Medical device technologies: Who is the user?

A myriad of medical devices deployed by many users play an essential role in healthcare, and they, and their users, need to be defined, classified and coded effectively. This study provides definitions of terms frequently employed to describe the users of medical device technologies (MDT) as well as a classification of such users. Devices are widely used, developed and assessed by many others than clinicians. Thus, users of medical devices need to be classified in various relevant ways, such as primary and secondary users; user groups such as healthcare professionals, patients, carers, persons with disabilities, those with special needs, as well as professionals allied with healthcare. Proper definition and classification of MDT users is particularly important for integrating the users’ perspectives in the process of MDT development and assessment, as well as in relation to the regulatory, health and safety, and insurance perspectives concerning MDT

Adapting structuration theory to understand the role of reflexivity: Problematization, clinical audit and information systems

This paper is an exploratory account of the further development and application of a hybrid framework, StructurANTion, that is based on Structuration Theory and Actor Network Theory (ANT). The use of social theories in general and their use in information systems (IS) research in particular is explored leading to the use of the framework to examine the concept of what are termed humanchine networks in the context of clinical audit, within a healthcare Primary Care Trust (PCT). A particular focus is on the manner in which information systems-based reflexivity contributes to both entrenching a networks’ structurated order as well as contributing to its emancipatory change. The case study compares clinic-centric and patientcentric audit and seeks to further extend the understanding of the role of information and information systems within structurated humanchine activity systems. Conclusions indicate that the use of more socially informed IS methods and approaches can incorporate more emancipatory ideals and lead to greater adoption and usage of more relevant and useful clinical information systems and practices

From boundary object to boundary subject; the role of the patient in coordination across complex systems of care during hospital discharge

From boundary object to boundary subject; the role of 1 the patient in coordination across complex systems of 2 care during hospital discharge 3 4 Abstract 5 Advocates for patient involvement argue that seeking the active contribution of 6 patients and families in the coordination of care can help mitigate system 7 complexity, and lead to improvements in quality. However, sociological and 8 organisational research has identified barriers to involving patients in care 9 planning, not least the power of, and boundaries between, multiple professional 10 groups. This study draws on literature from Science and Technology Studies (STS) 11 to explore the patients' role in coordinating care across professional-practice 12 boundaries in complex care systems. Findings are drawn from a two-year 13 ethnographic study (including 69 qualitative interviews) of hospital discharge 14 following hip-fracture care, and describe the changing role of the patient as they 15 move out of hospital into community settings. Findings describe how 'the patient' 16 plays a relatively passive role as boundary object while recovering from surgery 17 within hospital, where inter-professional coordination was prescribed by 18 evidence-based guidelines, leaving little space for patient voice. As discharge 19 planning begins, patient involvement is both encouraged and contested by 20 different professional groups, with varying commitment to include patient 21 subjectivities in care. As patients move into home and community settings, they, 2

A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

BACKGROUND The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. METHOD We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. RESULTS Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. CONCLUSIONS In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.he Serious and Continuing Illnesses Policy and Practice Study (SCIPPS) is a National Health and Medical Council of Australia (NHMRC) funded program (no: 402793) conducted at the University of Sydney and The Australian National University and administered by the Menzies Centre for Health Policy

Dispensing care?: The dosette box and the status of low‐fi technologies within older people’s end‐of‐life caregiving practices

Abstract: Technology has been lauded as a solution to range of challenges presented by ageing population internationally. While the lion‐share of scholarship has focussed on high‐fi, digital technologies, there has been a recent shift to exploring the contributions mundane, low‐fi technologies make to older people's daily lives and our understandings of health, illness and care more broadly. Drawing from serial narrative interview data collected with 19 married couples aged 70 and over living in the U.K., this article explores the way one medical technology—the dosette box—was taken‐up and deployed in their end‐of‐life caring process. Informed by actor–network theory and critical feminist scholarship, this article considers how the dosette box played an active role in structuring relationships, scheduling daily care activities and enforcing medical compliance. In doing so, we suggest that the dosette box provided an unexpected companion and ‘weapon of the weak’ for older partner's attempting to assert their expertise and power while caring. We also explore how the dosette box demanded an even higher level of regular, vital care from older partner's once introduced into the home, thus entrenching the physical and emotional demands of dispensing care

Modes of innovation and responsibility within regional innovation systems:Reflections from the Twente region

Increasing public investments in distributed platform infrastructures have created new opportunities for economic growth and social welfare but at the same time have been associated with growing societal distrust in the power of science to solve societal problems. The concept of Responsible Research & Innovation has been advanced as providing mechanisms to recouple science and society to ensure that research and innovation continues to uphold its duties to society. In this paper, we explore the extent to which it is possible to identify repertoires of responsible innovation behaviour within extant research and innovation networks. We distinguish between two kinds of regional innovation network, those based on science and technology innovation, and those based on doing, using, inventing innovation in the eHealth sector where there are substantive societal concerns regarding responsibility and innovation. We contend that it appears that the coupling of patients to innovation networks through their prior association with innovators (e.g. as patients) affects the scope for responsibility. We therefore contend that more attention is required for understanding the dynamics of citizen-innovator coupling in regional innovation networks if responsibility is to become a more common property of these systems

Oldest-old partner’s experiences of providing end-of-life care: a narrative study

Background Population ageing has rapidly increased the number of people requiring end-of-life care across the globe. Governments have responded by promoting end-of-life in the community. Partly as a consequence, older partners are frequently providing for their partner’s end-of-life care at home, despite potentially facing their own health issues. Little is known about people aged 75 and over who are providing end-of-life care. In order to prepare our health and social care systems for rapidly ageing populations, we need to understand more about this group’s experiences of end-of-life care. Aim To explore the experiences of oldest-old partners looking after their partner approaching end-of-life care. Method First, I conducted a systematic review of the extant literature published since 1985 on the topic. Second, I conducted a longitudinal narrative interview study with 17 couples (19 participants in total). Findings A systematic review of the literature identified a small and only medium quality evidence-base with important empirical and theoretical gaps that require further research. Drawing on interview data, the first key finding was that older partners navigated the carer identity in relation to external and internal factors with not all subsequently embracing the carer identity for themselves. A second key finding is that older partners are actively engaged in integrating care in their capacity as home- keepers, networkers and vigilant visitors. A third key finding highlights the creative ways in which older partners engaged with a pill organizer called a dosette box to make their daily end-of-life caring and medical management bearable. Conclusions The overarching contributions of this thesis challenge notions of the fourth age as merely comprising “decline, passivity and frailty” by emphasizing the activity and creativity of older partners providing end-of-life care. Second, by thinking about oldest-old partners needs and experiences as interconnected, I suggest that policy-makers and health and social care providers will be able to more effectively design services that meet the needs of both oldest-old partners.Woolf Fisher Doctoral Scholarshi

Coping with complex environments: the case of digital healthcare technology producers

The aim of this thesis is to enrich the understanding of institutional complexity. To that end, my research focuses on an emergent field, as the most acute instantiation of institutional complexity, in addition to being an understudied phenomenon. Theoretically, the approach is anchored in the institutional logics perspective and the concept of institutional work. My research design is an inductive multi-level, multi-case study, found adequate to investigate a poorly understood and complex phenomenon. The research setting is the emerging field of digital health, at the intersection of healthcare and consumer digital technologies fields. By means of the theoretical framework and the operational methodology, the research offers a robust understanding of the field emergence and of the institutional work undertaken by organisations in the midst of high institutional complexity. At field level, findings reveal the logics at play: the state, medical profession, market, science and citizen logics, as well as how the emerging role of the empowered patient mediates institutionalisation. A significant contribution of my research is a new theoretical model for field emergence. This research provides insights on the understudied phenomenon of bottom up institutionalisation through the organisational level analysis. The study reveals the institutional work new organisations undertake in an emergent field, depending on their position, plurality and ambiguity and their own identity. It shows how organisations hybridise logics, often by co-creating digital solutions with stakeholders and by acting as institutionalisation agents. This research makes significant contributions towards the role trust and leadership play in organisation’s success and the field institutionalisation itself. In addition, it reveals how new organisations contribute towards field emergence by adhering to distinctive categories and the promulgation of the new role of the empowered patient. Not last, my research contributes to the understanding of how digital technologies, by the virtue of their unfinished character, play a significant part in institutionalisation