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Transformation in practice: an exploration of large scale implementation of Telehealth
in Bristol
Siân Jones, Bristol CCG, Jen Tomkinson, Bristol Community Health
& Paul Hitchcock, Safe Patient Systems
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A tale….
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Why Telehealth? Foundations for the future Care closer to home Ambition Innovation Cost
Evidence base Whole System
Demonstrator Knowledge/experience
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Our intentions• Method
– Collaborative partnerships• Aim
– Deliver a service at scale: NOT a pilot– Service redesign underpinned by telehealth
• Outcome– Reduce unplanned admissions & GP contacts,
increase community staff productivity and patient empowerment
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In reality…
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The bumpy ride…
CHALLENGES
PATIENT RECRUITMENT
APPROACH
STAFF
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ChallengesAPPROACH STAFF RECRUITMENTProject structurePeriod of impactLearning/experienceCultures
Community Services: organisational restructuringAnxiety of change: technology; workload; paternalistic careLanguage External factors/ influencesBehaviours
Detailed criteriaFear of increasing workloadPrimary CareChallenging targetsPotential patient ‘stagnation’
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What we did…APPROACH STAFF PATIENT
RECRUITMENT
Move from deployment (numbers) to supportive care (selection)
Champion Community Matron role
Telehealth Support Team
Rapid Learning Group
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Telehealth evaluation 2014 suggests…• Patients
– Positive experience: ‘reassuring’ ,’peace of mind’ – LTC6 (empowerment): 91% confident in managing their condition pre
telehealth, 100% post telehealth• Nurses
– Positive experience: working differently – Nurse phone contacts: 40% reduction (within 30 days)– Nurse visits to patients: 18% reduction (within 30 days)– Overall contact: 26% reduction
• GP practice– Calls to GP practice: 83% reduction– Visits to GP practice: 57% reduction
• Activity– Unplanned admissions COPD: overall statistical significant reduction
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Learning & critical success recommendations
• Not about deployment! • Readiness for change• Scale of change – incremental implementation• Clinical champions• Assessment of benefit and readiness for ‘discharge’• Expectations: staff and patients• GP practice: incentives, communication, engagement
APPROACH STAFF PATIENT RECRUITMENT
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Charging forward…• >1000 patients selected for Telehealth over 3 years• >450 currently live• 12 month extension• Resource for evaluation • Service evaluation – University of Bristol• Self Care Strategy – profile
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Contacts• [email protected]• [email protected]• [email protected]