Delivering Assisted Living Lifestyles at Scale (dallas) – What Can We Learn About Implementation From A Large Scale Deployment?
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Abstract
Background
Four service-led consortia in the UK have received funding (£37 million) to promote health and wellbeing using innovative service models and new technologies. The dallas programme is ambitious and aims to enrol circa 160,000 individuals. However, we know that the translation of innovation into practice remains slow and patchy internationally, even when there is strong evidence that implementing a given technology would be beneficial. The European Union has identified problems relating to “implementation†as a key barrier to the routinisation of new technologies to promote health and wellbeing.
Objective
The aim of our evaluation is to identify key barriers and facilitators to the large scale deployment of a range of innovative services and technologies across the UK.
Methods
Qualitative interviews are being undertaken with key stakeholders involved in the roll out of dallas across the four communities: Living It Up ; Mi ; I Focus; and Year Zero. Each of these communities represent partnerships between private firms; the voluntary sector; and three also involve health and social care organisations. They aim to enhance health and wellbeing through a range of diverse interventions developed in collaboration with members of their local communities. All interviews are being audiotaped and transcribed to provide data for framework analysis. Normalisation Process Theory (NPT), which has four constructs (coherence, cognitive participation (achieving buy-in), operationalisation and appraisal), aims to aid understanding of implementation issues, is providing the conceptual underpinning to our work.
Results
Thus far 17 interviews have been undertaken with project leads or managers, clinical staff, and representatives from participating industry partners from each of the four communities: Living it Up (n=3); Mi (n=5); I-focus (n=3); Year Zero (n=6). Coherence: A key facilitator of implementation is that the aims of dallas are “entirely compatible†with national policy. More challenging has been dealing with the “interpretation of that policy at practice levelâ€. Achieving Buy In: Commissioning care groups and other local decision-makers have accepted dallas interventions as a key feature of local strategies, which facilitates change, but recent changes in care structures within England have proven a challenge. Operationalising New Services: Consumers are finding new systems “pretty damn easy to use†which is a facilitator to uptake but differences in culture and perspective between supplier companies and local health service providers has proven a major challenge as has financial constraints. Appraisal: Initial reports suggest that individuals using new services have “loved†them which is a clear driver but consenting to a range of different company terms and conditions as well as evaluation is seen as a potential barrier to uptake.
Conclusions
The implementation of dallas is still in the early phases. However, already key barriers and facilitators to implementation are visible. Such data is being shared between communities to enhance the likelihood of success. The dallas implementation story will provide key lessons for future large scale efforts at using new technologies to transform services on a national scale.
Four service-led consortia in the UK have received funding (£37 million) to promote health and wellbeing using innovative service models and new technologies. The dallas programme is ambitious and aims to enrol circa 160,000 individuals. However, we know that the translation of innovation into practice remains slow and patchy internationally, even when there is strong evidence that implementing a given technology would be beneficial. The European Union has identified problems relating to “implementation†as a key barrier to the routinisation of new technologies to promote health and wellbeing.
Objective
The aim of our evaluation is to identify key barriers and facilitators to the large scale deployment of a range of innovative services and technologies across the UK.
Methods
Qualitative interviews are being undertaken with key stakeholders involved in the roll out of dallas across the four communities: Living It Up ; Mi ; I Focus; and Year Zero. Each of these communities represent partnerships between private firms; the voluntary sector; and three also involve health and social care organisations. They aim to enhance health and wellbeing through a range of diverse interventions developed in collaboration with members of their local communities. All interviews are being audiotaped and transcribed to provide data for framework analysis. Normalisation Process Theory (NPT), which has four constructs (coherence, cognitive participation (achieving buy-in), operationalisation and appraisal), aims to aid understanding of implementation issues, is providing the conceptual underpinning to our work.
Results
Thus far 17 interviews have been undertaken with project leads or managers, clinical staff, and representatives from participating industry partners from each of the four communities: Living it Up (n=3); Mi (n=5); I-focus (n=3); Year Zero (n=6). Coherence: A key facilitator of implementation is that the aims of dallas are “entirely compatible†with national policy. More challenging has been dealing with the “interpretation of that policy at practice levelâ€. Achieving Buy In: Commissioning care groups and other local decision-makers have accepted dallas interventions as a key feature of local strategies, which facilitates change, but recent changes in care structures within England have proven a challenge. Operationalising New Services: Consumers are finding new systems “pretty damn easy to use†which is a facilitator to uptake but differences in culture and perspective between supplier companies and local health service providers has proven a major challenge as has financial constraints. Appraisal: Initial reports suggest that individuals using new services have “loved†them which is a clear driver but consenting to a range of different company terms and conditions as well as evaluation is seen as a potential barrier to uptake.
Conclusions
The implementation of dallas is still in the early phases. However, already key barriers and facilitators to implementation are visible. Such data is being shared between communities to enhance the likelihood of success. The dallas implementation story will provide key lessons for future large scale efforts at using new technologies to transform services on a national scale.
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