No products in the cart.
MODULE 16: IMPLEMENTATION & GO-LIVE STRATEGIES
Section 4: Stabilization and Optimization Phase
The project isn’t over at go-live. Learn how to manage the crucial post-launch period, providing “at-the-elbow” support, monitoring system performance, and beginning the process of optimizing workflows based on real-world use.
SECTION 16.4
Stabilization and Optimization Phase
From Surviving to Thriving: The Journey to the New Normal.
16.4.1 The “Why”: The Finish Line is a Mirage
There is a deeply ingrained misconception in project management that the go-live is the finish line. For months, every ounce of energy has been focused on this single event. When the system is finally live, there is a powerful temptation to declare victory, disband the team, and move on. This is, without exaggeration, one of the most destructive mistakes an organization can make. Go-live is not the end of the project; it is the end of the beginning. It is the moment the theoretical system collides with the messy, unpredictable reality of patient care.
The period immediately following the launch—the stabilization phase—is where the project is truly won or lost. The command center’s reactive, fire-fighting posture got the organization through the initial shock. Now, the mission must pivot. The new goal is to methodically transform a functional but fragile system into a stable, efficient, and user-accepted platform. This phase is about moving from a state of crisis management to one of proactive support, continuous measurement, and deliberate improvement.
Your clinical expertise as a pharmacist is never more valuable than it is in this phase. You are no longer just a system builder; you are a clinical coach, a data analyst, and a workflow detective. You will provide the hands-on “at-the-elbow” support that builds user confidence. You will monitor the system’s vital signs through key performance indicators, diagnosing inefficiencies and safety risks that are invisible in the raw data. And you will begin the crucial process of gathering, triaging, and prioritizing the flood of feedback that will become the foundation for the system’s future evolution. Neglecting this phase is like discharging a critically ill patient from the ICU directly to their home without a transition plan; the initial survival is meaningless if the patient cannot achieve long-term stability and health.
Analogy: From the ICU to Rehab
A patient has just survived a massive, complex, 12-hour surgery. This surgery was the Go-Live.
Phase 1: The Command Center (The ICU/PACU)
For the first 24-72 hours, the patient is in the Intensive Care Unit. The focus is purely on survival and managing acute, life-threatening crises. A team of specialists provides one-to-one, moment-to-moment monitoring. Every alarm is treated as a potential catastrophe. The goal is not to thrive, but to simply make it through the night. This is the reactive, high-intensity world of the go-live command center.
Phase 2: The Stabilization Phase (The Med-Surg Floor)
The patient is now stable enough to be transferred to a standard medical-surgical floor. The crisis has passed, but the patient is still weak, vulnerable, and unfamiliar with their new reality. The focus now shifts from acute crisis management to building strength and functional independence.
- “At-the-Elbow” Support: Nurses, physical therapists, and pharmacists are constantly in the room. They aren’t just monitoring vital signs; they are proactively teaching, coaching, and supporting. The physical therapist provides hands-on help to get the patient walking again. The nurse teaches them how to manage their new ostomy. You, the pharmacist, provide bedside counseling on their new, complex medication regimen.
- Performance Monitoring: The team is tracking key metrics. How far did the patient walk today compared to yesterday? Is their pain score trending down? Are their lab values normalizing? This data tells the story of their recovery.
- Gathering Feedback: The team is listening. The patient reports that one of their new medications is causing nausea. This feedback is captured, assessed, and leads to a change in the care plan—a small but important optimization.
Phase 3: The “New Normal” (Discharge & Long-Term Support)
After several weeks, the patient is strong enough to go home. The intense, daily support ends, and they transition to a long-term care plan with routine follow-up appointments. The project is officially “over,” but the process of managing and optimizing their health continues indefinitely. This is the final handoff from the implementation project to the permanent operational support team.
16.4.2 The Art of “At-the-Elbow” Support: Coaching Confidence into Existence
“At-the-Elbow” (ATE) support is the cornerstone of a successful stabilization phase. It represents a fundamental shift from a reactive to a proactive support model. Instead of waiting in the command center for users to call with problems, you deploy your most skilled resources—informatics staff and clinical super-users—directly into the clinical environment. These individuals round on the nursing units, in the pharmacy, and in the clinics with the sole purpose of helping users succeed in their real-time workflow.
The psychological impact of this proactive presence cannot be overstated. For a stressed, overwhelmed end-user, the sight of a friendly, knowledgeable expert in a brightly colored vest is a lifeline. It transforms their experience from one of frustration and isolation to one of supported learning. The goal of ATE support is not merely to fix technical problems; it is to build user confidence, accelerate adoption, identify workflow issues, and serve as the human bridge between the project team and the front lines of care.
Masterclass Table: The At-the-Elbow Support Plan
| Aspect | Strategy & Logistics | Pharmacist-Specific Considerations |
|---|---|---|
| Staffing Model | A tiered approach is essential. The ATE team is a mix of informatics analysts (who know the system build deeply) and clinical super-users (who know the workflow intimately). Both are critical. | Your best ATE resources for the pharmacy are your most respected, tech-savvy staff pharmacists and technicians. They have the credibility to coach their peers effectively. |
| Scheduling & Duration | ATE support must be 24/7 for at least the first week. The night shift often feels the most isolated and requires dedicated support. The schedule should then taper over 4-6 weeks as ticket volumes decrease and user proficiency increases. | You must create a detailed 24/7 ATE schedule for pharmacy coverage. Don’t forget overnight baking of TPNs, early morning cart fills, and other off-hours critical tasks. |
| Deployment Strategy | Use a hybrid “Rover” and “Resident” model. Rovers constantly walk the floors, proactively asking users if they need help. Residents are stationed in high-volume, high-complexity areas like the Emergency Department, ICU, or the central pharmacy IV room. | Station a dedicated “Resident” ATE resource in the central pharmacy for the first two weeks. This person can help with the new batch printing, ADC restocking, and order verification workflows. |
| Standard Work & Tools | Every ATE supporter should be equipped with a standard toolkit: a fully charged laptop or tablet, a way to communicate instantly with the command center (e.g., dedicated chat channel), a log for tracking common questions, and a pocket full of tip sheets for frequent issues. | Create pharmacy-specific, laminated, pocket-sized tip sheets. Examples: “How to Document Compound Waste,” “5 Steps to Verify a Heparin Protocol Order,” “Troubleshooting ADC Discrepancies.” |
The ATE Support Playbook: How to Engage, Not Interrogate
The success of an ATE interaction depends entirely on the approach. An effective supporter is a coach, not an auditor.
- Don’t Ask: “Are you having any problems?” This question invites a “no” even if the user is struggling. They may feel embarrassed to admit they have a problem.
- Do Ask: “How is it going today? What tasks are you working on? Can I show you a quick shortcut for that?” This is a non-threatening, collaborative opening. Observe their workflow and offer helpful, unsolicited advice.
- Celebrate Small Wins: When you see a user correctly navigate a complex workflow, praise them. “That was perfect! You navigated that titration order set exactly right. You’re a pro at this already.” Positive reinforcement is incredibly powerful.
- Convert Problems into Training Moments: When a user has an issue, don’t just take over the mouse and fix it for them. Guide them through the clicks. “Great question. Let’s walk through it together. First, click on the ‘MAR Summary’ tab…” This builds their skills and confidence.
- Be a Listener First: ATE support is your primary channel for feedback. Listen to the user’s frustrations. Even if you can’t fix it on the spot, validating their experience is important. “I understand why that’s frustrating. That’s great feedback. Let me make sure that gets logged as a suggestion for improvement.”
16.4.3 System Performance Monitoring: The Pharmacist’s Data-Driven Dashboard
While ATE support provides a qualitative, human-centered view of the go-live, you must also have a quantitative, data-driven perspective. Intuition and anecdotes are not enough; you must measure the system’s impact on the core functions of the pharmacy and the medication-use process. During the stabilization phase, you transition from tracking go-live issues to tracking operational Key Performance Indicators (KPIs). This data is essential for three reasons: it tells you if the system is stable, it identifies areas of inefficiency that need optimization, and it provides the objective evidence needed to prove the project’s success to hospital leadership.
As a pharmacy informaticist, you will be responsible for defining, building, and interpreting these medication-centric dashboards. You are translating the raw data from the system into a meaningful story about performance, safety, and efficiency.
The Pre-Go-Live Baseline: You Cannot Measure What You Do Not Know
A common and critical failure is waiting until after go-live to think about metrics. This is too late. To understand the impact of your new system, you must have a baseline measurement of performance in the old system. Weeks or months before go-live, you should be collecting baseline data on the exact same KPIs you plan to measure post-go-live. Without this baseline, you can never definitively answer the crucial question from leadership: “Are we better or worse off with this new system?”
Masterclass Table: The Pharmacy Go-Live KPI Dashboard
| KPI Category | Specific Metric | Why It Matters (The Clinical Story) | Data Source | Goal / Trend |
|---|---|---|---|---|
| Efficiency & Turnaround Times (TATs) | Order Verification TAT (STAT vs. Routine) | Measures the time from when a physician signs an order to when a pharmacist verifies it. A rising STAT TAT is a critical indicator of a bottleneck in the pharmacy that could delay patient care. | Timestamp data from the CPOE and Pharmacy Information System. | Trend Downward. Goal is to meet or beat the pre-go-live baseline within 4 weeks. |
| First Dose Administration TAT | Measures the time from pharmacist verification to when the nurse documents administration. This is a key hospital-wide metric that reflects the efficiency of the entire medication delivery process (pharmacy, delivery, nursing). | Timestamp data from the Pharmacy System and the eMAR. | Trend Downward. | |
| ADC Stock-Out Rate | Measures the percentage of times a nurse attempts to pull a medication from an ADC, but the pocket is empty. High rates indicate problems with par levels, restocking workflows, or system communication. | Reports from the Automated Dispensing Cabinet system. | Trend Downward. | |
| Safety & Quality | Clinical Alert Override Rate | Measures the percentage of high-severity alerts (e.g., Drug-Allergy, Duplicate Major Class) that are overridden by physicians and/or pharmacists. | CDS and alert logs from the EHR. | Monitor Closely. A very high rate (>90%) suggests “alert fatigue” and indicates the alert is poorly designed and needs to be optimized. |
| Medication Good Catch / Error Reporting | Tracks the number of self-reported near misses or errors related to the new system. A temporary increase post-go-live is expected as users learn. | Hospital’s safety reporting system (e.g., RL Solutions). | Trend Downward after initial spike. Data needs careful analysis to identify trends. | |
| Adoption & Utilization | Order Set Utilization Rate | Measures the percentage of orders that are placed via a pre-built, evidence-based order set versus being placed as individual, free-text orders. | Order entry data from the CPOE system. | Trend Upward. Higher utilization indicates providers are adopting the standardized, safer workflows. |
| Barcode Medication Administration (BCMA) Scan Rate | Measures the percentage of medication administrations where both the patient’s wristband and the medication barcode were successfully scanned. | Data from the eMAR system. | Maintain High. Goal should be >95%. A dip in this rate is a major patient safety concern and requires immediate investigation and re-education. |
16.4.4 From Feedback to Feature: The Optimization Cycle Begins
During the stabilization phase, you will be inundated with feedback. Your ATE support staff will collect dozens of suggestions a day. The issue tracking system will be filled with tickets that are not break-fix issues but rather requests for improvement. This flood of information is not a sign of failure; it is a gold mine. It is the real-world, user-driven data you need to begin the process of optimization—the cycle of continuous improvement that will transform the system from what was initially built to what the organization truly needs.
The challenge is to create a structured, transparent process for capturing, evaluating, and prioritizing this feedback. Without a formal process, good ideas get lost, users feel ignored, and the system stagnates. A key role of the informatics team during stabilization is to establish the foundation of this long-term governance and optimization process.
Establishing the Formal Feedback Loop
To manage the influx of ideas, you must move beyond verbal requests and ad-hoc emails. The process involves several key components:
- Create a Single Front Door: All requests for changes or improvements must be submitted through a single, standardized channel. This could be a dedicated queue in your ticketing system, a form on the IT intranet, or a specific email address. This prevents requests from getting lost.
- Require a Business Case: The submission form should require the user to articulate the “why.” Don’t just ask “What do you want?” Ask “What problem are you trying to solve? How does this improve patient safety, quality, or efficiency?” This forces a higher level of thinking from the requestor.
- Triage and Log Everything (The “Parking Lot”): Every single request, no matter how small or outlandish, should be logged and acknowledged. This master log, often called the “optimization parking lot,” shows users that their feedback has been heard, even if it cannot be acted on immediately.
- Form a Governance Committee: You cannot make these decisions in a vacuum. A multi-disciplinary committee (including pharmacy, nursing, provider, and IT leadership) should be formed. This group meets regularly (e.g., monthly) to review the “parking lot” and make collective, transparent decisions about which requests to approve and prioritize for development.
Masterclass Template: The Optimization Request Form
Implementing a form like this elevates the quality of requests from simple complaints to well-reasoned proposals.
System Optimization & Enhancement Request
Please complete all fields to the best of your ability.
Request Title: e.g., Add Creatinine Clearance to Vancomycin Order Screen
Submitted By: John Smith, PharmD Department: Pharmacy
1. Description of the Problem / Current State:
“Currently, when verifying a vancomycin order, the pharmacist must leave the order screen and navigate to the patient’s lab results to find their most recent serum creatinine and calculate the CrCl. This is inefficient and increases the risk of missing a significant change in renal function.”
2. Proposed Solution / Desired Future State:
“Display the most recent serum creatinine value and a calculated creatinine clearance (using Cockcroft-Gault) directly within the order verification screen for any vancomycin order. This information should be clearly visible to the pharmacist without requiring extra clicks.”
3. Clinical Justification (How does this improve SAFETY, QUALITY, or EFFICIENCY?):
“Safety: This will significantly reduce the risk of nephrotoxic vancomycin doses being administered to patients with declining renal function. Efficiency: This will save approximately 30-60 seconds per vancomycin order verification, which adds up to significant time savings for the pharmacy department daily.”
Affected User Groups: All Inpatient Pharmacists
16.4.5 Defining the “New Normal”: When is the Project Over?
The stabilization phase cannot last forever. There must be a pre-defined point at which the project is considered “complete,” the temporary go-live support structures are dismantled, and the system is formally handed over to its permanent, long-term operational owners. This transition marks the official end of the implementation project.
This decision should not be based on a gut feeling or an arbitrary calendar date. It must be a data-driven conclusion based on the system meeting a set of objective stability criteria. Achieving this “new normal” is the final goal of the stabilization phase.
The Stabilization Exit Criteria Checklist
Before you can sunset the project, the Go-Live Commander and project stakeholders must agree that the following conditions have been met.
| Category | Criteria | Status |
|---|---|---|
| Support Metrics | Incoming issue/ticket volume has decreased and stabilized at a predictable, manageable baseline level for at least two consecutive weeks. | MET |
| Support Metrics | At-the-elbow support has been fully withdrawn from all units, and this withdrawal did not cause a significant spike in the ticket volume. | MET |
| Performance Metrics | Key performance indicators (e.g., Order Verification TAT, BCMA Scan Rates) have met or exceeded their pre-go-live baseline levels for at least two consecutive weeks. | MET |
| System Stability | There have been no P1 or P2 issues for at least one week. All critical defects discovered during go-live have been resolved. | NOT MET |
| Operational Readiness | The permanent IT support team has been fully trained on the new system and has formally accepted operational ownership. All system documentation has been updated and handed over. | MET |
| Project Closure | A formal “Lessons Learned” session has been scheduled with all key project members and stakeholders to document what went well and what could be improved for future projects. | MET |
Once all criteria are met, the project can be officially closed. The command center is dismantled, the project budget is finalized, and the informatics team transitions from the all-consuming focus of implementation to the equally important, ongoing work of maintenance, optimization, and governance.
