management challenges and strategies: unit m4. learning outcomes by the end of this section, you...
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Management challenges and strategies: Unit M4
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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
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M4/2
Managing Change
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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
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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
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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
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Confirming scope/recognising benefit
M4/6
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Confirming scope/recognising benefit
M4/7
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Confirming scope/recognising benefit
M4/8
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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
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M4/9
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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
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Managing change
M4/10
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The diffusion of innovation and ‘the chasm’ (Moore/Rogers)
M4/11
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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
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M4/14
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The process of delivering change (Kotter)
M4/13
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M4/15
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Service Specification
M4/16
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Service Design
Slide content courtesy of
M4/17
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Service Operation
C4/11
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Selecting a patient population
Telehealth patients
Risk stratification
Impactibility assessment
Based on Lewis (2010)C4/12
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M4/19
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Technology, Interoperability and Governance
M4/20
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• “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
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M4/22
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Workforce and Education
M4/23
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Its something about confidence and responsibility
M4/24
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Users and Carers
M4/26
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Communication
M4/27
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Pilot to Scale
TO
M4/28
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M4/29
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M4/30