Designing value creating and sustainable business models: An investigation of telehealthcare service ecosystem in North East England

A rising elderly population in England, together with the prevalence of long-term chronic health conditions and higher demands for social care, is creating significant challenges for both the English National Health Service (NHS), and for Local Authorities. These challenges relate to the effective planning, commissioning and provisioning of services for people with complex social and health care needs, amidst a predominantly public-funded health and care system. Digital technology innovations, such as telecare and telehealth (telehealthcare) can facilitate assisted living through technology-mediated preventions, early detections of risks, timely interventions, and self-directed care. Policymakers acknowledge the potential of these technologies to drive greater operational efficiency and cost savings by supporting the policy agenda of ‘ageing in place’, as opposed to an increasing reliance on commissioning expensive institutional provisions such as care homes. In order to realise the opportunities of technology-enabled care, policymakers have started advocating faster adoption, provisioning and implementation of telehealthcare services on an increased population scale. A review of the relevant health technology and systems literature indicates that prior and current research does not sufficiently address the business model and service perspectives, which are considered critical to the practical justification and adoption of complex health service innovations such as telehealthcare. This research study and thesis brings together two interdisciplinary and complementary theoretical frames, synthesised from the extant literature on business models and service innovation. A new theoretical framework is developed in order to examine, interrogate and explain the phenomena of value creation and value realisation within a telehealthcare service ecosystem. Conventional business model-based thinking focuses on value propositions and the financial realisation of value. In contrast, service-dominant logic offers more relational and systemic insights on value co-creation (emphasising social as well as economic factors) through stakeholders’ resource integration within the entire service ecosystem. Using the principles of Critical Realism (CR) to inform a case study approach, this qualitative study employs a multiple case-based research design, resulting in five case studies of telehealthcare services (including one pilot) in the North East of England. The analysis of empirical data collected from the case studies, including a representative sample comprising forty key-informant stakeholder interviews, combined with documentary and observational evidence, reveals four main themes. In the next stage of analysis, following a critical realist perspective, abduction and retroduction based reasoning are applied, leading to a theoretical explanation concerning the underlying structures and their causal powers (mechanisms). Three most significant causal mechanisms, namely Organisational Inertia, Fragmented Ecosystem, and Quasi-market Characteristics, have been identified to explain the stratified reality within a telehealthcare service ecosystem. This research analysis results in both theoretical, and practitioner related contributions concerning the development of a typology for telehealthcare service business models with illustrations of three archetype business models and their related elements. These archetype models signify the dynamic possibilities or potential variations of business models and new service designs contingent upon the operational contexts in which the business models are to be situated

Telecare technologies and isolation : some ethical issues

Telecare technologies involve the remote monitoring of patients who have health, rehabilitation or social needs. These technologies, although deployed unevenly in developed countries, represent a shift in the ways in which care is practiced. Research on the consequences of this shift away from more traditional ‘hands-on’ care has focused primarily on quantitative measurement (for example cost savings) with less attention paid to how recipients themselves experience these new care practices. This paper discusses two aspects of telecare technologies which are under researched; the potential for isolation which may arise as a result of the use of these technologies, and the ethical issues raised by this. The primary locus of the discussion is the United Kingdom, where a major public policy shift towards telecare is under way and where telecare research has been particularly well funded by government. The discussion concludes that isolation raises the potential for loneliness – which is increasingly recognised as a significant factor in overall health and well-being – and is not being sufficiently considered, in part because the ethical frameworks in use do not adequately address the issue of loneliness itself, given their bio-medical, rather than relational focus

Advancing Ubiquitous Collaboration for Telehealth - A Framework to Evaluate Technology-mediated Collaborative Workflow for Telehealth, Hypertension Exam Workflow Study

Healthcare systems are under siege globally regarding technology adoption; the recent pandemic has only magnified the issues. Providers and patients alike look to new enabling technologies to establish real-time connectivity and capability for a growing range of remote telehealth solutions. The migration to new technology is not as seamless as clinicians and patients would like since the new workflows pose new responsibilities and barriers to adoption across the telehealth ecosystem. Technology-mediated workflows (integrated software and personal medical devices) are increasingly important in patient-centered healthcare; software-intense systems will become integral in prescribed treatment plans [1]. My research explored the path to ubiquitous adoption of technology-mediated workflows from historic roots in the CSCW domain to arrive at an expanded method for evaluating collaborative workflows. This new approach for workflow evaluation, the Collaborative Space – Analysis Framework (CS-AF), was then deployed in a telehealth empirical study of a hypertension exam workflow to evaluate the gains and gaps associated with a technology-mediated workflow enhancements. My findings indicate that technology alone is not the solution; rather, it is an integrated approach that establishes “relative advantage” for patients’ in their personal healthcare plans. Results suggest wider use of the CS-AF for future technology-mediated workflow evaluations in telehealth and other technology-rich domains

Design Strategy for Integrated Personal Health Records: Improving the User Experience of Digital Healthcare and Wellbeing

This dissertation addresses the timely problem of designing Integrated Personal Health Records (PHR). The goal is to provide citizens with digital user experiences, sustainable and flexible enough, for gaining control over their personal health information in a seamless way. Most importantly, so that people are able to reflect and act upon their selfknowledge, towards the accomplishment of their good health and wellbeing. Towards this end, the Integrated PHR as an emerging model in the field of Health IT, was the framework that set this research forward on exploring how communication and collaboration between patients and providers can be improved, which naturally impacts the field of HCI. Acknowledging that today patients are the ones who own all that is recorded about their health data, this new model was object of a design strategy that shaped the results presented in this dissertation. These have showed how patients can have more control of their health over time, through a patient-centered, organic system, which has the ability of combining multiple sources of data both from patient and provider side. As this new type of PHR fosters the creation of integrated networks, this milestone was achieved in this research by interacting with cross-channel user experiences that took part of nationwide healthcare ecosystems. The work presented herein, has demonstrated through the analysis and development of two use cases in cooperation with organizations connected to the Portuguese Ministry of Health, how an Integrated PHR can be a powerful personal tool, to be used by the citizen with undeniable value to the demands of an aging society. The use cases structured the thesis into two parts. The first part in collaboration with the Portuguese National Patient Portal, combines an Integrated PHR and incorporates the Portuguese Data Sharing Platform (PDS), which can be used by any Portuguese citizen. This use case study led to a proposal of the portal by also creating a foundational model for designing Integrated PHRs. The second part in collaboration with the Portuguese National Senior Telehealth Program (Saúde 24 Sénior), led to another proposal for an Integrated PHR, applying the outcomes from Part 1 and the requirements that derived from the findings explored in this second use case study. The proposed solution, has the potential to be used by the Portuguese senior community in the scope of home assistive care. Both proposals applied a user experience design methodology and included the development of two prototypes. The engagement of the stakeholders during the two case studies was accomplished with participatory design methods and followed a multidisciplinary approach to create solutions that would meet the human, politics and behavior interdependencies that were inherent to the process of working with large healthcare organizations. The provided contributions from this thesis intent to be part of a transition process that is changing the behavior of the healthcare sector, which is increasingly moving towards the improvement of the patient-provider relationship, patient engagement, collaborative care and positive computing, where digital technologies play a key role

The Development of Social Competence in Children with Disabilities

Children with disabilities experience unique challenges in developing social skills critical to achieve their social goals. Although there are individual differences, children with delays and disabilities may struggle to communicate with others, understand gestures, and take other people’s viewpoints. These differences may prevent children with disabilities from initiating and sustaining social interactions and, in turn, from developing high levels of social competence (Hebbeler & Spiker, 2016). To support social development of children with disabilities, it is important to promote positive relationships within the family system as well as the teaching of social skills in inclusive early learning environments (Mahoney et al., 2020). The Collaborative for Academic, Social, and Emotional Learning (CASEL) is a framework for supporting social emotional learning (SEL) from preschool through high school and across home and school settings (Weissberg et al., 2013). CASEL focuses on five SEL core competencies that include self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. These social and emotional competencies provide a foundation for children to adjust to challenges, develop positive relationships with peers and adults, and engage in learning tasks in ways that can benefit children with disabilities (Durlak et al., 2011). In this chapter, we first introduce two theoretical frameworks that can guide research and practice relevant to social competence of children with disabilities. Second, we discuss personal and contextual factors that either facilitate or hinder social development of children with disabilities in everyday interactions. Third, we address cultural understandings of disability that influence children’s socialization within family and community contexts. Finally, we conclude with the implications of using social intervention approaches for children with disabilities in home, school, and community-based contexts

Exploring the impact of telehealth videoconferencing services on work systems for key stakeholders in New Zealand : a sociotechnical systems approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Albany, New Zealand

Figure 2.9 is re-used under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. Figures 2.11 and 2.13 are re-used with the publishers' permission.This thesis explores how the impacts of telehealth videoconferencing services (THVCS) on work systems are perceived by key stakeholders in New Zealand. Telehealth - the use of information and communications technologies to deliver healthcare when patients and providers are not in the same physical location - exemplifies how technological developments are changing the ways in which healthcare is provided and experienced. With the objectives of improving access, quality, and efficiencies of financial and human resources, THVCS use real time videoconferencing to provide healthcare services to replace travel to a common location. Despite the benefits of telehealth reported in the extant literature, there continues to be difficulties with developing and sustaining services. The aim of this inquiry is to understand how THVCS impact key stakeholders in the work system. Specifically, it seeks to examine the characteristics of THVCS in the New Zealand context, identify the facilitators and barriers to THVCS, and understand how the work system can adapt for THVCS to be sustained practice. The research design is framed by a post-positivist approach and underpinned by sociotechnical systems (STS) theory. STS theory and a human factors/ergonomics design approach inform the methodology, including the use of the SEIPS 2.0 model. Forty semi-structured qualitative interviews and contextual observations in a two-phase methodology explore the perceptions of an expert telehealth group, and providers, receivers, and decliners of THVCS. These data are analysed using the framework method of thematic analysis. The key findings suggest that to enable sustained THVCS in New Zealand, factors such as new ways of working; change; human connection; what is best for patient; and equity need to be recognised and managed in a way that balances costs and consequence and ensures fit across the work system. Theoretical contributions to knowledge are made through the development of a conceptual model from the literature, exploring THVCS with an STS theory lens and developing SEIPS 2.0. Methodologically, this inquiry contributes a theory-based, qualitative approach to THVCS research and draws on the perceptions of unique groups of participants. Significantly, the findings make practical contributions to the design of the THVCS in the New Zealand context