Putting the social back into sociotechnical: case studies of co-design in digital health
Autor: | Trisha Greenhalgh, Clare Morrison, Sara Shaw, Joseph Wherton, Chrysanthi Papoutsi |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Rural Population
Sociotechnical system AcademicSubjects/SCI01060 Process (engineering) telehealth Health Informatics Telehealth Mainstreaming sociotechnical theory. video consultations Research and Applications 03 medical and health sciences 0302 clinical medicine Seizures Health care Humans 030212 general & internal medicine AcademicSubjects/MED00580 Service (business) Heart Failure business.industry 030503 health policy & services Remote Consultation Patient portal Public relations Digital health Telemedicine United Kingdom Featured Patient Care Management Organizational Case Studies co-design AcademicSubjects/SCI01530 0305 other medical science business Psychology Biomarkers |
Zdroj: | Journal of the American Medical Informatics Association : JAMIA |
Popis: | Objective We sought to examine co-design in 3 contrasting case studies of technology-supported change in health care and explain its role in influencing project success. Materials and Methods Longitudinal case studies of a seizure detection and reporting technology for epilepsy (Southern England, 2018-2019), a telehealth service for heart failure (7 UK sites, 2016-2018), and a remote video consultation service (Scotland-wide, 2019-2020). We carried out interviews with 158 participants and collected more than 200 pages of field notes from observations. Within- and cross-case analysis was informed by sociotechnical theory. Results In the epilepsy case, co-design prioritized patient-facing features and focused closely around a specific clinic, which led to challenges with sustainability and mainstreaming. In the heart failure case, patient-focused co-design produced an accessible and usable patient portal but resulted in variation in uptake between clinical sites. Successful scale-up of video consultations was explained by a co-design process involving not only the technical interface, but also careful reshaping of work practices. Discussion A shift is needed from co-designing with technology users to co-designing with patients as service users, and with healthcare staff as professionals. Good co-design needs to involve users, including those who engage with the technology-supported service bothdirectly and indirectly. It requires sensitivity to emergence and unpredictability in complex systems. Healthcare staff need to be supported to accommodate iterative change in the service. Adequate resourcing and infrastructures for systems-focused co-design are essential. Conclusions If co-design focuses narrowly on the technology, opportunities will be missed to coevolve technologies alongside clinical practices and organizational routines. |
Databáze: | OpenAIRE |
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