title: Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study.
abstract: This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal.
  
  
  
  Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model.
  
  
  
  19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice.
  
  
  
  The implementation of home telehealth services is still in an early stage. Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems. This should assist health leaders to move from trials to large-scale services.
authors.affiliation: Discipline of General Practice, The University of Adelaide, North Tce., Adelaide, 5005, Australia. victoria.wade@adelaide.edu.au.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Wade
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Taylor
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kidd
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia.
authors.forename: Colin
authors.initials: C
authors.lastname: Carati
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003299:Cooperative Behavior; D006291:Health Policy; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008389:Marketing of Health Services; D010166:Palliative Care / Q000458:organization & administration; D010342:Patient Acceptance of Health Care; D010549:Personal Satisfaction; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D017216:Telemedicine / Q000458:organization & administration*; D000069341:Transitional Care / Q000458:organization & administration
keywords: Change management; Deliberative forum; Home telehealth; Models of care; Qualitative study; Sustainability