At HTN Now, we were joined by Ideal Health’s director of implementation services Rod Gamble for a discussion on the keys to running a high-performance EPR programme. Rod explored the key elements that he deems essential for achieving success in EPR implementation, including a transparent culture that promotes team member success and high-quality output.
Why high-performing teams matter
“The very big picture here is getting your organisation from pre-implementation into consuming its own data to further improve care and operations,” said Rod.
“With that in mind, for an implementation, money matters. A typical small team of 50 costs about £25,000 per week. If that team misses a deadline, it’s usually at the cost of a one-month delay or more. That cost is typically at least £100,000.” If deadlines are often missed, he added, these costs can add up quickly.
The long-term benefits of high-performing teams generally revolve around quality, Rod continued. “If you’ve got a team putting in high volumes of effort, they’re not just doing things according to a timetable. They’re doing them well. This helps to avoid, minimise and improve efforts around rework.” After go-live, Rod acknowledged, there will inevitably be some rework; redesigning, rebuilding, retesting, retraining in order to fix things, expand the system, and optimise it. How easy or hard this is will “depend on the quality of work that has gone into it so far, and ultimately determines how much value for money the trust gets from the EPR.”
With that in mind, Rod asked, “How do we measure success? How do we know that we have a high-performing team?”
In a project that Rod has been involved in with Calderdale and Huddersfield NHS Foundation Trust, one of the measures used was team turnover. Rod shared how they experienced about five percent total turnover over the entire course of the programme. This helped them avoid falling into the trap of “forming, storming, norming, performing” on repeat. “We were able to keep the team in high performing mode for almost the entire time, which affected time spent, the amount of money spent, our ability to absorb necessary scope changes and ultimately the quality of our work.”
What does a multiplier’s team look like on an EPR programme?
Rod shared a graphic illustrating the make-up of a multiplier’s team. Key components include excellent communications; clear goals; clear roles; executive alignment; effective processes; and solid relationships within the team.
Rod said: “For excellent communications, you need a communications strategy. If I look at a communications strategy for a particular project or programme and it’s under 30 pages, it’s probably not robust enough. This strategy needs to stratify the stakeholders with two-way communications. It can’t just be sending messages out about what the team is doing, what is going to happen, what you can expect. You have to have messages back, it has to be two-way. It requires peoples to do that work and to be in a dialogue with the entire user base. It needs to be part of everything; communications has a place in design, project events, testing, go live.”
On types of communications, Rod highlighted two main categories. Firstly, looking at non-traditional types of communications, he shared the example of using YouTube for an end-of-week wrap-up, available to members of the team only. These videos shared what the goals were at the beginning of the week, what had been accomplished, and any challenges that had been faced. “This would take me about 30 minutes to create,” he said. “I doubt that whilst not everyone watched the video, almost everyone listened to it. They liked the flow of information and when I said something that spiked their interest, their head would snap to the video and start to take it in.” Other examples of non-traditional communication channels include Twitter and Facebook, which Rod’s project used to engage with the rest of the stakeholders. On the traditional side, Rod suggested examples such as intranet sites, emails, posters and flyers. On emails, Rod added, “Emails need to be tracked so that we know who is opening what and when, so that we can identify unengaged stakeholder groups. Whichever group is unengaged will be the group most dissatisfied at go-live. They had to be chased down during the project to get them engaged.”
Rod also commented on the importance of meetings within the realm of communications. “Look around the room, count the number of heads, and multiply that figure by £100 per hour, per person,” Rod advised. “That gives you a rough measure of the cost of that meeting.” Structuring meetings is key, he emphasised, with a need for an agenda, headlines; items should be actioned and the focus should be placed squarely on the necessary, not the extraneous.
Rod specified the importance of having team members pulling in the same direction. He explained how there are two major aspects to setting clear goals: scope control and cadence.
“When you need to have full scope formalisation before the work begins,” he said. “The scope will change during the execution because when we begin there will be things that we don’t know and can’t know. That change must be formalised so that the cost in both time and money can be captured and accounted for in project planning.”
Best practices must also be formalised, he added; not just organisational best practice, but vendor best practice too.
“Within the change control, we need to have a deferred mechanism where we don’t have to say ‘no’ – we can say, ‘not now’.” With Calderdale and Huddersfield, most of the submitted change requests fell into this category, Rod noted; some of these requests included “really good ideas that we just didn’t have time for. So we stored them as deferred ideas so that we had a list of good ideas to feed our optimisation, post go-live.”
It is also useful when everyone in the team has an out-of-scope mentality, Rod continued, so that they can recognise the worth of ideas but also recognise whether or not it’s something that the project can take on.
With regards to scope control, the final aspect Rod drew attention too was that of the ‘vendor first’ mentality. At Calderdale and Huddersfield, he explained how they firstly used the system that the trust had invested in. “If that cannot work because of the big three – patient safety, regulatory compliance or reimbursement – then we can explore other options. But first we have to eliminate that vendor as a viable provider of that service.”
Moving into cadence goals, Rod emphasised how everyone on the entire programme needs to have clear deliverables for every day, week and month. These goals should be, in part, event-based, with a detailed plan that extends 90 days into the future and is constantly re-worked to keep up-to-date.
“Lastly, a practical recommendation; put the events up on a wall,” said Rod. “Email’s not good enough, it needs to be in big letters. It needs to stretch out for the entire programme, showing all of the big events with lots of detail around what is happening over the next three months. Put it up so that everyone can see it and they can point to it when they want to get something done. It tends to drive meetings too. It’s an extremely useful artefact in day-to-day team management and leadership.”
There are numerous different roles forming an EPR project team, Rod noted, in areas such as technical, clinical, operational, design, change, risk, comms and benefits.
“The people responsible for an aspect need to have authority over that aspect and they need to know who the other people with authority are. They need the ability to say no to things that are outside of scope, not part of deliverables, and so on.”
Rod highlighted a big mistake that he said “normally plagues EPR programmes”: leadership normally wants to be in charge of the final decision. “The problem on an EPR programme is that there are tens of thousands of decisions, and they will bottleneck. It will take up so much time that leadership won’t be able to lead and nobody will be at the wheel. Proper authority delegation is key to this, so that everyone is confident in their roles.”
Here, Rod emphasised that it is key that the workstream leader knows that they have the support of the project manager, who has been assigned to the project by the programme director, and the senior responsible wants transformation to happen.
“A good senior responsible officer will have given direction that squashes thousands of off-topic tangents, which gets rid of a lot of the political chafe that happens on these programmes.”
Three main elements were highlighted here: governance, transparency and achievable goals.
“You have to have a culture of transparency where the team is not afraid to report failure, because failure is valuable,” said Rod. “When we fail fast, what we are doing is making failures transparent as soon as possible – when they are as cheap as possible to correct. When team members are afraid and keep it themselves, we delay the resolution of that issue.”
On achievable goals, Rod said, “It’s important to note that executive will doesn’t get things done. An executive can give a deadline, but if it’s not achievable, it won’t happen. Goals have to be realistic and achievable, assigned out on a regular basis; they need to be tracked, resolved, mitigated, so that we can add up to success.”
Finally, looking at governance, Rod said that it needs to “start bottom-up, so that the entire team has access to the levers of governance… they need to know how to work that governance structure. Governance, when combined with transparency and achievable goals, is what keeps that team turning over. It makes them fearless to go and give their full effort because they know that it is accountable.”
“Another thing that makes teams fearless is solid relationships.”
Although reiterating his earlier points around structured meetings, Rod suggested that it can be a good idea to have just one informal meeting where people are free to speak; to use less formal language and to tell you what they have heard through rumours, so that you can take that into account.
Each team member needs to have a clear route to success, he added. “The rules around goals and roles need to be absolutely clear.”
Rod noted that socialising with after-work gatherings can help teams bond, and encourages the rotation of venues and days of the week so that different people can join in.
Another key element to handle is that of giving credit and taking blame, with Rod specifying the importance of recognising team members individually for their specific accomplishments.
With regards to holding some events and meetings off-site, Rod said: “Pulling people off-site to a different location pulls them out of their day-to-day and puts them more in a work-free environment where they are free to focus on the things in front of them. Holding if off-site has great value.”
Finally, Rod brought the discussion onto negative stakeholders. “There are only two ways to deal with a negative stakeholder,” he said. “One is to have them put skin in the game; give them assignments, make them accountable. The second is to consult your senior responsible officer and have the negative stakeholder removed from the effort, because they’re bringing everybody down.”
Ultimately, Rod said, “We get the most value from the amount of money and time that we’ve invested in the team. We get increased productivity from them as a result of their focus, because of their clear goals. We get higher quality and non-crossover – if someone isn’t in charge of something, they can let it go and hand it over to the person they know is actually in charge of it. We also see decreased turnover, which then doesn’t suck down the entire team’s effectiveness.”
Then there’s reputation; because your programme is going so well, you’re more likely to attract the best. With frontline digitisation, Rod pointed out that a lot of trusts are going to be doing a lot of projects all at the same time. “The ability to attract and retain the best is going to be valuable. Everyone likes to be on a winning team.”
At this point, Rod took questions from the audience; go to 30:23 to watch in full.
Many thanks to Rod for joining us.