Implementation

The implementation phase begins when the project plan is approved. This phase involves the execution of the planned project and change management activities that are required to assist the organization and stakeholders implement and adopt the BPG Order SetsTM. During this phase, the project manager/lead and project team work collaboratively to complete the project deliverables and provide them to the appropriate stakeholders for testing and sign-off.1 Processes that support ongoing monitoring and control of the project are essential to ensure that it progresses as planned within the timelines and budget allocated. Key factors that influence the project’s success during this phase include:

  1. dedicated project team with the required competencies;
  2. backfilling the project team members’ positions;
  3. visible support by the project sponsor;
  4. adequate stakeholder and communication management;
  5. appropriate implementation strategy; and
  6. recruitment of champions and super users to assist with staff education and training and provide post-implementation support.1

Activities during this phase include:

  • Schedule regular project team meetings to coordinate the implementation activities;
  • Implement the stakeholder management and communication management plans;
  • Build ICNP®-encoded BPG Order Sets in the organization’s test system;
  • Write queries to extract evaluation and reporting data from the test system;
  • Validate future state design and build in the test system;
  • Develop test scripts for user acceptance testing (UAT);
  • Complete end-to-end testing that includes the extraction of evaluation data and report generation;
  • Log, review and incorporate changes proposed to address issues identified during the UAT;
  • Obtain sign-off for the design and integration of the BPG Order Sets within the existing systems and workflows;
  • Update policies and procedures to support the BPG Order Set implementation;
  • Implement the staff education and training plan;
  • Schedule implementation;
  • Develop and implement a migration plan to move the BPG Order Sets to the live system; and
  • Develop and implement post-implementation support plan.

Implementation Strategy

Selecting the most appropriate implementation strategy for the organization is essential. Two implementation approaches may be used for the deployment of BPG Order Sets; “big bang” or “phased-in”.1 The “big bang” approach consists of simultaneously deploying the BPG Order Sets across the organization for immediate utilization by all relevant stakeholders. This approach requires a relatively short-term use of human resources for post-implementation support, which may be advantageous for some organizations. Nonetheless, a major disadvantage is the need for a large number of human resources to provide adequate support to minimize the risk of poor adoption.1 The “phased-in” approach is a more conservative implementation strategy, where the BPG Order Sets is/are deployed in planned stages. The advantages include: 1) a more manageable implementation; 2) fewer resources required for post-implementation support; and 3) ability to pilot test the BPG Order Sets in a small area and resolve any issues before wide-spread deployment. One disadvantage of this approach is that the longer implementation timeline may impact some project team members if competing priorities arise over time.1

Champions and Super Users

The use of champions and super users during the implementation phase can be extremely beneficial for health care organizations. Although these terms are often used interchangeably, there is a distinct difference in the roles they play during a BPG Order Set implementation project.

Champions

Champions may or may not be an end user. Champions who are also end users of the BPG Order Sets are called clinical champions. Champions can wear multiple hats as needed throughout the project but their primary role is to act as an advocate for evidence-based practice and the BPG Order Sets as an enabler.  Ideally, in this context, a champion should be a respected nurse leader in the organization, department, program or unit where the BPG Order Sets will be implemented and have the ability to:

  • spread awareness of the BPG Order Sets; and
  • support ongoing adoption through participation in monitoring and evaluation activities.2

Super Users

A super user is an end user with extensive knowledge of the electronic health information system, the BPG Order Sets and the associated workflows. Super users are often the “go-to” people in their units, programs or departments. They should also possess the following characteristics:

  • strong communication skills;
  • enthusiasm for evidence-based practice and the BPG Order Set;
  • willingness to participate in the pre-implementation UAT;
  • knowledgeable of or willingness to learn the 'train the trainer' model;
  • willingness to act as a trainer and coach to increase the staff’s proficiency in the use of the BPG Order Sets; and
  • ability to provide end-user support during and after the BPG Order Set implementation. 

Post-Implementation Support

Post-implementation support is integral to the successful adoption of the BPG Order Set.2 Clinical champions and super users play an important role during and after the deployment of the BPG Order Sets by providing real-time support to optimize end user effectiveness and efficiency.3

During and after the deployment of the BPG Order Sets, clinical champions and super users provide support for end users at the point of care. They answer questions, help individuals use the order sets, and promptly report issues to the project team to expedite their resolution. Clinical champions and super users may also attend regularly scheduled meetings where the results of the evaluation are reviewed and strategies are identified to promote continuous quality improvement. Clinical champions and super users serve as liaisons in these meetings to communicate lessons learned back to their peers.3

References:

  1. Registered Nurses’ Association of Ontario. (2017). Adopting eHealth solutions: Implementation strategies. 
  2. Registered Nurses’ Association of Ontario. (2012). Toolkit: Implementation of best practice guidelines (2nd ed.) 
  3. McAlearney, A., Robbins, J., Kowalczyk, N., Chisolm, D., & Song, P. (2012). The role of cognitive and learning theories in supporting successful EHR system implementation training: A qualitative study. Medical Care Research & Review, 69(3), 294–315.