Making way for bottom-up innovations: learning about the role of complexity in healthcare technology projects using the NASSS-CAT (Preprint)

Abstract

New digital technology presents new challenges to healthcare on multiple levels. There are calls for further research embracing the complex factors related to digital innovations in complex healthcare settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity.

This study aimed to increase our understanding of the role of complexity in bottom-up innovations by 1) assessing complexity to identify unique and shared challenges for four bottom-up healthcare innovations and 2) reporting experiences of use and the utility of the complexity assessment tool.

Four bottom-up innovators identified complexities in their innovations using the NASSS framework with its seven domains; the related Complexity Assessment Tool (CAT); and Constant Comparative Analysis (CCA), in collaboration with the Innovation Platform in Region Västra Götaland in Sweden.

In this retrospective exploration of the role of complexity in four bottom-up healthcare innovations in a Swedish region, both similarities and differences emerged between the four examples. In the domain of condition/diagnoses, an initiated understanding of the complexity relating to the condition/illnesses (diabetes, cancer, bipolar disorders and schizophrenia disorders) in the innovation is of great importance. In the domain of value, value proposition needs to be clearly described early, to enable an understanding of costs and outcome. Individual and shared experiences regarding specific complexities in each domain were identified; for example, for organization and wider system, it was revealed that, if laws only permit the regional use of innovations, national spread is hindered and there will be no dissemination and the innovations risk failing after the initial project phase. The questions in the NASSS-CAT long tool were sometimes difficult to comprehend, not only from a language perspective but also from a lack of understanding of the system and setting. The CCA was useful in defining specific questions in the NASSS-CAT framework. Identified complexities belonged more to the system environment rather than the specific project environment.

Using a validated tool to identify complexities early in the innovation process was helpful, but it required a profound knowledge of complexity and the wider system in which the innovation is embedded. Complexities in bottom-up innovations in healthcare are related to the wider system, the organisation in which the innovations are embedded and the organisation’s visions, rules/lack of rules and framework/lack of framework. Finding and defining complexity does not resolve the issues, but it will increase the opportunities for implementing the innovation if the right support competence is available. The NASSS-CAT long helped awareness of when the complexities were within the organisation and when complexities were within the specific innovation but was time consuming, sometimes difficult to use and should not be used as a checklist.

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