The work of the Cumbrian Centre for Health Technologies (CaCHeT) at University of Cumbria. Elaine Bidmead

Transcription

1 The work of the Cumbrian Centre for Health Technologies (CaCHeT) at University of Cumbria Elaine Bidmead

2 The Cumbrian Centre for Health Technologies (CaCHeT) Was established in 2012 to develop and promote digital technologies to improve health and wellbeing, with applications especially to rural, dispersed communities and ageing populations. We are a multi-disciplinary team situated in the department of Health Psychology and Social Studies We focus on technology adoption and technology translation models for digital technologies in health and social care. We are interested in understanding the barriers to and enablers of adoption of digital technology in health and social care, facilitating user engagement in service design, and understanding how to monitor and measure success for appropriate decision-making.

3 Technology Adoption Issues in Telehealth:- Evidence based medicine and the highly structured regulatory system that protects us from risks mean that many good innovations get stuck in the pilot/evaluation stage and never become adopted as mainstream services. There are particular problems with telehealth. The technology is mature in other domains, but often has short product lifecycles, so that a conventional RCT approach simply takes too long Most telehealth innovations do not alter practice, rather they facilitate a different way of delivering a practice The users are not just healthcare staff but also include patients and service users (or their families), so the stakeholder group is complex and there is often more than one professional group, or healthcare organisation involved.

4 The Stakeholder Empowered Adoption Model University of Cumbria The model provides a process for stakeholder values, benefits and goals to be incorporated into an evaluative pilot so that appropriate evidence is collected to enable adoption to take place.

5 Using the StEAM Model in Practice:- StEAM provides a rigorous academic framework to perform an objective analysis of stakeholder needs. Within the model, there is a process for working alongside stakeholders before, during and after a pilot to ensure that the benefits and appropriate evidence is available to each of the decision makers. Key to the process is a focus on implementation, with an iterative and action based approach to evaluation. Case studies have identified some of the barriers to adoption of successful pilots.

6 StEAM Telehealth Adoption studies: Teleswallowing An adoption study for Blackpool Hospital of an innovation using video technology to undertake swallowing assessments with nursing home residents Renal telemedicine An adoption study for Royal Preston Hospital of an innovation using video technology to support home haemodialysis Patients Know Best An adoption study of a project using electronic patient controlled records to support self management in patients with inflammatory bowel disease. Fetal telemedicine - A study of clinical stakeholder acceptance of using video for joint fetal sonography consultations between West Cumberland Hospital and Newcastle Fetal Medicine Unit

7 What are the barriers to adoption? Let us take a few minutes to consider What stops good interventions being adopted?

8 Barriers to adoption - What the literature says Poor functionality of technology (Brewster et al, 2013; Buck, 2009; Odeh et al, 2014; Taylor et al, 2015; Vuononvirta et al, 2011). Readiness, for example: poor implementation processes and unresolved problems (Taylor et al, 2015:328). Digital innovations being bolted on rather than integrated (Taylor et al, 2015; Vuononvirta et al, 2011; Wade et al, 2010). Lack of recurrent funding (Joseph et al, 2010; Odeh et al, 2014; Taylor et al, 2015; Wade et al, 2010) and funding for service re-design is a barrier to integration (Taylor et al, 2015:333). Lack of Staff acceptance (Brewster et al, 2013; Buck, 2009; Segar et al, 2013; Taylor et al, 2015; Vuononvirta et al, 2009).

9 Lack of staff acceptance Staff perceptions of benefits and usefulness Lack of ability and/or confidence in using technology Compatibility with established/routine practices Staff autonomy, credibility and professional identity Impact on workload and staff capacity Requirement to work with others in ways that are at variance with accustomed divisions of labour

10 CaCHeT Case Studies Teleswallowing Was an innovation designed by Blackpool Speech and Language Therapy Department to enable remote swallowing assessment of dysphagic patients resident in nursing homes It was a response to the growing demand on Speech and Language Therapy departments for swallowing assessments The innovation was initially piloted in three nursing homes and was evaluated as successful in April Was expanded to five further nursing homes in October 2014 and was again evaluated as successful in by CaCHeT Bidmead, E., Reid, T., Marshall, A. and Southern, V. (2015)," Teleswallowing : a case study of remote swallowing assessment", Clinical Governance: An International Journal. 20(3) pp

11 The Benefits of Teleswallowing:- Upskilled Staff in Nursing Homes Quicker Assessment Avoidance of serious problems and hospital admission Less distress for residents and improved quality of life Benefits of not having to attend outpatient appointments Freeing up speech and language therapists time Prestige for participating nursing homes.

12 It gives us access to a service quickly that s needed quickly, that people don t recognise further up the management chain, if you ve got a 6 week wait for this sort of service that can be the difference between life and death. So, for us to be able to have a service that we can now access, quickly, timely... It s a win win situation where you get the service that you need, when you need it and the difference it makes to our patients is huge (Matron4).

13 Barriers to adoption Technological Problems Technological problems were the main perceived barrier to adoption; o It was not so much the technology but people s ability to deal with the technology that presented the barrier o The presence of small niggling problems did little to dispel negative attitudes o It was apparent that the technology had not been sufficiently tested before going live due to a delayed start to the project Consequently: Small problems impacted for longer than was necessary Negative experiences of technology reduced confidence in the innovation itself

14 Barriers to adoption Therapists Acceptability The delayed start and problems with technology resulted in fewer opportunities for therapists to experience and become skilled in remote assessments. Speech and language therapists were concerned about their workplace identity, they enjoy patient contact and do not welcome the prospect of being stuck behind a computer all day. I guess negatively, and this is something that I love about my job, that you go in and you have that interaction with somebody so it was quite hard It s not the same interaction as me being in the room, you know I really like my patients and I really like having that interaction with them, winning them over and having a bit of a giggle with them and doing a thorough assessment (SLT2).

15 Barriers to adoption Lack of perceived benefits The project took place against a backdrop of major staff shortages and pressures on the Speech and Language Therapy team Waiting times were going up rather than down meaning that any time savings were quickly used up and so were not felt by SLTs Therapists felt too under pressure to take on new ways of working and having to deal with tools they did not understand

16 CaCHeT Case Studies Fetal Telemedicine Pilot of Remote ultrasound consultation between West Cumberland Hospital (WCH) and the Fetal Medicine Unit (FMU) in Newcastle (AHSN NENC funded) Women being referred for outpatient appointments at the FMU are required to travel long distances and often at their own expense. The main aim of the project was to improve services to women in Cumbria by opening up access to expertise at a distance.

17 Findings Benefits to service users Convenience for women from being seen locally quicker and cheaper Improved relationships with WCH and staff Improved access to specialist fetal medicine Better case management for women with complex pregnancies

18 Benefits For WCH Participating sonographers have access to specialist support are upskilled, able to undertake advanced scans and interpret images better feel more involved in women s journeys find work more interesting and challenging

19 The fact that we re actually there while they re doing the scan, particularly if it is an abnormality, we never got a lot of feedback, we had to actually go and search to see what was the outcome if they d been to fetal medicine; we never got anything back. So from that point of view I think yes we re getting a bit more involved and we re actually saying well I found this and they re agreeing that that s what I think it is I like that aspect, knowing that I ve found this and they ve agreed with what I ve said and then I find out how they re going to treat the patient and what pathway for the baby. So I do like that aspect of it, I feel we re more involved in the lady s pathway (Sonographer).

20 Benefits WCH cont. Consultants have increased access to specialist support and are better supported in managing complex pregnancy Obstetric management of high risk patients has improved and consultants have developed insight into managing complex pregnancies As staff are better supported and less isolated professionally there is an improved standard of care being delivered locally Potentially leading to increased patient satisfaction; improved reputation/ kudos for WCH; making WCH more attractive to potential employees.

21 For the trust, it s educational, reputational and I hope it might attract more sonographers into the service (Radiology). I think it s a good thing because we re maybe being a pioneer in this service. So I think it s good because we seem to get a lot of negative vibes so this will maybe give us a little bit of a lift because we ve had so much negative press I would hope that this would show ladies that there is things coming back to us and this is a pioneering project that started here (Sonographer).

22 Challenges to implementation IT - Connectivity Management/executive engagement took longer, and was more difficult, than expected. This was mainly due to staffing shortages at WCH

23 It had to do a lot with staffing levels and there were a lot of scanners on maternity leave at the time when we were trying to plan this and actually, right until the day we were starting there was a huge amount of resistance, particularly from the seniors in the radiology department It was just they felt pressurised because other things were having to be cancelled or there were longer waiting lists for, I don t know, musculoskeletal scans or whatever. So that was the problem (Consultant).

24 Challenges to implementation - Sonographers Delivering a shared consultation when used to working alone it s being watched Communication knowing when an image has been satisfactorily acquired; knowing when to move on The need to resist scanning intuitively:

25 Instead of thinking right, the baby s lying in that position, I need to go in this position to get what I need, we maybe shouldn t be doing that until they ask us but it s hard when you ve done it for so long, automatically gone to that position, to stop yourself doing it (Sonographer).

26 Fetal Telemedicine - conclusions Fetal telemedicine enhanced maternity provision at WCH and improved the management of complex pregnancy. Initial challenges were reported; these could have been major barriers to success; the ways in which staff responded to and overcame these challenges was admirable. Whilst the literature identifies staff acceptance as a barrier to adoption, tangible benefits are known enablers. In this instance the identification of early benefits for both patients and all grades of staff influenced their acceptance of fetal telemedicine. Fetal telemedicine continues and over 100 scans have been undertaken.

27 Teleswallowing - conclusions Teleswallowing enhanced provision to dysphagic residents in nursing homes Nonetheless, a host of challenges were reported and these became major barriers to successful adoption Teleswallowing continues, but it has not become embedded into practice nor has it been expanded; it is has not reached its potential The lack of tangible benefits for staff was a major barrier to adoption

28 SLTs benefit least There were clear benefits for nursing homes, nursing home staff and patients; all nursing home informants reported benefits. Such benefits were perceived as gains Alternatively, whilst SLTs were able to suggest potential benefits they had not felt these benefits. Nor were SLTs convinced of the usefulness of teleswallowing. SLTs experience of teleswallowing was perceived as loss rather than gain.

29 Therapist s thoughts about teleswallowing I think initially you come up with lots of thoughts, is the clarity of the picture going to be good enough? Are the staff going to be trained enough? Initially I think what would you call it? A kind of a letting go sort of thing, you know? Do I really want to let someone else be in charge of my swallow assessment? I want to be there and in control, it is, it s control isn t it? I felt, when it was explained to us, that I would be letting go of that control whereas that isn t actually the case at all (SLT2).

30 Observations Repetitiveness of barriers faced Lack of preparedness to overcome these barriers Lack of learning

31 Digital Health: Use of Technology in Health and Social Care Flexible modular programme linked to our practice development framework can build to MSc/PgDip/PgCert or modules can be standalone Blended learning, with classroom and distance learning elements and a work-based project Aimed at any practitioner, manager or commissioner with an interest in using digital technology in health and social care Starting in September

32 CACHET EXPERTISE IN THE DIGITAL HEALTH INNOVATION PROCESS Basic research Concept development Prototyping, proof of concept Feasibility testing, trials, pilots Proof of scalability Implementation

33 Any questions?