Journal of Telemedicine and Telecare http://jtt.sagepub.com/
Role flexibility among telemedicine service providers in the north-west and west of Ireland A MacFarlane, P Clerkin and A W Murphy J Telemed Telecare 2005 11: 62 DOI: 10.1258/1357633054461813 The online version of this article can be found at: http://jtt.sagepub.com/content/11/suppl_1/62
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A MacFarlane et al. Role flexibility among telemedicine service providers
Discussion
....................................................................... The findings from the present study suggest that special training prior to using a videoconferencing system may not always be necessary. On initial presentation of the system, those of male gender, aged 40 years or younger and who had some computer skills had little difficulty in successfully linking with a remote site. Dedicated training in the use of videoconferencing equipment may not therefore
be necessary when simple pictorial instructions are available.
References 1 Campbell JD, Harris KD, Hodge R. Introducing telemedicine technology to rural physicians and settings. J Fam Pract 2001;50: 419–24 2 Brebner EM, Brebner JA, Ruddick-Bracken H, Wootton R, Ferguson J. The importance of setting and evaluating standards of telemedicine training. J Telemed Telecare 2003;9 (Suppl. 1):7–9
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" Role flexibility among telemedicine service providers in the north-west and west of Ireland A MacFarlane, P Clerkin and A W Murphy Department of General Practice, National University of Ireland, Galway, Republic of Ireland
Summary A recent review of telemedicine services in the north-west and west of Ireland identified 11 telemedicine services, most of which were in the early stages of implementation. A qualitative approach was used to review them. Semistructured interviews were conducted with a multidisciplinary group of primary- and secondary-care providers (n ¼ 21) who were involved with either synchronous or asynchronous telemedicine services. Data were analysed according to the principles of framework analysis. Participants described the ways in which they were flexible about their workload, professional identities and roles to facilitate the organization and delivery of telemedicine services, and to ensure that services ran smoothly. While the positive effect of product champions and members of a wider supportive network or alliance on the conception and development of telemedicine services must be acknowledged, questions remain about associated long-term implementation and sustainability.
Introduction
....................................................................... The defining features of Irish health-care delivery include a large rural population1 and significant numbers of island dwellers. There is great potential for telemedicine to improve access to health care. However, internationally, the field is characterized by a poor record of implementation and sustainability.2 The extent to which telemedicine successes are reliant on product champions and a wider supportive network or alliance is known.2,3 Little is Correspondence: A MacFarlane, Department of General Practice, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland (Fax: þ353 91 494 559; Email:
[email protected])
Journal of Telemedicine and Telecare 2005; 11 (Suppl. 1): S1:62–64
known, however, about the ways in which these factors affect the day-to-day workings of telemedicine services. A recent review of telemedicine services, commissioned by the Irish North Western and Western Health Boards, identified 11 telemedicine services, including synchronous (e.g. telepsychiatry) and asynchronous (e.g. teleradiology) services.4 The majority of these services were in either the planning or relatively early stages of development (i.e. less than one year old). All services had relied on the kind of networks and alliances between policy makers, clinical champions and equipment manufacturers that are known to be necessary to generate interest and establish telemedicine services.3 We have examined ways in which the participants have worked to organize and deliver telemedicine services.
A MacFarlane et al. Role flexibility among telemedicine service providers
Discussion
....................................................................... The findings from the present study suggest that special training prior to using a videoconferencing system may not always be necessary. On initial presentation of the system, those of male gender, aged 40 years or younger and who had some computer skills had little difficulty in successfully linking with a remote site. Dedicated training in the use of videoconferencing equipment may not therefore
be necessary when simple pictorial instructions are available.
References 1 Campbell JD, Harris KD, Hodge R. Introducing telemedicine technology to rural physicians and settings. J Fam Pract 2001;50: 419–24 2 Brebner EM, Brebner JA, Ruddick-Bracken H, Wootton R, Ferguson J. The importance of setting and evaluating standards of telemedicine training. J Telemed Telecare 2003;9 (Suppl. 1):7–9
...................................................................................................................................................
" Role flexibility among telemedicine service providers in the north-west and west of Ireland A MacFarlane, P Clerkin and A W Murphy Department of General Practice, National University of Ireland, Galway, Republic of Ireland
Summary A recent review of telemedicine services in the north-west and west of Ireland identified 11 telemedicine services, most of which were in the early stages of implementation. A qualitative approach was used to review them. Semistructured interviews were conducted with a multidisciplinary group of primary- and secondary-care providers (n ¼ 21) who were involved with either synchronous or asynchronous telemedicine services. Data were analysed according to the principles of framework analysis. Participants described the ways in which they were flexible about their workload, professional identities and roles to facilitate the organization and delivery of telemedicine services, and to ensure that services ran smoothly. While the positive effect of product champions and members of a wider supportive network or alliance on the conception and development of telemedicine services must be acknowledged, questions remain about associated long-term implementation and sustainability.
Introduction
....................................................................... The defining features of Irish health-care delivery include a large rural population1 and significant numbers of island dwellers. There is great potential for telemedicine to improve access to health care. However, internationally, the field is characterized by a poor record of implementation and sustainability.2 The extent to which telemedicine successes are reliant on product champions and a wider supportive network or alliance is known.2,3 Little is Correspondence: A MacFarlane, Department of General Practice, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland (Fax: þ353 91 494 559; Email:
[email protected])
Journal of Telemedicine and Telecare 2005; 11 (Suppl. 1): S1:62–64
known, however, about the ways in which these factors affect the day-to-day workings of telemedicine services. A recent review of telemedicine services, commissioned by the Irish North Western and Western Health Boards, identified 11 telemedicine services, including synchronous (e.g. telepsychiatry) and asynchronous (e.g. teleradiology) services.4 The majority of these services were in either the planning or relatively early stages of development (i.e. less than one year old). All services had relied on the kind of networks and alliances between policy makers, clinical champions and equipment manufacturers that are known to be necessary to generate interest and establish telemedicine services.3 We have examined ways in which the participants have worked to organize and deliver telemedicine services.
A MacFarlane et al. Role flexibility among telemedicine service providers Table 1 People interviewed (n=21) Project
Type
Current status
People interviewed
Telepsychiatry Tele-plastic surgery
Synchronous Synchronous
Dormant Ongoing
Teleradiology
Asynchronous
Ongoing
Tele-assessment for people with disabilities
Synchronous
Ongoing
Tele-general surgery
Synchronous
Ongoing
Teleradiology Telecardiology
Asynchronous Asynchronous
Planned Early stages/Ongoing
Tele-palliative care
Synchronous
Planned
Consultant psychiatrist General practitioner Consultant plastic surgeon General practitioner Consultant radiologist Radiographer Medical physicist Occupational therapist ( 2) Project managers ( 2) General practitioners ( 2) Consultant general surgeon Director of nursing Consultant radiologist Consultant cardiologist Cardiology nurse Palliative care consultant Palliative care nurse Outreach nurse
.......................................................................
commitment to report all the filmsyotherwise it wouldn’t work because people didn’t want to take it on.
A qualitative approach was used for the review. Eight out of the 11 telemedicine services were selected for further analysis using maximum variation sampling. Maximum variation sampling strategies were used to obtain good representation of services in the region in terms of service type (e.g. synchronous, asynchronous), status (e.g. dormant, ongoing) and developmental stage (e.g. pilot phase, established). The three that were not chosen were represented in the sample. Twenty-one service providers, out of a possible 24, took part in semistructured interviews5 which were designed to elicit their views and experiences of organizing and delivering telemedicine services. Participants were from a variety of disciplines and from both primary and secondary care (see Table 1). Data were analysed according to the principles of framework analysis6 using NVivo software.7
These new tasks and duties were often beyond the existing professional identities and roles of the participants. Examples of this were a radiographer who had taken on administrative work to facilitate transmission of information between sites and nurse practitioners who became involved in the organization of technical support for videoconferenced consultations. There was evidence that this flexibility occurred at a collective as well as an individual level, as participants described the ways in which they worked together to address aspects of telemedicine service delivery. There were several examples of participants communicating with each other by telephone or email to remind each other of forthcoming telemedicine appointments, negotiate appointment times and discuss case selection issues. It was noted that some participants emphasized that these interactions were very much ‘personality dependent’.
Methods
Results
Discussion
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As part of the interview protocol, participants were asked to describe their role in the implementation and day-today running of the telemedicine service with which they were involved. A strong finding in the interviews was that participants were being flexible on a daily basis in order to ensure that the telemedicine service ran smoothly. It was not uncommon, for instance, for participants to explain that they took responsibility for new tasks or duties in addition to their existing ones:
The analysis provided examples of clinicians and other professionals going ‘beyond the call of duty’ by undertaking additional tasks and duties. There were also examples of a collective flexibility where service providers worked together to address organizational and clinical barriers associated with telemedicine.3 In this way, there seemed to be a shared understanding and acceptance of changes to standard divisions of labour and professional identities and roles. We know from our data that participants in this study were telemedicine enthusiasts, confident that this mode of service delivery would improve access to services in rural areas and who were motivated to make it work.
the only way we could get it [the teleradiology service] operating was for one person, myself, to make a Journal of Telemedicine and Telecare Volume 11 Supplement 1
2005
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M Bryson et al.
Nurses’ perceptions of the National Health Service modernization programme
Our analysis elucidates some of the ways in which product champions and members of a wider supportive network or alliance affect the day-to-day workings of telemedicine services. The Irish and international experiences of telemedicine implementation are similar. However, our analysis raises two questions relevant to the sustainability of telemedicine. First, will enthusiasts be able to exhibit the same kind of flexibility over prolonged periods of time? Second, as services develop and expand, service providers who are less enthusiastic about telemedicine are likely to be involved. Will these reluctant actors be as flexible as the enthusiasts and go to the same efforts to facilitate the day-to-day running of telemedicine services?
Acknowledgements:
We thank our funders, the North Western and Western Health Boards, the Department of Community Rural and Gaeltacht Affairs (Clar Programme) and all our research participants.
References 1 Gabhainn SN, Murphy AW, Kelleher C. A national general practice census: characteristics of rural general practices. Fam Pract 2001;18:622–6 2 Harrison R, MacFarlane A, Wallace P. Implementation of telemedicine: the problem of evaluation. J Telemed Telecare 2002;8: 39–40 3 May C, Harrison R, Finch T, et al. Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Inform Assoc 2003;10:596–604 4 MacFarlane A, Clerkin P, Murphy A. A Qualitative Review of Telehealthcare Services in the North Western and Western Health Boards. Research and Development Report Number 3. Galway: Department of General Practice, NUI, 2004 5 Bryman A. Quantity and Quality in Social Research. London: Unwin Hyman, 1988 6 Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, eds. Analyzing Qualitative Data. London: Routledge, 1994 7 Richards L. Using NVivo in Qualitative Research. London: Sage, 1999
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" An online survey of nurses’ perceptions, knowledge and expectations of the National Health Service modernization programme Maria Bryson*, Natalie Tidyw, Michael Smithz and Sharon Levyy NHS Direct Essex, Broomfield; wNHS Direct North West Coast, Broughton; zMedix, London; yRoyal College of Nursing,
London, UK
Summary We conducted an online survey to investigate nurses’ perceptions, knowledge and expectations of the National Health Service (NHS) modernization programme in the UK. The questionnaire was available for 28 days via the Website of the Royal College of Nursing. The questionnaire was completed by 2020 nurses, midwives and health visitors working in all sectors of the health service in a wide range of specialties and environments of care. Less than one-quarter of respondents felt that they had adequate information about NHS information technology (IT) developments. In all, 528 (26%) said this was the first they had heard of the initiatives. Only 383 respondents (19%) felt adequately informed about the development of electronic health records; 470 (23%) felt inadequately informed and 456 (23%) had only heard something about it. The findings of this survey suggest that nursing staff are not widely aware of current IT plans and programmes in the NHS. They suggest that nurses also lack confidence in using advanced IT, which is compounded by lack of training.
Introduction
....................................................................... The clinical environment is often described as information dependent, where clinicians require relevant, accurate, Correspondence: Maria Bryson, NHS Direct, Hospital Approach, Broomfield, Chelmsford, Essex, UK (Email:
[email protected])
Journal of Telemedicine and Telecare 2005; 11 (Suppl. 1): S1:64–66
timely and credible data to support their practice. The National Health Service (NHS) in England, Scotland, Wales and Northern Ireland is spending several billions of pounds on information technology (IT) to support the modernization of health services. Nurses are by far the largest group of clinicians in the NHS. They are important partners in transforming the e-health vision into a clinical reality. We have conducted an online survey to investigate
