背景:新的数字技术在多个层面上对医疗保健提出了新的挑战。有人呼吁进行进一步的研究,考虑复杂的医疗保健环境中与数字创新相关的复杂因素,以弥合从线性移动时的差距,接受和测试复杂性概念的逻辑研究。不被收养,放弃,扩大规模,传播,可持续发展(NASSS)框架的开发旨在帮助研究数字创新的复杂性。
目的:本研究旨在通过回顾性评估自下而上发起的4项数字医疗保健创新所面临的挑战,调查复杂性在创新开发和部署中的作用。
方法:多酶回顾性,演绎,并使用NASSS复杂性评估工具LONG进行探索性分析。总的来说,探索并比较了在瑞典VästraGötaland地区开发的4项自下而上的创新,以确定与复杂性相关的独特和共同挑战。
结果:分析产生了联合见解和个人学习。总的来说,复杂性主要是在实际创新之外发现的;更具体地说,它与组织整合新创新的准备程度有关,如何管理和保持创新,以及如何资助他们。NASSS框架揭示了各种可能促进或阻碍采用的观点,扩大规模,和技术创新的传播。在病情或诊断领域,对与病情或疾病相关的复杂性有充分的了解(糖尿病,癌症,双相情感障碍,和精神分裂症障碍)对创新非常重要。需要尽早清楚地描述价值主张,以便能够理解成本和结果。NASSS复杂性评估工具Long中的问题有时很难理解,不仅从语言的角度来看,而且由于缺乏对周围组织系统及其设置的了解。
结论:即使在同一支持组织中出现自下而上的创新,复杂性可以根据开发阶段和每个项目的独特特征而变化。识别,定义,理解复杂性可能无法解决问题,但会大大改善成功部署的前景。复杂组织中的成功创新需要适应性领导和结构来克服文化阻力和组织障碍。一个僵硬的,线性,逐步方法有忽视相互关联的变量和依赖关系的风险,导致次优结果。成功在于拥抱复杂性和不确定性,培养创造力,并采用非线性方法,适应复杂组织内创新过程的迭代性质。
BACKGROUND: New
digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to
digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in
digital innovations.
OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4
digital health care innovations initiated from the bottom up.
METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.
RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization\'s readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization\'s system and its setting.
CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.