Progression Towards Sustainability in the National Delivering Assisted Living Lifestyles at Scale: “dallas” Programme

Problem: The ‘dallas’ programme was a pan-UK programme designed to deliver a broad portfolio of digital tools and services for Healthcare self-management and preventive care through leveraging the potential of technologies. There is currently great interest in the factors which contribute to, or impede, the implementation of such complex interventions at scale and in real world settings. Approach: We conducted a longitudinal qualitative evaluation to help us chart the complex change processes within and across the ‘dallas’ programme during its lifecycle (May 2012 - May 2015). We have drawn on a rigorous socio-technical theory; Normalisation Process Theory (NPT), which has been used previously to investigate the implementation of e-Health interventions. We conducted a series of in-depth, e-Health Implementation Toolkit (e-HIT) -led interviews at ‘Baseline’ (n=17); ‘Mid-point’ (n=21); and ‘End-point’ (n=10) of the ‘dallas’ programme, with a purposive sample of key stakeholders from each of the four ‘dallas’ communities. Ethnographic data was gathered at ‘dallas’ Lead Stakeholders’ meetings/events held at key points during the evolution of the programme. Data were analysed using a Coding Frame work drawing from NPT and synthesis of results was guided by Framework Analysis. Findings: Data analysis showed that key stakeholders recognised the role that ‘dallas’ has played in enabling them to operationalise aspects of Service re-design to deliver more personalised, digital tools and services for citizens and health service users. The ‘dallas’ communities reported significant “distance travelled” towards sustaining new service models developed during the programme. For example, some communities were awarded EU Reference Site status, others had attracted significant onward funding, whilst other new models were being integrated into routine service provision. Several of the stakeholders also reported arriving at "destinations" that were unforeseen at the outset of the programme, such as a shift to aligning more closely with pro-active GP practices when implementing some Telehealth interventions. Consequences: As the ‘dallas’ communities progressed towards ‘End-point’ there was evidence of greater ‘Coherence’ across the four communities resulting in sharing of knowledge to help sustainability at a wider programme level. There was also active emergence of knowledge during real-world implementation of ‘dallas’. This resonates with the current literature on implementation of interventions in uncertain, complex systems such as Healthcare services in the real world. Importantly, the knowledge captured from the process evaluation of the unique ‘dallas’ programme will help identify underpinning factors that may contribute to, or impede, such complex eHealth implementations programmes in the future