Abstract
BackgroundIn order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers.MethodsEleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team.ResultsFive main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities.ConclusionsThe managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.
Highlights
In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed
Mobile radiography as a telemedicine service allows residents to stay in the nursing home, which may reduce these kinds of complication and avoiding admission to hospital [11, 12]
Eighty key dimensions were identified in the matrices developed in QSR International’s NVivo Pro version 11 software (NVivo), these were allocated into five categories: national health policy, regional and municipal policy and conditions, interorganizational implementation projects, experienced outcome, and professional skill and personal characteristics
Summary
In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. There is a high incidence of infections and injury due to falls [5,6,7] All these elements increase the need for specialized healthcare services, including imaging service, among nursing home residents compared to the rest of the population [3, 7]. Radiological services for nursing home residents are usually provided at a hospital or in an emergency room New surroundings such as an x-ray department may increase the risk of falling and/or developing anxiety or delirium [7,8,9,10]. Oxman et al [14] list a number of barriers to coordination or integration in healthcare systems, based on Nolte and McKee [15] These barriers are structural, financial, legal, procedural, professional, conflicting views, organizational self-interest, organizational turbulence and introduction of a competitive environment [16]. Adequate finances for training and for building the structure are important during implementation in order to succeed
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