ImpleMentAll Midterm Workshop 10th October 2018 The Science and Practice of Implementation – Pathways to make your eHealth intervention stick Bianca Albers European Implementation Collaborative Centre for Evidence and Implementation

Practice Implementation = Systematic and active efforts to enhance and improve the integration of evidence in practice or policy Intermediary Policy Science Effective Interventions Effective Implementation Enabling Contexts = Positive Outcome ✖️ ✖️ ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

ImpleMentAll – G.A. 733025 Midterm Workshop Key Messages Implementation ….. …. is really that difficult? … is a process not an event Yes. … requires readiness Yep. … depends on leadership Indeed. … calls for data Correct. … never stops Absolutely! ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

Stage your eHealth implementation Exploration Preparation Implementation / beginning implementation Sustainment / full implementation ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018 Albers et al., 2017

ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018 The eHealth reality ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

Check first: Are you really ready? R=MC2 Organisational Readiness Component M = Motivation General Capacity Innovation-Specific Capacity Definition ‘… perceived incentives and disincentives that contribute to the desirability to use an innovation…’ (p. 486) ‘…attributes of a functioning organisation...’ (p. 486) ‘…the human, technical, and fiscal conditions that are important for successfully implementing a particular innovation with quality…’ (p. 487) Influenced by The innovation’s relative advantage, compatibility, complexity, trialability, observability, priority – as perceived by stakeholders An organisation’s culture, climate, innovativeness, resource utilisation, leadership, structure, staff capacity Innovation-specific knowledge, skills, abilities; program champion(s); specific implementation climate supports; inter-organisational relationships Scaccia et al., 2016

The eHealth situation Core readiness: Ability to identify needs / gaps and solutions Engagement / buy-in readiness: Ability to engage all relevant stakeholders Technological readiness: an organisation’s ability to meet technological requirements IT skills readiness: Ability to train and learn 63 papers included “… a myriad of constructs/readiness assessment factors …“ „… lack of reliable measuring tools for even the most commonly used constructs …“ Right hand box: Most mentioned

Lead your eHealth implementation Proactive Develop plan, remove obstacles, establish standards Knowledgeable Knowing the intervention = ability to represent, present, discuss it Supportive Recognising / appreciating / supporting efforts to learn and do Perseverant Carry on, continue, address problems, remove barriers Aarons et al., 2016; Ehrhart et al., 2018 ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

ImpleMentAll – G.A. 733025 Midterm Workshop The eHealth situation Communicate clear vision / goals Provide leadership support Establish a governance structure Establish training Identify and appoint champions Address work process change Continuously follow up 32 studies included – no MA. Moderate level of evidence for a positive association between leaders not only holding, but also effectively communicating, clear visions, goals, and outcomes ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

Measure, monitor, assess …. Feedback cycle based governance P-D-S-A Imp Team Plan Do Study Act ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018 The eHealth situation „ ... eHealth interventions appear and change so quickly that they challenge the way we conduct research. By the time a randomized trial of a new intervention is published, technological improvements and clinical discoveries may make the intervention dated and unappealing. …” „ ... Perhaps eHealth researchers need to think more like engineers, who tend to use the continuous improvement principle whereby every product is in a sense a beta version, that is, always the target of improvement and refinement ...“ The development of new technologies on the one hand and the ever changing needs of different populations on the other make it more important than ever to integrate CQI mechanisms into eHealth implementation. So consider ... Baker et al., 2014 ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

You’re in it for the long haul! This is where I want to close the cycle and get back to my first point: This may never stop. Why not. Firstly, because your technology changes all the time. Secondlt because populations change. Thirdly because systems change. Therefore you will not get to a point where everything remains static - that is the relaity of implementation today. ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018 eHealth – a „new era“? Granja et al. (2018) Most mentioned success factor = Quality of healthcare (N=55) Most mentioned failure factor = Costs (N=42) Key requirement = work flow. Barriers: Work load Role definition Undermining face-to-face communication Workflow disruption Alignment w/ clinical processes Staff turnover Granja et al.: Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature (N=221) So if we then try to take the temparature on how eHealth implementation has been faring in recent years - what picture do we get? ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

EHealth Implementation Challenges How do map and understand the specific contextual factors characterising eHealth (e.g. self-management) How to enable rapid learning - before new technologies are obsolete? How to establish a culture of strong user and patient involvement? How to practically / pragmatically measure the use of eHealth interventions in real world services? How to build our knowledge about some of the so far ‘neglected’ implementation outcomes (e.g. costs, sustainability) ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018

ImpleMentAll – G.A. 733025 Midterm Workshop So ….. Implementation ….. …. is really that difficult. … is a process not an event Got it. … requires readiness Check! … depends on leadership For sure. … calls for data Totally! … never stops All right then. ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018