Our four hospitals, Collingwood General and Marine Hospital (CGMH); Georgian Bay General Hospital (GBGH – Midland); Headwaters Health Care Centre (HHCC – Orangeville) and Royal Victoria Regional Health Centre (RVH – Barrie) have partnered to implement the latest version of the MEDITECH platform, called Expanse. This transformational project, which has been named CARE4, is designed to improve the quality of patient care and the delivery of that care throughout the partner hospitals.
This is not just an Information Technology upgrade. The CARE4 project is a clinical and operational transformation project enabled by technology. It will provide the catalyst to accelerate our digital health services strategy and enable our hospitals to:
This is one of the largest and most exciting projects in our collective history. It will positively impact several hundred clinical and operational workflows across the continuum of care.
The transition to MEDITECH Expanse represents a substantial change for our hospitals, staff and providers. Our goal is to ensure that we support you, the leaders and managers, by providing the necessary supports you require to prepare yourself and your teams through this transition.
The Playbooks are a collection of electronic resources with actionable strategies, tools, templates, key messages and surveys for managers, leaders and providers to prepare themselves and their teams for a successful GO LIVE. This is your one stop shop for CARE4 readiness.
Each of the playbooks will focus on four key readiness areas:
The information included in the playbooks will be delivered to you primarily through the CARE-4.ca website. The website includes a calendar of events and activities and other helpful tools and resources. Information will be added throughout the duration of the playbook stage. When updates are made you will receive an email notification with a link to the updated resources and action items.
Prior to the release of each playbook, leaders, managers and providers will be invited to watch virtual orientation session. Here, we will walk through the information and requirements for that playbook and answer questions. You will also receive an email with a link to the most current playbook
Not all the information provided in the playbooks will be applicable to you and your team. We have included icons which will indicate if the section is relevant and needs to be actioned by you:
A manager checklist has been created with the top Playbook items that require your action. Please complete the following form, print and scan to your site lead by February 12 2021.
The people readiness section includes change management, communication and engagement and information regarding training and education to support you and your teams with the transition.
What is your role as leader? 
The CARE4 project is an organizational priority for all four partner hospitals. As a leader, you will play an integral role in supporting your teams through positive encouragement, coaching and acting as a champion for the project. As a leader, you will:
Understanding the CARE4 Project 
Building awareness of CARE4 is vital to the success of this project and will allow for staff and providers to prepare for this change. As a leader, you play a critical role ensuring information about CARE4 is shared with staff and providers in your departments and across your organization.
Due to the pandemic there has been a communication hiatus to allow for organizations to focus on their response to COVID-19. The Establish stage is focused on re-orienting staff and providers to the CARE4 project and communicating the need for change.
Review the information sources below and determine the information needs of your team. The amount of information you need to communicate at this stage of readiness will largely depend on your teams understanding and involvement in the project to-date. Distribute the information and check for understanding amongst your team(s).
CARE4 Project Overview
Nearly every staff member and provider will be impacted by MEDITECH Expanse – whether you will use the standardized provider order sets, nursing assessments, general ledger account structure or the new module for employee incident reporting.
The CARE4 project uses the following Guiding Principles in decision making:
Your input is critical to our success, so ample time has been allotted for staff and providers to participate in the project, and many have already been engaged through the work of the CARE4 committees, working groups and build teams.
CARE4 Timeline : As we reach new milestones, the updated timeline will be circulated.
Name the mascot: As part of the CARE4 project, we have created a mascot – the CARE4 robot. The robot name has been chosen! Meet Dot, your friendly CARE4 robot. Dot is an easy way for your staff to identify when information is related to CARE4. Watch for more activities, events and contests featuring Dot!
Engage your support team
The CARE4 project is an organizational priority for all four partner hospitals. This transformation will require a significant amount of work and engagement from leaders, managers and providers.During the Engage stage, individuals that have been identified during the Establish stage will begin their key role in supporting the up-coming change.
We have added CARE4 Coaches to support each of the partner sites with this massive change. Coaches are your conduit to help you build your team. Please utilize the coaches to assist in Playbook activities, preparing teams for readiness and answering any questions you may change about the playbooks or managing the change within your department or unit. Please accept their invite to assist you and your team through the transition and make the change. Their contact information has been added to the bottom of the Manager Checklist.
A robust project structure and team has been put in place to ensure the success of the CARE4 project. You can reach out to members of the team to answer questions about the different aspects of the project.
Site Leads will play a significant role as your conduit to the CARE4 Leadership Team. Please familiarize yourself with your CARE4 Site Lead.
Change management and communicating change
In the Engage stage, the Change Management focus is centered around engaging with your team for the upcoming changes. We can already see changes in our departments as the project moves forward, changes such as team members joining the CARE4 Project, internal recruitment for Training and Superuser positions and the selection of non-medical devices.
Assisting you in guiding your team through change from CARE4 is our primary focus in Change Management. Recognize that individuals on your team will transition through change at different times with different reactions, and this is normal.
The RVH Learning Academy is a resource our CARE4 team utilizes to assist in change.Through Change Management classes, the RVH Learning Academy has provided the following tools to support leaders as we move through the Engage Stage:
Virtual Office Hours
Members of the CARE4 Leadership are on-line virtually through Microsoft TEAMS. Join the office hours to learn about the weekly topic listed below, after a brief educational presentation, ask questions, and engage with CARE4 Leaders and Coaches.
Topic Schedule
Dec 2, 2020 Change Curve
Dec 9, 2020 Stakeholder Identification – Purpose of identifying stakeholders
Dec 16, 2020 Stakeholder Personas
Jan 6, 2021 Stakeholder Impact assessments
Jan 13, 2021 Stakeholder Empathy mapping
Jan 20, 2021 Stakeholder Prioritization
Jan 27, 2021 Change Curve
Feb 3, 2021 Stakeholder segmentation / Radar
The CARE4 office hours are held every Wednesday from 1:00 pm to 2:00 pm. Drop-in in virtually via Microsoft Teams. Click here to access the CARE4 Virtual Office Hours . This is not mandatory, but you are highly encouraged to participate if you have questions or concerns.
Education and Training 
A vital part of our success will be ensuring that staff and providers have the skills, ability and confidence to use MEDITECH Expanse effectively and efficiently. The CARE4 team is preparing an extensive Training and Education plan for staff and providers. This includes the recruitment of Trainers and Super-Users (who will provide at-the-elbow supporting during GO LIVE), arranging rooms for safe, in-person learning, preparing education materials and the new Learning Management System providing E-Learning. As a leader you will be provided information to support your staff with training including when it will take place and how they can access it.
Our future state CARE4 Learning Management System (LMS)
All e-Learning will be housed on the cloud based CARE4 LMS. Courses will be assigned to users based on their role in their organizations. All learners will receive support to access and use this system. The LMS will also be used to house tip sheets and other helpful training materials. Using a cloud-based Learning Management System will allow content experts the ability to update training content once in the system, administrators can visualize participants completion rates across all 4 sites as well provides access to our non-hospital staff (Physicians, Trillium Gift of Life staff) so they are trained to the same standard.
A list of the different training modalities can be found here.
We ask that you huddle with your staff about training. The huddle notes can be accessed here.
Training for Trainers and Superusers will take place in February. Training for end users will take place in March and April and further information will continue to be provided to leaders, staff and providers over the upcoming months.
Various supports will be provided to staff completing including office hours and support email. Any staff member requiring accommodation during training is to contact HR department for alternate accommodations.
Readiness Surveys
As we track towards GO LIVE in May 2021, it is important to know where staff and providers are in their change journey and how ready they feel for the implementation of MEDITECH Expanse. In order to measure progress over time the same questions will be asked for each of the four playbooks. The results from each survey will help the CARE4 team develop the next playbook in line with the needs of the four partner hospitals.
All Staff and All provider survey
Please share the survey link or QR codes with your staff and have them complete the 2 minute surveys prior to February 12, 2021.
QR codes can be used by pointing a cell phone camera at the QR code as if you are taking a photo. This will link directly to the survey. Please print and post for your staff to complete the survey.
Below is a suggested email to send to staff with the survey link. You can copy and paste it into the body of a new email message:
As we track towards a CARE4 GO LIVE in May 2021, it is important to know where you are in your change journey and how ready you feel for the implementation of MEDITECH Expanse. This survey is anonymous and your feedback will help us tailor our communication and engagement to meet your needs.
Leader/Manager survey only
Please answer the leader survey once per playbook. This will help us gauge your own knowledge and understanding about the project. The results will help us to determine how to meet your needs. Please complete the survey by February 12, 2021.
Standardization
To ensure we are following researched based, best practices, the CARE4 Project Team is working to standardize our clinical and administrative workflows and processes. This will ensure that we are providing safe, quality care. While many areas are being standardized within Expanse, for many staff, the most noticeable change will be the clinical documentation changes. Much of the work being done through the Clinical Stream is to standardize processes, assessments such as a nutrition screening tool and a violence screening tool, care plans, order sets, dictionaries and even the language.
Over 60 physicians have worked on standardizing order sets and many clinical staff have been hired as subject matter experts, build team members and committee members to guide this work. A CARE4 Professional Practice Committee is determining the process of how changes in practice and procedures will be rolled-out prior to GO LIVE. Skill labs and additional training will be provided to ensure that staff and providers are comfortable with the changes.
Please huddle with your staff about the standardization resulting from the CARE4 project. You can find huddle notes here.
Documentation Standardization
Documentation practices differ from site to site. Documentation standardization is happening for many reasons such as adopting an industry best practice, environmental, regulatory, quality, improving patient safety, or because the new workflow is more efficient. Our CARE4 team of experts have weighed all of these reasons to ensure that documentation meets the needs of our patients, providers and staff.
A benefit of the new documentation – users will have the ability to chart entire patient system assessments with just one click!
Some individuals will easily accept the change in our documentation practices and others will struggle with the change in routine. It will be important to continue to communicate the reasons and the benefits for the standardization and support staff and providers as they become accustomed to a new way of doing things.
Within Defined Standards (WDS)
Users will have the ability to click a box “within defined standards” for many patient assessments, such as a cardiovascular assessment. This means if the patient’s Cardiovascular Assessment meets all the requirements in the defined standard or normal findings (shown in the chart below) charting the assessment is as easy as checking off Within Defined Standards.
Summary page
MEDITECH Expanse has an electronic summary page where a summary the patient’s data is found. This summary page replaces Kardex style charting found in many clinical areas.
Other documentation changes coming
Standardization and the tools used for charting patient assessments will be shared by your Professional Practice departments as they are finalized for GO LIVE. Some of these new practices may have been adopted from your department while others may result in a change in your department.
The implementation of MEDITECH Expanse is a huge leap forward in modernizing our share Health Information System (HIS). An ERAM score is a measure of an organization’s transition to a paperless environment. On the seven-point scale, through CARE4, we will be leaping forward from score of three all the way to a six!
This project is truly a transformation and we will need you and your teams to be actively involved in the upcoming months to ensure that we make this leap forward successfully. Part of this process will be removing unnecessary paper from your unit.
Before February 12, 2021 book a team Clean-Up Day. Identify individuals on your team who will participate in the clean-up and other team members that will help with the discarding paper such as Environmental Service workers.
Please work with your teams to clean your department of the following.
Check desks, workstations, filing drawers, cabinets, communication boards and break rooms.
Inventory the documents/Care plans/tip sheets/posters that you are keeping. Take note if they have expiration dates or a review date.
Engage your team to understand which documents are no longer used and remove from the unit. It is a good practice to keep documentation you are unsure of staged for a period of time to understand if anyone uses it. If no one uses the documentation within a few weeks – clean it out.
This is the beginning of the Clean-Up Days. Further cleaning and paper removal will occur right before GO LIVE. Teams will be deployed to remove paper documentation that is no longer required as it is transferred into MEDITECH Expanse.
Building Capacity
Every unit in the hospital needs to be aware of the May 2021 GO LIVE and participate in building a capacity plan for your unit.
Your Senior Leadership team supported by the Site Leads and the CARE4 Project Leadership team would like you to think about and document your strategies to manage the J-Curve (image below) which is the period of learning, and inefficiency during the GO LIVE stage as staff and providers learning to navigate the new system.
Strategies may include, increasing staff during the GO LIVE period, communication to stakeholders about the changes, lengthening appointment times, decreasing clinical volumes during, and reducing non-essential work or meetings that are not related to CARE4. This period of adjustment in the work will provide staff and providers with the time they need to work with and learn the new Expanse system while maintaining patient safety and quality of care.
You may be approached by your Site Lead or the CARE4 Project Leadership team to think about strategies to manage the J-Curve, these strategies may include, decreasing clinical volumes during GO LIVE and reducing non-essential work and meetings not related to CARE4. This will provide staff and providers with the time they need to work within the new system while maintaining patient safety and quality of care. A plan for increased staffing, service reductions and associated requirements will be created for each site. Site Plans will be presented and vetted at the Clinical Steering Committee and will be included in future playbooks.
Resources and preparation activities to help integrate new technology and devices into your physical spaces and workflows.
Non-Medical device assessment 
This section will provide updates regarding project milestones, timelines and other important project information.
Healthtech
As part of our robust CARE4 project structure, we have hired Healthtech as a consultant group to assist with project management, training and education, and to provide their expertise on managing Health Information System (HIS) implementations. Healthtech consultants are working closely with staff and providers through the CARE4 build teams, working groups and committees. You may see them on site from time to time as they work on preparing us for.
Project Status
The initial build phase of the project is projected to be complete by the end of December to early January. We will start integrated testing in January. The Technical Applications stream that is working to develop a master testing plan. Testing will include end-users, outside of the project team, to come and test both the Expanse system, devices and the associated workflows. This is a proven strategy for ensuring a robust and solid product, as end-users tend to find creative ways to confuse or break a system that we would never have considered.
The Establish playbook has been completed. Thank you for completing the activities and sharing information with your team.
The Engage playbook will take us until the period of time when the build is complete and end user training will begin.
Establish – Sept 30, 2020 – November 27, 2020 Complete
Engage – November 27, 2020 – February 12, 2021 YOU ARE HERE
Enable – February 12, 2021 – April 16, 2021 In Development
Embed – April 16, 2021 – June 30, 2021 In Development
The subsequent two playbooks (Enable and Embed) will continue to build on each other and will include more information, action items and activities for you to review and complete with your teams. This is a significant transformation and organization priority that will affect essentially every employee within our hospitals. Your engagement in this project is paramount to our success.
Materials will be released intermittently throughout each Playbook to allow for timely and accurate information sharing. We will send email communication and coaches will remind you to complete your playbook readiness activities, we welcome your feedback and questions as they arise. The CARE-4.ca website will be your primary access point for the playbooks moving forward. Please check it regularly.
Together, we are improving our staff and provider workflows and enhancing the quality and safety of the care we provide to our patients and community.
