How to Scale-Up And Sustain Health Care Innovation
SUMMARY:
It has been challenging to scale-up and sustain small scale healthcare demonstration projects.
The track record of telehealth programs requiring major changes is poor with lack of adoption and abandonment.
Long term sustainability and spread can be attained by evaluating the 7 areas of innovation identified below.
REVIEW
Most studies focus on short term acceptance of a single innovation.
The more complex an innovation or setting, the harder it is to be successful in adoption, scaling-up into widespread use and sustainability.
Barriers include:
Technological
Patient
Staff
Team
Financial
Regulatory
An innovation is more likely to be adopted and sustained if it:
Is developed after adequate identification of the problem it is trying to solve.
Easily fits into existing workflows and routines.
Has widespread support (or limited opposition)
Has undergone systematic assessment
SUMMARY:
The Non-Adoption, Abandonment, Scale-Up, Spread, Sustainability (NASSS) framework is designed to assist stakeholders in building a case for a sustainable innovation within healthcare.
It is not a checklist, but rather a guide in the development process of a solution.
NASSS consists of 7 domains which can range from simple to complex.
1. The Condition: The target illness as well as co-morbidities and social determinants.
2. Technology:
o Technical features and useability
o Accuracy of the data
o Sufficient information for decision makers
o Amount of knowledge needed to use the technology
o How the technology is procured
3. Adoption & Continued Considerations of Use:
o Threats to specific practices
o Safety & welfare of patient
o Assumptions inherent in the platform
4. Value Proposition:
o What value is generated
o What is the developers business case
o Desirability; efficiency; safety and cost effectiveness
5. The Healthcare Organization(s):
o Capacity of system to absorb and innovate
o Readiness for the innovation
o Budget
o Clinical validation
o Lack of support for program
o Interdependencies between organization and care team
6. Organization Limitation to Only a Successful Demonstration Project
o Inability for wide content transferability and sustainability
o Health Policy
o Fiscal Policy
o Professional Association positions
o Regulatory & Legal aspects
7. Continual Adaptation: How resilient is the organization in address unforeseen and major events toward adoption.
CONCLUSIONS:
Typically, an individual factor does not break a healthcare innovation, but rather the interaction between a number of factors.
Building a business case for a sustainable telehealth solution involves addressing key critical factors essential for success.
The NASSS Framework offers one such approach.