Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users' uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly.
Background Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective Our objective was to gain a deeper understanding of ERCP practitioners’ attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons’ beliefs about teleguidance’s contribution to performance and factors that might interact with implementation. Results Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard “Ease of Use” items for “Compatibility and Implementation Climate.” In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64% (~9/14) among experts and 75% (~7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64% [~9/14], novices 69% [~6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79%) and 8 of the 9 novices (89%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57%) and 6 of the 9 novices (67%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36%) and 3 of the 9 novices (33%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43%) and 6 of the 9 novices (67%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items ( P <.05). Conclusions Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the...
Background A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative “discovery and modeling” approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.
Background Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). Conclusions Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.
BACKGROUND The starting point for this research was a desire to understand the outcomes of scaling up a telemedicine service, which had shown promising results in a feasibility study. Teleguidance is a practitioner-to-practitioner service for remote surgical guidance during a highly technical endoscopic procedure, called ERCP (Endoscopic retrograde Cholangio-Pancreatografy). Due to numerous differences in how ERCP was conducted at the clinics involved, there was a need to create a fuller picture of what set the implementation sites apart sites in order understand the implementation and outcomes of teleguidance. However, the complexity that characterizes highly specialized clinical work systems made understanding the differences between the implementation contexts a methodological and practical challenge. There is increasing recognition that the outcomes of complex interventions are determined by dynamic interactions between social, organizational and design factors. While several recent implementation and evaluation frameworks emphasize complexity, they provide little guidance for how to understand or evaluate technological change in complex settings, or identify the interactions that contribute to implementation success and system-level outcomes. Work Domain Analysis (WDA), a method for analyzing and characterizing complex work settings in systems development, was identified as a candidate method for identifying and charting the contextual factors which shape clinical work during ERCP. However, applying the method was not straightforward, due to a number of methodological issues and practical hurdles: WDA method was initially developed for engineered, industrial systems which contrast to open, adaptive, healthcare systems. OBJECTIVE The objective was to investigate whether and how WDA could be applied to a widely defined clinical work system, by applying WDA to a practical case to create a baseline description of the work systems that would be impacted by the telemedicine implementation. METHODS As expected outcomes of the implementation had been expressed in terms of clinical, economical and training outcomes, the boundaries of the analysis were set widely. Three iterations of qualitative data collection were conducted at five clinical sites, followed by theoretically guided thematic analysis. Service blueprints were made as intermediary graphical representations during data collection. The common WDA representation, a matrix called the abstraction hierarchy (AH), was then constructed through multiple iterations, during which the results were presented to practitioners and suggestions about how to decompose the work system and to populate the cells of the AH-matrix gradually developed. RESULTS Multiple models of the domain representing three facets of the same work system were created. The clinical facet represents “primary” clinical work mainly performed in the operating room, and the administrative and development facets represent the “secondary” work systems providing infrastructure and resources necessary for the clinical procedures. The results show numerous contextual factors on multiple system levels which can come to impact the implementation and use of teleguidance. CONCLUSIONS WDA proved to be an efficient way to model the implementation context, providing guidance for qualitative analysis, identifying multiple sources of variability that can influence implementation outcomes. In addition, WDA provided a compact representation that supported multidisciplinary communication. CLINICALTRIAL n/a
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