1. ImpleMentAll Midterm Workshop
10th October 2018
The Science and Practice of Implementation – Pathways to make your eHealth intervention stick
Bianca Albers
European Implementation Collaborative
Centre for Evidence and Implementation

2. Practice
Implementation = Systematic and active efforts to enhance and improve the integration of evidence in practice or policy
Intermediary
Policy
Science
Effective Interventions
Effective Implementation
Enabling Contexts =
Positive Outcome ✖️ ✖️
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

3. ImpleMentAll – G.A. 733025 Midterm Workshop
Key Messages
Implementation …..
…. is really that difficult?
… is a process not an event
Yes.
… requires readiness
Yep.
… depends on leadership
Indeed.
… calls for data
Correct.
… never stops
Absolutely!
ImpleMentAll – G.A Midterm Workshop
Odense, 10 October 2018

4. Stage your eHealth implementation
Exploration
Preparation
Implementation / beginning implementation
Sustainment / full implementation
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018
Albers et al., 2017

5. ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018
The eHealth reality
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

6. Check first: Are you really ready? R=MC2
Organisational Readiness
Component
M = Motivation
General Capacity
Innovation-Specific Capacity
Definition
‘… perceived incentives and disincentives that contribute to the desirability to use an innovation…’ (p. 486)
‘…attributes of a functioning organisation...’ (p. 486)
‘…the human, technical, and fiscal conditions that are important for successfully implementing a particular innovation with quality…’
(p. 487)
Influenced by
The innovation’s relative advantage, compatibility, complexity, trialability, observability, priority – as perceived by stakeholders
An organisation’s culture, climate, innovativeness, resource utilisation, leadership, structure, staff capacity
Innovation-specific knowledge, skills, abilities; program champion(s); specific implementation climate supports; inter-organisational relationships
Scaccia et al., 2016

7. The eHealth situation
Core readiness: Ability to identify needs / gaps and solutions
Engagement / buy-in readiness: Ability to engage all relevant stakeholders
Technological readiness: an organisation’s ability to meet technological requirements
IT skills readiness: Ability to train and learn
63 papers included
“… a myriad of constructs/readiness assessment factors …“
„… lack of reliable measuring tools for even the most commonly used constructs …“
Right hand box: Most mentioned

8. Lead your eHealth implementation
Proactive
Develop plan, remove obstacles, establish standards
Knowledgeable
Knowing the intervention = ability to represent, present, discuss it
Supportive
Recognising / appreciating / supporting efforts to learn and do
Perseverant
Carry on, continue, address problems, remove barriers
Aarons et al., 2016; Ehrhart et al., 2018
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

9. ImpleMentAll – G.A. 733025 Midterm Workshop
The eHealth situation
Communicate clear vision / goals
Provide leadership support
Establish a governance structure
Establish training
Identify and appoint champions
Address work process change
Continuously follow up
32 studies included – no MA. Moderate level of evidence for a positive association between leaders not only holding, but also effectively communicating, clear visions, goals, and outcomes
ImpleMentAll – G.A Midterm Workshop
Odense, 10 October 2018

10. Measure, monitor, assess ….
Feedback cycle based governance
P-D-S-A
Imp Team
Plan Do
Study
Act
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

11. ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018
The eHealth situation
„ ... eHealth interventions appear and change so quickly that they challenge the way we conduct research. By the time a randomized trial of a new intervention is published, technological improvements and clinical discoveries may make the intervention dated and unappealing. …”
„ ... Perhaps eHealth researchers need to think more like engineers, who tend to use the continuous improvement principle whereby every product is in a sense a beta version, that is, always the target of improvement and refinement ...“
The development of new technologies on the one hand and the ever changing needs of different populations on the other make it more important than ever to integrate CQI mechanisms into eHealth implementation. So consider ...
Baker et al., 2014
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

12. You’re in it for the long haul!
This is where I want to close the cycle and get back to my first point: This may never stop. Why not. Firstly, because your technology changes all the time. Secondlt because populations change. Thirdly because systems change. Therefore you will not get to a point where everything remains static - that is the relaity of implementation today.
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

13. ImpleMentAll – G.A. 733025 Midterm Workshop Odense, 10 October 2018
eHealth – a „new era“?
Granja et al. (2018)
Most mentioned success factor = Quality of healthcare (N=55)
Most mentioned failure factor = Costs (N=42)
Key requirement = work flow. Barriers:
Work load
Role definition
Undermining face-to-face communication
Workflow disruption
Alignment w/ clinical processes
Staff turnover
Granja et al.: Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature (N=221)
So if we then try to take the temparature on how eHealth implementation has been faring in recent years - what picture do we get?
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

14. EHealth Implementation Challenges
How do map and understand the specific contextual factors characterising eHealth (e.g. self-management)
How to enable rapid learning - before new technologies are obsolete?
How to establish a culture of strong user and patient involvement?
How to practically / pragmatically measure the use of eHealth interventions in real world services?
How to build our knowledge about some of the so far ‘neglected’ implementation outcomes (e.g. costs, sustainability)
ImpleMentAll – G.A Midterm Workshop Odense, 10 October 2018

15. ImpleMentAll – G.A. 733025 Midterm Workshop
So …..
Implementation …..
…. is really that difficult.
… is a process not an event
Got it.
… requires readiness
Check!
… depends on leadership
For sure.
… calls for data
Totally!
… never stops
All right then.
ImpleMentAll – G.A Midterm Workshop
Odense, 10 October 2018