10 – System Optimisation

Implementation is in many ways just the beginning. Often only a subset of benefits can be fully realised during the initial implementation period. This leaves much room for future improvement. Optimisation, through system iteration and developments, should be a constant feature of the implementation strategy to utilise the full potential of a system in the long-run and to take advantage of new technology and functionality that emerge along the way. On-going optimisation activities can include:

  1. System maintenance. This includes upgrading/developing of software and hardware, medication and knowledge databases, and the provision of on-going support to users.
  2. Customisation/refinement of the installed system (e.g. relating to clinical decision support, re-use of datareporting and ‘rule breaking’) and further improvements in interoperability.
    1. For ‘rule breaking’ see: Position Paper on electronic decision support within Newcastle upon Tyne Hospitals and Sample interaction rule 2 Ciclosporin / Statin
  3. Continued engagement with end-users to maintain motivation and to assess existing and anticipated workarounds that users may employ to overcome difficulties with the system. This can help guide the continuous process improvement journey to identify how to rethink existing process and practice.
  4. Identifying ongoing training needs (for different roles such as nurses) and developing human and technological capabilities to support optimisation.
  5. Monitoring and evaluation of progress over time to assess whether anticipated benefits and returns on investment have been realised and are seen by end-users and patients. The evaluation strategy should acknowledge that, due to continuous and iterative development, different benefits can be realised at different moments in time. Potential techniques in this respect include data quality monitoring, critical incidence reports, analytics, clinical audit, periodic reviews of progress, and assessment of changing requirements.
  6. Developing relationships with other hospitals. This includes benchmark sites such as University Hospitals Birmingham that have been using ePrescribing for mulitple years and that have already implemented and refined optimisation approaches. This will enable the sharing of transferable lessons (e.g. on barcode medication administration), particularly in relation to continuous system improvement and data reuse.
NIHR Programme Grant for Applied Research, Principal Investigator: Professor Aziz Sheikh
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