How do I get 4,000 hospital professionals learning without training? Part 3: Life after go-live

Things get serious

April 2016. Across the organisation the go-live becomes ever more ‘tangible’. A kind of unease arises from every quarter. Is it going to be all right? Are we ready? What if we do not have enough basic knowledge? And in this phase the request for instruction sessions keeps popping up. Here too we listen empathetically, but we do not grant the requests. We hold firm to the principle that the training component has had enough attention.

Play a game

What have we been doing these past months? We provided instruction for key users. We facilitate learning from one another and guidance by key users at department level. There is a set of around 700 help cards, each aimed at specific work processes, tailored to different target groups and individual users.

Inspired by colleagues in our network, in this final phase before go-live we go one step further. We have some thirty mini-games developed. The games are designed to let users experience, in a playful way, whether they have mastered a number of basic principles (the most critical tasks) in the EHR. It is not rocket science. How do I log in? How do I place a particular order? How do I report something? The games can be played in a minute and the end result (‘passed’ or ‘not passed’) is shown immediately. They are played a great deal, and use rises sharply towards go-live. A positive result on the games is, of course, no guarantee whatsoever of an adequate level of mastery of the EHR. Nor is that what we are after: we are not trying to use them for selection. What does matter is shaping end users’ feeling that they have learned something that is not a given, and that they are ready for it. They can, after all, also be ‘done’ and have to start again. The learning yield is hard to judge too. We simply lack the time to measure validity. We do not regret that, because what we see is interaction arising from playing the games, colleagues huddling together behind the screen, and the learning process being continuous and often literally visible and audible on the ward through the games’ images and sound.

Demonstration of competence

The EHR supplier gets a little nervous. There are concerns about users’ level of mastery. From the start of the “Learning & Development” track the supplier has expressed a wish to test the effect of the educational approach. The cognitive aspect is to the fore: they want to see that the buttons of the system are mastered. As the client, we do not want to be pressured. On the other hand, for our own organisation’s awareness it is also good to make our progress visible.

It helps me to keep mirroring outcomes against the original goal: what was it all for again? The original aim of our operation was that all end users “can make optimal and patient-safe use of the EHR”.

I can hear you thinking: “not exactly SMART…” Quite agree, and yet a deliberate choice, because we have focused on the users’ experience. After all, who better than our professionals to judge whether they are ready for go-live? The aim, then, is to develop a foundation that differs for every end user, but that is solid enough to minimise risks in care and treatment and, at the same time, sufficient to keep learning on the job.

After all, you only really learn to drive once you have passed your test.

In our learning management system every EHR end user is assigned a module. The learning material consists of the set of mini-games, which can be played without limit. The module is formally completed when the user, by ticking a box, declares they can make optimal and patient-safe use of the EHR and are therefore ready to start working with it.

Through this source in the learning management system we can show very nicely what percentage of end users has ticked the self-declaration. The status is updated daily and made visible in a chart on the homepage of our intranet.

The finale

A few weeks before go-live, efforts around learning and development intensify. There is a lot of frequent practice on the floor, with help cards, guided by the key users. Countless games are played and the percentage of self-declarations in our learning management system rises in a fine curve. The embedding teams gauge the mood of the organisation at regular intervals: we are ready!

On 24 June 2016 the day arrives: almost the entire hospital switches to the new EHR in one go. The conversion is virtually flawless and the first few days are relatively quiet. Bed capacity is reduced and allowance has been made for the extra time that going live takes. All in all, a week after go-live we can conclude that the organisation really was ready, and that the end users had the necessary body of knowledge about the EHR.

Looking back

Shortly after the transition the holiday period begins. Those involved from the Academie ease into a quieter mode after a very intensive period, but not before we evaluate our approach with line managers, key users, embedding and build teams and, of course, the end users.

Key users report that they did not find drawing up a plan of action easy, but that it forced them to think hard about a tailored approach for their colleagues. That last point, incidentally, was a good choice: colleagues are easier to approach and you get feedback from them faster, about and within the learning track. Key users also sought each other out during the go-live phase. The atmosphere was positive and everyone was willing to help one another.

Embedding and build teams

For the various parts of the organisation it was very pleasant to have a single point of contact for their questions. Embedding teams were found quickly and very frequently for questions, discussing bottlenecks and thinking through solutions. In practice most questions turned out to be substantive ones about the EHR. The required input from application managers was underestimated by us. They turned out to need far more time than initially assumed, for instance to develop the necessary set of help cards. Generally speaking, the resources needed from the Jeroen Bosch Academie were underestimated. In the end it took roughly three times more time than had been estimated up front.

Sharing with and learning from one another

It is July 2017. We are a year into a journey towards a destination that will never quite be reached. It is, and remains, a fascinating trip. We are constantly learning. Old knowledge is replaced by new. We very frequently share our approach with peer organisations working on their own implementation. We also draw on the experiences and material of others. For major changes to the EHR we confidently apply the principles we chose before going live: a dynamic combination of knowledge, sharing together and, above all, learning on and in the work.

In closing

The challenge was to teach 4,000 users to work with the system and to help them cope with the many changing work processes. I can state with full conviction that the Jeroen Bosch Academie made an essential contribution to that.