King’s College Hospital sends patients home after EPR failure: 8 steps to improve supplier performance

By Allan Watton on

epr failureA recent article in Computing highlighted the stark reality of just how much we continue to rely on technology. It was reported that a failure in the Electronic Patient Records – EPR System at King’s College Hospital meant that patients were actually turned away.

The article stated that outpatients with appointments at the hospital had to suffer long waits, crowded waiting rooms and the inconvenience of having to go home, unseen due to the EPR failure. In fairness, appointments were rebooked for later the same month.

If you’ve ever had a hospital appointment for something that is concerning you, you’ll know that it can often take up to several months to actually see the consultant your GP has referred you to. You will have rearranged your work commitments and often your personal commitments, including who will be looking after dependents/relatives that are unable to look after themselves. Therefore, if your appointment then gets cancelled, the added stress of not having your concern dealt with and having to rearrange all your work and personal commitments again to attend the new appointment, doesn’t really help.

Apparently, this was not the first time this issue had occurred. So, what brought the hospital to this point, how common a problem is it really, and who was responsible for the issues with the EPR failure that left so many patients disappointed?

EPR Failure – Problems with the Patient Records System

King’s College Hospital NHS Foundation Trust is one of the UK’s largest and best-known teaching hospitals, so when things go wrong they make the news. It was reported that the system in question is the Trust’s EPR system which was updated in 2015 to an integrated Allscripts Sunrise clinical solution. This promised to provide “improved efficiency and engagement”.

Nick Moberly, the Chief Executive of the Trust until 2018, stated at the time: “King’s is committed to providing the best experience for our patients and providing our staff with the tools they need to deliver outstanding care.”

Allscripts is an experienced technology provider to the healthcare sector; a global organisation that has offices in the US, Australia, Israel, Singapore and the UK, with over three decades of experience in this field, classified as a ‘Trusted NHS Partner’. They claim 18 clients in the National Health Service and a proven track record. Their credentials suggest their awareness of the importance of reliability and the discomfort and dangers of downtime.

Clearly, nothing can prevent issues arising in technology from time to time – it’s the ‘nature of the beast’. But it’s how often, how big an impact it creates, and how quickly and effectively these issues are resolved that determines the degree of accountability that needs to be allocated to a party, and whether lessons need to be learned from the experience.

The Computing article did go on to state that staff at King’s College Hospital had said that the EPR system had been “generally reliable”, but this was the second time something like this had happened in recent months.

Complex IT Solutions Often Have a Number of Ongoing Challenges

Statistically, a significant number of IT projects fail to achieve the ongoing outcomes expected of them or suffer from issues that put a strain on partnership relationships, post-implementation.

8 Foundations to Remediate Complex Supplier Performance

From our experience of over 500 complex project relationships of this nature, there are eight foundations, which if implemented at the outset, will improve the ongoing effectiveness of your IT project partnerships. These foundations will realign them when they have become problematic, because when things go wrong, you want to be sure that your partners are ready, willing and able to optimise a sustainable resolution, quickly.

1. Return to your business case

If the operation of your project is not quite going to plan, then the first thing you’ll need to do is to identify what issues there are and how significant they have become. Return to your business case, the expectations you shared with your project partner at the outset, and objectively evidence each material instance where they have served you well and met/exceeded your expectations. Separately, evidence where they have not and have fallen (or are expected to fall) short on expectations, how long those issues have been going on for, how often have they occurred and the specific impact (including reputational concerns) of this.

2. Return to the contract

It’s one thing to have expectations – it’s another entirely to have had those expectations identified and clearly expressed into contractual obligations. In this respect, it’s important to check your contract because, over time, each party often forgets the express provisions agreed and misunderstandings can, and usually do, creep in.

Firstly, are the issues you’ve identified included in the written contract? Are they specifically itemised or implied (obligated, but not documented)? Is there any guidance in the agreement as to what should happen if these expectations are not being met by either party, and does an effective roadmap exist that will show the way to resolving the matter?

Your written contract should provide all parties with a guide to managing your relationship, in good times and bad – it should be concise, fully understood, and the first port of call for guidance when things go wrong to minimise any formal escalation of the matter.

3. What has it cost you?

In item 1 of this list, you’ve identified the issues. In item 2, you’ve looked to find out if there is an already agreed way of handling the matter, but next is the task of itemising the costs that you have specifically incurred as a result of the issues you’ve identified.

These costs often include:

  • Your team’s time in dealing with the matter
  • The cost of others you have been forced to instruct – both internally and externally – to deal with the problems created
  • The amount you have spent on your IT partner’s services that they have not delivered.

4. Did you inadvertently stop the supplier from delivering its service?

While it’s easy, and often convenient, to blame the supplier for all of the adverse issues on your project, it’s vital that you do a little soul-searching yourself, to determine whether any of your own team’s actions or inaction could have contributed to the problems you today identify.

It’s important to pre-empt the likelihood of a counter-argument from your supplier by reviewing your own involvement at each stage in the process. Did you do what you said you would, when you said you would do it? Did you provide clear enough instructions and check that they were understood? Did you always follow up and rapidly address any issues raised to you by the supplier and what documentary evidence do you have of this?

Adverse issues are often caused by a complex combination of factors, so please resist the temptation to generalise and oversimplify by assuming the supplier is at fault. Get into the detail – you need to check your evidence to see who is accountable and to what degree.

5. What do you want from your IT partner now?

This exercise should not be used to damage or end your IT partnership. It is to highlight where you are already working well together and the benefits you are both receiving. It is also to be clear about where the relationship is not working as well as it has done, so you can realign it and highlight the challenges you’ve identified, so both parties can move together to resolve them.

However, to do this you need to know what you now want from your IT partner and be able to communicate it both internally and to the supplier, in clear terms. What do you think they can and should do? What would be a reasonable objective to ask of them? Do you feel that there should be some form of recourse for the issues that have occurred – either in reduced or rebated fees or something more?

Think of things also from your supplier’s perspective here. It’s not about punishment: it’s about realignment and recognition. Draw up a list, a plan you think they should reasonably be expected to carry out, that you feel might put the relationship and the project back on track.

6. Is it appropriate to seek an independent view?

It can sometimes be difficult to see the wood for the trees when you’re immersed in a complex project and/or strategic supplier relationship and this is when it can be beneficial to have a fresh pair of eyes on the evidence.

Independent specialists can assess whether your expectations of your partner were/are reasonable, the degree to which the issues you’ve identified are causing significant adversity and the workaround costs. They can scrutinise:

  • the agreements you have,
  • the practical recourse they allow for,
  • the steps you should take, and
  • what may have led you to where you are now.

Experienced and independent specialists can take a dispassionate view of the key aspects of your relationship and share knowledge between you of the most effective solution pathway, a recourse that will realign behaviours in the right direction and a way to present this to your partner to give you the best chance of transforming the way you work together.

7. Do you have the evidence?

If you are going to approach your partner because you believe they are underperforming, you need to be absolutely sure that you have accurately assessed the evidence and are clear where you (if appropriate) and they have contributed to any problems.

It makes sense, therefore, to sanity check this evidence. To review, once again, where your own team could have impacted on your partner’s ability to execute their duties, where your supplier partner may have failed to discharge their professional ‘duty to warn’ about matters that could impact on their ability to deliver the outcomes you expressly identified for them, and so forth.

Evidence can sometimes have ‘shades of grey’, so look at it from all angles, predict potential counter-arguments and assess whether they are reasonable in the light of all the information you have now gathered.

8. Plan your supplier meeting carefully

The seven actions above help you to identify what you need to say. This one is all about the way you approach saying it. Firstly, keep in mind that the purpose of this meeting is to build a stronger, more productive relationship, not to tear it down, so keep your tone and approach convivial.

Start at the beginning. It may be obvious but by reminding everyone why you chose your partner in the first place, you are underlining the expectations you agreed between you. Then identify what you feel has gone astray, providing evidence throughout. Accusations are not helpful; everything you say must be followed with evidence to back it up.

Explain why you are bringing these issues up now and the costs that have been suffered as a result of the project not delivering along the agreed lines. Then turn to your IT partner and ask them for their thoughts, what they agree with, what they disagree with, and why?

It’s important to constantly monitor the mood of the room, look to keep the conversation constructive, assure them that you are looking to find a resolution, to build a better relationship and not ‘butt heads’. Then work towards a reasonable time frame to establish a solution, a plan of action to get things back on course.

Conclusion

King’s College Hospital is reported to be weighed down under the strain of some significant PFI financial challenges, which will no doubt result in many issues that will reverberate across the Trust. While the EPR system being down for a time may seem to be a relatively minor matter in the scheme of things, for every outpatient sent home that day, it will have been both worrying and an inconvenience for each of them personally.

The hospital sees over 120,000 patients a year, approximately 350 a day, so the likely chaos that is often caused if other systems issues were to occur will be substantial. Staff assurances that these systems are usually stable and reliable provides some peace of mind, though hopefully discussions are occurring behind the scenes, in the wake of the recent problems, to reassess reliability and reaction times.

Complex supplier relationships can so easily take a wrong turn or start to go off the boil, it’s important to understand that some ongoing steering will be required to improve effectiveness, to realign expectations, to shift direction or to enhance reaction times.