Implementing technology within a health and social care setting can be challenging. Change projects have up to 80% chance of failure, often due to their complexity and ambition. Yet we are living in an era where our health services are under immense pressure to adapt and improve. There is an overwhelming appetite for workable technological solutions within the NHS.
A new analytical framework has been developed by Prof Trisha Greenhalgh and colleagues at the University of Oxford to explain these varied and often disappointing outcomes. Developed following three years of research, the NASSS (Non-adoption, Abandonment and challenges to Scale-up, Spread and Sustainability) framework aims to identify and explore where key challenges lie in technology projects.
Dr Joe Wherton, a researcher on Prof Greenhalgh’s team, was funded through the Oxford Policy Engagement Network (OPEN) Fellowship scheme to explore how NASSS could be used to support the planning and implementation of technology-support change programmes within health care organisations. This has included engagements and partnerships with a number of NHS organisations to support the development of remote video consultations within outpatient care.
Dr Wherton engaged with the Aneurin Bevan University Health Board, who are leading the Technology Enabled Care (TEC) programme to develop best practice approaches to technology-supported change across Wales. This includes the use of video-mediated communication to allow care homes to access GP ‘out of hours’ care and specialist swallowing (dysphagia) assessment and therapy.
This fellowship also provides me, as a researcher, with a deeper understanding and appreciation of how academic outputs can be more effectively communicated and applied to inform policy and service improvements.
The fellowship has allowed Dr Wherton to develop and strengthen relationships with organisations leading on a range of other technology-supported change initiatives. This includes the Scottish Centre for Telehealth and Telecare, which has been exploring the use of NASSS to evaluate new health monitoring and remote consultation applications.
Dr Wherton says: “We are keen to use NASSS with these organisations to see how well it works in a real-world setting. These organisations have been very enthusiastic and engaged in the goal of establishing a tool that will enhance the scalability and sustainability of technology change projects.”
These national collaborations are helping the research team develop the NASSS framework into a practical assessment tool for policy makers and project planners. To support this, they are combining NASSS with a previously-developed project management tool developed by Prof Harvey Maylor at the Saïd Business School, called the Complexity Assessment Tool (CAT).
With the support of the Oxford University OPEN Fellowship, the NASSS-CAT is being developed, piloted and refined to ensure the tool is practical and easy to use for staff running and supporting technology-supported change in health care settings.
We have already had a lot of interest and requests from local, national and international policy makers and hope this work will allow us to get NASSS-CAT and its application to the stage where it can be easily accessed and used by a range of stakeholder groups involved in health technology projects.
Dr Wherton explains: “Through the application of NASSS-CAT within our partner organisations, we are able to develop a better understanding of how this instrument should be adapted and used elsewhere. This fellowship also provides me, as a researcher, with a deeper understanding and appreciation of how academic outputs can be more effectively communicated and applied to inform policy and service improvements.”
The lessons learned will help shape the ongoing development of NASSS-CAT so that it can be presented and used in different formats for different groups.
Dr Wherton says: “We have already had a lot of interest and requests from local, national and international policy makers and hope this work will allow us to get NASSS-CAT and its application to the stage where it can be easily accessed and used by a range of stakeholder groups involved in health technology projects.”
Following the OPEN fellowship, Dr Wherton has continued to engage with policymakers and inform national TEC programmes using the NASSS framework. In 2020 he used the framework as part of an evaluation of NHS Scotland’s web-based platform, ‘NHS Near Me’, which helps health care providers offer video consultations. scaling up initiative.