Strategies for Success—What Does It Really Take?

Over the past three decades, we as editors have been involved in some form of education, whether in the operating room, classroom, or a virtual space. We have aptly developed curriculum for all levels of learners based on our experiences in many faraway places with different cultures, different languages, different technologies, and certainly different attitudes. Our work, funded in part by NASA early on, set the stage for innovation and discovery and laid some of the very foundation we stand on today. It was those early projects in 1993, which were focused on the Web and use of the Internet, that helped usher in a new paradigm. These events provided a foundation for developing curriculum. People had to be trained on what, why, where, and how to do things. The very results from this work served as fodder for curriculum development and content. Others have followed our path, and others have charted their own course. We nevertheless end up on the same road. As an analogy, the road started out as dirt and gravel and is now paved with nicely marked lanes.

So what was the strategy for success? What did it take to do what we did or, more importantly, what you are doing now? Perhaps we could come up with a craftily worded “Letterman-style” Top 10. Maybe there are not 10 items, less or more, depending! But it is important to review the past, as it influences us in many ways. Having been at this a long time, we are amazed at how some people never review the past. Recall George Santayana's 1905 publication Life of Reason in which he stated, “Those who cannot remember the past are condemned to repeat it.”

Pedagogy is a vitally important step in preparing our physicians, nurses, pharmacists, and allied health workers for their career of providing care. We know that we must integrate more technology into care. This is the ongoing mantra of the telemedicine and telehealth community. Without this integration, healthcare will be stymied and will become a burden for all. So a key element is education—teaching that next generation the skills they need. But what skills? These skills are based on effective implementation of past activities, including those with positive and negative outcomes.

Therefore an effective first step in developing a strategy is to conduct a needs assessment. This implies there is an interest or intent on improving care through the integration of telemedicine and telehealth. This assessment may be influenced by many determinants, including leadership or lack thereof, strategic vision of your organization, an actual identified problem, the capabilities of staff (clinical and non-clinical), access to technology, and geography. Although this is not an exhaustive list, it does lay out issues that must be addressed in the assessment phase.

In the Journal we have published several articles on strategies. Initiate, Build, Operate, and Transfer (IBOT) was developed through the International Virtual e-Hospital, a non-governmental organization that works in the Balkans primarily but does work in other parts of the world. In addition to the publications by Latifi et al., ^1,2 Schwamm ³ reported in 2014 seven strategies for telehealth, and Eason and Waterson ⁴ in 2013 discussed lessons from England. We use this IBOT strategy as an illustration of how 10 steps (although it is not our intent to provide a “Top Ten” list) can be used to gain success. These steps include (1) needs assessment, (2) identify the problem, (3) identify a champion, a person who is passionate and can lead the effort, (4) solicit input from all participants—at all levels, (5) develop a plan, (6) train, educate, and prepare (and repeat), (7) implement the plan, (8) conduct the plan, (9) review the plan for process improvement, and (10) transition the plan to fully operational status.

Each of these 10 elements will provide a strong foundation for the implementation of telemedicine and telehealth within your organization. You may find tool kits available from many sources, but these elements are key to success.

Ecosystems, a group of interconnected elements that work in concert to accomplish a task, are becoming a part of strategic development in telemedicine and telehealth implementation. Similar to symbiotic relationships, all systems benefit, even if they do so in different ways. León et al. ⁵ reported on digital ecosystem for healthcare and wellness using the IBOT strategy. To use a business case to further explain this concept, Procter and Gamble sells many consumer products. A new idea is generated that has a huge potential market, but before moving forward, all members of the team must be assembled and review the plan. This includes disciplines of design, branding, marketing, sales, distribution, manufacturing, finance, etc. Without this step, products will not be successful. Implementing telemedicine and telehealth can follow similar paths. There are exceptions where telemedicine and telehealth are necessary tools for the delivery of healthcare.

Nevertheless, a well-thought-out and vetted strategic plan is imperative. We encourage you to go back and look at IBOT and other strategies as effective tools. The published literature in our Journal provide an excellent foundation for curriculum development.