DPH 850 Module 5 Implementation and Change Management Example

Go-Live Is the Beginning: Implementation and Change Management for a New Surveillance System

Student Name

Doctor of Public Health Program, Aspen University

DPH 850: Health Informatics for Public Health Leaders

Instructor Name

Month Day, Year

Go-Live Is the Beginning: Implementation and Change Management for a New Surveillance System

A well-planned system can still fail at implementation, when people must change how they work. This paper examines implementation and change management for a new disease surveillance system in a composite state health department, which is rolling the system out to state staff and 34 local health departments over 18 months.

Why Implementation Fails

Reviews of health information technology implementation find that organizational issues, such as leadership, user engagement, workflow fit and training, often matter more than technical features (Cresswell & Sheikh, 2013). Systems imposed without involving users, or launched without adequate support, are resisted, worked around or abandoned.

Implementation Phases

The table outlines the phases of implementation.

Readiness

A readiness assessment asked each local health department about staffing, computer equipment, internet capacity, leadership support and experience with prior systems. Three small rural departments lacked adequate equipment and bandwidth; the project provided laptops and funded connectivity upgrades before their go-live.

Super Users and Training

Each local health department named at least one super user who received advanced training and became the first point of help for colleagues. Training was role-based, so investigators learned investigation workflows and supervisors learned reporting. A practice environment with realistic test cases let staff rehearse before go-live.

Unintended Consequences

New systems can introduce new errors. Ash et al. (2004) described unintended consequences of patient care information systems, including errors in entering and retrieving information and disruptions of communication and coordination. The project watched for similar problems, such as cases routed to the wrong county because of address matching errors, and fixed them quickly.

Go-Live Support

During each regional go-live, project staff and vendor specialists provided on-site support for two weeks, a dedicated help desk line answered calls within ten minutes and daily huddles reviewed problems. Issues were logged, prioritized and resolved publicly so users saw action.

Resistance

Some experienced investigators resisted the new system, preferring familiar workflows and doubting its benefits. Resistance often signals real concerns. The team listened, adjusted forms where the new workflow added steps and showed data on reduced manual entry. Peer champions who had adopted the system early helped persuade colleagues. Investigators who raised concerns were invited onto the group that refined the forms, turning critics into contributors.

Communication

A communication plan kept staff informed through a monthly newsletter, short videos showing new features, updates at local health department directors' meetings and a feedback form. Messages emphasized what the system would do for users, such as fewer faxes and faster case assignment, rather than technical details. Local directors received talking points before each announcement so staff heard consistent messages.

Complexity of Scaling

Scaling across 34 local health departments with different sizes, cultures and resources adds complexity. The nonadoption and scale-up framework warns that complexity across the technology, the organizations and the wider system increases the risk of failure (Greenhalgh et al., 2017). Staging rollout by region and adapting support to each department reduced that complexity.

Measuring Adoption

Adoption will be measured by the share of case reports processed electronically, the share of investigations documented in the system rather than on paper, login frequency by role, time from report to assignment and user satisfaction scores. Targets include 90% electronic processing within six months of go-live.

Sustaining Change

After stabilization, the old system will be retired so that parallel processes cannot persist. A user group will meet quarterly to suggest improvements, and super users will continue in their roles with recognition in performance reviews.

Leadership

Visible leadership matters. The state epidemiologist used the system in meetings, praised early adopters and made clear that the old system would be retired on a set date. Leaders at local health departments were briefed first so they could answer staff questions.

Workflow Redesign

Technology changes work. Investigators who once received faxes and entered data now review automated reports and focus on follow-up. Workflow redesign sessions before go-live mapped current steps, identified those the system would eliminate and defined new ones, such as reviewing automated matches. Staff who helped redesign workflows were more comfortable with the change.

Managing the Vendor

The vendor relationship affects implementation. Weekly meetings, a shared issue tracker, clear escalation paths and payment tied to milestones keep the vendor accountable. When a key interface fell behind schedule, the contract's milestone payments gave the department grounds to insist on additional vendor staff.

Supporting Small Departments

Small rural health departments often have one or two staff handling all communicable disease work. For them, go-live meant learning a new system while keeping up with cases. The project scheduled their go-live during low-activity months, provided remote support daily for a month and paired each with a mentor from a larger department.

Lessons From the Pilot

The pilot with six local health departments revealed problems that testing had missed: slow screens on older computers, confusing labels for case statuses and a report that timed out for large counties. Fixing these before statewide rollout prevented frustration for hundreds of users and built confidence that feedback would be acted on.

Celebrating Progress

Change is tiring. Recognizing milestones, such as the first month with no faxed laboratory reports, and thanking super users publicly helped sustain morale through the long rollout.

Measuring Readiness Before Each Wave

Before each regional go-live, a short checklist confirmed that equipment was in place, all users had completed training, super users were named, interfaces for local laboratories had passed testing and leaders had set a date to stop using the old system. Regions that did not meet the checklist were delayed by a few weeks rather than launched unprepared.

Documentation

Clear documentation supports users long after trainers leave. The project produced short guides for common tasks, a searchable knowledge base, recorded demonstrations and release notes for each update. Super users helped write guides in plain language, drawing on the questions colleagues actually asked during go-live.

Conclusion

Implementation succeeds when people are prepared, supported and heard. Readiness assessment, super users, role-based training, a staged rollout, on-site go-live support, attention to unintended consequences and honest communication help a new surveillance system take root. Measuring adoption and retiring old processes turn a go-live into lasting change.

References

Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471

Cresswell, K., & Sheikh, A. (2013). Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. International Journal of Medical Informatics, 82(5), e73-e86. https://doi.org/10.1016/j.ijmedinf.2012.10.007

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), Article e367. https://doi.org/10.2196/jmir.8775