Research Team

PhD Student: Louise Newbould (lknewbould1@sheffield.ac.uk)

Supervisors

Professor Gail Mountain

Professor Mark Hawley

Dr Steve Ariss

Funded by: The Abbeyfield Research Foundation

Executive summary

Background: Research has shown that older adults who reside in care homes can experience challenges in accessing the healthcare that they need. A rapidly developing and increasingly popular method of delivering health care is videoconferencing, which has shown some promise in addressing some of these challenges. The main service provider in Yorkshire and the Humber region is a hub provided through Airedale NHS Trust (URL: http://www.airedale-trust.nhs.uk/services/telemedicine/), but some care settings may choose to organise their own videoconferencing system.

Aim:  This research, conducted between (01/01/2015 – 01/01/2018) has explored factors that affect the uptake and sustainability of videoconferencing as a method of enabling care home residents to access healthcare and from this key recommendations have derived.

Method:  The study that underpins these recommendations has involved a literature

review (URL: https://www.hindawi.com/journals/ijta/2017/5785613/), a regional survey of care homes and a comparative case study of three homes.

From the results of the survey, three homes were identified and looked at in detail; one care home where videoconferencing was integrated into regular care and the use of it had been sustained for three years; one where they were trialling videoconferencing and were struggling to optimise the use of it; and a third where videoconferencing was not in use and the home had no future plans to implement it.

Data was analysed to identify the factors that enable use of videoconferencing in such settings. The findings were then used to create a series of recommendations for commissioning and for practice. These recommendations are not definitive, but have been identified by this research as the most pertinent in the successful uptake and sustainability of videoconferencing. 

Findings from existing evidence: The results of the literature review found that research on the use of videoconferencing has been sparse globally, with most of the research originating from geographically vast countries such as the USA and had most frequently been researched as a method of conducting assessments. For the full review, please see here: https://www.hindawi.com/journals/ijta/2017/5785613/

Survey results: Survey results found that most of the homes that responded were residential and privately funded. Prior to implementing videoconferencing, findings suggest that care homes are not convinced that technology will enhance their practice. However, those that were using it reported being happy with the service provided. One of the main drivers to successful uptake appeared to be access to services (e.g. GP out of hours) and the perceived advantage of implementing videoconferencing in light of this. Detailed results available upon request.

In-depth case studies: Analysis of data from the three homes where in-depth research was conducted identified 12 issues from which recommendations were derived.

 

Recommendations for practice and for commissioning are as follows;

Characteristics of the care home

Culture

1)    The manager needs to be committed to the successful implementation of the service and have a willingness to embrace new ways of working. Managers need to have a high level of autonomy within the care home, as this will reduce barriers to implementation. Videoconferencing may be best suited to homes that are dissatisfied with other remote services such as ‘out of hours GPs’.                                       

2)    Videoconferencing is not a substitute for knowledge of how to manage resident health. Senior staff need to support care assistants in using the system until they have developed this knowledge.

Staffing

3)    Videoconferencing services appear to be suited to homes where the home is only staffed by qualified carers or where nurses work alone. A package such as the Airedale hub, provided a broad range of services that may aid less qualified care home staff and professionally isolated nurses in managing resident care.

 

4)    Care home managers need to be committed to the buy-in so they can advocate for the use of the service (the technology and support provided from remote staff) and facilitate implementation. Homes should have the time and space to undertake the training required to feel confident in using the service. Staff need to support each other in having time and space to learn as well as encouraging and learning from each other.

5)    Extent of ‘buy-in’ to videoconferencing needs to be regularly reviewed and assessed in relation to staff turnover and the training required by new members. Leaders (managers, deputy managers, senior carers and nursing staff) in the home need to be effective in providing hands on training for the use of videoconferencing and encouraging shared learning amongst all care home staff.

 

Characteristics of staff

6)    Training should be provided to ensure staff are confident in using technology. Where they do not feel confident, they have to feel able to access helplines provided by the service. All staff should encourage each other in undertaking training to use the technology until everyone is confident in using the equipment. Staff need to feel confident in using technology to feel more able to overcome any challenges.

 

Features of videoconferencing

Willingness to embrace new ways of working

7)    There needs to be care home staff ‘buy-in’ at all levels. This can be achieved by promoting the potential benefits of using videoconferencing. One example is, where staff are not confident in conveying a situation over the phone they can show staff at the remote service site the situation. This can also be valuable to those whose first language is not English.                  

Opportunity to trial the service

8)    Gaining staff ‘buy-in’ can be achieved by allowing staff to see the technology being demonstrated and enabling them to test it out in a safe environment.                                        

Ease of use

9)    The technology and associated service requires good Wi-Fi access for success.  If this is not readily available, care home staff will become rapidly discouraged from using it. Ease of use is promoted by the technology being portable or can be situated in a room which can be used for the purpose.

 

Relationships with the remote site (in this case, the Airedale hub)

Relationship with the remote service provider

10) Care home staff need to know about, and have confidence in, contacting and communicating with the remote service provider. This can be achieved by allowing care home staff to regularly communicate with the provider, to build a trusting relationship.  

11) Promoting videoconferencing services effectively is required to enable staff to make an informed decision about use.  

                       

The way videoconferencing is implemented                                               

12) From the outset, the home needs informal and formal champions of videoconferencing to help encourage the use of videoconferencing and the willingness of staff to try new ways of working.      

 

Conclusion: In conclusion, there are a broad range of factors that affect the uptake and sustainability of videoconferencing in the care home. Several recommendations can be identified to facilitate successful use. For the full report, please see here.