Project ECHO®: a global cross-sectional examination of implementation success.

BACKGROUND: Organizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation- Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation. METHODS: An empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics. RESULTS: The 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12-18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams. CONCLUSIONS: These findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.

Client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services.

OBJECTIVE: To examine allied health client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services to facilitate adoption. DESIGN: A qualitative design employed semistructured interviews with the three key stakeholder groups. SETTING: Stakeholders were associated with BUSHkids (The Royal Queensland Bush Children's Health Scheme), a not-for-profit organisation serving children and families in Queensland, Australia. PARTICIPANTS: Thirty-nine stakeholders (12 clients, 16 providers and 11 community referrers). MAIN OUTCOME MEASURES: Participants were asked about familiarity with telehealth, willingness to use telehealth and perceived barriers and facilitators to telehealth acceptability. RESULT: Fifty-nine percent of participants had experienced telehealth and 77 percent were willing to use it. Participants perceived that technology problems were a barrier to telehealth, that children would not be able to concentrate on or enjoy telehealth sessions, that relationships and communication would be inferior to in-person sessions, and that telehealth was inappropriate for disciplines employing physical touch. Participants identified access to health services as a key benefit of telehealth, said that technology problems could be worked around, and said that telehealth services could be supported with internal partners (eg, assistants) and external partners (eg, local medical centres). They also identified a variety of telehealth benefits to families (eg, convenience, privacy). CONCLUSION: Overall, telehealth was acceptable to stakeholders. Providers need training to facilitate child participation online and identify alternatives to physical touch. Co-learning opportunities should be used to address low provider and referrer self-efficacy.

"The Secret" to Success? The Psychology of Belief in Manifestation.

We explored the psychology of those who believe in manifestation: the ability to cosmically attract success in life through positive self-talk, visualization, and symbolic actions (e.g., acting as if something is true). In three studies (collective N = 1,023), we developed a reliable and valid measure-the Manifestation Scale-and found over one third of participants endorsed manifestation beliefs. Those who scored higher on the scale perceived themselves as more successful, had stronger aspirations for success, and believed they were more likely to achieve future success. They were also more likely to be drawn to risky investments, have experienced bankruptcy, and to believe they could achieve an unlikely level of success more quickly. We discuss the potential positives and negatives of this belief system in the context of growing public desire for success and an industry that capitalizes on these desires.

Integration intrapreneurship: implementing innovation in a public healthcare organization.

Aim: As global events impact the way organizations operate and innovate in response to regional, workforce and consumer needs, the concept of intrapreneurism is attracting growing interest from policymakers and executives, particularly within the healthcare sector. The aim of this study was to capture the key learnings from the implementation of a telementoring pilot, to understand how intrapreneurship can embed innovation within an established organization to effect more integrated healthcare. Purpose: A qualitative approach was used with a phenomenological lens to explore the key learnings of the Project ECHO® (Extension for Community Healthcare Outcomes) pilot implementation to provide an understanding of what the project team's strategies and tactics were during the process of embedding a new business innovation. The implementation and piloting of Project ECHO®, a telementoring model, in a large-scale public healthcare organization in Queensland, Australia, was investigated as an exemplar of integration intrapreneurship. Findings: Through an inductive approach, this qualitative study found the implementation of the Project ECHO® pilot had specific dimensions and strategies/tactics which were exemplars of intrapreneurism. The organizational context and workforce characteristics described in this study presented new knowledge of how intrapreneurs implemented an innovation to address fragmentation of healthcare service delivery, professional isolation and instances of low-value care. This research contributes to a better understanding of the strategic and tactical approaches to implementing intrapreneurial innovations within a public healthcare organization, with learnings that can be adapted by intrapreneurs in other contexts.

Measuring the Success of a Project ECHO Implementation: Results from an International e-Delphi Study.

There is an increasing global need for organisations to utilise high-quality telementoring models to support workforce development and mentorship. Project ECHO is a validated telementoring model that has been adopted by over 700 organisations globally across multiple sectors. To date there is no consolidated list of success indicators by which organisational teams can assess or benchmark their implementation of Project ECHO across sectors. An e-Delphi methodology was adopted to facilitate a comprehensive means of identifying indicators that could be used to assess the implementations of Project ECHO globally. This paper presents a consolidated framework of indicators that support teams to assess their implementation of Project ECHO. These indicators have been derived by an international panel of experts across the healthcare, education, and university sectors. The final framework identified 54 distinct indicators across four domains: (1) spoke participant engagement, (2) ECHO Hub/teleECHO Network design and operation, (3) ECHO Hub team engagement and (4) Local Impact. This paper highlights that Project ECHO implementation indicators can vary between being dynamic, static, and iterative, depending on the phase of implementation. These findings are significant because they are generalisable to any organisation/sector implementing Project ECHO or similar telementoring models. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00050-7.

Supervising Students During a Global Pandemic: Clinical Educators' Perceptions of a Student-Led Telerehabilitation Service During Covid-19.

Scope: In March 2020, COVID-19 restrictions prompted services delivered by student-led clinics in the university sector to transition to telehealth. This provided a unique opportunity to explore the challenges and opportunities faced by clinical educators when supervising students to deliver telehealth. Methodology: Semi-structured interviews were conducted with allied health clinical educators who supervised students on clinical placement who were required to provide services via telehealth. Clinical educators across the disciplines of audiology, occupational therapy, physiotherapy, and speech pathology were asked to reflect on their experiences and perceptions of the rapid transition to a telehealth model for student clinical placements. A content analysis approach was used to analyse qualitative data. Conclusions: From the perspective of clinical educators, student-led telehealth services can effectively meet client needs while achieving student learning outcomes. This study highlights many opportunities for student learning via telehealth in the clinical education environment and the role of the clinical educator in the learning experience.

Staff perspectives on the key elements to successful rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments.

BACKGROUND AND PURPOSE: During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19. METHODS: This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically. RESULTS: Twenty-five physiotherapists (22-60 years of age; 68% female) with 1-40 years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions of the key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) 'it requires a whole team approach', (2) 'technology issues will be encountered and can be overcome', (3) 'optimise the situation while understanding the differences' and (4) 'modifying your approach doesn't imply inferior quality of care'. CONCLUSION: Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage.

Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity.

BACKGROUND: There is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases. OBJECTIVE: This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation. METHODS: Qualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD). RESULTS: Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier. CONCLUSIONS: The findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.

A Co-Designed Active Video Game for Physical Activity Promotion in People With Chronic Obstructive Pulmonary Disease: Pilot Trial.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. OBJECTIVE: The primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). METHODS: Participants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. RESULTS: Most participants (8/9, 89%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. CONCLUSIONS: The co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population.

Executive Decision-Making: Piloting Project ECHO® to Integrate Care in Queensland.

INTRODUCTION: A Queensland project team secured grant funding to pilot Project ECHO®, a telementoring model, to drive vertical and horizontal integration across paediatric, education and primary care services. This study sought to understand what influenced healthcare executives' decision-making processes to organisationally commit to and financially invest in the pilot proposal within an organisational context. THEORY AND METHODS: A phenomenological approach methodology was adopted to investigate healthcare executives' conscious decision-making processes. Semi-structured interviews with key stakeholders were conducted alongside project documentation analyses to create a thematic framework. RESULTS: The qualitative thematic analysis identified five key themes that influenced the decision-making processes of healthcare executives to invest in Project ECHO® as an integrated care pilot. The themes were: (i) personal experiences, (ii) benefits, (iii) risks, (iv) partnerships, and (v) timing. Executives' reflections explored how their decision-making processes considered the intrapreneurial project team as an indicator of future sustainability. DISCUSSION: Findings highlighted healthcare intrapreneurs' drive to foster more integrated and people-centred approaches to care. Intrapreneurial aims of financial sustainability, ongoing improvement and scalability of the proposal positively influenced investment confidence. CONCLUSION: Intrapreneurial champions must provide a compelling narrative to convince executive decision-makers that benefits will outweigh risks, that integration is achievable through strengthened partnerships as well as future sustainability beyond the pilot phase.

Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review.

INTRODUCTION: Rural children are likely to benefit from the telehealth delivery of multidisciplinary allied healthcare. This study aimed to (a) identify the scope of literature describing the telehealth delivery of allied health services to children living in rural areas and (b) understand the extent to which implementation - that is, specific activities designed to put telehealth into practice - has been investigated in such literature. METHODS: Systematic scoping review methodology was used to locate studies in which telehealth delivered allied health services to children aged 0-12 who lived rurally (January 1998-January 2018). Two reviewers screened the studies, extracted data and appraised quality with Critical Skills Appraisal Programme checklists. Databases searched were PubMed, MEDLINE, CINAHL, PsycINFO, ERIC and Cochrane Library. RESULTS: Data were extracted from 23 papers (two randomised controlled trials, one pseudorandomised controlled trial, one non-randomised experimental trial, two interrupted time series without parallel control groups, 10 case series and seven studies of diagnostic yield). Most were level III (n = 4) or IV (n = 17) when classified according to National Health and Medical Research Council guidelines. One study met all Critical Skills Appraisal Programme quality criteria. Allied healthcare interventions were aimed at improving functioning in communication (n = 10), behaviour and socio-emotional domains (n = 8) and identifying hearing concerns (n = 5). Many studies (n = 12) identified implementation facilitators, largely training and equipment. Only one study referred to an explicit framework for telehealth implementation (user-centred design). DISCUSSION: Future research should target occupational therapy, physiotherapy, dietetics and social work, and determine the implementation factors and models likely to create successful telehealth services for this population.