Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia

Abstract

Background Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice. Methods In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data. Results The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service. Conclusion Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives.

Identifying the Roles of Healthcare Leaders in HIT Implementation: A Scoping Review of the Quantitative and Qualitative Evidence

“…According to the included studies, the most common role for healthcare leaders in HIT implementation was that of supporter [33][34][35][38][39][40][41][42]47,48]. Leaders at all levels were responsible for supporting HIT implementation [33,35,39,47]. When leaders did not support implementation, it struggled to succeed [41].…”

“…When leaders did not support implementation, it struggled to succeed [41]. Healthcare leaders often recognised their role as a supporter by themselves [35,39], but occasionally the need for leaders' support was determined by other stakeholders, such as healthcare professionals [33,43]. It seems that the leaders' support formed a chain where leaders at a higher level were responsible for supporting their closest subordinates [33,40], for example, clinical leaders were often the ones supporting healthcare professionals and chief executives supported senior managers [33].…”

“…The quality of the provided support varied. In some studies, support was described as providing sufficient resources to advance HIT implementation [35,42,46]. These resources were either financial [42] or they were to enable HIT training for the healthcare professionals using HIT [38,48,49].…”

“…In one study, healthcare leaders even provided technical support for healthcare professionals [46]. In other studies, leaders stated that they felt insecure about their own skills with HIT and required training so they could better guide their colleagues, healthcare professionals and customers [35,39].…”

“…If health professionals were reluctant to use HIT, managers had to make it a necessary part of their work [37] and they also took an active part in resolving conflicts between stakeholders [34]. Due to the changes, healthcare leaders were also responsible for developing new routines, roles and responsibilities [33,35] and organising the workflow [39].…”