1. Management challenges and strategies: Unit M4

2. 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

3. Infrastructure and technology Benefits realisation and evaluation Resourcing and procurement Workforce and education Service requirements M4/2 Managing Change

4. Roles and responsibilities Commissioner 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

5. 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

6. Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation

7. 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

8. Confirming scope/recognising benefit M4/6

9. Confirming scope/recognising benefit M4/7

10. Confirming scope/recognising benefit M4/8

11. 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

12. Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation M4/9

13. 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

14. Managing change M4/10

15. The diffusion of innovation and ‘the chasm’ (Moore/Rogers) M4/11

16. 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 Innovations M4/12

17. M4/14

18. The process of delivering change (Kotter) M4/13

19. Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation M4/15

20. Service Specification M4/16

21. Service Design Slide content courtesy of M4/17

22. Service Operation C4/11

23. Selecting a patient population Telehealth patients Risk stratification Impactibility assessment Based on Lewis (2010) C4/12

24. Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation M4/19

25. Technology, Interoperability and Governance M4/20

26. “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

27. Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation M4/22

28. Workforce and Education M4/23

29. Its something about confidence and responsibility M4/24

30. Users and Carers M4/26

31. Communication M4/27

32. Pilot to Scale TO M4/28

33. Managing Process Project Management Framework: Specify (Scope and Scale of the Objectives) Resource Manage, Monitor, Report Programme Office Benefits Realisation Evaluation Managing Culture Leadership Vision Goals Enablers Normalisation Communication and Engagement Knowing your Audience Champions The Power of a Good Story Retell, Refresh and Regalvanise M4/29

34. M4/30