| Incentivising individuals to adopt the intervention |
Develop and distribute educational materials |
In line with findings stressing the importance of promoting the value of eHealth, materials (e.g. newsletter bulletins, flyers, social media posts and PowerPoint presentations) should be developed and circulated to potential sites to highlight the likely benefits that adopting the new way of working might have, to maximise engagement (e.g. to facilitate communication, improve care procedures, streamline workload). Comprehensive training materials should be developed and distributed to all users. These should be a mix of materials, including, for example, a glossary, FAQ'S, a training manual and pre-recorded training videos.
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| Identify and inform local opinion leaders and influencers |
This is a key part of the site recruitment strategy and relates to informing individuals who are ‘educationally influential’ about the intervention, encouraging them to influence others to adopt it. In England, this includes identifying representatives from the National Institute of Health and Care Research (NIHR) Clinical Research Network's (CRN), and the NIHR ENRICH (Enabling Research in Care Homes) network of ‘research ready' care homes, to help identify and recruit potential sites and care home forums. Contact with other multi-disciplinary team members who might be involved in using the Framework, including district nurses and local GP's.
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| Conduct educational outreach visits to encourage teamwide change |
Implementation requires a whole-team approach and a sense of shared responsibility. Once sites are identified, a meeting should be held initially with care home management to explain the purpose of the eHealth intervention, what participating in the study would entail for all staff members and what support can be provided. Time and consideration must also go into careful explanation of what the requirements and benefits of enacting the intervention would be to all remaining staff, for example, professional development and improved work processes, to encourage collective commitment to its use.
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| Involve residents and family members in the implementation effort |
Involving users and stakeholders prospectively throughout development of the intervention and implementation plan is key to ensure a sense of shared ownership, increase the credibility of the intervention and promote its uptake. Prioritising the needs and wants of the resident and involving their family members is a hallmark of good quality palliative care. Where possible, the person with dementia should be encouraged to be involved in all care decisions. To accommodate varying preferences regarding the extent to which family would like to be involved, levels of communication concerning the resident should be tailored to the preference of the family and clarified prior to implementation.
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| Access new funding |
Cost is a major barrier to implementing eHealth in care homes. This can be alleviated by providing reimbursement for care homes for staff time. Reimbursement should be offered for meetings with management to initiate site set-up, staff training and for any ongoing additional duties which will be required of them.
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| Ensure alignment with regional and national priorities, and regulations, for example, data sharing |
Implementation of the eHealth intervention will be facilitated if its aim is supported by external recommendations and acts to address regional and national priorities. Implementers should work closely with policy makers to ensure alignment of the intervention with current policy and guidance to enhance impact of the intervention, and synchronicity between the two should be promoted as part of the implementation plan. eHealth also needs to comply with national requirements to ensure it complies with, for example, GDPR and information sharing.
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| Ensuring individuals can enact the intervention |
Promote adaptability and tailor strategies |
Tailoring the intervention to the both the setting and user will be essential for its uptake and to optimise compatibility. To maximise adoption, sites should be encouraged to utilise the intervention in a way that is most compatible with their current practice and the individual residents, for example, regularity and timing of assessment, how information is communicated with families and external health care professionals. Flexibility of the intervention should be promoted, whilst being mindful of maintaining its fidelity.
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| Assess for readiness and identify barriers and facilitators |
A baseline assessment of each individual care home should be conducted so that the intervention can be tailored to the site's needs. Care home management should be met with in advance to ensure that they have sufficient resource to support the intervention, for example, bandwidth and tablets (which should be provided if not available); and to learn about their current routine practice, for example, arrangement with external health care professionals, communication routes, MDT meeting schedules and current training processes. Research readiness should be assessed prior to implementation using an appropriate measure, for example, the Holt Readiness for Organisational Change Tool,
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which measures features of the organisational context that might impact a care homes’ capacity to implement new ways of working, for example, leadership styles.
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| Remind practitioners |
Uptake of the intervention can be facilitated by introducing a reminder system designed to prompt users to initiate the intervention. Diarized reminders should be tailored to each resident dependent on need. Electronic alerts should notify either when an assessment should be initiated, or if a symptom or concern is identified in the assessment.
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| Identify and prepare champions |
Two or three staff ‘champions’ of varying grades and experience should be identified in each care home by the care home manager to drive implementation of the intervention, deliver training, monitor implementation and support other users. Certificates should be provided to recognise, value and incentivize participation in a champion role.
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| Conduct educational outreach visits |
Multiple methods should be used to ensure that sufficient training is provided for all users. Emphasis should be placed on the ability of training to benefit staff career progression, and empower them to escalate concerns. Where possible, training should be delivered to both health and social care workers together. Prior to implementation training and support will include:
A pack of training resources including a user-manual, a glossary and contact details to access technical support (phone number and email). At least one face-to-face interactive training session should be offered to all staff. A series of ‘bitesize’ instructional videos built into the app should also be provided, so they can be easily and regularly accessed. Further training should be delivered to two or three ‘champions’; individuals who have been identified to lead the intervention in the individual care setting, and drive it forward in absence of the research team. Certificates should be provided to staff on completion of training for personal development records.
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| Ensuring individuals sustain use of the intervention |
Audit and provide feedback on the impact of using the Framework |
Ongoing evaluation of progress is vital in order to appraise the impact that an intervention is having, and to ensure it is effectively embedded. Data should be collected and summarised over the implementation period and fed-back to staff, families and residents. Data should include usage of the app and any impact it is having on symptom management, quality of life measures and carer burden. This can be relayed in staff meetings, or via newsletters or email. Graphs depicting changes in measures, for example, resident symptoms over time should also be made available and circulated to stakeholders.
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Purposely and regularly re-examine and evaluate outcomes of the implementation and opportunities to strengthen use in clinical care |
Uptake of the intervention should be closely monitored over the implementation period, and strategies adjusted throughout the process to promote continuously its sustained use and improve the quality of care. Short weekly meetings with champions should take place to understand ongoing experience of using the intervention, to monitor implementation and identify and rectify problems. The implementation strategies should be reviewed regularly and refined, for example, if there a need for more education/training, if the adaptable component is working, if the reminders are occurring at sufficient frequency etc. Care records can be cross-referenced with app-usage data to infer if the intervention is leading to a change in care, for example, in medication, referrals to external services. Focus groups and interviews should be conducted at the end of the implementation period to explore if and why a change in care was or was not observed.
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