Implementing Telecare
Plan for integration

By this stage most project teams will have considerable experience of managing service re-design supported by telecare. Successes in early stages should have encouraged senior management to approve a further extension of the project, with the aim of integrating it into mainstream service provision, e.g. linking with joint equipment stores, Single Shared Assessment & care case management processes, etc. All the essential project management skills set out in the earlier steps will still need to be applied – clarifying outcomes, identifying stakeholders, securing top management buy-in and all the rest – but to a larger and more complex task. Every situation will be different, but some new themes that are likely to arise during this stage are those of managing across organisational boundaries, clarifying roles and responsibilities of different agencies, resourcing and dealing with cultural differences and “politics” at a local level. This may be particularly applicable if telecare projects are considering broadening their scope to include “telehomemonitoring” (or remote health monitoring) and telehealth within the acute hospital and primary care settings.

Defining “mainstreaming”

There is no simple agreed definition of what a mainstream service is. Intuitively, a fully mainstreamed service would be one where there is wide agreement on the need for and value of the service, where relevant staff have a sound understanding of when it is appropriate to provide the service, where all necessary protocols and processes are fully defined, agreed and in place, where ongoing core funding is agreed and forward business plans fully take the service into account.

Mainstreaming is therefore multi facetted, and likely to be achieved over time rather than instantaneously, although there may well be some critical point at which future progress with mainstreaming becomes assured.

A new project

As with expansion, it is best to think of the work around integrating telecare into mainstream services as a new but much bigger project – so take the opportunity to revisit the activities of Chapter 2 and Chapter 3. It is as important now as then to ensure strategic leadership and governance of the expanded project, to develop and communicate a vision of the expected outcomes, and to write a new project terms of reference document. However these should be completely integrated with the strategic leadership and governance of the parent body/partnership, e.g community planning partnership.

Senior management may have changed, a new project lead may be required, and it is almost certain that there will be a need to strengthen or expand the project team to reflect the different challenges of integration, and the different stakeholders – especially as more of these will be from other services or agencies. Option would be to integrate the project team role into an existing joint planning structure.

The project lead should use the activities in Chapters 2 and 3 to organise their approach to this new task. That will help to ensure appropriate support from senior managers, by presenting a persuasive business case, and ensuring they realise the strategic implications of the integration of telecare into mainstream services that have been proposed.

Aspects of the expanded project plan

In developing a new project plan, as before the tasks should be set out as clearly as possible, stating who is responsible for them and a time-scale for completion. As well as incorporating any lessons learned from the expansion phase which will help the process, the project team is likely to face issues relating to:

  • Strategic leadership of the project, including steering groups
  • Strategy development – how they relate to other strategic agendas across the relevant agencies
  • Clarifying responsibilities – who does what within and between agencies
  • Managing cultural differences
  • Training programmes – identifying the skills and experience required for new ways of working
  • Communicating to raise awareness
  • Resources and their availability
  • Designing new operating processes and procedures
  • Procurement and maintenance
  • Monitoring and evaluation
  • Development of an exit strategy, for when mainstreaming has been achieved

The project lead should produce a report for partnership senior management outlining plans for integration, incorporating the lessons learned from the expansion phase, and the views of key stakeholders involved in mainstream service delivery. This information should be used to develop new Project Terms of Reference and Business Case.

Tool 20 outlines tips for mainstreaming as identified by the Angus Partnership as they move towards mainstreaming telecare within the partnership. The text is extracted from the JIT Factsheet – Integrating Telecare as a Mainstream Service.

Tool 20 – Key considerations when mainstreaming telecare in Angus

At a Telecare Learning Network event in November 2008, Angus Council outlined their experiences of working towards implementing telecare into mainstream services. The extracts below outline the key lessons learned that other partnerships could benefit from when beginning to plan for mainstreaming.

Angus Telecare Delivery Structure

The delivery structure for telecare in Angus broadly works like this:

The Angus partnership has identified that telecare project managers need to be clear how to enthuse and motivate their key stakeholders to persuade them to become involved. There may be a fear of failure or costs and lengthy timescales associated with transition. These need to be addressed to secure buy-in and commitment.

Maintaining Momentum

The partnership recommends that the following activities be adopted to maintain the momentum around telecare projects / programmes:

  • Prove the technology works
  • Overcome the fear of intrusion
  • Prove the benefits of technology (need the evidence)
  • Demonstrate the added value of using telecare
  • Talk it up – need to keep it in local consciousness
  • Link it to outcomes
  • Link it to efficiency and value for money
  • Use real life examples (case studies) to illustrate

In summary, the following key elements are of prime importance:

  • Using ‘the elephant in the room’ – ageing and dependency. Be aware of it and use it. Fundamental strides need to be taken to redesign services and telecare can play an important role in this.
  • Persistent leadership is essential!
  • Financial constraints should be seen as an opportunity for telecare. Look for ways to demonstrate value for money and efficiencies.
  • Outcomes – telecare can demonstrate a real impact on outcomes for service users/carers/systems.
  • There is a vested interest for most of us in making this happen for ourselves – use this with others.
  • The benefits may be several years off, but they will come!

Mainstreaming Telecare

Angus has a population of around 21,500 people over 65, and there are around 4,200 community alarm users. Angus already uses a wide range of telecare equipment, but have deployed this in ways which target specific local issues.

  • Looking at addressing social isolation through the creation of virtual sheltered housing models.
  • Justifying services in smaller villages is problematic but enabling access via nurse led virtual clinics to address this.
  • Developing intermediate care within a home environment.
  • Deploying technology to support self care for people with long term conditions.
  • Creative approaches to training – Need a clear vision to drive this forward, but have provided demonstration flats as an opportunity for front line staff to play with equipment and understand how it fits into care planning. Angus have adopted a ‘case-based training’ approach which looks at how telecare can impact on individual situations and use this to inform others.
  • Safety and Security application to protect the most vulnerable by installing bogus caller buttons as part of ‘No Cold Calling Zones‘. Microphones are installed close to door, so that doorstep conversations can be recorded and potentially used as evidence. This approach involves the police and community safety colleagues.
  • Domestic Violence – telecare is used to alert police via call centre of any incidents or concerns.

In considering ‘What is mainstreaming?’ i.e. when does an initiative become mainstream and what is essential to make that change, the partnership felt that for telecare this will require a huge shift in perceptions about tasks and roles.

Angus has taken time to get to where they are at now, but they consider that this preparation has been worth it. Their experience so far has suggested that four key things were instrumental in moving them forwards:

1. Get a Champion

The first telecare champion for Angus was Gordon Peterkin, GP, who went on to become the Director of the Scottish Centre for Telehealth! They have also benefited from the interest and involvement of a colleague in Environmental Health, who was keen to use telecare as part of their approach for community safety. According to the partnership, the ideal ’person specification’ for a local telecare champion is:

  • They should be a generalist, not a techie – as fundamentally telecare needs to be about people not technology.
  • They need to be able to think both strategically and operationally.
  • They should be (trusted) risk takers, who have had some success in managing complex change in the past.
  • They should have a ‘Seat at the Table’ (linked to the project team / steering group) and be a voice which is listened to.
  • They need to be outcomes-focused – for service users and staff and need to understand what it is like to deliver a service.
  • And they need to have a long term vision and be a patient persuader.

2. Communicate

Good communication is important, and there is a need to use different approaches and mechanisms to integrate telecare within local systems. We all speak different professional languages so there is a need to make analogies that make sense to person that you are trying to persuade. We also need to think through what any change will mean to front line staff and explain it to them in a way that they will support and relate to.

The use of stories / case studies to illustrate points has been really useful. Also don’t underestimate the importance of the written document, so get the use of telecare written into key strategy documents to secure commitment and interest.

3. Why? Or Why Not?

  • A focus on outcomes is critical and using the voice of service users/carers and staff is persuasive.
  • Interrogate the existing system to identify where changes can be best made – ask “why?” seven times minimum! Very useful to map existing processes and pathways to understand barriers and opportunities.
  • Need to challenge risk management models – ‘whose life is it anyway?’.
  • Important to get operational staff involved from the start to be clear how it can fit in. The ‘case-based training’ approach has been found to be very useful for this.

4. Model the Impacts

  • Models need to be set up to be able to demonstrate the impacts on the whole system locally and not just for community care partners.
  • Need to be clear and be able to demonstrate how telecare links in with the wider strategic agendas around efficiencies and community safety.
  • Try and model what the impacts are, and costs saved/avoided. These will be great levers for investment in times of budgetary pressures.
  • The softer outcomes are also critical and you need to be able to demonstrate beneficial outcomes for service users and carers.
  • Make the links to Single Outcome Agreements – strategic vision for those who need care in the community. Needs to be represented in a strategic document.

Practice examples and further information

Links to examples of related documents produced by telecare partnerships from across Scotland and the UK and further information can be found in the Telecare Resource Bank, including:-

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