Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study

Llewellyn, Sue; Procter, Rob; Harvey, Gill; Maniatopoulos, Gregory; Boyd, Alan

doi:10.3310/hsdr02230

Cited by 38 publications

(34 citation statements)

References 169 publications

(211 reference statements)

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“…Namely around convenience, type of information and data being included in research. This could be attributed to the app presenting itself as a potential solution capable of overcoming the language barrier [4, 38,39]. Potentially the app could have a list of different languages to choose from, that would allow a diverse range of people to utilise the app with complete understanding.…”

Section: Discussionmentioning

confidence: 99%

Consumer preference to utilise a mobile health app: A stated preference experiment

2020

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BackgroundOne prominent barrier faced by healthcare consumers when accessing health services is a common requirement to complete repetitive, inefficient paper-based documentation at multiple registration sites. Digital innovation has a potential role to reduce the burden in this area, through the collection and sharing of data between healthcare providers. While there is growing evidence for digital innovations to potentially improve the effectiveness and efficiency of health systems, there is less information on the willingness of healthcare consumers to embrace and utilise technology to provide data. AimThe study aims to improve understanding of consumers' preference for utilising a digital health administration mobile app. OPEN ACCESSCitation: Lim D, Norman R, Robinson S (2020) Consumer preference to utilise a mobile health app: A stated preference experiment. PLoS ONE 15(2): e0229546. https://doi.org/10.

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Section: Discussionmentioning

confidence: 99%

Consumer preference to utilise a mobile health app: A stated preference experiment

2020

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“…We examined the adoption of three healthcare technologies: insulin pump therapy; a breast lymph node metastases diagnostic (BLNA); and an ultra-wide field diagnostic for retinal imaging (Llewellyn et al, 2014). This paper reports on the adoption of BLNA.…”

Section: Research Setting and Methodsmentioning

confidence: 99%

Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology

Maniatopoulos¹,

Procter²,

Llewellyn³

et al. 2015

Social Science & Medicine

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This paper explores the ways in which technological innovation becomes adopted and incorporated into healthcare practice. Drawing upon the notion of 'field of practices', we examine how adoption is subject to spatially and temporally distributed reconfigurations across a multi-level set of practices, ranging from the policy level to the micro-level setting of individual action. The empirical backdrop is provided by a case study of the adoption of Breast Lymph Node Assay (BLNA), a diagnostic technology innovation for the treatment of breast cancer patients. Our aim is to contribute to the development of a more comprehensive analysis of the processes surrounding the adoption and incorporation of complex healthcare technologies into routine practice.

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“…Therefore, although innovation can improve productivity, at least in the short term, innovation can reduce patient throughput and, therefore, income under the tariff. 94 In sum, the adverse effects of PbR are: l increased hospital admissions l unco-ordinated care across settings l undertreatment l cost shifting to other budgets l cherry-picking lower-risk cases l up-coding or misreporting. 79 We found examples of all of these disadvantages in our case studies.…”

Section: Advantages and Disadvantages Of The Tariff And Payment By Rementioning

confidence: 99%

Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy

Llewellyn

Chambers

Ellwood

et al. 2016

Health Serv Deliv Res

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BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study

Cited by 38 publications

References 169 publications

Consumer preference to utilise a mobile health app: A stated preference experiment

Consumer preference to utilise a mobile health app: A stated preference experiment

Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology

Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy

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