Mainstreaming telecare services: An organisational analysis of process and progress

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Mainstreaming telecare services An
organisational analysis of process and progress

• Care Services Improvement Partnership
• 24 January 2008
• Dr. Jane Hendy
• Prof. James Barlow

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Overview

• Research approach and research questions
• Methods
• Initial findings
• Conclusion
• Way forward

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Research overview

• 24 month EPSRC funded project from June 2006
• Local PTG funded telecare projects as unit of
  analysis
• Overarching aims
• To understand the organisational processes and
  outcomes of attempting to develop mainstream
  telecare service
• To identify local and national facilitators and
  barriers to progress
• Help improve the future implementation of
  telecare services both in UK and aboard

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Overview

• Research approach and research questions
• Methods
• Findings
• Conclusions
• Way forward

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Work conducted

• 5 case studies (front runners) chosen from a
  possible sample of 151 LAs rolling out telecare
• Attendance at project group meetings and other
  strategic meetings observation of project roll
  out (50 hours)
• Analysis of project documentation
• 47 one-to-one taped, transcribed semi-structured
  interviews with range of telecare project
  managers
• 37 contextual interviews (to embed findings in
  national context)

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Overview

• Research approach and research questions
• Methods
• Findings
• Conclusions
• Way forward

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Key findings

• Our results confirmed the organisational
  complexities of attempting to mainstream telecare
  services
• Difficulties encountered and the major processes
  that emerged are divided into 5 main themes (30
  sub themes)

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Five overarching themes

• Belief in telecare versus a lack of hard evidence
• Pushing forward the role of entrepreneurial
  leadership, risk taking and hard work
• The transformational potential of telecare and
  inherent dangers
• The processes and organisational challenges of
  achieving whole system change
• The need for constant recruitment and marketing

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Theme 1 Belief in telecare versus a lack of hard
evidence

• Telecare overwhelmingly described as leap of
  faith
• The need for evidence that demonstrates, beyond
  doubt, that telecare services save money
• Our sites attempted to evaluate telecare with
  limited success
• Telecare project managers described feeling under
  pressure to produce a type of evidence they did
  not have or could not gather

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Theme 2 Pushing forward the role of
entrepreneurial leadership, risk taking and hard
work

• Despite tensions about the current lack of
  evidence telecare was pushed forward with
• Strong entrepreneurial leadership
• Top level management support
• Innovative thinking and risk taking BUT
• this risk needs to be backed by hard work and the
  development of a shared vision

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Theme 3 the transformational potential of
telecare and inherent dangers

• Telecare as a litmus test for transformational
  change joint working
• Opportunity to do things better, new levels of
  integration and efficiency
• Also inherent dangers
• Telecare as an attractive object
• Equipment sitting in boxes
• Blurring of responsibilities and boundaries
• Confusion and anxiety who should do what and
  pay for what
• Potential service gaps

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Theme 4 The process and organisational
challenges of achieving whole system change

• Implementation measured / incremental versus
  voluntary / chaotic (scalability issues)
• Learning hindered by reorganisation staff
  turnover, loss of knowledge and commitment
• Government funding period learning from
  mistakes
• Lack of engagement
• Local government rivalry
• Strategic and cultural differences across health
  and social care animosity reported
• Differences in the conceptualisation of illness,
  care and evidence

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Theme 5 The need for constant recruitment and
marketing

• Despite difficulties significant progress made
• Large amounts of organisational commitment needed
• Energy and leadership build a shared language
  and vision
• Joint working requiring constant attention or
  people quickly retract
• Driving forward quickly to build-up momentum
• The need for critical mass to prevent backward
  movement

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Overview

• Research approach and research questions
• Methods
• Findings
• Conclusions
• Way forward

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Conclusions

• Evidence for benefits is important if the right
  organisational characteristics (entrepreneurial,
  risk taking culture) are present
• Sustainability of trials requires constant
  attention and reinforcement
• For scaling up telecare, care providers need to
  understand how to integrate telecare into
  existing and new care pathways
• but cultural differences need to be addressed,
  and
• the right incentives for different care
  organisations need to be in place

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Overview

• Research approach and research questions
• Methods
• Findings
• Conclusion
• Way forward

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Whole system demonstrator evaluation

• Next step 2 of our 5 case studies will form
  part of the evaluation of the WSD allowing us to
  conduct a more detailed longitudinal study of
  telecare implementation
• Pre WSD implementation study during January-April
  2008

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Thank you and questions.

• Contact
• J.Hendy_at_imperial.ac.uk