Management challenges and strategies: Unit M4

Learning outcomes

• By the end of this section, you will be able to;– Identify the key management challenges

associated with telehealth– Discuss the steps necessary to ensure effective

commissioning, implementation and monitoring of telehealth services

– Apply change management theory to the adoption of telehealth services

M4/1

M4/2

Managing Change

Roles and responsibilitiesCommissioner• Vision• Needs assessment• Pathway redesign?• Principles for AT/Telehealth

deployment• Realising efficiencies at scale• Procurement frameworks &

advice• Governance• Assurance• Market making• Measures of

success/evaluation

Provider• Vision• Pathway redesign• Staff engagement• User/Carer engagement• Clinical leadership• Managing change• Education, training and

development• Resourcing –

human/financial• Procurement• Programme governance• Benefits realisation

M4/3

Do you haves?• Large numbers of face to face contacts with service users that are

not value added?• A dispersed geographical area with substantial distances between

clinical contacts?• Remote clinical decisions being made with imperfect information?• A percentage of patients who could be discharged more quickly

from hospital with a reablement or rapid discharge package that includes advice, support , vital signs monitoring?

• A significant level of sub-optimal care or professional isolation in the nursing and residential home sector?

• Sufficient numbers of catalysts within the system to spur greater integrated working practices?

• Large numbers of admissions in ambulatory care sensitive conditions?

• Potential for greater ability of patients/carers to self care? M4/4

The statement of requirements for Telehealth

• The national policy imperatives • Taking an “ideal” candidate perspective• Taking a workforce efficiency perspective• Taking a quality perspective• Taking an “ideal” service model perspective• Taking a “common purpose” perspective• Taking a participation perspective

M4/5

Confirming scope/recognising benefit

M4/6

Confirming scope/recognising benefit

M4/7

Confirming scope/recognising benefit

M4/8

Acute Trusts • Bringing emergency admissions below the 30% tariff baseline• Reducing <30-day readmissions, LoS and total bed days• Ability to release cash savings by allowing reduction in bed base

Commissioners (including CCGs) 

• Reduction in hospital admissions (not including <30-day readmissions)• Reduction in 999 calls, ED attendances and out-patient appointments• Reduction in out-patient appointments• Reduced transport costs

Community care providers 

• Reduction in need for face-to-face community visits• Increased productivity (e.g. higher caseloads)• Reduced transport costs

General Practitioners

• Reduction in GP appointments by reducing demand• Enhanced quality of care (links to QOF) • Reduced practice workload

Local authorities • Reduced need for residential care• Reduction of domiciliary care requirements• Promotes user independence and supports informal carers

Patients/Carers 

• Increased insight into condition and self-management behaviour• Ability to engage with other patients in an informed way • Reduced anxiety• Increased freedom and flexibility

M4/9

Change in practice

• Think of a recent change introduced in your workplace (either by you or someone else)– Was the introduction of change successful?– What worked in its favour?– What worked against it?– Did people resist change? Why? How was this

overcome?

C4/5

Managing change

M4/10

The diffusion of innovation and ‘the chasm’ (Moore/Rogers)

M4/11

Factors that influence adoption

• Relative advantage– Is it better than we already do?

• Compatibility– does it fit with current processes?

• Simplicity– How easy (or difficult) is it to use?

• Trialability: – Can it be tested easily?

• Observability– Can others see the benefits of using it?

Rogers: Diffusion of InnovationsM4/12

M4/14

The process of delivering change (Kotter)

M4/13

M4/15

Service Specification

M4/16

Service Design

Slide content courtesy of

M4/17

Service Operation

C4/11

Selecting a patient population

Telehealth patients

Risk stratification

Impactibility assessment

Based on Lewis (2010)C4/12

M4/19

Technology, Interoperability and Governance

M4/20

• “Information Governance (IG) is about setting a high standard for the handling of information and giving organisations the tools to achieve that standard” (Connecting for Health)

• Considerations when using telehealth are;– Data confidentiality– Information security– Security of transmission– Records management

M4/21

Information governance

M4/22

Workforce and Education

M4/23

Its something about confidence and responsibility

M4/24

Users and Carers

M4/26

Communication

M4/27

Pilot to Scale

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M4/28

M4/29

M4/30