Abstract
BackgroundFailures and partial successes are common in technology-supported innovation programmes in health and social care. Complexity theory can help explain why. Phenomena may be simple (straightforward, predictable, few components), complicated (multiple interacting components or issues) or complex (dynamic, unpredictable, not easily disaggregated into constituent components). The recently published NASSS framework applies this taxonomy to explain Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability. This paper reports the first empirical application of the NASSS framework.MethodsSix technology-supported programmes were studied using ethnography and action research for up to 3 years across 20 health and care organisations and 10 national-level bodies. They comprised video outpatient consultations, GPS tracking technology for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organising software and integrated case management via data warehousing. Data were collected at three levels: micro (individual technology users), meso (organisational processes and systems) and macro (national policy and wider context). Data analysis and synthesis were guided by socio-technical theories and organised around the seven NASSS domains: (1) the condition or illness, (2) the technology, (3) the value proposition, (4) the adopter system (professional staff, patients and lay carers), (5) the organisation(s), (6) the wider (institutional and societal) system and (7) interaction and mutual adaptation among all these domains over time.ResultsThe study generated more than 400 h of ethnographic observation, 165 semi-structured interviews and 200 documents. The six case studies raised multiple challenges across all seven domains. Complexity was a common feature of all programmes. In particular, individuals’ health and care needs were often complex and hence unpredictable and ‘off algorithm’. Programmes in which multiple domains were complicated proved difficult, slow and expensive to implement. Those in which multiple domains were complex did not become mainstreamed (or, if mainstreamed, did not deliver key intended outputs).ConclusionThe NASSS framework helped explain the successes, failures and changing fortunes of this diverse sample of technology-supported programmes. Since failure is often linked to complexity across multiple NASSS domains, further research should systematically address ways to reduce complexity and/or manage programme implementation to take account of it.
Highlights
Failures and partial successes are common in technology-supported innovation programmes in health and social care
Below, we apply the different domains of the NASSS framework to our case studies before considering the implications of our findings in terms of complexity theory
Through in-depth, longitudinal ethnography across a maximum-variety sample of local technology-supported innovations, along with an analysis of national context, we have shown that failures, partial successes and unanticipated problems are common
Summary
Failures and partial successes are common in technology-supported innovation programmes in health and social care. We drew in particular on published technology implementation frameworks and key theoretical work on diffusion of innovations [17, 18], technological entrepreneurship [6, 19], the patient experience of chronic illness [20], clinician resistance to technologies [21], the social processes of ‘normalising’ technologies in organisations [22,23,24,25], business and financial planning [14], organisational resilience and sustainability [26,27,28], and theoretical studies on complex adaptive systems [29, 30] Our synthesis of this diverse literature occurred in parallel with testing of candidate domains and theories from our systematic review on a sample of six empirical case studies. The NASSS framework is shown diagrammatically in Panel 1 and Fig. 1
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