Capturing artificial intelligence applications' value proposition in healthcare - a qualitative research study.

Artificial intelligence (AI) applications pave the way for innovations in the healthcare (HC) industry. However, their adoption in HC organizations is still nascent as organizations often face a fragmented and incomplete picture of how they can capture the value of AI applications on a managerial level. To overcome adoption hurdles, HC organizations would benefit from understanding how they can capture AI applications' potential.We conduct a comprehensive systematic literature review and 11 semi-structured expert interviews to identify, systematize, and describe 15 business objectives that translate into six value propositions of AI applications in HC.Our results demonstrate that AI applications can have several business objectives converging into risk-reduced patient care, advanced patient care, self-management, process acceleration, resource optimization, and knowledge discovery.We contribute to the literature by extending research on value creation mechanisms of AI to the HC context and guiding HC organizations in evaluating their AI applications or those of the competition on a managerial level, to assess AI investment decisions, and to align their AI application portfolio towards an overarching strategy.

The sustainability of midwifery group practice: A cross-sectional study of midwives and managers.

PROBLEM: Although there is robust evidence for the benefits of midwifery group practice (MGP) caseload care, there are limited opportunities for women to access this model in Australia. There is also limited knowledge on how to sustain these services. BACKGROUND: MGP can benefit childbearing women and babies and improve satisfaction for women and midwives. However, sustainability of the model is challenging. While MGPs are often supported and celebrated, in Australia some services have closed, while others struggle to adequately staff MGPs. AIM: To investigate midwives and managers opinions on the management, culture, and sustainability of MGP. METHODS: A national survey of MGP midwives and managers was distributed (2021 and 2022). Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using content analysis. RESULTS: A total of 579 midwives and 90 managers completed the survey. The findings suggest that many MGPs do not support new graduates and students to work in MGP. Over half (59.8%) the participants (midwives and managers) reported that the women and families were the best aspect about working in MGP, while 44.3% said the effects on midwives' lifestyle and families were the worst aspect. DISCUSSION: The relationship with women remains the major motivator for providing MGP care. However, work-life imbalance is a deterrent, exacerbated by staffing shortages. Staffing might be improved by adequate renumeration, strengthening orientation, and attracting new graduates and students through experience in MGP. CONCLUSIONS: There is a need to attract midwives to MGP and improve work-life balance and sustainability.

Equity, diversity, and inclusion in the Multinational Association for Supportive Care in Cancer: a global membership survey.

Equity, diversity, and inclusion (EDI) are essential for healthcare organizations since they allow for the development of programs and initiatives that bring together diverse perspectives and knowledge. Global multidisciplinary organizations, such as the Multinational Association for Supportive Care in Cancer (MASCC), need to understand the perspective of their members regarding EDI to identify opportunities to enhance diversity and inclusiveness and to better meet the needs of members from different backgrounds and resources. The MASCC Health Disparities Committee designed a survey to identify issues related to disparities faced by MASCC members when providing supportive care to patients with cancer and to examine the EDI landscape within the organization. Here, we report results related to EDI initiatives within the organization. Two-hundred and eighteen MASCC members responded to the survey (response rate 10.2%). The results indicated that respondents were generally satisfied with how MASCC manages leadership, membership, and organization-related EDI issues. Opportunities for improvement noted by respondents included developing strategies to foster a more diverse membership, improving communication regarding diversity in the organization, and increasing EDI content in educational sessions and publications. The results of this survey represent the first attempt at understanding how to improve EDI within MASCC and will be utilized to guide further initiatives and programs.

Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review.

INTRODUCTION: Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting. METHODS AND ANALYSIS: In this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as 'financial' or 'governance arrangement' according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done. ETHICS AND DISSEMINATION: No ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences. PROSPERO REGISTRATION NUMBER: CRD42023391897.

Transgender Patient Preferences When Discussing Gender in Health Care Settings.

Importance: Transgender (trans) patients report frequent discriminatory and harmful experiences in health care settings; gender-affirming, competent health care improves trans individuals' health and well-being. Objective: To identify factors influencing trans patients' decision-making regarding sharing gender-related information with providers (clinicians, health care organizations, health care systems) and trans patient preferences for gender-related questions, as well as the subsequent impact on health care experiences. Design, Setting, and Participants: A qualitative, interpretivist phenomenological study was conducted via telephone or video (using Zoom) in English and Spanish from August 10 to September 11, 2020. Participants were recruited via trans-specific social media groups and email listservs. Interviews were transcribed verbatim and analyzed from October 2020 to January 2022 using thematic analysis by a majority trans research team. Main Outcomes and Measures: Semistructured interviews explored patient health care experiences and preferences. Results: Participants included 27 trans and/or nonbinary adults (mean [SD] age, 30.9 [10.4] years; range, 21-69 years) from 13 US states. Four themes were identified: (1) impact of provider behaviors, (2) engaging in relational risk assessment, (3) receiving affirming vs medically competent care, and (4) "how are you going to fit [me] into your system?" The first theme reflected the impact of provider actions, including level of flexibility in care and interpersonal interactions, ability to explain medical relevance of gender-related questions, and preparedness to work with trans patients. Second, respondents weighed a variety of implicit or explicit safety cues when deciding whether and how to share information with providers. Third, participants spoke at length about affirming and medically competent care, noting that they have had to prioritize one over the other. Last, participants reported their needs often being at odds with health care system norms and standards of care. Conclusion and Relevance: In this qualitative study of trans patient preferences when discussing gender-related information with providers, it was found that equitable, gender-affirming, and competent health care requires flexibility and responsiveness to patient preferences. It requires provider humility and engagement, as well as institutional policies that support competent and gender-affirming spaces. Future research could identify additional roles that providers, administrators, and systems can play in ensuring competent care for trans patients.

Hospital and Physician Group Practice Participation in Prior and Next-Generation Value-Based Payment Programs.

This cohort study examines whether prior direct or indirect participation in the Centers for Medicare & Medicaid Innovation Bundled Payments for Care Improvement (BCPI) Initiative was associated with their participation in the next generation of the program.

Diversity Management: Practical Application in a Healthcare Organization.

If you are not confused, you don't know what's going on. -Jack Welch In commenting on the business environment today (1994), Jack Welch could have been talking about healthcare organizations experiencing the double-barreled assault on two sweeping changes simultaneously. Not only are hospitals preparing for yet-to-be-determined changes in national healthcare delivery systems but they are doing so in the midst of shifting demographics in both the population and employee base. While many make the case for managing diversity, we would like to go one step further in offering a framework for developing an organization's ability to build an inclusive environment that gets the best from its staff and provides the best service to its customers.

Toward a Theory of Organizational DNA: Routines, Principles, and Beliefs (RPBs) for Successful and Sustainable Organizational Change.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of "organizational DNA" to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called "social string," which contains the "soft" interaction or communication among the organization's members, and a so-called "technical string," which contains "hard" organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

Back to the Future: What Healthcare Organizations Need to Thrive in the Face of Persistent Environmental Uncertainty.

While uncertainty has always been a feature of the healthcare environment, its pace and scope are rapidly increasing, fueled by myriad factors such as technological advancements, the threat and frequency of disruptive events, global economic developments, and increasing complexity. Contemporary healthcare organizations thus persistently face what is known as "deep uncertainty," which obscures their ability to predict outcomes of strategic action and decision-making, presenting them with novel challenges and threatening their survival. Persistent, deep uncertainty challenges us to revisit and reconsider how we think about uncertainty and the strategic actions needed by organizations to thrive under these circumstances. Simply put, how can healthcare organizations thrive in the face of deeply uncertain environments? We argue that healthcare organizations need to employ both adaptive and creative strategic approaches in order to effectively meet patients' needs and capture value in the long-term future. The chapter concludes by offering two ways organizations can build the dynamic capabilities needed to employ such approaches.

Direct Secure Messaging in Practice: Addressing Workflow Challenges.

Direct Secure Messaging (DSM) is a sender-initiated communication technology for exchanging patient-specific information among clinicians and disparate healthcare organizations. As DSM adoption increases it becomes more difficult for clinicians and staff to manage the volume and variety of external data received. This can lead to information hazards that can produce cognitive overload and decrease the ability of clinicians to process patient data when reviewing multiple sources. While DSM is one of many options for electronically exchanging health information, we have found that poor user awareness of DSM features and variable EHR capabilities for sending, receiving, and managing messages and their contents demonstrate that additional work is needed to achieve DSM's potential as a low-barrier, ubiquitous option for clinical interoperability. This paper reviews these problems from end-user perspective and offers best-practices for both senders and recipients of DSM.

The 2021 ACR/RBMA Workforce Survey: Practice Types, Employment Trends, and Hiring Needs.

PURPOSE: The aim of this study was to analyze current radiology practice types, specific subspecialty needs, employment trends, and retirement trends. METHODS: ACR members, nonmembers, and Radiology Business Management Association members were surveyed using predominantly structured closed-ended questions about a variety of current and recent radiology practice characteristics. Responses were group practice deduplicated and weighted. RESULTS: Of 1,702 survey respondents, 64% were men, with a median age of 51 years. In 2021, 62% of responding practices hired radiologists, with the average practice hiring 2 radiologists and academic practices on average hiring the most (3.5). Most radiologists (87%) were hired for full-time positions, with independent practices hiring the largest proportion of part-time positions. Body and breast imagers represented the largest numbers of hired radiologists (17% each). Practices anticipated similar hiring patterns in 2022, prioritizing breast (37%) and body (35%) imaging. Of all practice types, academic groups were least likely to prioritize general radiologist hiring. A large majority (82%) of radiology practices permit remote work (teleradiology), more common at academic than other practices. Of currently employed radiologists, 16% plan to seek new employment in the next year; early-career radiologists indicated the highest likelihood (92%) and academic radiologists the lowest (66%) of remaining in the same practice for at least 5 years. A large majority of practices (80%) reported no radiologist retirements in 2021. Of those retiring, the average age was 75 years, and 66% worked full-time until retirement. CONCLUSIONS: Radiologist recruiting remains robust. Current information on practice characteristics may help inform radiology practice leaders seeking to right-size their groups.

President Biden's Executive Order on Artificial Intelligence-Implications for Health Care Organizations.

This Viewpoint discusses a recent executive order by US President Joe Biden about the development and implementation of AI, including the role of government vs the private sector and how the order may affect health care.

Midwifery group practice workforce in Australia: A cross-sectional survey of midwives and managers.

BACKGROUND: Despite robust evidence on the benefits of midwifery group practice (MGP), there remains difficulties with implementing and sustaining the model. However, contemporary data on the MGP workforce and how each model has been operationalised are limited. This constrains an understanding of the factors that help or hinder implementation and sustainability of MGP. AIM: To describe the characteristics of Australian MGPs and the factors that help or hinder sustainability. METHODS: A national cross-sectional survey was undertaken in Australia between March 2021 and July 2022, inclusive. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using content analysis. FINDINGS: Of 669 survey responses, 579 were midwives and 90 were managers. The mean years of experience for clinical midwives was eight years, and 47.8% (almost twice the national average) completed a Bachelor of Midwifery (BMid). Half (50.2%) the models provided care for women of all risk. Midwives resigned from MGP because of the MGP work conditions (30%) and how the service was managed or supported (12.7%). Managers resigned from MGP because of role changes, conflict with their manager, and limited support. Almost half (42.6%) of MGP managers also managed other areas, leading to heavy workloads, competing demands, and burnout. CONCLUSION: The BMid appears to be a common educational pathway for MGP midwives, and many MGP services are providing care to women with complexities. Flexible practice agreements, organisational support and appropriate workloads are vital for recruitment, retention, and sustainability of MGP.

"It's all about cultural understanding": A reflexive thematic analysis of women's experiences at a dedicated refugee midwifery group practice service.

BACKGROUND: Inequitable maternity care provision in high-income countries contributes to ongoing poor outcomes for women of refugee backgrounds. To address barriers to quality maternity care and improve health equity, a co-designed maternity service incorporating community-based group antenatal care, onsite social worker and interpreters, continuity of midwifery carer through a caseload design with 24/7 phone access was implemented for women of refugee background. OBJECTIVE: To explore and describe women's experiences and perceptions of care from a dedicated Refugee Midwifery Group Practice service. DESIGN: Qualitative exploratory descriptive study using focus group discussions and interpreters. SETTING: The study was conducted at a community-based Refugee Midwifery Group Practice service in a tertiary maternity hospital in Brisbane, Australia. METHODS: We conducted three focus group discussions (June - December 2020) with 16 women, born in six different countries, in three language groups: Sudanese Arabic, Somali, and English. We used reflexive thematic analysis to interpret women's perspectives and generate informed meanings of experiences of care. RESULTS: We generated four themes 1) accessibility of care, 2) women feeling accepted, 3) value of relationality, and 4), service expansion and promotion. Results demonstrate positive experiences and acceptability due to easy access, strong woman-midwife relationships, and culturally safe care. CONCLUSION: The service addressed concerns raised in an early evaluation and provides evidence that redesigning maternity services to meet the needs of women with a refugee background speaking multiple languages from many countries is possible and promotes access, use, and satisfaction with care, contributing to improved health equity and perinatal outcomes.

Assessing health care leadership and management for resilience and performance during crisis: The HERO-36.

BACKGROUND: Whereas organizational literature has provided much insight into the conceptual and theoretical underpinnings of organizational leadership and management during emergencies, measures to operationalize related effective practices during crises remain sparse. PURPOSE: To address this need, we developed the Healthcare Emergency Response Optimization survey, which set out to examine the leadership and management practices in health care organizations that support resilience and performance during crisis. METHODOLOGY: We administered an online survey in April to May 2022 to health care administrators and frontline staff intimately involved in their hospital's emergency response during the COVID-19 pandemic, which included a sample of 379 respondents across nine rural and urban hospitals (response rate: 44.4%). We used confirmatory factor analysis and quantile regressions to examine the results. RESULTS: Applying confirmatory factor analysis, we retained 36 items in our survey that comprised eight measures for formal and informal practices to assess crisis leadership and management. To test effectiveness of the specified practices, we regressed self-reported resilience and performance measures on the formality and informality scores. Findings show that informal practices mattered most for resilience, whereas formal practices mattered most for performance. We also identified specific practices (anticipation, transactional and relational interactions, and ad hoc collaborations) for resilience and performance. PRACTICE IMPLICATIONS: These validated measures of organizational practices assess emergency response during crisis, with an emphasis on the actions and decisions of leadership as well as the management of organizational structures and processes. Organizations using these measures may subsequently modify preparedness and planning approaches to better manage future crises.

The Evolution of Employee Assistance Programs to Best Support Healthcare Organizations.

GOAL: Employee assistance programs (EAPs) have been evolving since they first became prevalent in the 1970s. The important counseling component of EAPs is sometimes lost in discussions about what they do, with many EAPs marketing a broad portfolio of services such as childcare, elder care, legal referral, and other concierge services rather than counseling. The objective of this study was to examine outcomes for the EAP of one organization (Mayo Clinic), compare them to outcomes reported in the literature, and gain insights to help all healthcare organizations best support their employees. METHODS: Consistent with customary EAP practice, data for this study was collected through an anonymous survey link distributed by e-mail to users of individual counseling as well as users of organizational consulting services such as advising leaders and supervisors and leading educational sessions. PRINCIPAL FINDINGS: All (n = 82) individual counseling respondents indicated they would recommend the EAP, none reported worse symptoms, 90% decreased their stress levels, 92% reduced their feelings of anxiety, 88% enjoyed an overall improvement in mood, and 95% developed new skills. If their concern was work-related, 96% agreed the counselor understood the work culture and was able to provide helpful guidance; of the clients who were feeling burned out, 86% agreed they gained strategies to reduce its symptoms. Thematic analysis of individual counseling services indicated that participants highly valued their counselors. Regarding organizational consulting services, respondents (n = 50) indicated EAP services increased their confidence as leaders, supported their work, and provided tangible guidance. They appreciated having an internal EAP counselor. Thematic analysis of organizational consulting services indicated that EAP supported leaders by listening, coaching, and empowering them to normalize issues. PRACTICAL APPLICATIONS: EAPs have evolved into distinct internal, external, and hybrid internal-external models. Internal model counselors are company employees with inside knowledge of company culture, external EAP model counselors are contracted outside of the company, and hybrid models combine a small cadre of internal counselors with the support of outside contractors. Regardless of the model, EAP counselors must collaborate with internal stakeholders, notably the human resources department, to efficiently identify and troubleshoot employee relational issues and allow for customized initiatives to improve mental health. Based upon these findings and the authors' direct experiences with EAP providers, components of an ideal EAP are outlined to show how EAPs can best support employees. Healthcare leaders seeking to add EAP services are advised to focus on offerings that are custom fit to the organization.

Exploring the Operational and Technical Changes in the Healthcare Sector During the COVID-19 Pandemic.

The COVID-19 pandemic has affected the healthcare sector globally including Sweden, creating subsequent operational and technical changes to the wide range of digital healthcare services utilized by healthcare professionals or end consumers. A qualitative study using a self-assessment survey based on the national health services digital maturity assessment was used to study these changes from the perspective of personnel working in Swedish healthcare-related organizations. The number of 30 respondents was selected using purposive sampling, out of them 11 responded. The study highlighted positively perceived changes such as boosting digitalization, improving the procurement process, and introducing crisis management teams. Improving the offered digital services, the tools' effectiveness, efficiency, and technical support were also some of the results. On the contrary, the negatively perceived changes were limiting access to the services, limiting technical support, and reprioritizing non-essential services and projects.

Building a Group Practice and Going Big.

Guided by experiences learned over 50 years of guiding a solo practice to an independent private practice with 28 providers and 7 practice locations in southeastern Virginia, the author describes some of the pros and cons as well as pearls and pitfalls and gives practical advice on how to evolve from a small practice to a large group while maintaining independence in today's ever-changing medical marketplace.

Linguagem e funcionalidade pela CIF e grupo fonoaudiológico na percepção de pessoas com Doença de Parkinson / Lenguaje y funcionalidade por la CIF y grupo fonoaudiológico en la percepción de personas con Enfermedad de Parkinson / Language, functioning by ICF and SLP group intervention in the perception of people with Parkinson Disease

Introdução: O envelhecimento e a presença de doenças crônicas como a Doença de Parkinson (DP) podem gerar incapacidade e afetar a vida da pessoa, sendo que a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), na perspectiva biopsicossocial, permite conhecer a funcionalidade na DP. Objetivo: Investigar a funcionalidade de pessoas com Doença de Parkinson em atendimento fonoaudiológico grupal, tomando a CIF como base conceitual. Método: Pesquisa transversal, aprovada pelo CEP, com 10 participantes com DP, em atendimento fonoaudiológico grupal. Foi elaborado roteiro de entrevista para coleta do perfil sociodemográfico e questionário autoaplicável para coleta da autopercepção nas categorias da CIF em entrevistas com os participantes em três encontros grupais videogravados, com duração de 35 minutos cada. Para estabelecimento de parâmetros de referência, duas juízas fonoaudiólogas classificaram as respostas nas mesmas categorias. Resultados: Os participantes relataram prejuízos em Funções do Corpo (voz, articulação, fluência e do ritmo da fala, movimentos involuntários), dificuldades em Atividades e Participação (fala, conversação, uso fino da mão, andar, vestir-se, realização de tarefas domésticas, e recreação e lazer) e barreiras nos Fatores Ambientais. Em 60% dos casos a concordância entre participantes e juízas foi discreta, 30% regular, e em um caso (10%) foi forte. Conclusão: Os resultados mostram as dificuldades de linguagem e de funcionalidade na percepção das próprias pessoas com DP, conferindo um caráter original à pesquisa por dar voz a elas e trazer subsídios para o cuidado centrado na pessoa, transpondo, assim, a visão biomédica da atenção centrada na doença. (AU)

ntroduction: Aging and the presence of chronic diseases such as Parkinson's Disease (PD) can generate disability and affect a person's life, and the International Classification of Functioning, Disability and Health (ICF), from a biopsychosocial perspective, allows studying the functioning in PD. Objective: To investigate the functioning of people with PD in a speech-language pathology (SLP) group, taking the ICF as a conceptual basis. Method: Cross-sectional study, approved by the Ethics Committee, with 10 participants with PD, in SLP group. An interview script was developed to collect the sociodemographic profile and a self-administered questionnaire to collect self- perception in the ICF categories in interviews with participants in three videotaped group meetings, lasting 35 minutes each. To establish a reference parameter, two SLP with experience in the ICF (judges) classified the answers in the same categories. Results: Participants reported impairments in Body Functions (voice, articulation, fluency and rhythm of speech, involuntary movements), difficulties in Activities and Participation (speech, conversation, fine use of the hand, walking, dressing, performing household chores, and recreation and leisure) and barriers in Environmental Factors. In 60% of the cases, the agreement between participants and judges was slight, 30% regular, and in one case (10%) it was strong. Conclusion: The results showed language and functioning difficulties in the perception of people with PD, giving an original character to the research by giving them a voice and bringing subsidies to person-centered care, thus transposing the biomedical view of disease-centered care. (AU)

Introducción: El envejecimiento y la presencia de enfermedades crónicas como la Enfermedad de Parkinson (EP) pueden generar incapacidad y afectar a la vida de la persona, siendo que en la Clasificación Internacional del Funcionamiento, Incapacidad y Salud (CIF), en la perspectiva biopsicosocial, permite conocer el funcionamiento en la EP. Objetivo: Investigar el funcionamiento de personas con EP en la intervención fonoaudiológica grupal, tomando la CIF como base conceptual. Método: Estudio transversal aprobado por el CEP (Comité de Ética) con 10 participantes con EP, en tratamiento fonoaudilógico grupal. Se elaboró un guion de entrevista para colección de perfil sociodemográfico y un cuestionario autoaplicable para recopilar la autopercepción en las categorías de la CIF en entrevistas con los participantes en tres encuentros grupales videograbados, con una duración promedio de 35 minutos cada uno. Para establecer parámetros de referencia, dos juezas fonoaudiólogas clasificaron las respuestas en las mismas categorías. Resultados: Los participantes informaron déficit en las Funciones del Cuerpo (voz, articulación, fluidez y ritmo del habla, movimientos involuntarios), dificultades en las Actividades y Participación (habla, conversación, uso fino de la mano, caminar, vestirse, realizar las tareas domésticas, y recreación y ocio) y barreras en Factores Ambientales. En el 60% de los casos la concordancia entre participantes y juezas fue discreta, en el 30% fue regular y en un caso (10%) fue fuerte. Conclusión: Los resultados mostraron las dificultades de lenguaje y funcionamiento en la percepción de las propias personas con EP, dando un carácter original al estudio por darles voz y traer subsidios para el cuidado centrado en la persona, transponiendo así, la visión biomédica de la atención centrada en la enfermedad. (AU)

Preconditions for Implementing a Nursing App to Improve Digital Maturity.

The aim of the paper is to conduct a formative evaluation and assess the implementation of a nursing app using the qualitative TPOM framework to outline how different socio-technical aspects of the process influence digital maturity. The research question is: what are the main socio-technical preconditions for improving digital maturity in a healthcare organization? We conducted 22 interviews and used the TPOM framework for analyzing the empirical data. Exploiting the potential of lightweight technology demands a mature healthcare organization motivated actors' extensive collaboration, and good coordination of the complex ICT infrastructures. The TPOM categories are used to show the digital maturity of the nursing app implementation in relation to technology, human factors, organization, and the wider macro environment.