Expert in e-health, telehealth/telecare, integrated care, long-term conditions, quality of life and ageing. Theti is an expert in implementation and evaluation studies of policy and technology innovations in healthcare. She worked at Imperial College London where she was involved in the evaluation of the biggest randomised controlled trial of remote care/assistive technology (telehealth/telecare) undertook worldwide, the Whole System Demonstrator Programme (WSD) and the North West London CLAHRC evaluation. She also worked at the London School of Hygiene and Tropical Medicine (LSHTM) as a Healthcare Services and Policy Lecturer and as a study coordinator to a large evaluation DH funded project on the effectiveness of Memory Assessment Services in England for people with dementia and their carers (Using Patient Reported Outcome Measures (PROMs) to Improve Dementia Services: Evaluation of Memory Assessment Services). In collaboration with the team in Surrey, she is the PI of a project that explores the design and acceptability of using a digital story-based communication system for care home settings (TiME Matters UK Project see: https://www.surrey.ac.uk/digital-world-research-centre/funded-projects/time-matters ) and she is the Process Evaluation Lead of a large UK RCT study that investigates the effectiveness of an Internet of Things (IoT) integrated assistive technology solution (telehealthcare) to support people with dementia and their carers to live independently at home (TIHM for Dementia Test Bed Project see: https://www.sabp.nhs.uk/tihm). She is still a visiting fellow at Imperial College London and continues to search, consult and co-ordinate large policy initiatives for government, applying social psychological and organizational theories to healthcare adoption and innovation processes.
My publications and research relate to barriers and facilitators in the use, implementation and scalability of remote care technologies and services for ageing population with dementia and long term care needs. I am currently working on projects that examine the views and practices of care home staff towards dementia and sexuality as well as the use of technology as a sustainable approach to improving quality of care and outcomes (i.e quality of life) for people living with dementia and their carers both in the home care environment and care home setting.
Through my work I have established excellent links with a variety of stakeholders in academia (i.e. Imperial College London, LSHTM, UCL, LSE, Oxford University Strathclyde University, Manchester University Kingston University, Winchester University) practice and industry particularly the Department of Health, NHS, King’s Fund, Innovate UK, NatCen, FrontierEconomics, e health innovators and networks and various NHS Trusts across the country.
Postgraduate research supervision
I am supervising undergraduate, MSc dissertations and I am currently the lead supervisor in two PhD theses:
- Mrs Tosan Edematie: Readiness for innovation in Public Healthcare and Service Delivery Organisations in the UK (PhD Status: Completed)
- Mr Ramin Nilforooshan: Using AI and Big Data for Dementia Care: The TIHM study (PhD status: In progress)
I am teaching both at postgraduate and undergraduate level at the University of Surrey. At postgraduate level, I lead Utilising Technologies and also Implementing Change in Practice Modules. I am also the co-leader of Innovation of Quality Improvement and Patient Safety module. At undergraduate level, I also teach on Innovation & Leadership, Understanding Research and Evidence Based Practice, Developing Skills and Supporting Quality Dementia Care in the Acute Environment and Managing Mental and Physical Health Challenges modules.
The effectiveness and efficiency of memory assessment services (MASs) is unknown. Our aim was to determine if a typology can be constructed, based on shared structural and process characteristics, as a basis for a non-randomized evaluation of their effectiveness and cost-effectiveness.
Survey of random sample of 73 MASs in 2015; comparison of characteristics and investigation of inter-correlation.
It was not possible to group characteristics to form the basis of a typology of MASs. However, there was considerable variation in staff numbers (20-fold), new patients per whole-time equivalent (WTE) staff (20-fold), skill mix and the nurse:doctor ratio (1?10).
The operational performance also varied: first appointments (50?120 minutes); time for first follow-up (2?12 weeks); frequency of follow-up in first year (1?5). These differences were not associated with the number of new patients per WTE staff or the accreditation status of the MAS.
Post diagnosis, all MASs provided pharmacological treatment but the availability of non-pharmacological support varied, with half providing none or only one intervention while others providing four or more.
In the absence of any clear typology, evaluation of MASs will need to focus on the impact of individual structural and process characteristics on outcomes.
There are calls for widespread scaling up of remote care ? ?telehealth? and ?telecare?. These are driven by an ageing population, increasing numbers of people with chronic conditions and constrained resources available for health and social services. This report is concerned with the supply-side of remote care and its ability to meet anticipated future needs. This is an important, but overlooked, question in the debate, which usually concentrates on demand-side issues such as the fragmentation of the health and social care system, or commissioning and funding issues.
Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months.
Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral.
Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130?220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non-pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months.
There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes.
Despite sexual expression being recognised as a fundamental human need, sexuality in old age is often ignored and frequently misunderstood, with residents with dementia in a nursing home often viewed as asexual or incapable of being sexually active.
The current study aims to understand the views held by nursing care home staff towards dementia and sexuality and explore the roles they may adopt whilst responding and managing sexual needs and expression for residents with dementia.
Face to face, in-depth, semi structured interviews were conducted with eight staff members working in two nursing homes in Greater London, United Kingdom. Data were analysed using Interpretative Phenomenological Analysis.
The findings suggest that representations of sexuality in dementia held by nursing home staff ranged from the perception that sexual expression in old age was part of human nature and a basic human right to others that proposed that with the loss of memory, people with dementia may also experience loss of interest in sexuality and intimacy. Based on the representation of sexuality held (personhood versus biomedical model), nursing home staff adopted a role or a combination of roles (a facilitator, an informant, a distractor, an empathiser, a safeguarder) that legitimised past and anticipated responses in managing sexual expression in the nursing home setting. Nursing home staff?s responses varied depending on the severity of the condition, level of involvement of the resident?s family and their own personal views on their duty of care, old age, sexuality and dementia.
The simplified binary labelling and classification of sexual behaviour in dementia as appropriate or inappropriate often applied in institutional settings, fails to account for complex factors that may influence staff?s decisions on the ethical dilemmas raised by dementia. A role based continuum approach could help staff move away from rigid binary judgments and train them to adopt formal carer roles that promote a more contextualised rights based approach in the provision of dementia care.
Methodological approach ? The thesis included three studies. First, a narrative systematic review was conducted across different bibliographic databases to explore the associated meanings and factors influencing organisational readiness for innovation. The search revealed that there were different meanings and processes associated with the development, implementation and sustainability of the construct. These included the stage vs. the process-based debate, the various disagreements amongst theorists on the multifaceted nature of the construct and its impact (i.e. behavioral, psychological and structural), and its relation to organisational change. This led to the adoption of a qualitative research method to further investigate the topic in the context of UK public healthcare services. Twenty semi-structured individual interviews in total were conducted. The data were collected in two phases. The first phase consisted of a total of ten senior managers working in NHS organisations. This first phase investigated from an internal point of view how organisational readiness for innovation was successfully managed within the National Health Service (NHS) ? it explored meanings, discrepancies between organisational change management and innovation, and identified contextual (pre) conditions and processes of how leadership may influence readiness for innovation, its enactment and sustainability. In the second phase, a total of ten semi-structured personal interviews were conducted with senior management representatives from the Academic Health Science Networks groups. This second phase provided information on the perspective and role of an external facilitator?s organisation in supporting and sustaining an innovation ?ready? culture in the NHS. Conducting the study in two phases allowed the researcher to see the level and reasons for alignment in the senior management?s views from different organisational perspectives ? internal and external.
Summary of results ? A significant distinction was found in the senior managers? opinion regarding the definition of innovation and organisational change. Successful innovation management was described as a much more complex and intricate process than organisational change management. Readiness was perceived as an iterative process of interaction between different stakeholders, their new ideas and the environment to enable innovation development and service improvement. Participants acknowledged that readiness for innovation was driven by collective engagement and intrinsic motivation from members of the NHS organisation. The findings presented, among others, some unique key contextual factors enabling organisational readiness for innovation which include: free spaces, communities of practice, and five types of leadership style: systems leadership, collective leadership, distributed leadership, lateral leadership, and transformational leadership.
Conclusions ? The study generated new understanding about the theoretical distinction of innovation from organisational change. It provided new rationale about the meaning of organisational readiness for innovation based on views from those managing the process internally and externally in the NHS. The study recommended a conceptual framework enabling scholars, practitioners, senior managers, and policy makers to understand the actions required in order to prepare the NHS for the long-term success, adaptability, and the susta
contemporary life by helping us to remember the past, communicate with each other and
represent our identity to others. In this chapter we explore the value of such media for
supporting wellbeing in older age, drawing on concepts from literatures on art,
reminiscence and music therapy. Theoretically we argue for a new category of assistive
technologies involving media creation and consumption to enhance wellbeing. We propose
a framework for understanding and designing such assistive media systems which highlights
the interaction between media item, author and audience. This framework is then
illustrated through early attempts to explore a new kind of digital story therapy for people
with dementia in a residential care setting. We conclude with recommendations for the
design of future ?assistive media? systems and experiences that might enhance not only the
lives of people with dementia, but also those around them.