Addressing pilotitis: A qualitative study on the implementation of eCoaches in hospital-based chronic care

Area of Science:

• Digital Health Implementation Science
• Healthcare Management and Policy
• Clinical Informatics

Background:

• Widespread adoption of eHealth solutions in hospitals faces significant challenges despite pilot successes.
• eHealth implementation, specifically eCoaches, requires understanding professional perspectives for successful upscaling.
• Previous pilot initiatives show promise but struggle with transitioning to broader hospital integration.

Purpose of the Study:

• To explore barriers and facilitators influencing the implementation of eCoaches from the perspective of healthcare professionals.
• To identify factors affecting the integration of eCoaches for chronic disease management (heart failure, inflammatory bowel disease) in hospital settings.
• To provide actionable insights for designing, implementing, and upscaling eCoaches and related eHealth technologies.

Main Methods:

• Qualitative research design utilizing semi-structured interviews with 10 management and healthcare professionals.
• Interviews guided by the Consolidated Framework for Implementation Research (CFIR), including an added domain for Patients' Needs and Resources.
• Thematic analysis of interview data to identify barriers and facilitators across all CFIR domains.

Main Results:

• Barriers and facilitators were identified across all CFIR domains, including intervention costs, financial compensation, ICT infrastructure, and team dynamics.
• Key factors included integration into care pathways, professional motivation and competencies, patient resources, digital literacy, and management information availability.
• Specific barriers noted were eCoach design/licensing costs, lack of financial compensation, ICT integration issues, and task reallocation challenges.

Conclusions:

• Implementing eCoaches in hospitals is a complex, multi-domain challenge requiring comprehensive strategies for sustainable integration.
• Addressing "pilotitis" necessitates strategies that concurrently tackle barriers across intervention, setting, individual, patient, and process domains.
• Understanding healthcare professionals' experiences is crucial for guiding the successful design, implementation, and upscaling of eHealth solutions.