Delivering digital health and well-being at scale: Lessons learned during the implementation of the dallas program in the United Kingdom

Alison M. Devlin, Marilyn McGee-Lennon, Catherine A. O'Donnell, Matt Mouley Bouamrane, Ruth Agbakoba, Siobhan O'Connor, Eleanor Grieve, Tracy Finch, Sally Wyke, Nicholas Watson, Susan Browne, Frances S. Mair*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)
16 Downloads (Pure)


Objective - To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a largescale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and wellbeing. 

Materials and Methods - Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n=38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. 

Results - Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. 

Conclusions - The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care.

Original languageEnglish
Pages (from-to)48-59
Number of pages12
JournalJournal of the American Medical Informatics Association
Issue number1
Early online date8 Aug 2015
Publication statusPublished - 1 Jan 2016
Externally publishedYes


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