One of the Good Things of the Whole System Demonstrator (WSD) was that in addition to analysing the actual results, a group of researchers were assigned to look at the organisational processes employed in the implementation to see if there were lessons to be learned about how to implement telecare and telehealth. The researchers observed managers and practitioners in meetings, administered semi-structured interviews and document reviews. The results have just been reported (in provisional form) in BMC Health Services Research 2012, 12:403, 15th November. An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator (Abstract, with link to download the full, free PDF version).
In short, it confirms what many suspected from the beginning: the constraints of running an RTC (needed to produce robust benefits evidence) hindered the ability of the participants to share learning and to adapt and evolve in response to local conditions – processes which, one assumes, would have made the trial results even better!
At last we have an explanation of where the ‘whole system’ the Whole System Demonstrator was supposed to demonstrate, disappeared.
According to the study, apart from it being a vague aspiration from the start, the whole system concept fell apart early on when it was found too difficult to recruit into the study a significant number of people who required both telecare and telehealth technologies. Once the decision to drop this third cohort from the study had been made there was little incentive to join up the systems that were tending to the telecare and telehealth groups. Only in Cornwall, where both of these were less developed than in Newham and Kent, was some progress made in that direction. Furthermore, the requirements of the RTC actually inhibited budding organisational changes towards integration that may have otherwise developed during that time. Then, when the trial funding ended, the sites lost people who had been most closely involved and who therefore had valuable experience that could have been built upon.
A number of these lessons are, therefore, negative. Happily, the academic team has been evaluating other places where these constraints did not apply and which may offer some more positive lessons.
Do not just read the abstract. The full report rewards careful reading (despite some outrageously split infinitives and at least a couple of ‘comprise of’s which somehow eluded the authors, peer reviewers and journal proof readers. <sigh>)
For those reading the provisional paper (the third in the WSD series), you may also be interested in the WSDAN Paper which looked at sites not covered by the RCT.