Steps to setting up a new Telesolutions service
It is recommended that technology change agents create clear clinical leadership around telehealth, supported by 'clinical advocates' and champions. These new service delivery processes require new ways of thinking and delivering services which breaks with traditional routines. Taking time out to redesign pathways needs upfront investment and involves backfilling and logistics to get everyone together. Furthermore, local capacity for change management support is often limited and external support may be required.
It is important to design and plan your service change carefully so that you can collect evidence, monitor changes and know every aspect of the process. The Teleswallowing projects in Blackpool formulated a five-step checklist which can be followed to ensure the successful design, development and delivery of a Telesolution to a clinical dilemma:
For successful delivery of clinical telesolutions, the following sequence (in this order) should be considered:
The importance of care pathway design is critical to the successful implementation of any telesolution, without which there is a danger that the technological solution will become a bolt-on rather than a trigger for larger scale service redesign. Given the current challenge of growing numbers of the population developing long term conditions, it is no longer an option simply to continue delivering the current model, the cost of which is becoming unsustainable. Failure to redesign will only add additional costs and will not deliver better patient outcomes.
Design - it's important to consider all elements of the project and ensure they are written down in a format which can be monitored for example with a Gantt Chart.
Develop - as the project starts, you may have to consider adjustments and changes, bearing in mind how these changes impact on your timeline and budget. To achieve success, it is imperative to stick to the purpose that you have written down in your design document which will keep you to your target if circumstances change. If dedicated, ring-fenced project time away from clinical work is involved, you will need to adhere to this rigourously or colleagues will try to pull you back into clinical work to cover shifts, holidays etc. if they do not see the value of your work to the whole team. Keep colleagues informed and involved so they maintain ownership of the change and work with you. Put first things first; if this project is going to deliver better service, cost efficiencies in the longer term, then you must deliver the actions in the short term to achieve the results you want. Look for synergistic opportunities to develop the project with others so that the whole process becomes easier for everyone. Do not underestimate the personal traits of perserverance and focus which will be needed to press on in the face of entrenched views and unwillingness to change.
Deliver - "begin with the end in mind" (Stephen Covey) i.e. what you want to see at the end of the process, and reverse engineer the actions. Written evaluations and a robust process of dissemination are pivotal to changes being understood, scaled up and implemented by others.
Technology support - pivotal in helping manage and sustain compliance to new ways of working. Any technology enabled project can only benefit from the continued expertise and support of the clinician's IT Project Management Team and the commitment of the clinician's IM&T Manager. It is recommended that close collaboration between clinical and IT departments is maintained and grown.