Page - 199 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Complexity in Domain 5, then, may relate to the organisation’s general capacity to innovate (such as leadership, clinician-managerial relationships, absorptive capacity for new knowledge and availability of slack resources); its readiness for this particular technology (tension for change, balance of supporters and opponents); the nature of the adoption and funding decision (more complex if it depends on inter-organisational agreements and speculative cross-system savings); potential disruption to existing routines (the less there is, the simpler it will be); or the extent of work needed to implement the changes (including ensuring staff buy-in, delivering the change and evaluating the change). Domain 6 is the wider system. There are many potentially relevant theories that suggest how external social, political, technological and economic context may affect the uptake of innovations. One example is Richard Scott’s neo-institutional theory, which proposes that innovation and change in healthcare organisations is heavily influenced (and may be slowed down) by three broad types of social forces or “institutional pillars”: regulative (laws, regulations and contracts which stipulate what must happen), normative (professional and societal expectations about what should happen) and cultural-cognitive (taken-for-granted scripts and mental models about what generally does happen). Each pillar offers a different rationale for legitimising human action or inaction, by virtue of being (respectively) legally sanctioned, morally (e.g. professionally) authorised, or culturally supported. The wider system also embraces the networks that exist between organisations and theories of how networking and knowledge-sharing between organisations can significantly increase the uptake and embedding of innovations within them [25]. Complexity in Domain 6 may relate to negative perceptions of the innovation or specific blocks to its introduction from policymakers, regulatory or professional bodies, or the general public [8]. It may also indicate limited scope for networking activities among organisations (for example via quality improvement collaboratives), which are known to improve organisations’ capacity to innovative. Domain 7 is continuous embedding and adaptation over time (of both the technology and the service or organisation). Relevant theory here includes Everett Rogers’ consistent finding that ‘potential for reinvention’ is a key determinant of successful adoption of an innovation [28], and also to the notion of organisational resilience [29], which has been defined as “the intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continued stress” (page 1) [30]. Complexity in Domain 7 may thus relate to the technology’s lack of potential to adapt to changing context or to the organization’s lack of resilience. 2. Usage of NASSS framework in health informatics: A case study of a telehealth system for heart failure (SUPPORT-HF) Empirical studies by our own team [2, 31] and others (as yet unpublished) have demonstrated the value of the NASSS framework for constructing a rich narrative of an unfolding technology-supported change programme and identifying the various interacting uncertainties and interdependencies that need to be contained and managed if the programme is to succeed. An example from our empirical dataset is a home-based telehealth system for heart failure, known as SUPPORT-HF, which provided remote data on patients’ blood T.GreenhalghandS.Abimbola /TheNASSSFramework–ASynthesisofMultipleTheories 199