Shared Staffing Model
For every good Electronic Medical Record Implementation, a good plan must be in place to support the users and its varying degree of sophistication. One strategy that has been proven as a model sought after was a Super User Model. Super Users are often healthcare providers who, during deployment, are assigned to system support not patient care (Hunt, Sproat, & Kitzmiller, 2004). The Super Users become the first line troubleshooters who can assist users. When implementing EMR’s there is the software implementation team (SIT), and then there is the super user. The great distinction between the two is the fact that the SIT is the group that is very much familiar with the software and the super users are the ones familiar with workflow particulars for the intended department affected by the EMR roll out. In the process what the intent of the relationship includes is a symbiotic marriage between the software implementers and the super users assisting users gain knowledge of the practical use of the software. The super users are also helpful in assisting overcome resistance because the SIT now has an ambassador to whom the users trust evangelizing on the system capabilities with the overall intent of obtaining compliance with application use.
A qualified super user is experienced within their healthcare specialty, knowledgeable about their unit and is recognized as an expert resource that will prove invaluable in helping others to understanding the work processes of the unit (Hunt, et al). In an optimum situation, the super user should have a deep interest in the project. Unfortunately at our organization, due to labor shortages of nurses, the default super user becomes, whoever is drafted by the department manager. The unintended consequence is now the SIT is working with an unwilling participant that is not interested with doing the task at hand and provides minimal effort at best. In some situations, you may get a very willing participant, but they are typically the younger clinicians, who may not have enough tenure to overcome resistance from a more seasoned staff. Compound the problem with an organizational goal to deploy a super user ratio based on project scope size and proven published methodologies (McNeive, 2009). The other intent with the super user deployment was for these identified staff to maintain their post after activation, with each department managers assessing the needs of users to maintain super users support model. Again, due to labor shortages department management were forced to pull the plug on the proposed super user model prematurely due to pressures to meet patient care demands. Therefore, there was a leveling off in the engagement of our super users to a point they have dwindled off from the department’s workflow. There was now a perception issue that super users are no longer needed and that they were super users only when it was convenient for the identified super users. The SIT team now faces the challenge of having a user base with varying degree of experience with the application. Boudreau (2003) studied a state institution’s successful implementation of an enterprise system and found some employees who became functional, experienced users while other employees were struggling with using the new system – with some just able to perform their job responsibilities and lacking an understanding of the systems capabilities. Consequently our current help desk model, which is staffed by analyst type, that is essentially equipped to handle day to day software issue such as password resets and security issues and not the very specific workflow processes that patient care entails. The help desk model did not prepare for this unintended consequence due to the original strategy to rely on departmental super users to field these types of issues. Because the super users are practically non existent, in review of the help desk tracking system, there has been a significant increase in training request. On average the organization receives approximately 250 help desk request a month for our application. Findings further indicate that 60% of these were training related that should a good super user model been established one can conclude would make this issue nonexistent.
To solve this inequality with the super user engagement, and the increasing help desk request for additional training on software features and functionality, what I would propose as a solution is what I call a “shared staffing model.” The key difference in this model would be the fact that the staff reports to the Software Implementation Team. The shared staff is carefully hand selected to ensure proper fit, as opposed to hand selected by department managers who may not know what the right qualities a super user should possess. By nature of the shared staff reporting to the SIT, there is now a much better control and a more directed approach at the distribution of the resource. With the shared staffing model, the SIT can concentrate their efforts on future development projects and not be slowed down fielding an increasing need for more education on how to properly utilize the application. The new model would also employ a day and night shift personnel which is a deviation from standard SIT working hours of day shift only. To be fiscally responsible, the ideal candidate for the position is a clinician that has part time status. Since most hospital employees work 12 hour shift (3 shifts a week for full time designation and 2 shifts a week for part time designation), the ideal candidate would be a part time staff, who can continue to work their typical 2 shifts a week, but will now pick up an additional 2 days / 8 hour shift working with the SIT not to exceed 40 hours a week. This will be a win-win situation for both parties, organizationally not incurring any overtime and the staff being given the opportunity to work extra hours and be introduced to a growing specialty – Healthcare Information Technology.
As a status update to date, this model has been proposed and escalated up to the executive level of the organization for approval. The original proposal was to hire 6 shared staff (3 for days and 3 for nights) but the leadership decided to take a more conservative route to pilot this new model for effectiveness first, and approved the hiring of 2 shared staff (1 for day and 1 for night). There will be a formal review in 6 months to evaluate effectiveness at which point it will be decided if this model will continue. In further review of the same benchmarks used to propose this new model, in 1 month since implementing this new shared staffing model, there has been a significant decrease in training request from 60% down to 48%.
Hunt, E., Sproat, S., & Kitzmiller, R. (2004). The Nursing Informatics Implementation Guide. New York, NY: Springer-Verlag
McNeive, J. E. (2009). “Super users have great value in your organization.” CIN: Computers, Informatics, Nursing 27(3): 136-9.
Boudreau, M.-C. and Seligman, L. (2003) A Learning-based model of quality of use: Insights from a case study of ERP implementation, Pre-ICIS DIGIT Workshop, Available at http://mis.uah.edu/sigadit/workshops/files/DIGIT_2003_Boudreau.pdf.