Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
JMIR Hum Factors. 2024 Apr 26;11:e50889. doi: 10.2196/50889.
New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations.
This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up.
A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.
The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting.
Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
新的数字技术在多个层面上给医疗保健带来了新的挑战。有人呼吁进行进一步的研究，考虑与复杂医疗环境中的数字创新相关的复杂因素，以缩小从线性、逻辑研究到接受和测试复杂性概念之间的差距。非采用、废弃、扩大规模、传播和可持续性（NASSS）框架是为了帮助研究数字创新中的复杂性而开发的。
本研究旨在通过回顾性评估从底层发起的 4 项数字医疗保健创新所面临的挑战，调查复杂性在创新的开发和部署中的作用。
使用 NASSS 复杂性评估工具 LONG 进行了多案例回顾性、演绎和探索性分析。总共探索和比较了瑞典西约塔兰地区开发的 4 项自下而上的创新，以确定独特和共同的与复杂性相关的挑战。
分析结果产生了联合见解和个体学习。总体而言，复杂性主要存在于创新之外；更具体地说，它与组织整合新创新的准备程度、如何管理和维护创新以及如何为其提供资金有关。NASSS 框架揭示了各种可以促进或阻碍技术创新采用、扩大规模和传播的观点。在病症或诊断领域，对病症或疾病（糖尿病、癌症、双相情感障碍和精神分裂症）相关复杂性有充分的了解非常重要。需要尽早清楚地描述价值主张，以了解成本和结果。LONG 中的 NASSS 复杂性评估工具的问题有时难以理解，不仅从语言角度，而且由于缺乏对周围组织系统及其环境的理解，也难以理解。
即使在同一支持组织内部产生自下而上的创新，复杂性也可能因项目的发展阶段和每个项目的独特特征而有所不同。识别、定义和理解复杂性可能无法解决问题，但会大大提高成功部署的前景。在复杂组织中成功创新需要适应性领导和结构来克服文化抵制和组织障碍。僵化、线性和逐步的方法有风险，可能会忽略相互关联的变量和依赖关系，导致结果不理想。成功在于接受复杂性及其不确定性，培育创造力，并采用非线性方法，适应复杂组织中创新过程的迭代性质。
