Several guests, that are involved in joint eHealth projects with Åsa Cajander and me, have been visiting us this week. The blog picture was taken yesterday and shows, from left to right, me, Christiane Grünloh (KTH, TH Köln), Gunilla Myreteg (Örebro University) and Maria Hägglund (Karolinska institutet).
Christiane Grünloh, who is a Ph.D. student from the Royal Institute of Technology (KTH) and living in Germany, will be with us this entire week to work with us on a large observation/interview/survey study which will be conducted with physicians and nurses at Uppsala University hospital. She is also a member of the HTO group, but is mostly connecting from Germany via Skype. We have been working mostly on refining the interview template, since we have not yet conducted any interviews. Yesterday, Gunilla Myreteg from Örebro University and Maria Hägglund from Karolinska Institutet also joined in to, among other things, help us finalize and pilot the interview template. It was a very productive day – it’s nice to sit down with colleagues you don’t meet that often to really focus on a common task. Those who want to know more about our study at the oncology department, which is a part of the DISA project as well as the larger DOME consortium, can read this blog post for an introduction of the entire research team behind the study and this blog post for an introduction of the different parts of the study.
While all of us were gathered, we also took the chance to work on the first paper based on a large national patient survey, which we and several other researchers within the DOME consortium are also a part of. And of course we couldn’t just split up after being done working – we had to end the day at a nice Italian restaurant here in Uppsala! 🙂
Thomas Lind will defend his PhD thesis the 15th of September 2017. This week we had a seminar where the work was discussed with an external reviewer, José Abdelnur Nocera.
The thesis is about the deployment of IT systems. Thomas Lind’s PhD thesis has several contributions:
The development of a theory for understanding deployment: Inertia.
Deeper understanding of deployment of IT from a sociotechnical perspective.
The evaluation of the method “Vision seminars” as a method to use when deploying IT systems.
During the seminar Thomas Lind first presented his work, and this was followed by a discussion with José Abdelnour Nocera. The discussion concerned both the six papers that are included in the thesis as well as the introductory text for the papers.
In the evening we had a nice dinner at Basilico.
The HTO group thanks José Abdelnour Nocera for a very valuable discussion. Now we are looking forward to the final defense of the PhD thesis. 🙂
Jonas Moll became a member the council for eHealth and national information structure (e-hälsorådet) at the National Board of Health and Welfare (Socialstyrelsen) in Sweden. He wrote a blog post about it found here.
Åsa Cajander is also a member of the same board, and we contribute with our different knowledge and expertise to the work done.
The DOME Consortium had its own track at Vitalis 2017 and a number of presentations relating to research on electronic patient journals. Jonas Moll has written more on the presentations on his blog – head over there for an update.
With 180 exhibitors and a huge number of presenters Vitalis 2017 was indeed vital. For a first time visitor such as myself it really made the impact of e-health on society tangible.
The exhibitions gave an understanding of the actors in the field, raging from service designers to robotics. (Plus more espresso than a man could drink, though I tried.) The presentations showcased how the same technology was introduced and effected health care on a many different levels. The combination of exhibition and presentation also created a nice tension between the promises of technology and the sometimes more complicated implementations of the same technology.
Given the sheer number of parallell sessions it was impossible to cover more than a few select presentations. The DOME consortium, of which we are a part, had great visibility with a track of its own. Jonas Moll of the HTO-group has written more on this topic. Quite impressive was also the fact that our students had been invited to give their view on the future of health care. Given how professional they were, I would say it looks promising. I also enjoyed the presentation made by Carl Johan Orre from Malmö University on the topic of person centered technology.
I might be a bit biased but what I found really inspiring was the presentations made by our colleagues from Uppsala University Hospital with whom we are collaborating in a number of projects.
Birgitta Wallgren discussed the complexities of large scale implementations in a setting with other ongoing large scale implementations.
Annemieke Ålenius and her colleague presented lessons learned from the unplanned and almost week long downtime for the hospital’s patient journal system. While interesting in itself–for instance the comment that soon staff will have no experience of paper based back up routines–they also managed to convey some of the drama from behind the scenes. Still, it was a good thing that the crisis had a happy ending–thanks to a strong group effort from the whole hospital staff.
Finally Morten Kildal discussed the various strategic paradigms that have succeeded each other as the solution for health care, including the current concept of value centered care. While no doubt new paradigms will come, Morten Kildal did make a solid case for the benefits of the current strategy–as well as the need for relevant data.
In summary all of the three presentations stressed the importance of coordination–between implementations, in crisis or in the patient journey. Yet, what I really found positive for our ongoing collaboration was not only the fact that the presentations were analytical and reflective but that the presenters had a strong humanistic outlook.
This also, is promising for the future of eHealth.
Earlier today, Ida and I presented the DISA project at Vitalis 2017. The project is dedicated to investigating the effects of digitization on nurses’ work environment. The outline of the project is described in the leaflet shown above, which can be downloaded here.
DISA will be ongoing for three years and comprises three different work packages, each with a slightly different focus. The poster shown below illustrates the structure of the DISA project and provides some more detail on the project’s core research questions.
We are altogether 7 researchers working on DISA under Åsa’s supervision. However, not all of us work on the same topics and with the same hospital departments. As such, Jonas and Christiane mainly work with the EPR online and the oncology department at the Uppsala University Hospital, while Lars, Ida, Gerolf, Minna and me primarily work with nurses’ digital work environment and two different hospital departments: the surgery department at the Uppsala University Hospital and the department for blood and tumor diseases at the Uppsala Children’s hospital.
Last Friday, Ida, Gerolf and I had a very instructive and thought-provoking meeting with one of the team members working on value-based care at the Uppsala University Hospital. The hospital is indeed in the process of optimizing its care-delivery processes in order to provide patients with both a better experience with hospital-based treatments and a higher quality of care. This relatively new, international “value-based” approach has its origins in the realization that hospital-based care processes lack efficiency and, from a patient perspective, objective ways to evaluate their quality. Statistics frequently used to assess the quality of the provided care include for example the number and the length of hospital visits, which the value-based approach argues are not actually representative of quality. More meaningful quality factors from a patient-centered perspective include for example how the patient feels, how quickly a diagnosis is established or whether the treatment is effective (whether the symptoms are effectively reduced by the treatment). As such, the value-based care optimization process aims to achieve quality in terms of patient-centered factors as well as provide valid measurements for the different factors taken into account, i.e. make it possible to evaluate the achieved quality level from a patient perspective. To carry out this high-level optimization process, the value-based care team at the Uppsala University Hospital is working together with inter-department groups of clinicians, for example in the form of workshops, in order to model the existing care flows and identify ways they can be improved as well as meaningful evaluation measurements.
Although those high-level organizational changes are beyond the scope of the DISA-project, it was important for us to get an insight into this change process currently taking place at the Uppsala University Hospital. Those workflow changes may indeed influence the documentation procedures (most of which are carried out digitally), and a good understanding of those procedures, their context and their purpose is essential in order to be able to interpret correctly what we will hear and observe while out in the field throughout the project.
Personally, I wonder whether a similar optimization could be applied to the doctors and nurses’ digital work environment. However, if patient-centered quality factors are relatively easy to come up with, the task is more complex when it comes to digital, nurse-centered processes. When it comes to computer-mediated documentation and, more generally, care delivery, what is quality? How can we assess and ensure that the existing digital workflows support nurses’ efficiency and well-being? I really hope that our work within the DISA-project will make it possible for us to answer those questions.
Jonas Moll and Åsa Cajander from HTO has worked together with a large group of researcher and the EU coordinators at Uppsala University in writing an application to Horison2020. We have been working on this and having meetings about this since the early fall, so this has taken quite a lot of time, and the application is around 14o pages of text including everything. This week the application was finally submitted, and it looks very good.
Writing this kind of large application requires good coordination, and we really had excellent coordinators this time which gives a good indication of the work in the future project.
If funded both Jonas Moll and Åsa Cajander will be working in the project and be in charge of one of the work packages.
Anticipating exactly what will resonate with your audience is not always easy. During the last couple of weeks I have been presenting some results from a study on the healthy digital workplace, as a part of the SISU-project. The presentations were part of the studied organisations change effort and my presentation was one part, embedded in the information from the organisations project leaders. The overall message was thus one of progress. The study I presented created a baseline for measuring the effects of the coming changes. It also indicated some strategic areas to observe during the change.
The one thing that really seemed to catch everyones attention was not so much the results as one of the slides I used to frame my message. In this slide I contrasted the idea of a linear progression from the current state to the next with the classic J-curve or change curve as it might be called (originally the Kübler-Ross model describing grief). The J-curve in this context is mainly a rhetoric tool, it presents a generic path through change, the big difference to the simple linear progression is the understanding that things will get worse, before they get better. As basic as this concept might seem, it did however seem to catch the interest of both managers and employees. It did seem as if it created a common ground for discussing the upcoming challenges.
As time was limited I did not expand on the concept however. Taken at face value it might be misunderstood as support for the idea of simple linear progression (A->B), just with a more bumpy road. In practice there are at least two waypoints that should be noted. The first is that there is a worst case scenario where there is no recovery and the change not only fails but even fails miserably (C). The second is that if the organisation navigates the turmoil it might still end up in some kind of status quo or rather same same but different (D). The promise of actual progress still needs to be fulfilled. Taking a note from Festinger’s theory of cognitive dissonance one might suspect that we might be tempted to rationalize our new position as an improvement without this actually being the case. Thus, we need to be careful to measure the right aspects during a change effort.
Finally, I didn’t use my favorite take on the change curve, namely the hype curve (hype cycle) made famous by Gartner. The inclusion of the hype is interesting as it puts focus on the rhetoric behind the change. Getting the boards interest and approval might well include some mild exaggerations regarding the benefits of the change. As is obvious from the hype curve the discrepancy between these promises and the coming turmoil might turn out rather dramatic. Thus, it is–as we all should know–important to manage expectations during change so as to avoid a roller coaster experience of change.