Feature / ESR: What Next?

Core implementation of the Electronic Staff Record in England and Wales was a key milestone. But it only marks the end of the first stage as organisations learn to exploit the system’s benefits fully. ESR’s Maureen Edwards reports

Core implementation of the Electronic Staff Record (ESR) across all 586 NHS organisations in England and Wales was completed successfully at the end of March 2008. Completion of one of the world’s largest IT implementations on time and within budget has been a major success story for the NHS, marking the conclusion of a crucial phase in the programme, but also the beginning of a new, challenging but exciting chapter.

The key priorities now are to ensure that ESR is fully exploited and utilised to deliver maximum benefits to all users. The programme is being implemented for the Department of Health by the NHS ESR central team, led by programme director Simon Willcock. Together with its supplier consortium, led by partner McKesson UK, it continues to invest in improving the operational service and assisting trusts to make full use of the ESR functionality.

An operations and benefits team of account managers, based in the strategic health authority regions, is working with local organisations to complete the initial implementation, so that the basic ESR modules of core human resources, recruitment and payroll are fully utilised.  They then work with organisations to implement ‘the expansion pack’ modules, Oracle Learning Management and Talent Management (OLM and TM) and manager and employee self-service. 

The team is currently funded until May 2010 and internal targets have been set for the completion of the expansion pack implementation by this date. OLM is progressing well with more than 54% of NHS organisations now using this functionality.

Readiness assessments

Organisations faced a number of readiness assessments during the implementation project.  Post go-live, a further readiness assessment (RA5) checks that all core functionality, interfaces and reports are being fully utilised and that ESR ‘best practice’ business processes are used.

Organisations working through the RA5 standard have found it useful both as a benchmark of progress and to ensure they are well positioned to implement the expansion pack and fully exploit the system’s benefits.  The aim is to complete RA5 for all organisations by December 2008.

A key benefit of ESR is its ability to integrate and report on all workforce activity, including pay cost information, in real time.  For example, ESR can report on how actual staffing profiles and costs relate to the agreed funded establishment, giving organisations improved and more immediate access to information, which will enable better monitoring of staff costs.

It also enables staffing and the associated budget responsibility to be devolved to department and line managers through the use of manager self-service.  This direct access empowers staff to manage their own data and encourages more accurate and timely information flows, providing tighter workforce management and financial control. This feature complements existing financial controls within each organisation and it is important that the finance team is engaged to ensure the system’s benefits are fully realised.

Using integrated HR, payroll and finance business processes in a new IT system can be a major challenge for staff. The regional operations and benefits teams are leading the support for organisations to manage the cultural change needed – offering training and familiarisation, as well as facilitating user networks.  Each region has a regional user group and special interest groups (SIGs) for staff engaged in specific system functions. 

The programme has also developed a knowledge management system, Kbase – a repository of support guides, outline project plans and case studies (register at www.esrsolution.co.uk/kbase).

The central team recognises that many organisations, particularly primary care trusts, are dealing with profound organisational change involving merging and separating services and changes in payroll service provision.  McKesson customer service managers and NHS ESR account managers are available to provide full support in dealing with the implications for local ESR configuration and use.

 After feedback from customers, McKesson is leading workshops to establish a network of ‘super user’ system experts in all organisations that can address issues at source where possible.  The planned introduction of an ESR information page – the system’s front page – will allow for instant access to timely, up-to-date information about the system and give access to other sources of information, the user notice library, Kbase and the user manual with new search facilities.

Two programmes of workshops for finance and payroll staff have been designed to enable more effective use of these specific areas of functionality.  The NHS interface team recently completed a series of workshops for finance staff across the regions, and workshops for payroll leads, delivered by the NHS development team in October, launched a revised best practice ‘end-to-end’ payroll process.    

The payroll workshops have been established specifically to address the slowing in system performance at peak times caused by inappropriate use of the system. For example, repeated ‘rolling backs’ and re-runs of adjusted payroll calculations for the entire workforce within an organisation causes slow performance for other users.  The combination of these workshops, the recent review of the end-to-end payroll process and payroll functional reports by the central team and the National Payroll group, and the super user training should result in a better service experience for all users across the system.

Problems in operation

Since the ESR system has been in live operation, significant system performance issues have been rare. There were two occasions recently, however, when users experienced severe problems.  McKesson and partners Oracle and IBM have now completed an investigation into the events of 19 and 20 August 2008, when users experienced extremely slow or failing processes.   At the time, McKesson worked closely with payroll teams to ensure that all payrolls completed, although other users were unable to access the system for periods on both days.

The problem occurred in the database in which the index information for payroll run results data was held in a single area of storage.  The root cause of the performance issue was linked to the payroll reports accessing the index in an inefficient manner. The immediate solution was to spread the index data into four separate areas of storage, to allow the report

to access the data in a timely manner.  This work was completed by the McKesson team on 20 August.

This data retrieval problem was entirely unforeseen and had not been encountered during previous testing or normal running.  As a result of the investigation, a planned architecture review into all areas of the system design has been brought forward. This will identify improvements or changes that should prevent this type of problem in future.  Oracle will also review the design of some of the payroll reports, including the gross to net report, to optimise processing.

Unfortunately, a completely unrelated problem occurred on 15 September with the failure of a component introduced to reconfigure a network connection. This produced similar symptoms for users until the network configuration change was removed.

Neither of these problems is an indication of general system capacity issues and the ESR system has since performed as expected.

The commitment and understanding of local teams in working through these problems has been very much appreciated.  McKesson and its partners are acutely aware that these problems will have affected confidence in system capacity. As a result there is renewed vigilance in monitoring all aspects of system performance.  The ESR service has the full attention and focus of both the NHS central team and McKesson as well as partners Oracle and IBM, in working to prevent such incidents happening in the future. 

There are two projects linked with ESR underway. The national learning management system (NLMS) project is a joint initiative between the Department of Health, NHS Connecting for Health and the ESR project.  It will extend ESR’s current learning management functionality by providing access to a centralised national e-learning catalogue and to local e-learning content.  The project pilot has recently concluded and national rollout will begin this month.

Integration of systems

In a second initiative, the registration partnership project will integrate ESR and the NHS Care Records Service (NHS CRS) systems to ensure identity management and access to clinical systems is tightly controlled. It will provide consistent assurance on identity management within the NHS, minimising risk to patient safety.

Work is ongoing to exploit synergies with other workforce systems.  For instance interfaces are being developed with medical and dental postgraduate deanery systems, registration bodies and with locally procured time and attendance and e-rostering systems.

Data quality and reports development in ESR are key to the strategic workforce agenda.   A suite of standard reports from the data warehouse has been developed to facilitate the workforce planning and education commissioning activities with the SHAs.  A similar suite will be available to all organisations in early spring.

The increased focus on workforce information has highlighted the need to improve data quality.  The ESR central data analysis team is leading work to generate ESR data validation reports that highlight gaps or errors in the underlying data. It is intended to provide all NHS organisations with access to local versions of these validation reports later this year, enabling data integrity issues to be corrected at source.

The completion of the ESR implementation project in March 2008 really was just ‘the end of the beginning’.  ESR has the potential to transform the way workforce is planned for and managed across the NHS, with real benefits for the people who work in the NHS and, ultimately, for patients. The NHS central team and its partners are determined to ensure the ESR programme delivers both local and strategic benefits and that service quality ensures that confidence in the system is maintained.

Maureen Edwards is senior user/HR director in the NHS Electronic Staff Record central team.