Information Systems Frontiers , 17, 1, Matthiesen, S. In Holden, N. International Journal of Human Resource Management 26, , pp. Available here Christensen, L. Christensen, L. Esbensen, M. Jensen, R. Jeuris, S.
ACM, In Bell, E. Qualitative Research in Business and Management. London: Sage. New York: ACM, pp. Zahedi, M. Ali Babar, M. V, Vol. Majumdar, M. Journal of International Management 19 4 , Gertsen, M. Korver-Michan, R. ACM Bangalore, India. Majumdar, A. In Holmgreen, L. Culture and Identity in Organisations. Aalborg: Aalborg University Press, Some of the installed technologies for example, the weighing scales and thermometer do not seem to match his medical conditions.
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Importantly, the very conditions for which he was deemed to need assistive technologies make him incapable of using them, mainly because of their non-specific effects on his energy and motivation. His medical conditions are neither stable nor fully diagnosed his vacant periods, for example, may or may not have a neurological origin.
What matters to him is getting out of the house — either to the back yard for a cigarette or to the pub for his pint. If the family routine does not mesh with that of the telehealth service, the technology quickly falls into disuse.
It is ironic that Walter has been equipped with a telehealth package costing several hundred pounds which he cannot use because the routine for sending the readings does not align with the wider routine of his host family , but has been classified as ineligible for the simpler and cheaper solution of incontinence pads on prescription. Much more rarely, technologies were helpful and valued — and this occurred when they extended existing support from either family or professional carers.
For example, participant Bonnie aged 81 also suffered from chronic obstructive pulmonary disease; her daughter Carol liked the telehealth equipment, mainly because the oximeter readings often allowed her to convince her mother that there was no need to panic. However, using the equipment to obtain these reassuring readings involved Carol making face-to-face visits and doing considerable additional work. In this respect, the technology was neither labour saving nor time saving. Further examples from our 40 ethnographic case studies are given in other academic publications [ 13 , 18 ].
The Day-to-Day Co-Production of Ageing in Place
In addition, 23 participants consented for the full text of their case summary to be published on the open-access ATHENE website [ 33 ]. Workshops provided a lively and creative forum for people with assisted living needs, informal carers, service providers and technology suppliers to discuss the ethnographic data, share their experiences, and elicit technology and service design ideas to address issues raised.
Key themes relating to the design of quality telehealth and telecare solutions included customisation and adaptation; information sharing and coordination; and ongoing social interaction and support. These are presented in turn below. Users, technology designers and service providers repeatedly emphasised the need to provide tailored solutions and gave numerous examples of barriers to effective customisation. An important component of this visit must be to spend time talking with the end user and those close to them in order to find out what matters to them and ensure that any technology solutions are fully personalised.
Workshop participants commented that this counsel of perfection was difficult to achieve in current clinical and social care practice, and that few technology suppliers are sufficiently skilled to undertake this work which was considered to require clinical or clinically-related training. Experiences with installing assistive technologies brought participants to the view that practical reasoning is required, focusing on individual contexts, material constraints and the ends that are to be achieved.
Where do you start and where do you end? And so I went into — almost like in an advisor capacity, assessed her and everything, but it turned out what she really wanted, what was really of value to her, was completely out of the box, you know.
And I kind of made loads of phone calls, I went online, to contact various people and look at websites, as we were doing this… And instead of kind of doing the standard, which I would have normally done, because it was outside of the statutory circuit I could do this. And I sort of felt, you know, this is really quite good, this is much more like a role that I believe would help people.
Beyond the challenge of understanding user requirements, personalisation appeared to be further hindered by the limited range of technologies available locally. Commissioners made the purchasing decisions, and clinicians then had to make the best of what was available.
The purchasing model preferred by our participants was characterised by greater engagement between commissioning and service staff; greater control and flexibility to explore and trial different technology options; and a change in relationship between industry and commissioners which currently assumes purchase of technologies in bulk. They jumped in feet first.
Participants identified a need to support knowledge sharing and co-ordination within and between care services, as well as across formal and informal care networks. Currently, service chains — with several people involved in supporting an individual patient or client — are complex and lack effective integration and information sharing. To the extent that aspects of the telehealth or telecare service for example, installation, the monitoring centre are outsourced to subcontractors, this can add another level of separation.
You might have the luxury of actually phoning or contacting that service and discussing something together, but that can be a luxury to be able to do that.
So again, the barrier, you know, is there physically to actually work together. And then things become a bit sort of strung out, it becomes a bit like Chinese whisper, as things go through different services.
Participants suggested, for example, that an assistive technology should be reviewed in conjunction with a routine clinical care visit, which could help sustain engagement with users in a more cost-effective way. Such collaborative models could potentially overcome many of the difficulties of data integration and patient consent to share personal and health information.
But as our workshop discussions highlighted, they presuppose an altruistic and collegial rather than commercial or contractual relationship between different professional staff and their respective organisations.
In reality, achieving high motivation across the multiple actors to engage and contribute to the collective task of supporting an individual over time will be hard to achieve. Prioritising the subjective lived experience of the patient over the application of standardised criteria and checklists as the shared quality outcome could go some way to strengthening this collective effort. This is because the precise combination and sequence of skills to be used in particular circumstances cannot always be specified in advance [ 36 ].
Effective design and delivery of assistive technology therefore relies on spontaneous cooperative acts to deal with task complexity and uncertainty, which in turn requires a collective motivation to address problems as and when they arise. In healthcare settings, frontline staff have first-hand contact with patients, and so they have an advantage in establishing the engagement and empathy that motivates pro-social behaviours. A challenge for telecare and telehealth will be to foster a similar understanding and motivation across all those who contribute to the implementation, maintenance and sustained use of the technology solution.
Thirdly, participants talked about the role of social supports to bridge the design-realty gap. Family members usually played a key role in decision making, liaising with the services and solving problems with the technology, stepping in as needed to set up equipment or resolve technical issues.
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However, human resources within the care network of a patient or client were variable. For users who depended solely on professional services, even minor problems for example, replacing batteries on a device could pose significant confusion and disruption:. I put it on the settee behind the cushion…But it took them so long to come and change the battery for me I rang them and told them. So it went through Christmas and then New Year and then it was January before they came.
Participants emphasised that service providers need to assess available social resources, involve them in the design of the care solutions, and be prepared to respond to diverse and often subtle and mundane issues. They felt that investment in these human efforts would greatly increase effectiveness of the technology. And it is very difficult because, especially in my age group, we look such utter fools in asking for more help to understand what is going on and how it can help. If you went back a week, a fortnight, later and had it out, it would be more efficient, financially as well.
Participants also emphasised that building relationships through ongoing informal and open-ended interactions with clients would provide the service with information they needed to support and monitor the user effectively. In particular, building a relationship between the client and monitoring staff whether face-to-face or someone at the end of the telephone was important, because frequent and informal contact provided insight into aspects of their life that would have a bearing on the use or appropriateness of the technology for example, illness, life events, anxieties.
Technology developers acknowledged the importance of formal and informal social support networks, but they assumed these networks were usually in place to implement and support the technology effectively.