title: An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator.
abstract: BACKGROUND
  To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare).
  
  
  METHODS
  Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services.
  
  
  RESULTS
  The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT.
  
  
  CONCLUSIONS
  The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
authors.affiliation: University of Surrey, Department of Health Care Management and Policy, University of Surrey, Guildford, UK. j.hendy@surrey.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Hendy
authors.forename: Theopisti
authors.initials: T
authors.lastname: Chrysanthaki
authors.forename: James
authors.initials: J
authors.lastname: Barlow
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: Robert
authors.initials: R
authors.lastname: Bowen
authors.forename: Ray
authors.initials: R
authors.lastname: Fitzpatrick
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
authors.forename: Stanton
authors.initials: S
authors.lastname: Newman
mesh_terms: D004739:England; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care / Q000379:methods / Q000458:organization & administration; D019982:Organizational Case Studies; D009936:Organizational Innovation; D016730:Program Development; D036301:Qualitative Research; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*