Introduction
Within the dynamic landscape of healthcare, integrating telehealth services has become a crucial undertaking, particularly in mental healthcare delivery. This practicum project revolves around effectively implementing a telehealth position within a mental health clinic, requiring strategic foresight and skillful execution. The global pandemic has expedited the adoption of telehealth, providing distinctive opportunities to improve the accessibility, quality, and efficiency of mental health services. The detailed leadership journey involves applying Kotter’s 8-Step process, emphasizing the empowerment of employees to overcome resistance and fostering a cultural shift towards embracing telehealth. As the researcher embarks on this transformative initiative, the ultimate aim is to revolutionize mental health care, making it more centered around the patient, accessible, and resilient in the face of contemporary challenges.
The Problem
Description of the Problem
The researcher aims to address the issue of low adoption and integration of telehealth services in a mental health clinic. Telehealth involves using digital technologies to provide healthcare services remotely, particularly for patients facing barriers to in-person care (Haleem et al., 2021). Despite the increasing demand and potential benefits of telehealth in mental health care, the clinic has limited capacity and resources for such services. The researcher observed low awareness and readiness for telehealth among clinic staff and patients and concerns about its quality, effectiveness, and security. Mental Health America (2023) reports that more than half of adults with mental illness do not receive treatment, totaling over 28 million individuals. Even in Montana, ranked first, over 4 in 10 adults with mental illness did not receive care. Chen’s study (2022) found that telehealth is as effective as in-person care regarding treatment, diagnostics, and overall quality of care, emphasizing the importance of promoting telehealth in mental health services.
Impact of the Problem & Significance of Solving the Problem
The issue adversely impacts the organization across various dimensions. Firstly, it hampers clinic performance by diminishing patient numbers, visit frequency, and care coordination. Secondly, it compromises clinic quality by elevating the likelihood of errors and patient/provider dissatisfaction (Haleem et al., 2021; Gajarawala & Pelkowski, 2021). This, in turn, affects efficiency by raising travel and overhead costs. Additionally, it negatively influences the clinic’s reputation, making it less competitive and adaptable to market changes. According to Kotter (2012), addressing such problems significantly benefits organizations by enhancing outcomes and innovation. Integrating telehealth services can address these challenges. This move can expand care access, particularly for underserved populations facing barriers to traditional in-person care (Haleem et al., 2021). Moreover, adopting telehealth can enhance convenience, efficiency, and environmental sustainability by reducing travel-related time, costs, and emissions. The clinic can improve quality, safety, and effectiveness by utilizing evidence-based telehealth practices while reducing the risk of contagious diseases.
Establishing a Sense of Urgency (Step 1)
To instigate the change process, it is imperative to instill a sense of urgency (Step 1) regarding the identified problem, thereby providing a compelling rationale for the necessity of change and its immediate implementation. As delineated in Kotter’s 8-step change leadership framework, cultivating a sense of urgency proves instrumental in overcoming complacency, resistance, and fear, motivating individuals to participate (Kotter, 2012). The researcher will follow specific steps to establish this urgency: collecting and presenting data showcasing the problem’s magnitude, outlining the solution’s benefits, and emphasizing the risks and costs of maintaining the status quo. Additionally, communicating the project’s vision and desired outcomes to stakeholders, such as patients, providers, managers, and staff, will align the change with their values and interests. Soliciting feedback, addressing concerns, and involving stakeholders in the change process will ensure feasibility and effectiveness. Identifying and enlisting influential supporters will further propel the change effort while creating and publicizing short-term wins will underscore progress and incentivize continued commitment.
Vision & Desired Outcome
Strategic Vision & Desired Outcome
Kotter (2012) characterizes strategic initiatives as focused and coordinated actions that, when swiftly and effectively implemented, have the potential to transform a vision into reality. The project’s vision is to furnish superior, patient-centric, and economically viable mental health services to a broader and more diverse demographic by implementing telehealth technology. By December 31, 2023, the mental health clinic aspires to extend telehealth offerings to 90% of its existing and prospective patients via a secure and empirically supported platform. The desired outcome is to realize enhanced acceptance and efficacy of telehealth services among the clinic’s staff and patients, ultimately contributing to advancements in the clinic’s operational and financial metrics.
Formation of the Guiding Coalition (Step 2)
In forming a guiding coalition (step 2), the researcher will meticulously engage in a systematic process to designate individuals who will spearhead the realization of the envisioned change. According to Kotter (2012), this involves identifying paramount stakeholders and influencers associated with the change initiative and evaluating their preparedness, willingness, and capability to actively engage and endorse the transformation. Employing methodologies such as surveys, interviews, and focus groups will aid this assessment. Subsequently, the selection of guiding coalition members, distinguished as change champions and leaders, will be based on a judicious consideration of their competencies, authority, influence, and unwavering commitment to the established vision. The roles and responsibilities of these coalition members will be clearly defined, and a governance structure will be instituted, encompassing communication channels, meeting agendas, and reporting and feedback mechanisms.
The researcher will assemble a guiding coalition comprising key members, including the clinic director as the change sponsor and senior leader, possessing the vision and resources necessary for driving the change. The telehealth coordinator will be the project manager and operational leader, contributing organizational and managerial skills. In contrast, as the change agent and clinical leader, the clinical psychologist will leverage expertise to implement telehealth services and provide training (Johnson, 2020). The IT specialist will be a communication specialist and technical leader, using knowledge and tools to develop and maintain the telehealth platform and communicate progress to stakeholders. Lastly, the quality improvement officer will be the trainer and evaluator, employing skills and data to assess needs, preferences, and outcomes, offering feedback and support to the coalition and stakeholders.
Development of the Strategic Vision (Step 3)
Johnson (2020) states that the third step in strategic planning involves crafting a strategic vision, wherein the organization delineates its future aspirations. To formulate a vision and strategy for change (Step 3), the researcher and coalition must undertake the following tasks: review relevant literature and best practices regarding telehealth benefits and challenges, identify gaps and opportunities for the clinic; conduct a SWOT analysis of the clinic’s current telehealth situation; define SMART goals and objectives for the change, specifying expected outcomes, indicators, and targets; create a logic model and roadmap detailing the inputs, activities, and impacts of telehealth; and ensure alignment of the vision and strategy with the organizational mission and values, maintaining consistency with the clinic’s purpose and culture. Logic models provide a succinct representation of how interventions influence behavior to achieve a goal.
Communication of the Vision (Step 4)
In Step 4 of Kotter’s Leading Change, Communicating the Vision is crucial for ensuring the change message is clear and embraced throughout the organization (Kotter, 2012). To effectively communicate the vision of implementing telehealth, the researcher and coalition will craft a clear and catchy vision statement encapsulating the purpose and benefits. This statement will serve as a slogan and motto for the change. To reach stakeholders, they will employ diverse communication channels like posters, podcasts, and videos. Sharing stories, testimonials, and scenarios will vividly illustrate the vision and contrast the current and desired state of the clinic. Data, evidence, and facts will be used to substantiate the need and feasibility of telehealth. Lastly, interactive methods such as workshops and feedback sessions will involve stakeholders actively in the change process.
Barriers to Success
Resistance to Change among Healthcare Professionals
One significant challenge for researchers in implementing telehealth services in healthcare settings is the resistance to change among healthcare professionals. This reluctance may be rooted in concerns about losing control, distrust in technology, perceived threats to professional identity, or insufficient skills and knowledge. According to Lawrence (2001), such resistance can negatively impact the quality and safety of care, staff satisfaction, and retention. The researcher will follow Kotter’s fifth step to address this barrier to identify and mitigate obstacles to enable widespread action. The strategy involves empowering employees by presenting a clear and compelling case for change, emphasizing the need, benefits, and advantages of adopting telehealth services (Johnson, 2020). The researcher will communicate these aspects effectively and provide evidence and examples illustrating how telehealth has successfully enhanced mental health care delivery and outcomes in other settings.
Patient Concerns and Apprehensions
Concerns may revolve around protection, security, and the efficacy of virtual care compared to in-person visits. Some patients may also encounter difficulties accessing or using the necessary technology for telehealth services. Critics, such as Gajarawala and Pelkowski (2021), worry that telehealth may disrupt continuity of care due to perceived impersonality and potential dangers, as virtual providers lack a complete history and physical examination. To overcome this barrier, the researcher plans to communicate and educate patients on the benefits of telehealth, addressing their questions and concerns through various channels such as newsletters and meetings. Using stories, examples, and demonstrations, the researcher will illustrate how telehealth operates and what patients can expect.
Financial Constraints and Technology Infrastructure Investment
One of the inherent challenges hindering telehealth implementation involves the potential misallocation or misuse of funds and resources. Shamuel (2023) highlights fraudulent activities by some healthcare providers concerning telehealth services, including billing for services not provided. To overcome this obstacle, the researcher aims to secure adequate funding and resources for telehealth implementation. This involves exploring diverse funding sources such as grants and donations and conducting a cost-benefit analysis to showcase the return on investment and the value of telehealth services. This analysis will help justify the proper allocation and utilization of funds and resources.
Regulatory and Compliance Challenges
The barrier may stem from uncertainties surrounding the dynamic landscape of telehealth regulations, potential conflicts arising from regulatory variations across different locations, and the imperative to continually adapt to evolving legal requirements in the healthcare sector. These factors hinder seamless adherence to regulatory standards (Nohria & Khurana, 1993). To surmount this obstacle, the researcher commits to ensuring that telehealth services align with pertinent regulations and guidelines applicable to the clinic, staff, and patients. Regular consultations with legal and ethical teams will be undertaken to stay abreast of the latest telehealth regulations. Furthermore, staff will receive ongoing training sessions and updates to foster a comprehensive understanding of compliance requirements.
Short-Term Recommendations
Employee Training and Adoption
In the immediate term, a pivotal recommendation involves instituting a comprehensive employee training initiative focused on adopting telehealth. According to Felker et al. (2021), this approach facilitates the acquisition of essential knowledge and skills for the confident and competent use of telehealth technology and services. Workshops and webinars will be organized to educate staff on telehealth’s advantages and operational aspects. This initiative’s short-term win (Step 6) will be gauged by staff participation in training sessions, their interaction with telehealth tools, and their ability to integrate telehealth into their daily routines. The assessment of success will include pre-and post-training evaluations, participation rates, and feedback surveys. Continuous analysis of these metrics will yield insights into the effectiveness of the training program, with success defined by a substantial improvement in staff confidence and proficiency in utilizing telehealth services.
Patient Engagement Initiatives
Another short-term win involves implementing patient engagement initiatives to encourage the utilization of telehealth services. Felker et al. (2021) state that this approach educates patients and healthcare providers on telehealth’s advantages and best practices, covering technology utilization, expectations, and data privacy safeguards. The researcher intends to initiate informative campaigns through newsletters, posters, and social media platforms to enlighten patients about the advantages and convenience of telehealth access. Increased telehealth appointments and positive patient responses will measure success. The data collection will involve tracking appointment records, conducting patient surveys, and utilizing feedback channels. The analysis will specifically emphasize quantifying the heightened engagement of patients with telehealth services, providing a tangible indication of the successful short-term goal achievement in enhancing telehealth access and utilization.
Technology Readiness Assessment
To pinpoint shortcomings, a comprehensive evaluation will be conducted on current communication platforms, electronic health records, and hardware. Short-term success will be gauged by completing this technology assessment and initiating necessary upgrades or adjustments. Data collection will involve technology readiness checklists, feedback from IT professionals, and progress reports on infrastructure enhancements. Regular analyses will monitor the clinic’s readiness, ensuring these short-term accomplishments contribute to the overall success of telehealth implementation. This success will be evident through the smooth integration of upgraded technology, improved communication capabilities, and positive feedback from IT professionals, ultimately bolstering the success of telehealth implementation.
Long-Term & Sustainability Recommendations
Success of the Change Initiative
The enduring success of a change initiative hinges upon various determinants, encompassing the enduring support and dedication of stakeholders, the harmonization of telehealth aspirations with organizational mission and values, the seamless integration of telehealth services into extant workflows and systems, and the continuous scrutiny and evaluation of telehealth outcomes and impacts. The recommendations for sustaining momentum and institutionalizing change as an integral facet of the organizational culture derive from the seventh and eighth steps of Kotter’s 8-step change leadership process, specifically, the consolidation of gains and the generation of further change, along with the anchoring of novel approaches in the organizational culture (Kotter, 2012). The ensuing recommendations are delineated hereafter.
Sustaining Progress (Step 7)
This phase entails building upon the accomplishments and successes of short-term victories while also addressing the persistent barriers and challenges associated with the implementation of telehealth (Kotter, 2012). The positive results and outcomes achieved in the short term will be leveraged to underscore the advantages and feasibility of telehealth, motivating and inspiring stakeholders to sustain and broaden their efforts for change. The existing issues and gaps in telehealth will be identified and resolved, including technical, operational, regulatory, and cultural aspects. Subsequent improvements and adjustments will enhance telehealth’s overall performance and impact.
Institute and Anchor Change (Step 8)
This step involves ensuring the complete integration of telehealth services into organizational policies, procedures, and systems, aligning telehealth vision and goals with the organizational mission and values (Johnson, 2020). Adequate resources, infrastructure, and incentives will support telehealth services. Recognition and rewards for telehealth providers and users will be established based on their contributions and achievements. A culture of innovation, collaboration, and learning will be promoted among stakeholders, fostering the adoption and diffusion of telehealth best practices and standards.
Anticipated Outcomes
The alterations are anticipated to yield favorable and substantial outcomes for the organization and its overall performance. Implementing telehealth is expected to enhance the organization’s capacity to deliver improved access, quality, and efficiency of care, thereby fostering heightened satisfaction and engagement among patients and providers. Furthermore, the integration of telehealth is projected to yield cost reductions, revenue increments, and an augmentation of the organization’s competitive standing and market reputation.
Evaluation Tool
In the forthcoming 2 – 3 years, the Telehealth Capacity Assessment Tool (TCAT) will serve as a crucial instrument for gauging the continuous success of the ongoing change initiative. The TCAT, designed to evaluate telehealth services’ implementation process and outcomes, encompasses six pivotal domains: readiness, adoption, appropriateness, feasibility, fidelity, and sustainability. Each domain incorporates multiple items and scales to assess the quality and impact of telehealth service implementation (Wieczorek et al., 2023). The TCAT is poised to scrutinize the current and desired levels of telehealth service implementation within the clinic by offering guidance on selecting, collecting, analyzing, and reporting implementation data. Its utility lies in pinpointing the strengths and weaknesses of the implementation process.
Learning from Success Stories
The implementation of telehealth solutions, as demonstrated by the Mayo Clinic and the United Kingdom’s National Health Service (NHS), offers valuable insights for organizational change. Mayo Clinic’s successful integration of telehealth has resulted in enhanced access, quality, and efficiency of care, along with increased satisfaction among patients and providers (Haddad et al., 2021). Similarly, the NHS in the United Kingdom has achieved positive outcomes, including reduced hospital admissions, improved management of chronic diseases, and increased patient empowerment through the widespread adoption of telehealth services (Bhaskar et al., 2020). These success stories serve as instructive examples for organizations facing similar challenges in implementing telehealth initiatives.
Conclusion
In conclusion, the journey toward effectively implementing telehealth services in a mental health clinic necessitates a strategic vision to improve access, quality, and efficiency of care. Overcoming challenges like resistance to change, patient concerns, financial constraints, and regulatory issues demands a comprehensive approach. The researcher aims to empower staff through involvement, training, and communication, generating short-term successes that pave the way for long-term achievements. Sustaining progress involves integrating telehealth practices culturally and continually evaluating using comprehensive tools. As the organization adapts to the changing healthcare landscape, learning from successful experiences elsewhere and ongoing education will enhance the resilience and success of the telehealth initiative, promoting patient-centered, accessible, and effective mental healthcare delivery.
References
Bhaskar, S., Bradley, S., Chattu, V. K., Adisesh, A., Nurtazina, A., Kyrykbayeva, S., Sakhamuri, S., Yaya, S., Sunil, T., Thomas, P., Mucci, V., Moguilner, S., Israel-Korn, S., Alacapa, J., Mishra, A., Pandya, S., Schroeder, S., Atreja, A., Banach, M., & Ray, D. (2020). Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). Frontiers in public health, p. 8, 556720. https://doi.org/10.3389/fpubh.2020.556720
Chen, P. V., Helm, A., Caloudas, S. G., Ecker, A., Day, G., Hogan, J., & Lindsay, J. (2022). Evidence of phone vs video-conferencing for mental health treatments: a literature review. Current Psychiatry Reports, 24(10), 529–539. https://doi.org/10.1007/s11920-022-01359-8
Felker, B. L., McGinn, M. M., Shearer, E. M., Raza, G. T., Gold, S. D., Kim, J. M., Rojas, S. M., Roussev, M. S., Varkovitzky, R. L., Liu, H., Morrison, K. L., & McCann, R. A. (2021). Implementation of a Telemental Health Training Program Across a Mental Health Department. Telemedicine reports, 2(1), 26–31. https://doi.org/10.1089/tmr.2020.0011
Haddad, T. C., Blegen, R. N., Prigge, J. E., Cox, D. L., Anthony, G. S., Leak, M. A., Channer, D. D., Underwood, P. Y., Williams, R. D., Hofschulte, R. D., Christopherson, L. A., Coffey, J. D., TerKonda, S. P., Yiannias, J. A., Costello, B. A., Russi, C. S., Colby, C. E., Ommen, S. R., & Demaerschalk, B. M. (2021). A Scalable Framework for Telehealth: The Mayo Clinic Center for Connected Care Response to the COVID-19 Pandemic. Telemedicine reports, 2(1), 78–87. https://doi.org/10.1089/tmr.2020.0032
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, p. 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117
Johnson, W. (2020). Disrupt yourself with a new introduction: Master relentless change and speed up your learning curve. Harvard Business Press.
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The journal for nurse practitioners: JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013
Kotter, J. P. (2012). The heart of change: Real-life stories of how people change their organizations. Harvard Business Press.
Lawrence, P. R. (2001). How to deal with resistance to change. New York, NY: Harvard Business Review Case Services.
Mental Health America. (2023). The state of mental health in America. https://mhanational.org/issues/state-mental-health-america
Nohria, N., & Khurana, R. (1993). Executing change: Three generic strategies. Harvard Business School Cases, Aug. 1993, P1.
Shamuel, N. (2023). Telehealth Fraud and Abuse Before and “After” the Pandemic: Are Things Going to Get Better? DePaul Journal of Health Care Law, 24(2), 3. https://via.library.depaul.edu/jhcl/vol24/iss2/3
Wieczorek, E., Kocot, E., Evers, S., Sowada, C., & Pavlova, M. (2023). Development of a tool for assessing the performance of long-term care systems about care transition: Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC). BMC Geriatrics, 23(1), 760. https://doi.org/10.1186/s12877-023-04467-z
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