The informal way to success or failure? Findings from a comparative case study on video consultation training and implementation in two Danish hospitals

Background This study evaluated an attempt to implement video consultations through a novel education interven-tion in telehealth training and implementation in two middle-sized hospitals in Denmark. Three units tested the edu-cation intervention along with a regional decision to strengthen multidisciplinary and cross-sectoral collaborationthrough technology to improve service delivery by making the process more coherent and saving time and resources.This study aims to identify what contextual factors enable workplace learning, skills acquisition, and utilization of newdigital skills to use and routinize video consultations in workplace practice.Methods This qualitative case study draws on the principles of the realist evaluation framework using cross-casecomparisons to test and refine program theories by exploring the complex and dynamic interaction among context,mechanism, and outcome. The methods in this study include participant observations, document analysis, semi-structured individual interviews, and focus groups. We performed an interpretive cross-case analysis, which exploredthe context-mechanism-outcome relationship using the guiding question, “What works, for whom, under whatcircumstances, and why?”.Results Two broad mechanisms appeared to enable skills acquisition and routinization of video consultations:informal workplace learning and adjusting video consultations to professional judgment. The three units had differ-ent approaches to the implementation and training and, as such, had different outcomes. First, the skills acquiredin the units differed; therefore, how and with whom they used video consultations varied. Second, video consultationuse was more likely to be adjusted to workflows if unit managers were responsive to staff’s professional judgmentsregarding patients, as was evident in all three units.Conclusion Our study shows that a formal training course alone is insufficient to provide healthcare professionalswith the skills needed to use video consultations in workplace practice. Informal workplace learning with supporton the spot and continuous follow-up seems to equip healthcare professionals with the skills to use video consulta-tions. Video consultations are more likely to be used confidently if novel workflows are adjusted to health care profes-sionals’ knowledge, skills, and judgment and their concerns regarding patient soundness.