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Analysing the role of complexity in explaining the fortunes of technology programmes : empirical application of the NASSS framework
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Greenhalgh, Trisha, Wherton, Joe, Papoutsi, Chrysanthi, Lynch, Jenni, Hughes, Gemma, A'Court, Christine , Hinder, Sue, Procter, Rob and Shaw, Sara (2018) Analysing the role of complexity in explaining the fortunes of technology programmes : empirical application of the NASSS framework. BMC Medicine, 16 (1). 66. doi:10.1186/s12916-018-1050-6 ISSN 1741-7015.
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Official URL: https://doi.org/10.1186/s12916-018-1050-6
Abstract
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.
| Item Type: | Journal Article | ||||||||||||||||||
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| Subjects: | H Social Sciences > HM Sociology Q Science > Q Science (General) |
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| Divisions: | Faculty of Science, Engineering and Medicine > Science > Computer Science | ||||||||||||||||||
| Library of Congress Subject Headings (LCSH): | Medical care -- Technological innovations, Technological complexity, System theory | ||||||||||||||||||
| Journal or Publication Title: | BMC Medicine | ||||||||||||||||||
| Publisher: | BioMed Central Ltd. | ||||||||||||||||||
| ISSN: | 1741-7015 | ||||||||||||||||||
| Official Date: | 14 May 2018 | ||||||||||||||||||
| Dates: |
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| Volume: | 16 | ||||||||||||||||||
| Number: | 1 | ||||||||||||||||||
| Article Number: | 66 | ||||||||||||||||||
| DOI: | 10.1186/s12916-018-1050-6 | ||||||||||||||||||
| Status: | Peer Reviewed | ||||||||||||||||||
| Publication Status: | Published | ||||||||||||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||||||||
| Date of first compliant deposit: | 21 May 2018 | ||||||||||||||||||
| Date of first compliant Open Access: | 21 May 2018 | ||||||||||||||||||
| RIOXX Funder/Project Grant: |
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