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dc.contributor.authorGreenhalgh, Trisha
dc.contributor.authorShaw, Sara
dc.contributor.authorWherton, Joe
dc.contributor.authorPapoutsi, Chrysanthi
dc.contributor.authorLynch, Jennifer
dc.contributor.authorHughes, Gemma
dc.contributor.authorA'Court, Christine
dc.contributor.authorHinder, Sue
dc.contributor.authorProcter, Rob
dc.date.accessioned2018-05-25T14:07:48Z
dc.date.available2018-05-25T14:07:48Z
dc.date.issued2018-05-14
dc.identifier.citationGreenhalgh , T , Shaw , S , Wherton , J , Papoutsi , C , Lynch , J , Hughes , G , A'Court , C , Hinder , S & Procter , R 2018 , ' Analysing the role of complexity in explaining the fortunes of technology programmes : Empirical application of the NASSS framework ' , BMC Medicine , vol. 16 , 66 . https://doi.org/10.1186/s12916-018-1050-6
dc.identifier.issn1741-7015
dc.identifier.otherPURE: 13754787
dc.identifier.otherPURE UUID: 7f36ac5b-4232-490a-8e05-3d9669de4178
dc.identifier.otherScopus: 85046753352
dc.identifier.urihttp://hdl.handle.net/2299/20090
dc.description© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.description.abstractBackground: 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.en
dc.format.extent15
dc.language.isoeng
dc.relation.ispartofBMC Medicine
dc.rightsOpen
dc.subjectHumans
dc.subjectTechnology Assessment, Biomedical/methods
dc.titleAnalysing the role of complexity in explaining the fortunes of technology programmes : Empirical application of the NASSS frameworken
dc.contributor.institutionCentre for Research in Public Health and Community Care
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionOlder People's Health and Complex Conditions
dc.description.statusPeer reviewed
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85046753352&partnerID=8YFLogxK
dc.relation.schoolSchool of Health and Social Work
dc.description.versiontypeFinal Published version
dcterms.dateAccepted2018-05-14
rioxxterms.versionAM
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.1186/s12916-018-1050-6
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.typeJournal Article/Review
herts.rights.accesstypeOpen


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