Implementing Telecare
An overview

Quicklinks on this page:

Getting started
Planning to implement
Early implementation
Expanding
Integrating into mainstream service

Drawing on the evidence and experience from telecare and other change projects, this step-by-step guide provides a map which telecare project managers can use to plan / plot their telecare project activity.

Figure 1 shows that a successful project moves through progressive stages from the initial roll-out towards becoming integrated into mainstream operational services. Managing these different stages becomes progressively more complex, requiring more resources and greater management skills.

Getting started

Getting started is the initial phase, when the appropriate senior managers authorise the local project and assign staff to begin working on implementation. There is a need to gather information and identify who will be affected by the project. It is also recommended that they develop a clear statement commonly known as the project terms of reference. They also need to develop robust governance arrangements (e.g. a reporting structure for the project steering group) and begin to clarify the strategic vision – showing how the telecare project will add value and help meet the partnership’s strategic goals.

Although this may sound a cumbersome task, experience (gathered from the Telecare Review process during 2008) has shown that unless the strategic vision is clearly set out from the beginning, it can cause difficulties for the project further down the line – particularly when trying to secure long-term financial investment in the telecare service from key stakeholders. The strategic vision can be revisited during the project lifespan to take account of changing priorities / agendas within the partnership.

Planning to implement

The next step is to lay out in more detail how the project will be managed. This involves creating a project team and establishing some ground rules for how it will operate.

The team itself then needs to work on defining specific outcomes and measures of success – at least for the early stages of the project. The outcomes may have been set in broad terms by those who authorised the project – the team needs to make them more specific, and include measures of success (i.e. “how will we know when we’ve got there?”).

Finally the team needs to begin to develop a project plan, covering what needs to be done – (e.g. development of operating processes, technology procurement, etc) and how it will be done (e.g.. communication methods, training programme, and the resources required), lead roles and timescales for completion.

Early implementation

The most common approach has been to begin with a focused implementation – usually with the aim of gathering information and experience to inform the mainstream implementation of telecare. This increases the chances of successful mainstream implementation by enabling staff to develop skills and expertise in telecare. This is necessary because there is currently a limited market from which to buy in these skills and expertise.
Key early tasks for the project steering group and project team will be to:

decide on the focus of early implementation – e.g. which service user group, or geographic area.
identify staff resources to deliver early implementation project.
identify some baseline measures of present service provision which the project is likely to affect, e.g. number of people receiving home care packages over 10 hours per week; number of nights of respite care provided; number of admissions to care homes, etc.
identify what data will be gathered during and after project completion to monitor and evaluate the impact of the early implementation project. Agree reporting and review format and timescales.
carry out research into potential suppliers of elements of telecare service provision (telecare equipment, call handling, servicing and maintenance, call monitoring, response, etc) to inform decision making processes and procurement routes.

Expanding

If the evaluation of the early implementation project shows positive benefits, the project steering group may authorise the expansion of the project to other groups of users, or to a larger geographical area. This will increase not just the scale of the project, but also its nature. New and unfamiliar issues will arise, so although the early implementation project will offer valuable lessons, expansion will undoubtedly raise new challenges.

A business case may be needed to justify the expansion and the investment of resources required to deliver it. The business case will propose where the expansion should focus for maximum impact.
Technology will become more significant, as issues which probably did not present major difficulties in the early project may do so now as the service is set to expand – such as:
the formalities of procurement processes;
compatibility of equipment with existing equipment and systems;
equipment maintenance, storage, battery replacement and other asset management issues.
Larger numbers of staff will be involved in a more permanent way, therefore managers may have to deal with a range of Human Resources issues.
Care management processes including those for referrals, assessment, care planning and review may need to be re-designed. This may have implications for the financial resources required both in the short and long term.
Charging for services may need to be considered.
Managers will need to consider how they will gather the data required to evaluate the broader service development programme and to disseminate the lessons learned to inform future service development.

Integrating into mainstream service

The final step is when the decision is taken that telecare is no longer a distinctive project, but is to be embedded in mainstream service provision.

Many of the issues already addressed (especially technology, staffing and process re-design) are likely to arise again, but on a larger scale. There may also be new issues e.g. previously separate services or agencies have to begin to work more closely together, therefore roles and responsibilities need to be clarified. This step may also include exploring the potential for reorganisation or restructuring of services.

Where do I start?

Considering the work and issues that may arise during all five stages, the telecare project manager may well wonder ‘where do I start?’

This guide is intended to help partnerships and project teams to answer that question, by encouraging them to work in a logical way from the start to help to set the project moving in the right direction, which in turn should build the project team’s confidence that they can handle new or unexpected situations which may arise later in the project.

The guide includes advice based on the experiences of telecare projects within Scotland and elsewhere, however it obviously cannot cover every circumstance. As the national Telecare Programme continues to evolve, the Joint Improvement Team will continue to gather examples of telecare practice and resources which will be stored in the new Telecare Resource Bank so that local partnerships can access them as and when required.