Cutover and Early Live Support Management

THE CHALLENGE

Royal Berkshire NHS Foundation Trust (RBH) is a “Fast Follower” Acute Hospital Trust partnered with Oxford University Hospitals NHS Foundation Trust (OUH) within NHS England’s Global Digital Exemplar (GDE) Programme. The GDE Programme aims to identify proven best practice and
innovation that can be dispersed across the NHS to improve the delivery of health care across England.

As a part of this Programme and the Trust’s own Digital Hospital Programme the Royal Berkshire team were working with OUH and their Electronic Patient Record (EPR) supplier, Cerner, to adopt Clinical Documentation and Electronic Prescription solutions as well as enhance the EPR in their Emergency Department. These solutions would migrate a significant proportion of Trust processes largely managed on paper to a robust digital solution and will enable improved and appropriate sharing of data at the point of care while enabling analysis to improve the overall delivery and management of care.

The Trust were keen to have a dedicated and experienced Cutover Manager in place to work with both IT and Operational teams and help ensure the project went live successfully and have the assurance of the availability of additional Cutover Management resources for the Cutover period where required. Nautilus was engaged a few months before Go Live to develop and then manage the Cutover Plan for the project, i.e. the plan to transition the solutions into the live environment and operational use. Nautilus were also requested to help design and run the early live support processes to facilitate a phased roll out over a three-week period across the hospital.

THE SOLUTION

Nautilus provided Cutover Management services to RBH as an integral part of the Trust Project Delivery team in the final months of the Deployment. Nautilus:

  • Worked as an integral part of the Hospital Trust team and established a trusted relationship with all stakeholders including suppliers.
  • Identified, planned and tracked the completion of technical Service Readiness activities across Trust and Supplier teams ensuring:
    • All activities were appropriately scheduled and resourced for a successful Cutover.
    •  The downtime window was minimised, and data catch up activities optimised to contain and manage disruption to operational and clinical teams and prevent disruption to patient services.
    • Trust and third party technical teams were adequately prepared to support users both in the first few weeks of Go Live during and immediately after the phased roll out and beyond.
  • Assisted Trust Operational teams with the identification, planning and completion of their Service Readiness activities.
  • Helped the Trust Operations team plan and document Go Live preparation, downtime and recovery activities.
  • Managed the Full Dress Rehearsal (Go Live practice) from a Technical and Operational perspective. This included identifying and communicating operational return to normal service activities (particularly data catch up) and ensuring they were rehearsed and timed with the teams responsible for doing them.
  • Supported the Trust’s Communication Plan both internally to Trust staff and to outside parties, working with the Communication team to identify and in some cases craft key messages and content specific to Cutover and Go Live.
  • Created, co-ordinated and ran the Technical Cutover Plan and assisted the Trust’s Business Continuity Team and Operational Command teams to run the Operational Cutover. Acted as a technical coordination and escalation point throughout Cutover and the Early Live Support period.
  • Planned and managed the Early Live Support process during the three-week roll out until handover to Business as Usual Live Service after week four. This included:
    •  Implementing key co-ordination and communication mechanisms for managing support team efforts during the Early Live period.
    • Preparation and analysis of issue reports and providing direction to technical teams on priorities
    • Chairing daily Incident and Problem Management calls and ensuring operational and clinical input and feedback was factored into the prioritisation of issues.
    • Assisting with the co-ordination and resolution of high priority incidents.
    • Acting as the link between the Technical teams and the Operational teams during the roll out and ensuring Early Live Support processes were followed.
    • Providing input into daily Trust communications on roll out progress, key issues and service highlights.
  • Ensured any lessons to learn were captured and, where appropriate, applied.
THE OUTCOME
  • Timely execution of the Cutover Plan with minimised disruption to hospital services. The Cutover Plan enabled a Go Live that ran very closely to plan ensuring disruption to Trust staff was minimised and matched expectations that had been set. This allowed the Trust to focus on supporting adoption of the new systems rather than recovering from deployment delays.
  • A detailed, accurate Cutover Plan was developed in advance of the Full Dress Rehearsal in a series of detailed consultations with parties involved in  delivery. This was used to manage the Dress Rehearsal, modified to incorporate lessons learned and updated timings from the practice and then used to manage Live Cutover. This ensured:
    • Accurate identification of all the tasks and their dependencies at the detailed level necessary to ensure the eventual outcome: the plan running smoothly and delivering on time.
    • That the technical plan and the operational plan for data catch up activities was fully validated, in particular with regard to dependencies, appropriate resourcing and timing. This provided assurance to the Trust on the length of downtime required and the time needed for recovery activities and also ensured execution matched the expectations that were set.
  • Operational teams, Business Continuity and the Trust Communication teams were engaged with early and the Cutover Manager quickly became seen as an integral part of both the Technical team and the Operational Command team. This ensured there was an enduring link between them during rollout and that plans were aligned between them throughout the Cutover and Early Live Support period.
  • A re-useable Data Catch Up estimation model was created which the Trust can now add to their already mature EPR Business Continuity Plan and build on for future use. This can be tuned to the expected length of downtime to reveal likely data catch up duration. It will facilitate much easier estimation and planning of data catch up activities for managing future downtime and provides valuable additional information for the EPR
    Business Continuity Plan.
  • Appropriate and timely communication and documentation of the Cutover Plan, Downtime and Recovery processes, and Early Live Support arrangements ensured all affected parties were aware of the plan, the downtime window, how data catch up and early live support processes would be managed, and their responsibilities. This ensured the plan could be and was executed smoothly.
  • A robust Early Live Support process with clear escalation paths, fully documented processes and support materials provided clear direction to both Trust and Supplier technical teams and to Trust operational and clinical teams. The Trust and their suppliers had a single document, a Go Live bible, to refer to for all their Go Live process, governance, logistical and contact information saving time and effort during the roll out.
  • Daily capture of highlights and lowlights during the Early Live Support period facilitated easier and agreed daily communication round ups on the progress of the roll out, key workarounds and roll out of fixes.
  •  comprehensive capture of lessons to learn from the Cutover and Early Live Support for later Trust and Supplier review ensured areas for  mprovement for future go lives were clearly identified and will enable evidenced good practice to be carried forward.
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