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Delivering digital health and well-being at scale : lessons learned during the implementation of the dallas program in the United Kingdom

Devlin, Alison M and McGee-Lennon, Marilyn and O'Donnell, Catherine A and Bouamrane, Matt-Mouley and Agbakoba, Ruth and O'Connor, Siobhan and Grieve, Eleanor and Finch, Tracy and Wyke, Sally and Watson, Nicholas and Browne, Susan and Mair, Frances S (2015) Delivering digital health and well-being at scale : lessons learned during the implementation of the dallas program in the United Kingdom. Journal of the American Medical Informatics Association. ISSN 1527-974X

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Abstract

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—alarge-scale, national technology program that aims to deliver a broad range of digital services and products to the publicto promote health and well-being.  Prospective, longitudinal qualitative research study investigating implementation processes. Qualitativedata collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n ¼ 38), quarterlyevaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews withproject leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces ofqualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementationissues in complex healthcare settings.  Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agencypartnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including thebackdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design andachieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5)The challenge of interoperability and information governance, when commercial proprietary models are dominant.  The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementationchallenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, andresilience are key implementation facilitators when shifting to new digitally enabled models of care.