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Table 2 Factors that influence the sustainability and scalability of Health TAPESTRY operationsa across identified themes; and questions that can be considered to address barriers according to the National Health Service (NHS) Sustainability modelb

From: Sustainability and scalability of a volunteer-based primary care intervention (Health TAPESTRY): a mixed-methods analysis

Theme

Summary of sub-themes by challenges and facilitators

Challenges are described in the context of the Health TAPESTRY developer team

Suggested recommendations (as informed by participants)

NHS sustainability modelb factor level

Sustainability

Program complexity

Challenges:

• Health TAPESTRY large and complex with many different facets of research, so there is arge amounts of data to process and interpret.

• Health TAPESTRY’s focus and purpose is unclear in terms of how all the pieces fit together, and everything moves slowly due to the large number of people who are involved

• Technology development process is difficult because data gathering tools and the application are constantly changing

• Synchronize all the parts of Health TAPESTRY

• Make sure that various components and timelines fit together well to achieve program goals

Organization:

• Fit with organization’s strategic aims and culture

• Infrastructure for sustainability

Process:

• Adaptability of improved process

Program coordination & communication

• Gaps amongst the team to delegate responsibilities to move the project along

• Gaps amongst the team in certain skill sets

• Difficulties with adhering to and communicating deadlines and timelines

• Getting everyone to attend the same meetings

Facilitators:

• The team is enthusiastic and has excitement and passion in regards to program goals

• Scientific leads are experienced and well connected

• Program management/research team efficient and motivated

• Expand the central Health TAPESTRY team

• Identify the skills and knowledge that are needed internally to fill the gaps

• Be transparent in the decision making processes

• Provide the Health TAPESTRY developer team with a contact person who can relay their involvement and contribution

• Provide progress notes or a weekly update to be distributed to all Health TAPESTRY developer team members

Organization:

• Infrastructure for sustainability

Staff:

• Staff involvement and training to sustain the processa

Resource capacity

Challenges:

• Lack of adequate human resources pertaining to the Health TAPESTRY developer team (too few people doing the administrative tasks to oversee the project, and no one to manage the sub-studies being conducted by scientific leads)

• Funding the Health TAPESTRY in general; not being able to secure more funding

• Managing pulls and priorities from many organizations for funding within Health TAPESTRY

• Have an intermediary person that will facilitate communication between the two co-Leads and the team and between the volunteers and the Leads

• Bring in support on the IT side

• Investigate additional research opportunities and consider applying for funding for these; and to evaluate small components of Health TAPESTRY where there is great uncertainty or to make it work better

Organization:

• Infrastructure for sustainability

Process:

• Adaptability of improved process

Stakeholder buy-in

Challenges:

• The team is diverse, encompassing individuals from a broad range of disciplines and organizations

• The inter-professional team has not been involved or considered as part of the central Health TAPESTRY developer team

• Ensure mutual benefits between the project and the clinical and content experts involved continue to exist

• Invite the inter-professional team to be more involved in discussions, particularly to assess the best way clinicians could respond to the Health TAPESTRY report data

Organization:

• Fit with organization’s strategic aims and culture

Scalability

Adoption potential

Challenges

• It is unclear how data will be shared between sites if they have different hardware (i.e., tablets) and software (i.e., operating system) than pilot site, which may impair optimal functioning of the health tapestry application to create customized reports

• Create an application that will allow Health TAPESTRY to be accessed through any operating system and hardware device (i.e. laptop, tablet, desktop)

• Automate the Health TAPESTRY reports to create custom reports depending on the needs of different sites

Process:

• Adaptability of improved processa

• Effectiveness of the system to monitor progress

Organization:

• Infrastructure for sustainability

Fit with the organization’s strategic aims and culture

• Unclear how to keep the program consistent through the different sites and provinces that will adopt it

• Unclear how program values will be communicated consistently across sites

• Make sure that Health TAPESTRY communicates the same messages as intended by allowing the flexibility for change but keeping it consistent enough that it is still Health TAPESTRY

• Present Health TAPESTRY as a flexible approach with some of it key pillars, but understand that it might be implemented in different ways

• If the implementation plan is too rigid then Health TAPESTRY might become less scalable

• Currently, there is no implementation strategy in place that can be given to adopter sites about issues such as customizability and fit, key learnings from the pilot site, and the ability to monitor intervention use

• Develop an online implementation guide/manual/protocol to give to adopter sites that provides practical information on not just what to do but how to do it (e.g., how to recruit and train volunteers, how to overcome risk management, who should be involved at each step)

• There is no process in place for how to nurture adopter sites which do not have the benefit of close contact with the Health TAPESTRY developer team

• Provide an avenue for Health TAPESTRY site to compare their experiences and share their successes and lessons learned

• Have someone from the Health TAPESTRY developer team that can trouble shoot and coordinate at other sites initially until they are set up

• Have the pilot site provide implementation outreach to new sites

Adopter site characteristics

Challenges:

• Scaling up will be challenging for adopter sites that don’t have the same understanding of how Health TAPESTRY works

• It is unknown how Health TAPESTRY will function in culturally diverse populations (e.g. language barriers including the translation of outcome measures)

• Make sure that adopter sites have a complete understanding of Health TAPESTRY and the community in which it will be implemented

• Adopter sites should also be made aware that the partnerships that have been built within the pilot site may look very different in expansion sites

Organization:

• Infrastructure for sustainability

Readiness to scale

Challenge:

• Health TAPESTRY is not ready to be scaled up or sustained in other jurisdictions

• Work out the systems issues in the most supportive environment first (i.e., Hamilton site) to see if and how it works and then scale up

• Develop an implementation plan with adopter sites by reflecting on success and lessons learned at the pilot site, and assess how applicable these learnings are to the new site

Process:

• Credibility of the evidence

• Adaptability of improved process

Resource capacity

Challenge:

• Scaling up will be challenging for adopter sites that are not research intensive (i.e., capacity, skills, knowledge)

• Convey to adopter sites that the goal of Health TAPESTRY is not to replace or take over existing processes but to help individuals/organization identify which of its core components are valuable and fit within their setting (i.e., volunteers, the use of a PHR, the use of an interprofessional team, and support from a system navigator)

Organization:

• Infrastructure for sustainability

Undetermined efficacy of Health TAP

Challenge:

• Lack of demonstration of Health TAPESTRY’s effectiveness and cost-effectiveness

• Generate evidence of effectiveness and cost-effectiveness

• Ensure that new knowledge and evidence are disseminated, and to share early results about successes and lesson learned broadly

Process:

• Lack of demonstration Credibility of the evidence

  1. aHealth TAPESTRY operations refers to intervention support elements provided by the central developer team members, which includes the scientific leads, research staff, and program staff. Examples of activities the central team performs includes developing technological components of the intervention, conducting research studies to understand the impact of the intervention, and coordinating communication between the scientific leads, research staff, and program staff so they work as a cohesive unit
  2. bAdapted from: Maher L, Gustafson D, Evans A. NHS Sustainability Model. NHS Institute for Innovation and Improvement; 2010. Available at: www.institute.nhs.uk/sustainability