In her next column for Digital Health News, Natasha Phillips, chief nursing information officer at University College London Hospitals NHS Foundation Trust, reminisces on the trials and tribulations of the trust’s go-live of Epic in March 2019, and how coming together as a united front ensured it was not only a success, but an unforgettable experience for those involved.
As I sit on the sofa, finally relaxing after organising the family Christmas that has gone by in a flash, and I am reminded of Mila Kunis in the movie Bad Moms Christmas. Yes, not a particularly high-brow lens for a digital blog, but who doesn’t love a Christmas movie?
And as a working mum, this one resonates…so bear with me. In one scene, Mila laments: “Moms make Christmas: there is so much pressure to create the perfect Christmas, the sense of responsibility is overwhelming.” Unlike Mila, I resisted the urge to rebel, to run for the hills and abandon Christmas dinner for takeaway. I stayed in the race when the task seemed overwhelming, when the weight of responsibility, on top of an equally busy full-time job, threatened to drag me down.
Yes, a tad dramatic I know, but with a very happy family I am now recreating myself as the hero of Christmas – move over Santa. So, as I sit here in a post-Christmas daze, wondering how it went so well, my mind naturally starts to draw parallels with my Epic year.
This time last year, UCLH were in final preparations for its Epic go-live. There was so much to do: 10,000 staff to be trained, over 3,000 bits of hardware to be rolled out, technical dress rehearsal, the list goes on. It was daunting, but nurses are good at change. We have good structures and processes to adapt and implement. Our community and sub-communities were ready to be mobilised. Rosters were already planned to accommodate the 15 hours of training needed for each nurse; 22.5 hours for each midwife.
As Christmas 2018 drew to a close, we started our new year with renewed vigour for the task ahead. Following the example of our professional history, we organised ourselves along military lines. Weekly matron meetings for planning and familiarisation, cascade of key workflows from here downwards, weekly bulletins, and the development of our practice educators as Epic Experts.
Every nurse, from chief nurse downwards, trained to use Epic across a 24/7 roster for the go-live period, all to ensure we supported each other. We agreed our go-live focus would be not just doing this together, but to cultivate joy at work for each and every member of staff, whatever the challenges.
The big switch-on
31 March arrived and at 6am we switched on, our battle plans in place. We had mobilised: barriers came down and everyone remarked how easy it was to get things done. The often tiresome bureaucracy that slows things down fell away. Excitement was palpable as last-minute preparations were made. The Chief Nurse and I were on the wards getting those final Rover mobile devices deployed, meanwhile our technical team worked through the night to fix those technical things that were still not right. Just like the pre-Christmas period, there were cries of “we’ll never be ready”.
At 6am on 1 April, with our wards staffed with supernumerary superuser nurses, rostered nurse leaders, as well as clinical and non-clinical UCLH staff both patient-facing and those usually behind the scenes, we turned it on. We had ‘gone live’ and entered our new digital world, together as one, in one moment.
Nine hospitals, 10,000 staff, 3,500 nurses and midwives moved from disparate systems, paper and digital, multiple log-ins to one system – one patient with one record that we could all see and use together. The battle plans came into action, for nurse leaders starting the day reviewing the safety dashboard to monitor how we were doing and share our intelligence from the frontline, making plans in response to the issues that inevitably emerged.
All of it was fuelled by cake baked by matrons who had left children with grandparents and child minders, as well as poetry, photos of staff pulling together and lots of laughs. Our WhatsApp group ensured speedy responses as questions were asked from all corners of our organisation. Our Epic Educators were generating daily training sessions in response to what we learned, and we managed to turn around tip sheets and a round-up of the day’s learning every day, despite the inevitable exhaustion.
We were a community with one goal: to ensure every nurse was supported to keep delivering excellent and safe patient care, and to have joy at work. No one would be left behind.
It seems unbelievable looking back, but it worked. Twenty-six years in the NHS and I’ve not experienced anything like it. I feel privileged to have experienced this with my colleagues, to have made such a significant and positive change to nursing practice
And so: what does all this have to do with Bad Moms and Christmas? Well, as a nurse leader I had that mum sense of responsibility to ensure this experience was positive for every nurse in my UCLH family, that they had everything they wanted from the system. Like Mila, I put myself under undue pressure and like Mila’s fellow bad moms, my fellow nurse leaders stepped up and shared that pressure with a great deal of kindness and humour.
It doesn’t need to be perfect
And just like any Christmas, despite all the mum planning, there were things that didn’t go as planned or expected. Like presents that didn’t quite fit (or the kids had changed their mind about since they wrote their list), or items missing from the Christmas dinner (cranberry sauce this year), it wasn’t a perfect Christmas. Even so, the key ingredients were there, and it was a happy one – a success.
Similarly, our Epic go-live felt like a rush to the finish line. It was exhilarating, fun, and had a few bumps, but most importantly, it was a success. The nursing family adapted to the unexpected, responding rapidly as we learned our new way of working. Everyone didn’t get all the presents they wanted – sometimes the presents they thought they wanted weren’t quite as good as they expected and they quickly discarded them, instead loving something they hadn’t asked for. Today, nurses at UCLH say unanimously that they love Epic and they would never go back to how things were before March 2019.
I think we might have given them the best Christmas present ever…two weeks before Easter.