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      Pflege-Report 2021 : Sicherstellung der Pflege: Bedarfslagen und Angebotsstrukturen 

      Technik, Pflegeinnovation und Implementierungsbedingungen

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      Springer Berlin Heidelberg

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          Zusammenfassung

          Pflegeinnovationen liegen in technischer Hinsicht in mannigfaltiger Weise vor, finden aber nur sehr unzureichend Umsetzung in die Pflegepraxis. Dabei greifen Pflegetechnologien in vielfältiger Hinsicht an den Sorgebeziehungen Pflege an. Die Auswahl und Implementierung von Pflegetechnologien verändert das soziotechnische System Pflege, d. h. es gilt der Blick sowohl auf die handelnden Akteure als auch auf die begleitenden Strukturen sowie die durch Technik veränderten Auf- und Ablaufprozesse zu nehmen. Erfolgreiche Implementierungen können vom Wissen der Akteure und der Einrichtungen über gelingende Adoptionsbedingungen profitieren. Gleichwohl gilt es festzuhalten, dass im Pflegebereich, insbesondere im organisierten Bereich, den verschiedenen Handlungsrollen zwischen Nutzern, Nutznießern und Nachfragern Rechnung getragen werden muss. Die Frage der Verbreitung von Technologien im Sinne einer Diffusion benötigt jedoch neben einer gelungenen Adoptierbarkeit in einem pflegerischen Setting belastbare Hinweise zur Transferierbarkeit in ähnliche Pflegekontexte. Hier systematisches Pflegewissen institutionell zu fördern, auch als Teil einer Reformulierung von Infrastrukturen, kann zur effektiveren und effizienteren Nutzung von Technologien für die und mit der Pflege führen.

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            Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework

            Background 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. Methods 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. Results 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). Conclusion 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.
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              Beyond “implementation”: digital health innovation and service design

              Digital tools have shown great potential to enhance health services’ capacity to achieve the goals of the triple aim (enhance patient experience, improve health outcomes, and control or reduce costs), but their actual impact remains variable. In this commentary, we suggest that shifting from a perspective focused on “implementing” new digital tools in health care settings toward one focused on “service design” will help teams execute more successful digital technology adoption projects. We present value proposition design (VPD) as a service design strategy requiring that stakeholders are brutally honest in determining the value of a new digital tool for their everyday work. Incorporating a perspective focused on how the value proposition of a technology is understood by each team member, and implications for their work routines, will help project teams to better understand how services can be reinvented during technology adoption initiatives. We present the simple heuristic [Tool+Team+Routine] as a reminder of the central considerations that make up a service design initiative, and present an illustrative case scenario of designing the use of a digital care coordination platform in an actual digital technology adoption project. We conclude by outlining two important challenges that need to be addressed to advance service design approaches to technology adoption in health care.
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                Author and book information

                Book Chapter
                2021
                June 29 2021
                : 157-172
                10.1007/978-3-662-63107-2_11
                444d3652-cbc9-4b9f-8ba3-e957012d91d6
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