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The NASSS Framework – A Synthesis of Trisha GREENHALGHa,1 and Seye ABIMBOLAb aNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK b School of Public Health, University of Sydney, Sydney, Australia, The George Institute for Global Health, Sydney, Australia Abstract. Technologies are often viewed as the route to better, safer and more efficient care, but technology projects rarely deliver all the benefits expected of them. Based on a literature review and empirical case studies, we developed a framework (NASSS) for studying the non-adoption, abandonment and challenges to scale-up, spread and sustainability of technology-supported change efforts in health and social care. Such projects meet problems usually because they are too complex – and because the complexity is sub-optimally handled. NASSS consists of six domains – the illness or condition, the technology, the value proposition, the individuals intended to adopt the technology, the organisation(s) and the wider system – along with a seventh domain that considers how all these evolve over time. The NASSS framework incorporates a number of other theories and analytic approaches described elsewhere in this book. It is not intended to offer a predictive or formulaic solution to technology adoption. Rather, NASSS should be used to generate a rich and situated narrative of the multiple influences on a complex project; to identify parts of the project where complexity might be reduced; and to consider how individuals and organisations might be supported to handle the remaining complexities better. Keywords. NASSS framework; complexity of innovations; diffusion of innovation; value proposition; scale-up Learning objectives After reading this chapter the reader will be able to: 1. Articulate various individual theories of technology adoption and implementation within a multi-level integrated framework. 2. Draw different theories together to explain the multiple and complex challenges to the adoption, scale-up, spread and sustainability of technology-supported programmes in healthcare. 3. Design an evaluation of a health informatics intervention based on the NASSS framework. 1 Corresponding Author, Professor Trisha Greenhalgh, E-mail: trish.greenhalgh@phc.ox.ac.uk. Multiple Theories of Technology Implementation Applied Interdisciplinary Theory in Health Informatics P. Scott et al. (Eds.) © 2019 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0). doi:10.3233/SHTI190123 193