The informal way to success or failure? Findings from a comparative case study on video consultation training and implementation in two Danish hospitals.

BACKGROUND: This study evaluated an attempt to implement video consultations through a novel education intervention in telehealth training and implementation in two middle-sized hospitals in Denmark. Three units tested the education intervention along with a regional decision to strengthen multidisciplinary and cross-sectoral collaboration through technology to improve service delivery by making the process more coherent and saving time and resources. This study aims to identify what contextual factors enable workplace learning, skills acquisition, and utilization of new digital skills to use and routinize video consultations in workplace practice. METHODS: This qualitative case study draws on the principles of the realist evaluation framework using cross-case comparisons to test and refine program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. The methods in this study include participant observations, document analysis, semi-structured individual interviews, and focus groups. We performed an interpretive cross-case analysis, which explored the context-mechanism-outcome relationship using the guiding question, "What works, for whom, under what circumstances, and why?". RESULTS: Two broad mechanisms appeared to enable skills acquisition and routinization of video consultations: informal workplace learning and adjusting video consultations to professional judgment. The three units had different approaches to the implementation and training and, as such, had different outcomes. First, the skills acquired in the units differed; therefore, how and with whom they used video consultations varied. Second, video consultation use was more likely to be adjusted to workflows if unit managers were responsive to staff's professional judgments regarding patients, as was evident in all three units. CONCLUSION: Our study shows that a formal training course alone is insufficient to provide healthcare professionals with the skills needed to use video consultations in workplace practice. Informal workplace learning with support on the spot and continuous follow-up seems to equip healthcare professionals with the skills to use video consultations. Video consultations are more likely to be used confidently if novel workflows are adjusted to health care professionals' knowledge, skills, and judgment and their concerns regarding patient soundness.

Arrangements of wash toilets and ageing bodies - an exploratory study.

PURPOSE: The purpose of this study is to study how a specific assistive technology, namely wash toilet systems, are used and which values they enact for their users. MATERIALS AND METHODS: The study is primarily based on ten semi-structured interviews conducted with older adults who were offered a wash toilet as an element in the welfare service of a large Danish municipality. RESULTS: The study shows how, in various ways, specific aspects of wash toilet systems are associated with specific aspects of human physiology. Essential challenges to older adults that implicate the use of wash toilet systems either relate to 'arms that cannot reach behind', or the leakage of urine and eventually faeces. Furthermore the study shows that values enacted by wash toilet systems differ in the various arrangements, e.g., enabling social relations, being a part of something, being self-reliant or independent, preserving intimacy limits, or just 'be pleased with'. CONCLUSIONS: The wash toilet systems are woven into several different arrangements of the ageing body, wheelchairs, walkers, care personnel, spouses, diapers, etc. being situated in differently spaced bathrooms in different homes and different municipalities. We propose that the abandonment of focus on abstract policy values in favour of an emphasis on the actual arrangements of technology and the human body in old age will, in fact, be beneficial to our understanding of how welfare technology can contribute to enhanced citizenship.Implications for rehabilitationAn implication of this study for rehabilitation is not to take for granted how a wash toilet system will interact in arrangements with older adults, but attend to the potentially various/many ways the system can create value for the user in the actual arrangement it is part of.Another implication of the study is that it is always an empirical question whether self-reliance - which is often an aim of implementing assistive technologies - is an effect of a specific arrangement of a wash toilet system and the human body in old age.

Welfare Technologies and Ageing Bodies: Various Ways of Practising Autonomy.

Contemporary policy strategies frame welfare technologies as a solution for welfare states facing the challenges of demographic change. Technologies are supposed to reduce or substitute the work of care workers and thereby reduce attrition among their ranks, reduce costs, and at the same make elderly people self-reliant and independent. In this paper, it is suggested that this way of framing how welfare technologies work with elderly people holds an instrumental view of technologies as well as of bodies and needs to be challenged. Drawing on an STS (Science Technology Studies) understanding of the constituting role of technology in people's lives, the guiding question in this study is how autonomy is practised in the lives of elderly people using welfare technologies. The study is based on interviews with eight elderly citizens in a Danish municipality who have been provided with a wash toilet and often also other technologies as part of their welfare service package. The study shows how autonomy is practised in various ways, how autonomy is practised in specific areas of life linked to the specific life story and body of the elderly citizen, how autonomy is situational as it is practised in specific situations during the day/week, and how autonomy is relational as it is practised in relation to specific persons and things and with specific persons and things. Implications of these findings are discussed in relation to the implementation of welfare technology as well as forms of governance appropriate for embodied elderly citizens and technologies.

Meanings and experiences of assistive technologies in everyday lives of older citizens: a meta-interpretive review.

PURPOSE: The purpose of this study was to synthesize the available qualitative studies on the meaning of assistive technologies (AT) in elderly people's everyday lives in order to identify central concepts, themes, and findings from existing research. METHOD: A systematic search of the literature was conducted, using predetermined search strategies. Exclusion criteria were, in accordance with the meta-interpretive approach, developed iteratively during the reading of abstracts and articles. Interpretations from the studies were used as data for thematic analysis and synthesis of findings. RESULTS: Review of these studies show that older people not only have positive attitude towards AT, but also that acceptance of technologies is a potentially stressful process where trust towards technologies and other people are of importance. Older people have ambivalent experiences with technology, as it gives rise to possibilities as well as constraints, and safety as well as worries. AT enact sometimes conflicting values related to self and society. CONCLUSIONS: Although AT seem to support societal discourses on active aging, the empirical studies in this field show that the technologies enter older people's lives in complex ways, enacting social values and ambivalences and interact with caretakers, relatives and other actors, within specific institutional settings. Implications for rehabilitation In implementing AT, attention should be paid to ambivalences and conflicting values enacted by AT in older people's lives In implementing AT, attention should be paid not only to independency but also to the eventually dependencies, created by the use of AT.