The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems
The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what i...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-04-01
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| Series: | Digital Health |
| Online Access: | https://doi.org/10.1177/20552076231169835 |
| _version_ | 1797845392726949888 |
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| author | Hassane Alami Sara E Shaw Jean-Paul Fortin Mathilde Savoldelli Richard Fleet Bernard Têtu |
| author_facet | Hassane Alami Sara E Shaw Jean-Paul Fortin Mathilde Savoldelli Richard Fleet Bernard Têtu |
| author_sort | Hassane Alami |
| collection | DOAJ |
| description | The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the ‘wrong pocket’ problem – where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and ‘efficient’, it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field. |
| first_indexed | 2024-04-09T17:38:18Z |
| format | Article |
| id | doaj.art-3e79ba264ead4c85b6166e8128ad905e |
| institution | Directory Open Access Journal |
| issn | 2055-2076 |
| language | English |
| last_indexed | 2024-04-09T17:38:18Z |
| publishDate | 2023-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Digital Health |
| spelling | doaj.art-3e79ba264ead4c85b6166e8128ad905e2023-04-17T10:04:04ZengSAGE PublishingDigital Health2055-20762023-04-01910.1177/20552076231169835The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systemsHassane Alami0Sara E Shaw1Jean-Paul Fortin2Mathilde Savoldelli3Richard Fleet4Bernard Têtu5 Nuffield Department of Primary Care Health Sciences, , Oxford, UK Nuffield Department of Primary Care Health Sciences, , Oxford, UK Department of Social and Preventive Medicine, Faculty of Medicine, , Quebec, Canada School for Advanced Studies in Public Health, Rennes, France Department of Family Medicine and Emergency Medicine, Faculty of Medicine, , Quebec, Canada Faculty of Medicine, , Quebec, CanadaThe COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the ‘wrong pocket’ problem – where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and ‘efficient’, it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field.https://doi.org/10.1177/20552076231169835 |
| spellingShingle | Hassane Alami Sara E Shaw Jean-Paul Fortin Mathilde Savoldelli Richard Fleet Bernard Têtu The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems Digital Health |
| title | The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems |
| title_full | The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems |
| title_fullStr | The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems |
| title_full_unstemmed | The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems |
| title_short | The ‘wrong pocket’ problem as a barrier to the integration of telehealth in health organisations and systems |
| title_sort | wrong pocket problem as a barrier to the integration of telehealth in health organisations and systems |
| url | https://doi.org/10.1177/20552076231169835 |
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