Updating digital systems in an emergency department that never stops

Innovation Article - Jan du Toit, Senior Project Manager, and Corey Beavis, Senior Business Analyst, Digital Services, Health New Zealand 
 

If you have spent time in an emergency department, you will know there is rarely a quiet moment. 

Priorities can change in an instant, and access to timely and reliable information is critical. 

Working in digital health, we often face the same question: how do you introduce change into an environment that never stops moving? 

The importance of partnership
Over the past year, we have been working with staff at Wellington Regional Hospital's Emergency Department (ED) to support a programme of digital improvements while helping prepare for a wider redevelopment that will eventually create a larger emergency department. 

The answer, we have learned, is partnership. Throughout the programme, we have worked alongside clinicians, nurses, administrators, operational leaders and other frontline staff to understand how the department functions, where frustrations exist and which changes would make the biggest difference. 

We bring technical expertise, but the people who work in ED every day understand the realities of emergency care and that collaboration has shaped every stage of the work. 

Front of Whare
Our contribution forms part of the wider Front of Whare programme, which is preparing the hospital for a larger emergency department in the years ahead. Unlike many redevelopment projects, services are being relocated in stages across the campus while clinical areas are refurbished and repurposed. 

As those moves occur, Digital Services has a critical role to play as before staff can move into a new space, the digital foundations need to be ready. That includes network infrastructure, Wi-Fi, telephony and connectivity, ensuring clinicians and support staff can continue working without interruption. 

At the same time, we have been improving the systems staff use every day inside Wellington ED. 

One of the biggest opportunities has been helping existing systems work together more effectively. Before the first phase of our work, staff often needed to move between multiple applications to find patient information, track progress through the department, or check whether blood test results, radiology images and reports were available. 

We have since connected key systems that previously operated independently and introduced new patient-tracking capabilities that provide a clearer view of what's happening across the department. 

Patient tracking
One of the most popular changes has been a new patient-tracking view that allows staff to see more information in one place and reprioritise patients as circumstances change. 

Another improvement surfaces notification flags and status indicators directly within patient-tracking views, allowing staff to see when radiology images and reports become available without repeatedly checking separate systems. 

From a technology perspective, these are relatively modest changes. In a busy emergency department, however, they remove unnecessary steps, improve visibility and help staff focus on patient care. 

The feedback from ED staff has been encouraging. What began as a series of technical improvements is already helping people work differently and creating opportunities for further change. The next phase will support a triage-first model, making important patient information available earlier in a patient's journey and reducing reliance on paper-based processes. 

Implementing change in a busy ED
Introducing those changes safely has required careful planning. 

An ED is not an environment where technology can simply be switched off while upgrades happen. Every change must be tested and implemented around clinical operations. 

Earlier this year, we completed a planned three-hour outage to introduce the first stage of the integration work, the longest digital outage the department had experienced. 

During that period, ED staff reverted to manual processes while continuing to care for patients. It required close coordination between clinical, operational and digital teams and reinforced the importance of preparation, communication and trust. 

The experience also highlighted the value of the wider Health NZ digital workforce. Architects, database administrators, testers, engineers and other technical specialists worked behind the scenes to ensure systems were configured correctly, thoroughly tested and safe to deploy. Their professionalism and commitment played a critical role in the success of the implementation. 

Building trust
As with any complex change programme, there were challenges along the way. Some had the potential to become significant obstacles during go-live. What helped us navigate those moments was the trust we built across clinical, operational and technical teams, supported by open communication and a shared commitment to finding solutions. 

One of the things we gained a greater appreciation for was the role operational leaders and frontline staff play in making change possible. Digital projects are often judged by what happens on go-live day, but their success is usually determined by the relationships built long before that. 

Those relationships do not end when the technology is switched on. Following the successful implementation, our team hosted a morning tea to thank ED staff for their patience, flexibility and support throughout the project. It was a small gesture, but an important acknowledgement that the work had been a shared effort. 

While these lessons were learned in a 24/7 emergency department, they will be familiar to many people working across healthcare. Whether supporting an emergency department, hospital ward, operating theatre or outpatient service, digital change is most successful when it is designed with the people who use it every day. 

Meaningful digital change happens when people trust one another, communicate openly and work towards a shared goal. Whether they are delivering care, supporting operations or enabling technology, successful outcomes are built on collaboration. 

Image: from left to right – Jan du Toit, Senior Project Manager; Lisa Bottin, Team Leader – ED; Lincoln Earley, Specialty Clinical Nurse Technician; Yasaswani Bandi, Senior Solution Architect; and Corey Beavis, Senior Business Analyst.

If you have any questions re the above feature article, please contact the editor Rebecca McBeth

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