Staff adoption: resources for implementing telehealth
From the University of Sheffield
The aim of this workstream was to understand the key barriers and facilitators to staff adoption of telehealth within the four research sites. Then, the aim was to collaborate with those sites in order to help promote staff adoption and integration of telehealth into clinical practice.
A systematic review of the literature on frontline nursing staff adoption of telehealth was completed in order to feed into subsequent primary research stages.
Qualitative case studies of the use of telehealth in each research site were then developed via in-depth interviews with a total of 105 staff (frontline clinical and technical staff, operational and strategic managers and commissioners). These case studies fed into the development of two cycles of action research in each research site.
This work was run over six months to help incrementally improve local telehealth services and enabled the project to gain a longitudinal understanding of the barriers and enablers to telehealth adoption.
Clinicians are end-users of remote care technologies. Minimising the impact on workload, challenging myths and misconceptions that can occur around the introduction of new technologies, and maximising benefits for patient care and clinical practice, are crucial in driving up adoption.
Sharing good practice and stories of success can ensure that the benefits of telehealth are identified and realised in practice; however GPs are yet to be convinced of the benefits for primary care, and public awareness remains very low, which limits demand at present.
Telehealth champions and local enthusiasts can engage and train staff, and drive forward service improvements. However, the effort required to sustain momentum can be significant and a formalised role supported by management can be more effective.
Working in partnership with frontline staff throughout implementation, and allowing for an ‘experimental phase’ to enhance learning and enable staff to develop trust and confidence in telehealth are also important.
Action research and service improvement tools can facilitate opportunities for shared learning, and bring together multiple stakeholders to work together on improving processes and practices for telehealth. However, without explicit support from leaders and decision-makers, securing long-term investment and tackling wider organisational barriers are a challenge.
Establishing a remote care pathway from referral to discharge, and ensuring that resources are in place to deliver this, can enhance success and address key implementation barriers before they would normally occur in practice. Having a clear pathway can also facilitate better assessment and audit, and ensure that the most suitable patients are referred, that monitoring is tailored to need, and that patients are monitored for the optimal duration.
Whilst a systems approach is useful in identifying the range of factors affecting implementation, technology plays a key role in whether or not telehealth is successful. Inappropriate, unreliable and inflexible technologies can limit success, affect acceptance among users, and lead to increased workload as staff ‘work-around’ design flaws. Core design features can also shape the way in which care is delivered, and in ways that are not always anticipated.
The technological infrastructure within the statutory sector cannot currently support the mainstreaming of remote care technologies. A key benefit of telehealth is the ability to obtain data from patients remotely, and to use and share this data to make decisions about care, without always having to see a patient. Having multiple platforms and patient recording systems limits the potential to do this; something which is further compounded by strict regulations concerning access to patient data.
Evidence of success is important to all stakeholders; however, different types of evidence are preferred by different stakeholder groups. The current focus on cost-effectiveness within policy and commissioning, the problems with measuring cost-effectiveness of complex interventions, and on-going ambiguities about why to use remote care technologies cause decisional uncertainties about whether or not to invest, and how to measure success.
Enduring organisational barriers, including the multi-stakeholder landscape, continue to prevent mainstreaming of telehealth and other remote care technologies despite policy support and enthusiasm among core clinical teams. Recent and on-going changes within health and social care continue to cause uncertainty about what to invest in and how new technologies should be used, and this uncertainty is mirrored in both policy and practice.