Table 3 Summary table of change management practices reported in telemedicine literature with examples and related articles that refer to its application

1. Conduct a needs assessment

Assess organizational characteristics, readiness and needs of the clinics and providers to inform design process

[3, 10, 11, 14,15,16, 20, 23, 25, 29,30,31, 59, 60, 65]

2. Assess compatibility of telemedicine equipment and applications

Consider other services being provided, existing infrastructure, new technology and appropriate location for telemedicine equipment

[8, 11, 20, 27, 33, 55, 59, 65, 75, 76]

3. Establish plans

Collaborate with key stakeholders to plan and design telemedicine services

[2, 3, 6, 8, 11, 15, 23, 25, 29,30,31, 59, 65]

4. Gain leadership and management support and commitment

Provide direction through influence to bring about change

[4, 14, 20, 22, 24, 25, 27, 31,32,33, 58,59,60, 64, 74]

5. Identify champions

Select key staff to promote, legitimize and build awareness about telemedicine services

[3, 4, 11, 20, 22,23,24, 26, 27, 30, 33, 60, 64, 74, 75]

6a. Engage partners and stakeholders

Involve stakeholders in design process through frequent communication and building relationships and alliances

[3, 4, 6, 9, 10, 14,15,16, 20, 23, 24, 27, 29,30,31,32,33, 35, 60, 64, 65, 73, 75, 76]

6b/6c. (Continue to) engage partners and stakeholders

Continue engaging stakeholders to reaffirm value of telemedicine and to obtain feedback

[4, 9, 15, 30, 32, 60, 65]

7. Develop and articulate a clear, simple vision

Have a shared vision with partners and stakeholders

[4, 20, 22, 32, 62, 64]

8. Assign coordinating roles

Assign telemedicine coordinators at both participating and provider site

[1, 3, 4, 7, 9,10,11, 15,16,17,18, 21, 22, 24, 25, 27, 31, 37, 67, 75]

9. Ensure adequate resources

Complete a workflow analysis to ensure adequate resources are deployed to support telemedicine services

[1, 3, 4, 8, 11, 17, 20, 22, 26, 27, 58, 65, 67, 75, 82]

10. Communicate changes and understanding of telemedicine

Disseminate information about changes, benefits, limitations of telemedicine and raise awareness

[2,3,4, 6,7,8,9, 11, 16, 18,19,20, 24, 25, 27, 31, 32, 34, 58, 60, 64, 73, 75]

11. Gain stakeholder trust, acceptance and buy-in

Build confidence and familiarity for the new system and conduct regular site visits to provide education

[3, 7, 8, 10, 11, 15, 19, 20, 24,25,26,27, 30,31,32, 34, 35, 55, 59, 60, 62, 65, 74, 75]

12. Facilitate ownership of the service

Allow users as choose how and when service should be utilized to facilitate ownership

[9, 14, 20, 23, 24, 32, 33, 73]

13. Provide training and education

Training includes how to use equipment, troubleshoot and how to conduct consultations through the technology

[1,2,3, 6,7,8,9, 11, 12, 14,15,16, 18, 19, 21,22,23,25, 27, 31,32,33,34, 55,56,57,58,59,60, 67, 73, 75, 76, 82]

14. Develop new work processes, protocols and procedures

Develop guidelines and clinical protocols. Customize existing workflow to accommodate the use of telemedicine services

[2,3,4, 6, 8,9,10,11, 13, 15, 18,19,20,21,22,23,24, 26, 27, 29,30,31, 34, 35, 59, 60, 62, 73, 75, 76, 82]

15. Monitor change and maintain flexibility

Refine services by obtaining periodic feedback through reporting systems and regular meetings with stakeholders

[2,3,4,5, 8, 15,16,17,18, 25, 29,30,31,32, 55, 59, 60, 64, 67, 73, 75,76,77,78,79,80,81,82]

16. Evaluate the changes and maintain flexibility

Evaluate patient outcomes, quantify efficiency, assess the capacity of telemedicine operations and conduct a cost analysis

[2, 4, 5, 8, 11, 15, 16, 20, 22, 31, 59, 60, 76, 82]