It’s official. You’ve just received word that your hospital has signed a contract to acquire a new video on-demand system. Congratulations! Your hard work has paid off.

After all, your influence was instrumental in getting the administration to see the benefits that an on-demand system would bring to patients, staff and the bottom line. Then once your organization got serious about acquiring a system, you were a key member of the evaluation team, analyzing the offerings of several different vendors to help find the solution that would best meet your needs.

And finally your vision has become a reality. Time to relax and celebrate, right? Sure, but not for too long. Because now the real work begins – implementing the system. Once again you will have a crucial role to play. As a patient educator, your talents are essential to ensuring a smooth implementation process.

Stages of the Implementation Process

You might be wondering, what exactly is this implementation process? Doesn’t the vendor you’ve selected just install the equipment and then you’re ready to roll?

Not quite. While hardware installation is indeed part of the implementation, it’s only one part. The implementation process encompasses the entire time period from when your hospital commits to purchasing a particular vendor’s product to the official rollout of the technology to patients, and even beyond.

“This is the magic time,” says Kathy Levine, Director of TigrVision Customer Development at TeleHealth Services. “The implementation phase is vitally important. It’s during this phase that the hospital really has the opportunity to set the tone.”

Typically an implementation will take a few months or more and involves the following stages:

• Planning. As soon as the contract is signed, and often before, planning of the implementation process begins. As a patient educator, your key activities during this phase will be analyzing the strengths and weaknesses of your existing patient education library, as well as developing any new protocols surrounding the educational process.
• Installation and Training. As soon as the vendor has installed the hardware for your on-demand system, your focus will probably be the training process. Staff will need to be trained to use the system, as well as educated on its benefits. You may find yourself functioning as a training participant, a coordinator or even as an instructor. 
• Go-Live. The go-live date is the day that the technology is made available to patients. During this time, you’ll likely be answering questions from patients and staff, encouraging use of the system, and helping to troubleshoot problems.
• Expansion and Follow-Up. In many cases, only the basic functionality of an on-demand system is made available to patients during the initial rollout. Expanded capabilities may be added over time. In addition, the system should be evaluated periodically to determine how effectively it is being used. As a patient educator, you’ll be involved in planning and implementing any additional educational features, as well as analyzing the impact of the technology on the educational process.

The implementation phase is vitally important. It’s during this phase that the hospital really has the opportunity to set the tone.

Sound like a lot of work? Well, it is. But remember, the effort you put forth now will reap tremendous rewards in the future. And you won’t be going it alone. To be successful, your organization will need to create an implementation team consisting of all the appropriate parties – yourself included — and headed by a high level champion with the authority and influence to make things happen. Many vendors provide tools and best practices to assist in the implementation process; be sure to take advantage of them.

“Planning and executing are so important,” emphasizes Debby Randall Andrepont, Director of Education at Opelousas General Hospital in Louisiana, which launched an on-demand system in January 2006. “It needs to be right the first time.”

Analyzing the Patient Education Library

Basically an on-demand system is merely a method of delivering information to patients. It’s up to your hospital to determine what information is delivered — and to supply it. Because educational material makes up the bulk of the content presented via on-demand technology, you will play a pivotal role in selecting that content.

“The educator serves as the primary point of contact for facilitating what content is selected for placement on the system,” according to Kerry Lenahan, Director of Product Management at GetWellNetwork. “It can vary from hospital to hospital, but for the most part whenever there’s a content decision to be made, it’s the educator who’s helping with that.”

Your first challenge is to review your hospital’s current patient education library. Remember, one of the key benefits of on-demand technology is that all your videos can now be instantaneously available to all patients in every department. This tremendous capability will quickly bring to light any weaknesses in your collection.

“Educators recognize this opportunity to evaluate what they have,” says Valerie Fritz, VP of Marketing for Skylight Healthcare Systems. “They’re usually extremely excited to take a step back and really analyze their existing library.”

If your institution already keeps a master list of all the educational titles owned, then you’re ahead of the game. However, in many hospitals the educational function is compartmentalized, and sometimes even individual departments are unsure about what materials they have. If that’s the situation, you’ll need to spearhead an effort to catalog all the videos available in your organization. That means reaching out to every department and tracking down every title – even the ones the staff have “hidden away” so they’ll know where to find them next time.

Once you have a complete list, you can start your analysis. Working closely with the staff members in each unit who actually use the videos, consider the following:

• Is your library comprehensive, or do you need to add titles? Remember, your library can now be virtually unlimited: condition-specific titles serving the patient population of every department, general health and wellness programs, foreign language versions, and complete staff education too.
• Are any titles outdated or ineffective? If so, eliminate them from your library and acquire newer or better ones.
• Is the audiovisual quality of each title acceptable? All videos will need to be converted to the digital format used by your vendor. If the quality of your original video is poor – for example, a popular VHS title that has been played many times over the years — then the converted version is likely to be even worse. In such cases, you should consider acquiring a new copy of the program. Your vendor may offer a sizable discount on a replacement VHS copy or better yet, offer a digital file of the same program.

Budgeting and Broadcast Rights

If you determine that your collection needs additions – and it’s likely that you will – you’ll need to tackle the issue of budget. Unfortunately, budgeting for new materials is something that hospitals frequently overlook.

“It’s like buying a car and forgetting that you have to put gas in it,” says Levine. “And it’s more common than you would think.”

Studies show that patients who are actively directed to watch educational programs pertaining to their condition are much more likely to do so than those left to their own devices.

So you may need to remind the administration that money to acquire new content must be made available. And once you do have a budget, you may find that the purchasing process itself needs to be revamped. Since an on-demand system serves as a central repository for all educational videos, hospitals are often motivated to better manage the acquisition of new titles. Instead of an informal process in which each department buys whatever it thinks it needs, all purchases may need to be approved by a review committee to ensure quality and prevent duplication. The formation of this committee and its guidelines may also appear on your to-do list.

Another often overlooked issue is that of broadcast rights. Ordinarily when you purchase an educational video, you are buying the right to play it on a single machine for viewing by one patient at a time. Since on-demand systems allow a single title to be viewed simultaneously by many patients at once, you will need to secure licensing to do so. Typically this involves paying an additional one-time or annual fee for each title you own as well as any new ones you purchase. Most on-demand vendors provide assistance with this process.

“Deciding on what you want to include and getting the broadcast rights — that was definitely the most time-consuming part of the process,” says Andrepont about her implementation experience. “But you want to do it right. After all, you don’t want videos of people with 50’s hairdos,” she chuckles.

You should also be aware that some vendors automatically provide a certain amount of educational programming along with their solution. For example, your system might come packaged with 30 to 150 videos on various topics. That doesn’t mean, however, that you necessarily want to make all these titles available to your patients. Ideally, you should review these programs for quality and concurrence with hospital guidelines, just as with your own library, and decide which ones you want to include. Once again, having a review committee already in place will greatly expedite the process. 

Lenahan notes: “If a hospital is really organized and has a nice approval process in place, the implementation will go very quickly. So, for example, if a hospital has a patient education council already established, they can quickly review the materials and say, ‘Yes, I want that on my system.’ Where we struggle is when the processes aren’t in place – this is the first time they’re ever deciding, as a group, what a patient should see. That’s where we run into roadblocks.”

Developing Unique Content and Protocols

While all on-demand systems provide easy access to educational videos, the other types of content they can present will vary. So be sure you understand all the features of your particular system.

Then, based on those features, you may want to develop educational material unique to your hospital. For example, if you’d like to take advantage of your on-demand system’s ability to present a quiz at the end of a video, you’ll need to create the questions and answer choices. You’ll also have to develop a protocol for handling the quiz results: Who will receive them?  How many wrong answers will trigger a follow-up session with the patient? Who will conduct that session?

If your on-demand solution offers internet access to patients, you may want to include a list of educational URLs that might be of interest to them. Some hospitals now include a great deal of instructional information on their own web sites, in which case you would certainly want to provide a link.

Your facility may also want to include text-based materials like discharge instructions on the system, or electronic files such as PowerPoint presentations. Gathering such content is yet another task for which the patient educator is ideally suited.

The naming and organization of content within the system is also extremely important. You want patients to easily locate the videos they’re looking for, and be able to tell by their titles exactly what they’re about. Sometimes a video’s original title is a bit vague or too lengthy, in which case you’ll need to create a succinct, more descriptive title. After all, if a patient can’t figure out what a video is about, they are unlikely to take the time to watch it. As for organizing the titles within the system’s interface, ask your vendor for templates that have worked well for others. Most vendors have pre-established categories for organizing educational materials within the menu structure, but they can be edited to accommodate your specific needs.

At Opelousas General Hospital, patients are provided with a guide that lists each video and its description as well as how to access it. Recently, Andrepont discovered that it’s also important to let patients know how long each video runs. “We’re finding out that people want to know, ‘How long’s it take?’ They’re more open to doing it when they know it’s not going to take all day long.”

Even with a well organized and easy-to-access system, patients might not be motivated to watch anything educational and instead tune right into HBO. However, some on-demand systems provide the capability to alert patients that one or more videos relating to their condition are ready for them to view. For example, a cardiac surgery patient could be prompted to watch a program on home care. This kind of notification greatly increases the chances that a patient and his or her family will actually watch an educational video. If your system has this feature, you’ll need to determine which segments of the patient population should receive such alerts and which videos will be assigned.

Finally, you’ll want to designate a content gatekeeper. In an ideal situation, anyone in your organization who wants to add videos or other items to the system must go through the gatekeeper, who makes sure all materials have been approved by the review committee. The gatekeeper then notifies the vendor that the items are ready to be digitized and uploaded to the system. By creating a single point of contact, you streamline the upload process and ensure quality.

Installing the Equipment and Training the Staff

At some point while you are doing all the necessary planning to get ready for the go-live date, your vendor will begin installing the necessary equipment. This process could take days or weeks depending on the complexity of the system, the number of rooms, and whether the installation is done all at once or in stages. During the install itself, the most important thing to remember is that the vendor will need access to patient rooms. So it’s best to be prepared for a bit of disruption. Having the floor staff communicate with the installers to let them know which rooms are empty will also be a big help.

After the equipment is installed, training will take place. Hospital staff will learn to operate the system – how to navigate the menu and select a particular video, for example. If available, specialized functions will also be taught, such as how to add patient quizzes or surveys.

The training process may work in a number of ways. In many cases, the vendor conducts all the training. But in some instances, the hospital may want the vendor to train key members of the staff, who will then conduct the training for the remaining personnel. It depends what works best for your organization. Sometimes, an in-house trainer or “super user” will have more credibility with staff. On the other hand, the vendor will have the most knowledge about how the system works, at least initially.

Ideally, the floor nurses were educated about the benefits of the on-demand system previously and will be excited about using it. But if that’s not the case, then it’s absolutely crucial to obtain their buy-in now. They need to understand how the system will benefit both them and their patients. If not, they are unlikely to promote its use, and what good is a system that isn’t utilized? Therefore, training should cover not only how to use the system, but also why.

Going Live

After all the content-gathering and planning is complete, you’ll finally be ready to go live. That is, the system will be made available in patient rooms. Just as with installation, the system may be launched throughout the entire hospital at the same time, or the rollout may occur in stages.

Once the system is up and running, you may find that your primary role becomes promoting the technology. Many people are resistant to change, so it’s not uncommon for an on-demand system to be underutilized at first. Studies show that patients who are actively directed to watch educational programs pertaining to their condition are much more likely to do so than those left to their own devices. Therefore, it’s essential that the staff encourage use of the system — and your enthusiastic endorsement can go a long way toward making that happen.

“You have to constantly keep it out there in front of them,” says Andrepont. When her hospital’s system went live, she used a variety of means to spread the word both within the hospital and without: she bought promotional mousepads for each nursing unit, developed a press release, wrote an article for the local newspaper, put brochures in the hospital elevators and created a flyer for every department. “Nobody can say they don’t know about it,” she laughs.

She thinks word of mouth is especially effective, so she’s doing all she can to get exposure within the community. For example, she recently gave a demonstration to the local Rotary Club and found her audience very receptive. “They were asking, ‘Can we get this at our house?’ That’s how much they liked it.”

Expanding and Improving the System

In many ways, implementing an on-demand system is an ongoing process. After all, content can be added or updated continuously, and new features can be enabled. For example, you may want to provide only basic functionality during the initial launch and at a later date add comprehension questions, patient alerts and other more sophisticated options. Or you might begin by focusing only on patient education, but subsequently begin to shift all your staff training materials onto the system as well.

“Hospitals may not start with this kind of integration,” says Fritz. “Usually they walk before they run.”

Andrepont agrees. She plans to move forward with staff education next, but thinks it will take time to develop. She would also like to start “prescribing” specific videos to patients, a feature she’s tested but not yet implemented. “You want to know everything your system will do, but you only want to develop a certain part at a time so that you can manage it and do it well.“

One way to encourage rapid adoption is to review department reports of who is using the system most during the first month and give small rewards to “super users.” This can give things a real boost because initial usage often is an indicator of long-term use of the system.

Often vendors will provide an onsite presence to assist your facility in continuing to utilize the technology in the most powerful way. In addition, most systems offer reporting capabilities that provide valuable information to help you analyze the effectiveness of your system so that improvements can be made. For instance, you can learn which videos are being watched the most or not at all. Some reporting systems will even tell you how long a video is viewed before it is turned off – which could clearly indicate whether or not a particular program is meeting patients’ needs.

As you move beyond the initial implementation of your on-demand system, always be thinking ahead.  What other features of this technology could my organization take advantage of? What problems do we have that might be solved with this system? Remember that you have a mighty educational weapon at your disposal – one that can continue to serve the informational needs of both your patients and staff in new and exciting ways for years to come.