The role of preparation in implementation for rural healthcare innovation: a multi method evaluation of a virtual medical officer model of inpatient care in Australia

BACKGROUND: Preparation factors in implementation are critical for success but remain relatively unexplored in rural healthcare. This evaluative study investigated the introduction of a virtual medical officer model in three acute wards of a rural health service in Victoria, Australia. The paper describes the innovation and identifies important features of preparation in implementation. METHODS: The evaluation was process-outcome orientated, undertaken from December 2022 to June 2023; deemed the innovation's pilot phase. Multi-method data collection involved a review of documents pertaining to the model, an electronic survey specific to nurses at two time points (preparation and implementation), and semi-structured interviews targeting two groups; Group one, health system stakeholders (nurses, doctors, managers and virtual medical officers) and Group two, patients. Implementation frameworks informed the evaluation design, data collection and analysis. RESULTS: The document review emphasised the important preparation factors undertaken as an interdependent platform for subsequent implementation stages, for example having a clear understanding of determinants such as the rural context, the problem and need. Interview findings (n = 77), involving Group one (n = 39); and Group two (n = 38), were categorised into three overarching themes; Facilitators of the telemedicine model, Barriers to the telemedicine model, and Sustaining telemedicine innovation gains for the future of rural healthcare. Critical preparation factors identified were the relational culture of collaboration and partnership during innovation design negotiation, and the importance of organisational and individual leadership. Implementation factors highlighted the effectiveness of the project management approach, and responsive adaptation, such as active feedback loops leading to model adjustment to increase acute ward routine efficiency. Sustainment factors were predicted to be impeded or aided by preparation actions. CONCLUSIONS: The role of preparation in implementation requires clearer articulation with its features included in implementation plans. It is an active process which can influence any stage and eventual sustainability. Our description of facilitators and barriers, and contextual determinants, as contributors to implementation success, would aid decision makers when designing, introducing and adapting rural healthcare innovations. This study has policy implications for the development of rural medical workforce strategies and the planning of a rural digital healthcare strategy.