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by Prof. Louise Hicks
Published on 17 August 2020

When implementing a new system, it can be notoriously difficult to engage staff. But when Barts Health NHS Trust in London went live with e-nursing records last year, it became an opportunity to boost the morale of the staff. 

In this edition of the Cerner blog, we hear from Professor Louise Hicks, CNIO and director of development at Barts Health NHS Trust, about how the success of their rollout was boosted by positive staff engagement throughout the process.

At Barts Health, we are on a continuous mission to provide safe and compassionate care for patients across our five hospital sites in East London – and in looking back just a few years, it’s incredibly rewarding to realise how far we’ve come, especially considering that only a few years ago, our Trust was in special measures for both quality and finances.

Through positivity and professionalism, we have turned performance around and achieved a number of milestones – one of which was the implementation of Cerner electronic nursing records in October 2019.

Besides being expensive, relying on paper records was preventing us from truly providing an exceptional experience for our staff and patients. The process of documenting care was not only taking up an incredible amount of time, but we were also failing, in many instances, to document it in a structured and accurate way. Paper nursing bundles needed to go.

Empowering our nurses

In October 2018, we set ourselves a goal to put e-nursing records in place across our four inpatient hospitals over the course of one year – our ‘WeConnect’ project. 

Through this implementation, our aim was to reduce variation in quality from those wards that were supremely excellent to those wards that were continuously facing issues.

Beyond the benefits of the technology itself and the fact that nursing staff could now easily access data and information that wasn’t available before, the tool quickly became a vehicle to boost the morale of nurses who were lacking confidence.

It is now widely perceived across the Trust as a tool that gives a voice to nurses. By enabling them to showcase their positive work, this project has empowered our nursing staff and given them the confidence to lead the way for the rest of the organisation when it comes to changing the way we work for better.

Beyond convention

At the start of the project, we quickly realised that one of the challenges we would immediately face would be engaging nurses who viewed themselves as part of an older workforce – a group that typically think of technology as something that’s just ‘not for them’.

When I attended the Cerner Health Conference in 2018, I was lucky enough to hear Erik Weihenmayer’s keynote speech. Erik was the first blind person to climb Everest in 2001.

Hearing from Erik how he had made the ‘impossible’ possible made me realise that our goal wasn’t as dramatic or ambitious as some probably thought. He talked about having the courage and the discipline to reach out beyond convention. This is exactly what we set out to accomplish with this project – the convention had been there for many decades, and there we were, trying to enable people to open their minds to something new.

Leveraging relationships

Conscious that large-scale change can only be achieved through a well-functioning team that really rallies behind the same vision, we knew we had to establish a robust project leadership structure, one that was trusted by the rest of the organisation – and so we did. A new structure was created including a CNIO, a nursing informatics officer (NIO), deputy NIO and link informatics nurses on each site.

This group of people was absolutely key in bringing to life exactly what we needed to improve the way our nurses deliver care, informed by their own experience and knowledge around existing workflows, culture, and potential gaps in our current processes.

A strong relationship with Cerner was also essential for the smooth delivery of the project. The support from their nursing teams and their experience working with other NHS Trusts helped us draw a clear and realistic timeline for the implementation – and the milestones we needed to hit in order to ensure success.

“We engaged from board to ward. It was all about gaining that positive engagement and confidence from both staff and patients”

Positive engagement methods

Focusing on people was crucial for the success of this initiative – our Trust’s ultimate goal is to deliver outstanding care across Barts Health and to improve population health across East London. Always establishing a link between the technology and how it would give us the capability to achieve that was extremely important – it enabled us to prove that every single one of our project initiatives went hand-in-hand with our quality improvement work and objectives.

To do this, we created our WeConnect branding and focused Twitter account. The content shared via this account highlighted what the implementation meant for people and in practice, rather than the technology. This helped drive a sense of excitement across the staff – showing them the things they would be able to do post-implementation, and how that would ultimately lead to better care. The 90-day countdown to our go-live date kicked off with engagement activities across the wards, including demos of the system, Twitter chats, and an appearance by my own dogs wearing WeConnect t-shirts.

The countdown not only increased staff awareness and excitement, but it also served as a channel for us to remind people of the boxes that needed to be ticked for a successful go-live, and what they needed to do to complete these tasks. It served as some sort of readiness activity that carried over three months.

The first site to go live was Whipps Cross Hospital on 15 October. With a team of 500 super users acting as clinical trainers in situ, implementations followed systematically across each of the 80 wards, until 25 November.

Throughout the go-live, a buzz was created, and the positiveness and sense of achievement was almost palpable, as staff at each site were treated to WeConnect cakes and passed a torch, modelled on the Statue of Liberty, from one ward to another. It was a beacon of light symbolic of our organisation – we are one Trust, one group.

My main takeaway from this amazing implementation is the fact that you can really get people behind something through the power of positivity, professionalism and a really great team. Creating a real sense of belonging for those involved in the initiative and impacted by the change can make the difference between success and failure.