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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Jane Hendy, Theopisti Chrysanthaki, James Barlow, Martin Knapp, Anne Rogers, Caroline Sanders, Peter Bower, Robert Bowen, Ray Fitzpatrick, Martin Bardsley, Stanton Newman
Wichtige Hinweise

Competing interests

All the authors declare that they have no competing interests.

Authors’ contributions

JH, (Planning and reporting the work) JB, (Guarantor) (Planning and reporting the work) TC, (Conducting, and reporting the work) The other authors: MK, AR, RF, JD, CS, PB, RB, and SN – all helped with planning and reporting the work. All authors read and approved the final manuscript.

Abstract

Background

To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare).

Methods

Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services.

Results

The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT.

Conclusions

The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
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