. Identify the resistors and address their concerns as
soon as possible.
5. P
referably meet them face to face as email can be a
barrier to mutual understanding.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder management: analysis
Example stakeholders in a secondary care trust
medical director
director of nursing and midwifery
clinical directors
specialist teams
therapy heads and teams
radiology staff
ward teams
pathology staff
teaching staff
junior clinical staff
(especially around times of staff rotation)
out-patient staff
consultant committee
AHP forums
nursing groups
risk management staff.
Check! Your communications manager may already
have undertaken this stage and can support you in
this exercise.
Effective stakeholder analysis
Get a small group of the project team in a room.
Generate a list of everyone who is likely to be affected
by the project.
Clinical safety
Deployment
Challenge yourself and colleagues. Do you also need
to include other staff and teams such as:
medical secretaries
out-patient clerks etc?
Be clear about the scope of your work.
Jargon buster
Remember, your list will be unique
and specific to your trust.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder analysis: example questions
Questions to ask about stakeholders
What interest do they have in the project? Is it positive
or negative?
hat is their current opinion of your project?
W
Is it based on good information?
If they are not likely to be positive, what will win them
around to support your project?
ho influences their opinions generally, and who
W
influences their opinion of the project? Do some
of these influencers therefore become important
stakeholders in their own right?
What motivates them most of all?
Clinical safety
What information do they want from you?
If you don’t think you will be able to win them around,
how will you manage their opposition?
Deployment
ow do they want to receive information from you?
H
What is the best way of communicating your messages
to them?
W
ho else might be influenced by their opinions? Do
these people become stakeholders in their own right?
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder analysis: working out what
is important
On the following matrix map each stakeholder and
group should fall into the following groups.
High
Clinical safety
Deployment
HIGH POWER,
LOW INTEREST
HIGH POWER,
HIGH INTEREST
Put enough work in with these people to keep
them satisfied, but not so much that they
become bored with your message.
These are the people you must fully engage
with, and make the greatest efforts to satisfy.
LOW POWER,
LOW INTEREST
LOW POWER,
HIGH INTEREST
Monitor these people, but do not bore them
with excessive communication.
Keep adequately informed, talk to them to
ensure no major issues are arising. These people
can often be very helpful with the detail of your
project.
Power
Jargon buster
Low
Low
Interest
High
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder analysis: working out what
is important
The following example matrix map shows how each stakeholder
and group can be placed depending on where they fit.
High
Clinical safety
Deployment
r J Smith
D
Medical Director
MONITOR CLOSELY
MANAGE CLOSELY
GPs
Clinical service leads
elen Jones
H
Director of Nursing
Power
Lead for hospital at night
MONITOR
(MINIMUM EFFORT)
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KEEP INFORMED
Ward teams
Low
Low
Interest
High
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL ENGAGEMENT
Stakeholder management planning: action plan
From this analysis, develop a plan of action:
ork with your communications manager to develop
W
key messages appropriate to each audience
make sure you are clear of your facts
Clinical safety
e creative. Do you need to hold meetings,
b
groups sessions or have a stall in the local dining
room for example?
c an you supplement face to face with electronic
messages for the ‘keep informed’ group?
Deployment
ake sure it is the right person communicating
m
to the right person.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL SAFETY
Key information you will find in this section
Why clinical safety is important
Clinical safety
the role of the clinical safety officer
r ecommendations for the key safety activities when
deploying a new system
a description of some of the key clinical safety terms
how to access safety training and additional resources.
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Why is clinical safety important?
It is important to remember that technology can improve
patient safety, but can also sometimes lead to new sorts
of errors. Clinical safety represents the processes that are
intended to anticipate potential risks and control them.
“We want to maximise the benefits of patient
safety from new technology and, at the same time,
minimise any risks that the new technology itself
could introduce.”
Deployment
Dr Maureen Baker CBE, Clinical Director for Patient
Safety, NHS Connecting for Health.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Who should be involved?
The clinical safety officer role has been developed to
ensure health informatics related risks and incidents are
a part of every trust’s clinical governance procedures.
The senior management of the organisation, usually a
medical or nursing director also needs to support the
overall clinical safety management process.
The project manager should work with the clinical team
to plan clinical safety activities across the whole project
plan. They should identify all the required activities and
assign responsibility.
More information about a clinical risk management plan
can be found in:
Clinical risk management tasks can, and should be,
performed by the project team with representatives from
all areas of the trust or organisation which is deploying
the system, with each contributing their specialist
knowledge.
DSCN 18/2009 Health Informatics: Guidance on the
management of clinical risk relating to the deployment
and use of health software. LINK
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
The role of the clinical safety officer
The clinical safety officer (CSO) role is a requirement
of any NHS IT deployment. It provides leadership and
ensures that clinical safety processes are followed
throughout the project and after the system goes live.
Who should be the CSO?
The CSO should be a suitably qualified and experienced
clinician who will take a leading role in promoting,
supporting and enhancing the clinical safety
management system within the trust. They need to hold
a sufficiently senior position to take decisions on behalf
of the trust and to positively challenge project teams
when clinical safety may be compromised.
What type of skills are required?
Clinicians who attend the NHS CFH accredited clinician
training will meet the definition of suitably qualified
and experienced as described above. There are several
training courses freely available to provide the CSO with
the necessary skills for the role.
For more information email
[email protected] LINK
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
How to book on the safety training courses
How to Book?
If you would like more information on the safety
training courses including the course schedule or
how to book a place on this course, please email
[email protected] LINK
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
The role of the clinical safety officer
How much time does it take to fulfil the role?
It is difficult to estimate the length of time required
to do this job as each project is unique. As a guide,
approximately one day per week during the early phase
of the deployment is needed. In the four to six weeks
prior to the system being switched on it is possible the
time required to fulfil the role will increase to perhaps
three days per week.
Who can help?
The Strategic Health Authority (SHA) CSO and the
NHS CFH Clinical Safety Group LINK are available to
assist and offer expertise in clinical safety management.
Deployment
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL SAFETY
Some common clinical safety terms explained
What is a hazard?
A hazard is a potential source of harm to a patient.
Clinical safety
Deployment
Jargon buster
What is clinical risk?
Clinical risks is defined as the probability that a specific
adverse event will occur in a specific time period or as a
result of a specific situation. Risk is the combination of
likelihood and consequence of a hazard being realised.
What is clinical risk management?
Risk management is assessment, analysis and
management of risks. It is simply recognising which
events (hazards) may lead to harm in the future
and minimising their likelihood (how often?) and
consequence (how bad?).
What is an adverse event?
An adverse event is any event or circumstance leading
to unintentional harm or suffering.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
CLINICAL SAFETY
Some common clinical safety terms explained
What is a patient safety incident?
A patient safety incident is any unintended or
unexpected incident which could have or did lead to
harm for one or more patients receiving healthcare.
It is a specific type of adverse event.
The inherent clinical risk can be considered permanent
or currently unavoidable when used for the purpose
of risk assessment. The risk that should be targeted by
clinical risk assessment is the risk that is added to the
inherent risk from, for example:
What is harm?
Harm is defined as death, physical injury, or damage
to the health and well-being of a patient.
a
poor safety culture
What is an inherent clinical risk?
Inherent clinical risk is the permanent or currently
unavoidable clinical risk that is associated with a
particular clinical investigation or treatment. It is the
risk from undergoing a particular procedure in ideal
conditions and performed by the best staff using the
most up to-date research, equipment and techniques.
inadequate supervision of inexperienced staff
p
oor communication and teamwork
u
nreliable equipment
a
n unsuitable environment.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
What is a clinical safety management approach?
What is a safety approach?
A safety approach focuses on assuring that the clinical
safety risk of each system deployed is acceptable.
Clinical safety management activities can be
summarised as:
1. identifying potential patient safety risks
associated with systems and their use
2. d
etermination of risk controls and mitigations
for the identified risks
Deployment
Jargon buster
3. implementation and testing of risk controls and
mitigations in the system and its associated products
4. v erification that all risk controls and mitigations
are in place and effective
5. incident management including corrective
actions and learning.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
CLINICAL SAFETY
What are the practical steps to address
clinical safety?
People often find it helpful to break down clinical safety
assessment into three areas. Each area has a set of
recommended tasks, detailed later. These activities enable
the clinical safety officer to reach an informed decision
about whether the system can be safely switched on. The
process is similar to collecting clinical evidence, tests and
results before reaching an informed decision about what
to do next for a patient. The decision about whether
you can safely switch on the system should be clearly
documented and presented to the designated senior
responsible officer for the organisation. This could be the
project board or medical director for example.
Jargon buster
1. The
system
This is a group of tasks that are about the system itself.
How does it work? Has it got any known faults?
How will data migration be performed?
2. The
system and how you deliver care
This is a systematic assessment of how the system
matches the processes staff follow to deliver care to
patients and identify potential risks.
3. After
go-live
Sometimes things go wrong after the system is
switched on that were not anticipated. The trust needs
to have in place an approach to managing these issues
as they arise.
The following information gives more detail
of what to do.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
Jargon buster
CLINICAL SAFETY
Practical steps to assess the system
Review the supplier’s safety case
Each supplier who provides systems to the NHS should
undertake their own safety assessment to see if there
are generally any potential hazards in deploying their
system and how these should be mitigated. This is not
specific to a single project. Your own assessment needs to
review this to confirm if there are any potential hazards
that apply to your trust and to make sure appropriate
mitigations or actions are in place to manage the risks.
Ask your project manager to get this document for you.
Review the suppliers technical and deployment
specification or release notes
Each time a newer version of a system is released by a
supplier they have to produce a document that details
the system and if they are aware of anything that does
not function correctly. More often than not if there are
any known issues they will be minor but someone needs
to assess these to establish if they pose a risk to your
patients. You should also review whether the content
reflects exactly what you expect to be deployed.
Review testing and the known issues
No software is perfect and there are likely to be issues
that are identified by the supplier during their testing or
locally during your local testing. The clinical safety officer
needs to be assured that these issues have been reviewed
by a clinician to assess if they pose an acceptable level of
risk. They should also make sure any risks are mitigated.
You should be close to the testing process. Make sure the
testing reflects how your trust will use the system.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Making sure the system helps deliver safe care
It is best practice to undertake a number of formal hazard
assessment workshops by gathering together a group
of informed staff, often clinicians to systematically go
through how the system will be used. You should use the
business process maps to make sure no steps are missed.
if appropriate link this activity to business change.
If you are bringing staff together to detail the new
processes they will usually be the same people who
can helpfully assess and identify potential hazards.
You could save time if you build this into the same
workshops
Useful tips:
Consult the safety team either at the SHA
or NHS CFH for help
m
ake sure you are satisfied that cutover plans LINK
do not pose risks. For example, can you roll back? Is
there an escalation process if anything clinical is found?
ocument carefully in a hazard log and be
d
holistic and systematic
Deployment
t he output from the hazard assessment is the hazard
log and report.
r emember to involve staff as they know
where the risks may be
The following information gives more information about
how to assess risk.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Assessing the impact of the system
on the organisation
What is risk assessment?
During the assessment of risks to your organisation, seek
to answer these four simple, related questions:
How bad?
Is there a need
for action?
What can go wrong?
How did it go wrong
and how often?
Deployment
Jargon buster
It is not usually possible to eliminate all risks but
healthcare staff have a duty to protect patients as far as
‘reasonably practical’. This means you must avoid any
unnecessary risk.
Tips:
focus on the risks that really matter and those
with the potential to cause harm
eep risk assessment simple and do not use
k
techniques that are overly complex for the type
of risk being assessed.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Assessing the impact of the system
on the organisation
Five steps to Risk Assessment
STEP 1
Identify the hazards (what can go wrong)
STEP 2
STEP 3
Jargon buster
STEP 4
REVIEW
Deployment
Decide who might be harmed and how (what can go wrong? Who is exposed to the hazard?)
Record your findings in a log, record proposed action and identify who will lead on each action.
Record the date of implementation.
Decide who might be harmed and how (what can go wrong? Who is exposed to the hazard?)
STEP 5
Review your assessment regularly and update if necessary. This should also be done post go-live.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL SAFETY
Recording the outcome of the safety assessment
safety case report should be submitted to the project
A
board on all key areas of safety activity
Clinical safety
t he safety case need not be detailed but should
give assurance that appropriate and thorough
safety assessment activities have been satisfactorily
undertaken and all potential risks mitigated
final recommendation should be submitted
a
to the project board by the CSO
local sign off is a key milestone for moving
into cut over LINK
Deployment
Jargon buster
if appropriate, sign-off your trust’s safety case but place
caveats on your sign-off to allow for issues to arise that
need to be resolved. For example, if things need fixing
very quickly or soon after deployment.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL SAFETY
Post deployment
ontinue to manage your hazard log and make sure
C
your mitigations are in place
Clinical safety
et involved in service management (see following
g
section for definition). When the product is in live
service issues may still come up and the CSO may need
to assess for risk
ake sure you link to your local risk management
m
team, as appropriate, as they will need to know what
mitigations are in place.
Deployment
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
CLINICAL SAFETY
Top tips
1. It
is easy to fall into the trap of assessing risk across the
whole organisation so make sure the safety review is
bounded by the scope of the project.
6. R
emember the hazard log will need to be maintained
beyond the deployment of the system so make sure
there are processes in place to do this.
2. M
ake sure you have a wide range of people involved
as risk assessment is a many person job.
7. W
hen you have gone live make sure you link into
service management. They will need advice and
support to assess issues that come up when the system
is in use.
3. Be systematic and assess the whole product or process.
4. R
emember to use a risk matrix when
evaluating likelihood against consequence.
[email protected] LINK
Deployment
8. K
eep all the documents used for the production of the
safety case together in a safety file for audit purposes.
5. K
eep records of hazards and their mitigation
[email protected] LINK
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
CLINICAL SAFETY
References
ealth Informatics – Application of clinical risk
H
management of health software LINK
Clinical safety
N
HS CFH Guide to Logging Safety Incidents
LINK
N
HS CFH Patient Safety Assessment Guidelines
ealth Informatics - Guidance on the management
H
of clinical risk relating to the deployment and use of
health software LINK
S
afety Case Guidelines V1
LINK
LINK
S
afety Closure Report Guidelines V1
LINK
S afer Design Clinical Risk Guidance
- Key Clinical Safety Activities LINK
Safer
Implementation Clinical Risk Guidance
- A Guide to Implementation LINK
Deployment
Jargon buster
If you would like further information about clinical
safety contact [email protected] LINK
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Deployment Guide for Clinicians
Introduction
Clinical engagement
DEPLOYMENT – PROJECT MANAGEMENT
Key information you will find in this section
An understanding of how IT projects are structured
Clinical safety
ore detail about testing, data migration, benefits
m
and change management
information about key project roles
Deployment
n understanding of how clinicians can be involved
a
in various phases, stages and activities.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – PROJECT MANAGEMENT
Introduction
Getting involved in project management
Supporting an IT project usually means that you will
also get involved in formal project management. Project
management is a discipline which aims to ensure projects
achieve what they set out to do, on time and within
budget.
While project management is similar in some respects to
general management, it has a number of processes. The
following information is aimed at giving you a simple
overview of some of the terms and ways of working that
you might encounter working as part of a project team.
Other aspects of an IT deployment
Besides formal project management, there are
many other aspects to deploying a clinical IT system
that clinicians should have an awareness and
understanding of.
The following pages aim to explain the basic
components, including:
project and programme management
change management
benefits management
training
testing
data migration
cutover
service management.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
DEPLOYMENT – PROJECT MANAGEMENT
Getting started
What do you think about when you hear
about another project?
Clinical safety
Deployment
Getting to grips with IT deployment
This section should help to make sure you have a clearer
understanding of what to expect and who to ask.
CURIOUS: Will better project management make my
life easier or is it just another thing to do on top of everything else?
SCEPTICAL: The terminology people use around projects
is over complex. Surely it’s all just common sense?
SCARED: I’ve done no formal training in projects, and I
don’t understand the language they are using.
You can also find more information contained within the
leadership guides at the NHS Institute for Innovation and
Improvement LINK
CONFUSED: There’s so much guidance out there about
projects and I don’t know where to start.
Jargon buster
If you are interested in project management and you
want to know more ask your manager if there is any
training locally for project managers. The recognised
standard for project management in the NHS is a course
called PRINCE 2, but often organisations have a local
approach or offer their own training.
ENTHUSIASTIC: I’ve got a really clear vision about the
improvement I want to make, but I don’t know what
my first step should be.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
DEPLOYMENT – PROJECT MANAGEMENT
Projects vs. programmes
What is the difference between a project
and a programme?
The terms, project and programme are often used
interchangeably, but they are different. Many of the
same tools and techniques can be used to manage
programmes and large complex projects.
Programmes tend to be more strategic, involving the
long-term coordination of a number of projects to
make sure they fit together and deliver the desired
improvements and benefits. The skills required at
programme level and project level are also different.
Deployment
With programmes, more effort is focused on integration,
negotiating changes to plans and communicating
these effectively. Projects are usually more detailed and
have clearly defined activities and parameters, such as
timescales and resources.
Project management has two sides:
t he technical side with the project initiation
documents, plans and logs
This is why clinical engagement as part of a project
is vitally important.
t he people management side, with stakeholder
engagement, winning hearts and minds and
good communication.
Jargon buster
Go to the engagement section to learn more
LINK
Both sides are equally important, but some
projects fail because effective skills for managing
people are missing.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Key project management products.
What is a project initiation document (PID)?
The PID is a critical document that provides a baseline
against which project progress can be managed, ongoing
viability assessed and overall project success measured.
What is a project plan?
In any IT project that sets out to put some new
technology in place there will be a plan often referred
to as a Gantt chart.
The PID will:
summarise the scope and direction of the project
The following high level plan aims to show the key
activities that will happen as part of an IT deployment.
xplain how the project will be carried out, ie. what,
e
why, when, how
It is a simplified version of an IT deployment, showing the
key activities as well as those where a clinician should be
involved.
c apture and record key information needed to correctly
and directly manage the project
s et out the governance and management
arrangements for escalation and control
Jargon buster
s ummarise the project’s financial elements as in
the business case.
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Stage 1
Initiative
Implementation
workstreams
Stage 2
Prepare for go-live
Stage 3
Go-live
Stage 4
Post go-live support
Project management
activities
Establish project
governance
Manage workstreams
Coordinate transition
into new service
Project close /
Transition to “business as usual”
Develop project
initiation document (PID)
Manage project risks and issues
Monitor and resolve
go-live issues arising
Capture and share project
lessons learned
Clinical
activities
Clinical
engagement
Conduct stakeholder
analysis
Manage clinical
engagement activities
Clinical
safety
Evaluate supplier
safety case
Resolve clinical
safety issues arising
Transition hazard log to
ongoing risk mitigation
Clinical
content
Input content
assessment into PID
Clinical content development
Benefits realisation
planning
Benefits profiling /
Plan for benefits capture and monitoring
Initiate and refine
benefits capture
Ongoing benefits monitoring
and realisation
Training needs analysis
Design training
methods / materials
Cutover
Ongoing service management
Stakeholder
management planning
Monitor and resolve safety risks and issues /
Review release notes
Final hazard checks /
mitigations
Business change &
benefits activities
Training delivery
‘Current state’ business process analysis /
‘Future-state’ business process design
Initial infrastructure
assessment
Technical
activities
Testing
Data migration
Key milestones
Project kick-off
Project initiation document
(PID) sign-off
Key:
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4
Initial clinical safety
sign-off
Clinical implementation activity
5
6
7
8
9
Final clinical safety
sign-off
Non-clinical implementation activity
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to change management
What is change management?
Effective change management and communications
are key to winning the hearts and minds of NHS staff
and patients who will be affected by implementing
new IT systems.
Sometimes the improvements are directly about using the
technology but they can also be about making general
improvements and efficiencies as well. It is very important
that teams are involved in this process in order for it to be
successful.
If change has not been adequately planned for, adverse
effects may be seen especially during the go-live and post
go-live periods.
For more about change management check out the
following linked documents:
Planning for and managing change will involve liaising
with all clinicians who will use the new system. Typically
the change lead will analyse the activities in the trust
where technology is to be put in place, for example,
dealing with a referral. They will map out all the steps in
the process. Then they will work with the team to look at
how that process could be improved.
Managing change in the NHS:
Developing Change Management Skills
LINK
NHS Institution for Innovation and Improvement:
Thinking Differently LINK
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to benefits management
What is benefits management?
A definition of benefits, linked to change is a disciplined
approach that clarifies the measurable quality of care and
financial benefits that transformed services will deliver to
patients, staff and the local health economy as a result of
IT implementation.
Benefits management ensures that the desired business
or clinical change has been clearly defined, is measurable
and provides a compelling case for investment.
The benefits management process sets out the benefits
to be realised by the project and how these will be
managed throughout their life.
Jargon buster
It allows, following implementation and project closure,
for the expected benefits to be monitored, measured and
ultimately proven, or any necessary improvements to be
put in place.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to training
What is training?
In any IT deployment, training the staff to use the system
and to integrate the use of technology into their clinical
practice is vitally important. You may be asked to help to
devise appropriate training for clinical staff. Remember
when devising your trust’s training (and potentially retraining) schedule that clinicians are given at least six
weeks notice to attend.
It is recommended that refresher or on the job training
is planned around go live and beyond. You should also
ensure that trained staff, often called floorwalkers be
on hand to assist end users during transition to using the
new IT system.
Jargon buster
It is also important to put in place an ongoing training
plan for new starters and locums, and at the time of
significant software upgrades.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to testing
What is testing?
Thorough testing is a key part of implementation and
necessary to instil confidence that key trust processes
will not be disrupted nor safety of patient care be
compromised during transition to the new system.
The test schedule and plan are key components of
the overall project plan.
All of these terms are explained in the
Jargon buster section LINK
Issues identified during testing will generally be easier
and cheaper to fix during testing than if they were only
discovered during or post go-live.
Prior to commencing the cutover period (see later section)
testing is carried out to confirm how the new IT system’s
settings and interfaces are to be configured and the
business processes by which it will run. The outcome of
testing also feeds into the decision, by the clinical safety
officer, whether it is safe to deploy the system
and whether to contractually sign-off the software.
Clinicians’ role in testing is most critical during User
Acceptance Testing (UAT), where the system should be
tested using the planned new ways of working that will
be needed.
Testing provides evidence to demonstrate compliance
with the intended outcomes post go-live.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to data migration
What is data migration?
Data migration is the movement of the active clinical
records of patients from the old IT system to the new.
As a general principle, an organisation will be expected
to migrate the records of any patient currently being
treated (or on a caseload), scheduled to be treated or
whose treatment has recently been completed, i.e. an
active patient.
Find more information about which records should
be migrated LINK
History has shown that migrating data is one area that
extra care needs to be taken to make sure the transfer of
information held in the old system to the new system is
done correctly and in a logical way.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to data migration
How can clinical staff help in data migration?
Clinical staff should be involved from the outset in the
decision-making and planning of the data migration.
They are responsible for the quality of the original clinical
records but should also assist in the data cross-mapping
process and provide clinical sign off of the migration
process.
Key areas of activity usually include:
quality of the clinical records
assisting in the data cross-mapping
clinical sign-off of the migration.
Jargon buster
Data cleansing, prior to migration is also an area where
clinical input is important and where you can help by
focussing on key aspects of data quality.
Always check if a detailed data migration strategy is in
place early in the project and that this is being adhered
to during implementation. This should define how all
parties involved in a data migration are joined-up right
through to final data load and the start of the cutover.
PHASE 1
PHASE 2
PHASE 3
PHASE 4
PHASE 5
PHASE 5
Migration
Strategy
Data
Cleansing
Data
Extraction
Transformation
Data
Load
Data
Verification
Inviation phase of
overall project
At least six months
before migration
After successful data
cleanse
After successful
data extraction
After successful
transformation cycle
After successful Data
Load
PHASES 2 TO 6 ARE OFTEN AN ALTERNATIVE PROCESS
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – OVERVIEW
Introduction to cutover
What is cutover?
Cutover is the name given to the transition period into
go-live of the project, i.e. the last steps that take place
before the new system is switched on. Planning for
cutover should begin early in the project, with a detailed
plan created with input from each workstream team,
including clinicians.
The objectives of cutover planning are to identify all of
the critical tasks required for go-live, identify owners of
tasks and correctly sequence activities to ensure a smooth
transition.
Jargon buster
Cutover usually commences over a week prior to actual
go-live, with the data migration upload, followed by
staged tasks and rehearsals over the week. It is also
common to have floorwalkers on hand during this
period.
Sometimes it may be necessary for trust staff to work
on paper for a period of time between migration of the
old records and the new system becoming available. The
data from paper is input once the new system is switched
on. Clinical staff may be asked to help with this part of
cutover planning,in order to reduce risk and minimise the
impact when no system is available.
It is often useful to construct a high-level cutover plan
that can be used and updated during cutover planning
workshops. This can be developed into a more detailed
plan that takes into account stakeholders’ views and can
also act as a reference point.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – KEY ROLES
Who else on the deployment team
can help you?
Project manager
You will need regular reports from the project manager
to keep up with progress. They should be preparing
update and status reports that will advise you of where
the project is against the plan, and also what the key risks
and issues are.
Benefits lead
Will advise you what the project benefits should be
and how you can communicate these. They should also
have a baseline of the current position and how the
anticipated benefits can be measured. They may ask you
to be involved, using your clinical experience, to identify
benefits of the new system.
Communications team
Will help with materials, lines to take and so on. The
communications team should develop a communications
plan and it is important that there is clinical input into it.
Change manager
You need to be aware of the change processes involved
in your organisation, and how you can help and be
involved.
Jargon buster
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT – KEY ROLES
Conclusion of cutover
When does cutover end?
Cutover activities end when the trust formally accepts
the new IT system into live use.
Usually from the point at which the trust accepts the new
system into service, a warranty period begins.
From a project perspective, during this period the
remaining project team should work through any
outstanding remedial work as agreed, and plan for the
final stages of benefit realisation. Any other outstanding
project activity is also concluded.
By this stage of the cutover, any issues identified during
testing should be resolved, but it’s not uncommon for
some lower priority issues to be carried over into live
service.
The decision to accept the system into service ensures that
all these issues are formally logged. Appropriate plans
are then prepared to resolve any outstanding issues in
a timely way, taking into account the trust’s needs. This
plan of activity is sometimes called a work-off plan.
Also during the warranty period, the project team works
with service management (see later) to handover any
outstanding issues for resolution in the business as usual
environment.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
Clinical safety
Deployment
DEPLOYMENT
Business as usual – service management
Life after the project
A project team has delivered the system on time
and within budget.
What happens next?
At go-live, when all cutover activities are completed and
when the trust accepts the system, a team of staff called
service management take over responsibility for the
service. Service management look after the system after
it has gone live to make sure the trust gets the right level
and quality of service.
This includes how faults with the system are logged
and investigated (incident management and problem
management), how changes to the system are controlled
and executed (change management), and how the
supplier is performing in their overall delivery of the
service (service level management), amongst others.
As the project team delivering the system winds down,
service management will work with them to handover
any outstanding live issues from the project environment
into the business as usual process areas.
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Deployment Guide for Clinicians
Introduction
Clinical engagement
JARGON BUSTER
Common terms used in
IT deployments explained...
Our online jargon buster contains explanations and meanings of terms,
acronyms and abbreviations associated with IT projects LINK
Clinical safety
Contacts and further information
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Deployment
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