Mainstreaming telecare services: An organisational analysis of process and progress

Care Services Improvement Partnership 24 January 2008 Dr. Jane Hendy Prof. James Barlow Mainstreaming telecare services: An organisational analysis of process and progress

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

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

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

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)

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)

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

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

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

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

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

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

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

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

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

Thank you and questions…. Contact: J.Hendy@imperial.ac.uk

Mainstreaming telecare services: An organisational analysis of process and progress