Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
School of Health and Social Work, University of Hertfordshire, Hatfield, UK.
BMC Med. 2018 May 14;16(1):66. doi: 10.1186/s12916-018-1050-6.
Failures 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.
Six 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.
The 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).
The 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.
在医疗保健领域的技术支持创新计划中，失败和部分成功是常见的。复杂性理论可以帮助解释原因。现象可能是简单的（直接、可预测、组件较少）、复杂的（多个相互作用的组件或问题）或复杂的（动态的、不可预测的、不易分解为组成组件）。最近发布的 NASSS 框架将这种分类法应用于解释个人对技术的不采用或放弃以及难以实现规模化、推广和可持续性。本文报告了 NASSS 框架的首次实证应用。
使用民族志和行动研究方法对六个技术支持的项目进行了研究，这些项目在 20 个医疗保健组织和 10 个国家级机构中进行了长达 3 年的研究。它们包括视频门诊咨询、认知障碍 GPS 跟踪技术、吊坠报警服务、心力衰竭远程生物标志物监测、护理组织软件以及通过数据仓库进行综合案例管理。数据是在三个层面上收集的：微观（个体技术用户）、中观（组织过程和系统）和宏观（国家政策和更广泛的背景）。数据分析和综合由社会技术理论指导，并围绕 NASSS 的七个领域组织：（1）疾病或病症，（2）技术，（3）价值主张，（4）采用者系统（专业人员、患者和非专业护理人员），（5）组织，（6）更广泛的（机构和社会）系统，（7）所有这些领域随着时间的推移相互作用和相互适应。
该研究产生了超过 400 小时的民族志观察、165 次半结构化访谈和 200 份文件。六个案例研究在所有七个领域都提出了多个挑战。复杂性是所有项目的共同特征。特别是，个人的健康和护理需求通常是复杂的，因此是不可预测的和“偏离算法”的。多个领域复杂的项目实施困难、缓慢且昂贵。那些多个领域复杂的项目没有成为主流（或者，如果成为主流，也没有交付关键预期产出）。
NASSS 框架有助于解释这一多样化的技术支持项目样本的成功、失败和变化的命运。由于失败通常与多个 NASSS 领域的复杂性有关，因此应进一步研究如何降低复杂性和/或管理项目实施以应对复杂性。
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