Successful Implementation and Integration of a Digital Healthcare Platform Supporting Patient- and Workflow in a Swedish Primary Healthcare Center

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ABSTRACT This abstract is based on a pilot study from an ongoing project focusing the implementation of a digital platform offering support for both the patient- and workflow at a primary healthcare center in Western Sweden. The overarching aim of the project is to follow the introduction and adaptation (normalization) of the platform in primary healthcare centers to study how digital support of the patient- and workflow affects the healthcare professionals (HCP) working routines and workload. Through the platform, patients can make contact with the primary healthcare center digitally instead of through phone calls. Communication can take place synchronously or asynchronously and patient meetings digitally (through chat or video) or physically. Through the platform patients are directed to different categories of HCPs, depending on symptoms. We will present the findings of how the organization and leadership was prepared for the introduction of the platform and how the HCPs are prepared, trained and affected by the implementation. The primary healthcare center’s motive for implementing the platform was to increase patient accessibility and experience, enhance resource utilization, and to decrease workload for HCPs (primarily the nurses). Past research shows that implementations of this type of digital platforms are a complex process, involving a wide range of actors who translate means, actions, and objectives into care practices in different ways (Damschroder et al., 2009) not always rendering the expected effects (Cajander, Larusdottir, & Hedström, 2020). Also, early research on digital implementations in healthcare has been accused of being rich in data but “information poor” (Nilsen, 2020). However, several theoretical tools to comprehend and illuminate implementation failures or successes have been developed (Damschroder et al., 2009; C May & Finch, 2009; C. R. May et al., 2011; Nilsen, 2020; Tabak, Khoong, Chambers, & Brownson, 2012). One such explanatory framework is the Normalization Process Theory (NPT) (C May & Finch, 2009). NPT identifies and explains important mechanisms that promote or inhibit an implementation process. It allows a systematic exploration of how and why (or not) a digital healthcare platform becomes normalized and sustained in healthcare practice. NPT “characterizes and explains implementation processes as interactions between ‘emergent expressions of agency (i.e., the things that people do to make something happen, and the ways that they work with different components of a complex intervention to do so); and as ‘dynamic elements of context’ (the social-structural and social-cognitive resources that people draw on to realize that agency)” (Carl May, 2013, p. 1). We use NPT and its constructs as an explanatory framework for analyzing the empirical findings from the pilot study. Method Methods of inquiry included semi-structured interviews (N=12) and observations during training sessions with the HCPs (2), as well as at a formal workplace meeting (1). The interviews were conducted with four nurses, three doctors, two managers, one psychologist, and one rehabilitation coordinator from the same healthcare center. We also interviewed one of the main initiators and developers of the platform. NPT has inspired the framing of the interviews as well as the data analysis. Findings The findings suggest that the digital platform has been successfully implemented and integrated into the everyday care routines at the primary healthcare center. In specific, it has positively affected the patient- and workflow as well as the HCP’s working conditions. The findings also point at the importance of preparation on the organizational and leadership level before platform implementation. In the presentation, we will elaborate further on how the platform becomes successfully embedded and integrated by using the NPT constructs of coherence, cognitive participation, collective actions, and reflexive monitoring as an analytical lens. References Cajander, Å., Larusdottir, M., & Hedström, G. (2020). The effects of automation of a patient-centric service in primary care on the work engagement and exhaustion of nurses. Quality and User Experience, 5(1), 1-13. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science, 4(1), 1-15. May, C. (2013). Towards a general theory of implementation. Implementation science, 8(1), 1-14. May, C., & Finch, T. (2009). Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology, 43(3), 535-554. May, C. R., Finch, T. L., Cornford, J., Exley, C., Gately, C., Kirk, S., . . . Rogers, A. (2011). Integrating telecare for chronic disease management in the community: what needs to be done? BMC health services research, 11(1), 131. Nilsen, P. (2020). Making sense of implementation theories, models, and frameworks. In Implementation Science 3.0 (pp. 53-79): Springer. Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: models for dissemination and implementation research. American journal of preventive medicine, 43(3), 337-350.
Original languageEnglish
Publication statusPublished - 2021 Aug 19
EventWORK2021: Work beyond Crises - Turku Centre for Labour Studies (TCLS) at University of Turku, Finland, Turku, Finland
Duration: 2021 Aug 182021 Aug 19


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Subject classification (UKÄ)

  • Health Care Service and Management, Health Policy and Services and Health Economy
  • Information Systems, Social aspects

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