New configurations of services, technology in addition to infrastructure New rules about governance New types of ownership New types of identity (patient & professional) Different cultural attitudes to self care

New configurations of services, technology in addition to infrastructure New rules about governance New types of ownership New types of identity (patient & professional) Different cultural attitudes to self care www.phwiki.com

New configurations of services, technology in addition to infrastructure New rules about governance New types of ownership New types of identity (patient & professional) Different cultural attitudes to self care

Lekas, Bill, Host has reference to this Academic Journal, PHwiki organized this Journal Jane Hendy, James Barlow, Theti Crysanthanki May 2011 Implementing remote care in the UK Currently there is a strong UK policy push as long as telemonitoring (remote care) Over 25 UK government reports since 1998 have called as long as remote care Finance (£170m+ since 2006) via Preventative Technology Grant, POP, Whole System Demonstrators in addition to other regional initiatives

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Why Remote care (telecare / telehealth) can potentially shift healthcare out of expensive settings – hospital to home introduce more preventative models of care Our research focuses on the organisational challenges in achieving large scale trans as long as mational change Two projects (plus a sub-project) Initial EPSRC funded research focused on the £170m spend – remote care adoption involving 5 cases across Engl in addition to Ministerial led DH funded £30m RCT study – the WSD – involving 3 cases in Engl in addition to Additional money received as long as a third project on 3 non-WSD sites in addition to 3 sites in the Kings Fund LAN (also DH funded) To explore organisational factors that facilitate or inhibit the successful adoption, implementation in addition to potential mainstreaming of remote care services at a local level Assess current in addition to future possible impacts of implementation at both local in addition to national levels Identify in addition to disseminate the lessons learnt, as long as improving the future implementation of remote care nationwide Our research aims

Methodology Dense ethnographic shadowing in addition to mapping of the adoption in addition to implementation of remote care Case based approach Purposive sampling / interviewing c290 semi-structured interviews with key stakeholders in health in addition to social care organisations across 9 sites 380 hours of observations Longitudinal (2006 – 2011 with possibility of continued monitoring) Remote care adoption curve in the UK in addition to elsewhere Adoption Spread Mainstreaming Time Remote care adoption Growth in remote care users in Engl in addition to with many assumptions Source: Based on CQC returns, JIT (Scotl in addition to ) data, in addition to authors’ research as long as WAG. Includes LA in addition to other agency services. Assumes 30% drop-out rate each year With Scotl in addition to & Wales Assumes 15,000 remote care users (2005) in addition to 5000 users (2000)

Geographical spread Source: Based on CQC returns. Per 10,000 population. Includes LA in addition to other agency services. Another approach – how big is the potential market Source: based on CQC returns, JIT (Scotl in addition to ) data, in addition to authors’ research as long as WAG. Telehealth figures from Minutes of the Strategic Intelligence Monitor on Personal Health Systems [SIMPHS] meeting, Brussels, 17-18 November 2009. Assumptions: UK population aged 75+ rises from 4.9m (2010) today to 11.4m by 2050 c85% of older people wish to remain at home as long as possible 1/3 needs remote care at any given time

Dealing with this ‘perfect storm’ will need innovative healthcare business models New configurations of services, technology in addition to infrastructure Key factors in moving towards a mainstream adoption Adoption Spread Mainstreaming Time Remote care adoption STAGE The adoption – implementation journey organisational roles need to evolve to reflect the needs of each stage

The dangers of champions The champion’s identity – in contrast to traditional thinking – can cause knowledge to stick within boundaries Very high identification with the work – any change to this role seen as a threat Can cause dysfunctional rigidities to settle within sub-groups Help to sustain a culture of remote care ‘pilot necessity’ Both too much in addition to too little identification is detrimental to strategic change outcomes “(they) have gone off in addition to done their own little thing in addition to no one else really knows about it. To be honest they like to hold on to their own little kingdoms.” “Sometime you have to be a lion, in addition to kill the little cuddle animals. As I’ve said I won’t be cowed down to their bureaucracy, it’s my way or the high way. Top management, suddenly they want a h in addition to in this, but I’m telling you I am here to decide. This is not a job; this is my life .” The dangers of pilots Embedding new practice – within the remit of a small enthusiastic group Creates group distinctiveness in addition to rivalries Lack of scalability Normalising practices, lessons not transferrable 25 to 5,000 The integration in addition to redesign of existing models needs to be integral from inception ‘The fade away’ = loss of engagement The dangers of RCTs as long as complex innovations WSD clue in the title 3 sites with contextual differences charged with demonstrating WS integration in addition to service redesign Constraints of the trial required differences in local processes be flattened Robust evidence – at what cost Unresolved issues of ownership in addition to identity after the WSD trial ends

Mainstream implementation will need New rules about governance New types of ownership New types of identity (patient & professional) Different cultural attitudes to self care Blockers towards mainstreaming Current lack of integration within in addition to between care providers from acute, primary in addition to social care services Distribution of costs in addition to benefits across the system For scaling-up you need more than enthusiasts or champions, or organisational or financial support: Benefits evidence in addition to a business case are essential but these must also be scalable So finally I can reveal the solution to mainstreaming remote care

WSD legacy Huge success – enabled remote care to be delivered to thous in addition to s of people in addition to their carers in addition to roll-out will continue With additional thanks to: Charitini Stavropoulou Sarah Jasim

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