Factors affecting the implementation of a National Digital Health & Wellbeing Service at scale

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Implementation factors affecting the large-scale deployment of digital health and well-being technologies : a qualitative study of the initial phases of the ‘Living-It-Up’programme

Little is known about the factors which facilitate or impede the large-scale deployment of health and well-being consumer technologies. The Living-It-Up project is a large-scale digital intervention led by NHS 24, aiming to transform health and well-being services delivery throughout Scotland. We conducted a qualitative study of the factors affecting the implementation and deployment of the Living-It-Up services. We collected a range of data during the initial phase of deployment, including semi-structured interviews (N = 6); participant observation sessions (N = 5) and meetings with key stakeholders (N = 3). We used the Normalisation Process Theory as an explanatory framework to interpret the social processes at play during the initial phases of deployment.Initial findings illustrate that it is clear - and perhaps not surprising - that the size and diversity of the Living-It-Up consortium made implementation processes more complex within a 'multi-stakeholder' environment. To overcome these barriers, there is a need to clearly define roles, tasks and responsibilities among the consortium partners. Furthermore, varying levels of expectations and requirements, as well as diverse cultures and ways of working, must be effectively managed. Factors which facilitated implementation included extensive stakeholder engagement, such as co-design activities, which can contribute to an increased 'buy-in' from users in the long term. An important lesson from the Living-It-Up initiative is that attempting to co-design innovative digital services, but at the same time, recruiting large numbers of users is likely to generate conflicting implementation priorities which hinder - or at least substantially slow down - the effective rollout of services at scale.The deployment of Living-It-Up services is ongoing, but our results to date suggest that - in order to be successful - the roll-out of digital health and well-being technologies at scale requires a delicate and pragmatic trade-off between co-design activities, the development of innovative services and the efforts allocated to widespread marketing and recruitment initiatives

Implementing a national Scottish digital health & wellbeing service at scale : a qualitative study of stakeholders' views

Digital technologies are being used as part of international efforts to revolutionize healthcare in order to meet increasing demands such as the rising burden of chronic disease and ageing populations. In Scotland there is a government push towards a national service (Living It Up) as a single point of reference where citizens can access information, products and services to support their health and wellbeing. The aim of the study is to examine implementation issues including the challenges or facilitators which can help to sustain this intervention. We gathered data in three ways: a) participant observation to gain an understanding of LiU (N=16); b) in-depth interviews (N=21) with stakeholders involved in the process; and c) analysis of documentary evidence about the progress of the implementation (N=45). Barriers included the need to “work at risk” due to delays in financing, inadequate infrastructure and skill-set deficiencies, whilst facilitators included trusted relationships, champions and a push towards normalisation. The findings suggest that a Scottish ehealth service is achievable but identifies key considerations for future large scale initiatives

Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom

Background: Digital health has the potential to support care delivery for chronic illness. Despite positive evidence from localized implementations, new technologies have proven slow to become accepted, integrated, and routinized at scale.Objective: The aim of our study was to examine barriers and facilitators to implementation of digital health at scale through the evaluation of a £37m national digital health program: ‟Delivering Assisted Living Lifestyles at Scale” (dallas) from 2012-2015.Methods: The study was a longitudinal qualitative, multi-stakeholder, implementation study. The methods included interviews (n=125) with key implementers, focus groups with consumers and patients (n=7), project meetings (n=12), field work or observation in the communities (n=16), health professional survey responses (n=48), and cross program documentary evidence on implementation (n=215). We used a sociological theory called normalization process theory (NPT) and a longitudinal (3 years) qualitative framework analysis approach. This work did not study a single intervention or population. Instead, we evaluated the processes (of designing and delivering digital health), and our outcomes were the identified barriers and facilitators to delivering and mainstreaming services and products within the mixed sector digital health ecosystem.Results: We identified three main levels of issues influencing readiness for digital health: macro (market, infrastructure, policy), meso (organizational), and micro (professional or public). Factors hindering implementation included: lack of information technology (IT) infrastructure, uncertainty around information governance, lack of incentives to prioritize interoperability, lack of precedence on accountability within the commercial sector, and a market perceived as difficult to navigate. Factors enabling implementation were: clinical endorsement, champions who promoted digital health, and public and professional willingness.Conclusions: Although there is receptiveness to digital health, barriers to mainstreaming remain. Our findings suggest greater investment in national and local infrastructure, implementation of guidelines for the safe and transparent use and assessment of digital health, incentivization of interoperability, and investment in upskilling of professionals and the public would help support the normalization of digital health. These findings will enable researchers, health care practitioners, and policy makers to understand the current landscape and the actions required in order to prepare the market and accelerate uptake, and use of digital health and wellness services in context and at scale

Delivering Innovative eHealth Services at Scale: Implementers’ Views on Achieving ‘Buy-In’

The Living It Up project (LiU) is part of a £37 million UK-wide programme entitled Delivering Assisted Living Lifestyles at Scale (dallas). LiU aims to empower the people of Scotland to improve their health and well-being whilst enhancing their quality of life through innovative interconnected technologies and services at scale. This study sets out to understand the experiences of 'implementers' and determine their views on the factors which can promote or inhibit successful implementation of a large-scale innovative eHealth deployment. N=6 semi-structured interviews have been conducted to date, and a further 12 are being conducted in order to capture how the views of implementers change over time. Normalisation Process Theory (NPT) is being used as the underpinning conceptual framework for the study. In this case-study, we focus on the NPT domain of 'Cognitive Participation'. Initial findings highlight the difficulty of innovating at scale. For example, it became clear throughout our interviews that 'co-designing' innovative products and services takes time. This means that 'polished' end-products are not available immediately which in turns makes it more difficult to sustain enthusiasm and engagement from co-design activities participants. Also, personal communication has been a key driver of enrolment. However, this approach is difficult to sustain at scale. Further follow up of the implementation journey will allow us to gain valuable insights into the barriers and facilitators in the deployment of large-scale eHealth initiatives

Evaluation of the Delivering Assisted Living Lifestyles at Scale – dallas programme. 24 months Interim Evaluation Report.

Evaluation of the Delivering Assisted Living Lifestyles at Scale – DALLAS programme. 24 months Interim Evaluation Report

Delivering Assisted Living Lifestyles at Scale –DALLAS programme. Final Evaluation Report.

Delivering assisted living lifestyles at scale – DALLAS programme. Final evaluation report

Delivering Assisted Living Lifestyles at Scale –DALLAS programme. Final Evaluation Report.

Delivering assisted living lifestyles at scale – DALLAS programme. Final evaluation report

Evaluation of the Delivering Assisted Living Lifestyles at Scale – dallas programme. 24 months Interim Evaluation Report.

Evaluation of the Delivering Assisted Living Lifestyles at Scale – DALLAS programme. 24 months Interim Evaluation Report

Large Scale Digital Health Deployments - How Ready Are We?: Lessons From the UK Delivering Assistive Living Lifestyles at Scale (dallas) Programme

Context: Digital health has great potential but has proven slow to become accepted, integrated and routinized at scale. Here we have examined factors affecting readiness to implement digital health at scale, through the evaluation of a national digital health and wellbeing programme called ‘Delivering Assisted Living Lifestyles at Scale’ (dallas, 2012-2015, $52M). Objective: To identify barriers and facilitators to digital health and to make recommendations about how to promote uptake of digital health. Design: Longitudinal (3 years) qualitative study involving Interviews (n=126) with key stakeholders; Focus groups (n= 7) with professionals/public using dallas services; dallas leads meetings (N=12); ethnographic field work/participant observation in one community (n=16); and cross programme documentary evidence (N=215) used to evaluate the implementation of the dallas programme. Normalisation Process Theory underlying conceptual framework. Framework approach to analysis. Setting: UK wide general population. Participants: Key stakeholders: health professionals, managers, IT staff, industry, voluntary sector, and the public. Results: Issues influencing readiness for digital health were noted at three levels: Macro (market; infrastructure; policy), Meso (organisational) and Micro (professional/public). Factors hindering implementation included: lack of IT infrastructure both locally and nationally; uncertainty around information governance; lack of incentives to prioritise interoperability; lack of precedence on accountability within commercial sector; a market perceived as difficult to navigate; inadequate implementation resources; low IT skills and access across users (professional and lay); and concerns surrounding security and safety. Factors enabling implementation included: clinical endorsement; digital health champions; and public and professional willingness to embrace digital health. Conclusions: There is receptiveness to digital health, but substantial barriers to widespread use remain. Recommendations include: greater investment in national and local infrastructure, implementation of clear systems for accreditation and quality assurance, incentivisation of interoperability, and investment in upskilling of professionals and public would help support normalisation of digital health