Role of Co-creation for Large-Scale Sustainable Adoption of Digitally Supported Integrated Care: Prehabilitation as Use Case

To capture the patient experienceperspective of the service.

To identify factors of the prehabilitationservice at HCB that may limit scalability.

In-depth interviews to patients and caregivers.

Surveys to professionals involved in the prehabilitation unit.

Identification of actionable areas to be addressedin Session I – Immersion (see text).

To gain further insight on organizational and actionable factors of to enhance scalability of the existing prehabilitation to:

1. Optimize service workflow.

2. Identify ICT-support to scalability.

3. Explore financial needs for adoption.

Elaboration of the following material contributing to refinementof the PreHab service (*):

• Experience map

• Empathy map

• Context map

• Priority map

Agreement on the main challenges to face and solve in Sessions II and III. Main outcome of the Immersion was “to provide an accessible, round-the-clock personalized and modular service that the patients should be ableto use autonomously during the PreHab period. The service should combine remotely controlled actions and face to face interactions with health professionals”.

To generate, develop and assess ideas and plans to solve the challenges identified in Session I.

Two inspirational presentations (see text).

Small groupcreative sessions.

Positioning map (*)

Generation of a customer journey thatshould contribute to define a viable strategy for regional deploymentof prehabilitation. To this end, an overview of the prehabilitationservice workflow was produced, as a visual map depicting theend users touch points and needs for both ICT-supportand business model.

To consolidate theproposals and refine the actions resulting from Session II aimingto define a viable strategy for regional deployment of arefined service workflow.

Three working groups to separately tackle specific areas and final overall group meeting to generate consensus on specific proposals for each area:

• ✔ Implementation strategies.

• ✔ Technology-related aspects.

• ✔ Business model & reimbursement incentives.

Fulfil end-user touch points (see text for more details)

Creation of a capillary network of healthcare/wellness centres to enhance accessibility.

Mobile app fostering tailored patient empowerment for self-management and remote monitoring.

Interoperability of ICT-enabling tools with existing HIS.

ACM system to support prehabilitation knowledge intensive processes for enhanced service management.

To drive patient interactions and data collection through an AI assisted chat (i.e. Chatbot).

Cost-savings generated by prehabilitaton should cover the operational costs of the service. Investments needed to launch the service, as well as reimbursement incentives, could be covered by innovative PPP models.

– Prehabilitation as an integrated care component of ERAS pathways (enhanced recovery after surgery)

– Core components:

• Management multimorbidity

• Trimodal intervention

• Service workflow defined

• Define target patients’ profiles

• Personalize the service

– Adaptability of non-core components is required

– Continuous quantitative & qualitative build-in evaluation is needed

Increase service efficiency & value

Building capacity & Refinementof service delivery

Enhanced risk assessment & program prescription

Improving digitalsupport

Transfer to the community

– Patient-centred orientation, a core trait

– Networking across experiences needed

– Site customization is required to minimize potential negative impacts of external factors

– Bottom-up/Top-down interactions are needed for success. Champion driven programs show high success rates

– Key resources togenerate/reinforce a positive climate change are needed

– Continuous monitoring of satisfaction levels and consideration of feedbackfrom patients and professionals is highly recommended

– A building-blocks implementation strategy, with appropriate site customization prioritizing engagement, is required

– Continuous evaluation of results