Covid-19 outbreak and the new reality led to increase in the demands for remote health services. The health system faced with an adaptive challenge of redesigning remote health services in no time. The Digital Health Department at the Israeli Ministry of Health founded a cross-organizational and cross-professional health practitioners’ community to advance wide scale, informed and safe telemedicine practices through the creation of a learning environment, knowledge sharing, and joint action.
The Covid-19 outbreak led to drastic changes in the demands for remote health services. The social distancing and the fear of exposure enabled the provision of many services remotely, and patients embraced the change. The overnight surge in demands has led health practitioners to deal with a discrepancy between their desire to address the patients’ need and the incomplete solutions that existed. Unsuitable technology, regulations and guideline, and lack of appropriate training were the main difficulties. Many therapists felt professional loneliness. Israel has a public health system with limited resources. Therefore, it is important to develop frameworks and tools that will enable intelligent, high quality and safe use of remote health services, with an emphasis on treatment safety, clinical quality, demand management, accessibility and efficiency.
In august 2020, the digital health department in the Israeli ministry of health (MOH) together with partners (managers and clinicians) from the health organizations and INBAR healthcare management program of “MAOZ” organization identified the need. They decided to face the adaptive challenge of redesigning remote health services through the establishment of health practitioners’ community, the Israeli Telemedicine Community. That, in order to encourage the health system transformation into continuous learning system, while spreading acceptable and optimal processes and practices.
The community’s’ vision is to advance and integrate wide scale, informed and safe telemedicine practices, to increase productivity and promote accessibility of healthcare services through the creation of a learning environment, knowledge sharing, and joint action. The community's strategy focuses on the ability to lead change in the health system through the redesign of telemedicine services. The community’s impact stems from the following reasons:
- The community serves as a safe non competitive platform where high level of trust exists between the participants, indifferent to their organizational identity.
- The community enables eye-level dialogue between the various players in the health system in an equal manner: professional unions, MOH and health organizations professionals in various positions.
- The community provide input and feedback to MOH on challenges and gaps about remote health services, which in turn, lead to MOH actions.
- The community is open to all health professionals (clinicians, nurses, allied health professions etc.) from the healthcare system. The leading identity is their professional identity. The participants are not representing their organization, nor their current title and responsibility.
In the two years since the establishment of the community, it has expanded and has over 1100 members from all health organizations. The community operates in 11 discipline-specific working groups (Mental health, nutrition, genetics, oncology, family medicine, pediatrics, pediatric allied health professions, geriatrics, rehabilitation, and technology). Each group led by a clinical person who were carefully selected, works voluntarily, and has the ability to lead the group despite its heterogeneous nature, and without formal authority. The groups’ accomplishments constitute the core of the community’s activity and achievements.
The working groups identified critical topics related to their professional field in which they should act on. Several groups chose to develop telemedicine services guidelines, other chose to engage in design thinking workshop for service design processes that deal with professional challenges. For example, the family medicine group designed a clear, simple and accessible digital routing process (triage) that helps the patient receive a medical response and allows the medical team to give the answer that has the best therapeutic benefit.
The groups also developed simulation-based training for various scenarios from therapist-patient encounters. The training sets designed by the community members and widely distributed to all healthcare organizations, in order to provide therapists with tools that will enable them to provide better services. The community holds quarterly meetings used for peer learning and deal with different agendas such as sharing success stories regarding the development and implementation of telemedicine services or adapting telemedicine services to diverse populations (periphery, ethnic populations, etc.).
The community initiated The Accelerator program for intra-organizational entrepreneurs from the health organizations in order to provide tools to design solutions and accelerate telemedicine services’ ideas into practical solutions inside the organizations. Finally, the lack of a knowledge base regarding telemedicine led to the foundation of the Community Research Club, aimed to create best practices regarding telemedicine services. The club enable professional support, collaboration, knowledge sharing and funding.
What Makes Your Project Innovative?
- The community strive to lead change and redesign remote health services by health professionals who set the agenda, act in their free time and fully voluntarily, while MOH simply provides the platform and the tools to accelerate the processes.
- The community is design to encourage health system transformation into continuous learning system, while spreading acceptable and optimal processes in order to promote the informed and safe use of remote health services. The community create trust between its members and encourages health organizations, to share knowledge, success stories and failures.
- Designated Leaders lead the Community. The leaders are noteworthy characters, with charisma and ability to lead the groups to innovative processes and achievements.
- The community serves as a place for health professionals to take responsibility and action regarding issues that bother them, outside of the usual frameworks, at a faster pace and in a way that is more connected to the field
What is the current status of your innovation?
The Telemedicine community was founded during Covid-19 when its’ founders felt a sense of urgency to advance informed and safe telemedicine practices. Two years after its establishment, the community is still running. The status of the community is divided into several levels. The first concerns the ongoing work: Implementation - making the innovation happen: Ongoing work includes marketing and distribution in various of platforms in order to recruit new members and spread the story, impact and achievements. The community held meetings and strive to implement additional tools that will allow continual promotion of telemedicine services such as design thinking workshops, health professionals training, guidelines design etc. On the strategic level we plan to examine the community’s’ value, impact and evaluate the success criteria to be self-sustainable in coming years. The goals include expanding the impact, establish new groups and accelerate collaborations between the members.
Collaborations & Partnerships
- MAOZ: A trust-based network of influential and diverse leaders who collaborate and promote social change initiatives in order to strengthen socio-economic resilience. The community was founded in the accelerator program of Maoz and within the training program of the INBAR Healthcare Management Program.
- Health professionals: Constitute the members of the community, the leaders of the groups and the main engine of the community that formed the core of the community’s activities and achievements.
Users, Stakeholders & Beneficiaries
- The entire health system benefits. The health organizations benefits from services development and informal communication channel to the MOH.
- Health professionals and researchers, who specialize in telemedicine, find value in the community where they have the opportunity for peer learning, knowledge sharing, funding and support.
- The MOH benefits from the fruitful cooperation with health organizations and from the feedback, which helps processes design in an informed and responsible manner.
Results, Outcomes & Impacts
For the community to promote change and create an impact, the community’s members must be agents of change and echo the contents and insights with their colleagues. In order to examine the proactivity of the members and their influence outside the community, we conducted an echo survey. Results indicated that 86% of the respondents believe that the community can promote the telemedicine field at the national level. 33% echoed the content they received, 63% replied that in their opinion telemedicine services have added and unique value and 28% replied that they created a collaboration with another member. Additional results are guidelines publication, designing simulation based training, service design workshops for services (as part of the Accelerator program) and the research club establishment that support research and aim to increase the knowledge base. In the future, the community aims to maintain the value for its’ members and serve as a platform for collaboration.
Challenges and Failures
The health organizations have a formal and hierarchical structure in which the chain of management is clear, and competitive relations are established between them. From the early days of the community, the founding team faced several significant challenges.
- First, concerns the correct way in which a semi-formal organization (community) should act in front of the health organizations and their formal structure?
- Second, how to generate trust between the members and make them collaborate to promote a common goal and ignore competition. Third, what value do the community members receive from their membership? Finally, how to keep the community vital even though the sense of urgency starts to fade?
- In order to face these challenges, the community strives to demonstrate that its’ activity leads to significant changes.
The community share success stories, provide tools that give a solutions for the members’ pains and makes them feel a part of a major change made in the health system.
Conditions for Success
The community promote intelligent telemedicine services through the encouragement of health system transformation into continuous learning system. In order for the vision and goals of the community to be fulfilled, there are several conditions that must happen:
- MOH is responsible for ensuring that the achievements can be integrated into the health system:
- Funding the community’s operation.
- Establishment of clear regulation, guidelines, sustainable financing and reimbursement conditions.
- Rewarding innovative models and engage in telemedicine services that improve the quality of care.
- Trust between the community’s’ members between MOH and the health organizations.
- Providing continuous value to the community members: sharing success stories, creating meaningful connections and aiming for practical experience, in order to give the community members motivation to continue investing their time and efforts.
- Designated leaders that have the ability to cooperatively lead the groups
The telemedicine community model can be replicated to promote additional initiatives that will take advantage of a community structure to encourage a common goal and lead adaptive and transformative changes and impact in a certain field. For example, the model can be replicated for professional’s’ communities that deals with challenges that requires a deep, transformative change, requires variety positions and hierarchies combination and depends on the professional confidence and the ability of the end user to respond to change. For example government communities dealing with digital transformation in health, defense or education and aim to learn and receive feedback in order to conduct Intelligent planning at the national level.
The main lesson that can be learned from the success story of the Telemedicine Community is its’ ability to be a platform for dealing with dramatic challenges and leading significant changes through the engine of its members and leaders. Another lesson is the importance of acting fast during crisis or urgent need, and the ability of the government to provide platform to face the challenge. Some of it was formed on the go, responding to needs rise from the working group. This flexibility, in actions but also in mindset, was critical to the community’s success. The strength of the community lies in its ability to give continuous value to its members. As long as the community demonstrate significant achievements and ability to impact, the members will continue to follow and support the common goal and take proactive part in the processes. Finally, the leaders’ selection is critical to the ability to act together to lead change and to maintain the ongoing activity that carries achievement
- Implementation - making the innovation happen
- Evaluation - understanding whether the innovative initiative has delivered what was needed
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
2 January 2023