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  • 1.
    Eriksen, Sara
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Hofflander, Malin
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Blekinge Inst Technol, Karlskrona, Sweden..
    Lundberg, Jenny
    Lund Univ, Dept Design Sci, Lund, Sweden..
    Health in Hand: Putting mHealth Design in Context2014In: 2014 IEEE 2ND INTERNATIONAL WORKSHOP ON USABILITY AND ACCESSIBILITY FOCUSED REQUIREMENTS ENGINEERING (USARE), 2014, p. 36-39Conference paper (Refereed)
    Abstract [en]

    Wireless technologies, cloud computing and connectivity have enabled mobile services that extend the coverage of health services, resulting in a branch of eHealth now commonly referred to as mHealth. However, at least in Sweden, where the healthcare sector is heavily institutionalized and regulated, mHealth has so far mainly evolved in the form of applications for support of healthy life-style and self-management of chronic diseases, implemented outside of the firewalls of traditional healthcare delivery environments. In this paper we present an on-going Indo-Swedish research and development project in which we are putting mHealth design into context both from a patient's perspective and from the perspective of a healthcare team working within a professional healthcare organization. Our research approach is inspired by the Scandinavian tradition of Participatory Design of ICT and informed by studies of how to measure usability, user experience and impact of mHealth interventions. The involved research teams are multi-disciplinary, including researchers from engineering, computing and health sciences. The project includes, on the Swedish side, a partner from the public healthcare sector, three SME:s and an industrial partner who is currently providing Electronic Patient Record and other healthcare information system solutions and who is interested in developing mobile solutions for healthcare professionals. We are currently in the process of collaborative articulation and specification of problems, goals and requirements within the framework of the first Swedish case study of the project, focused on mobile support for patients with diabetes type 2 and their healthcare teams.

  • 2.
    Eriksén, Sara
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Lundberg, Jenny
    Blekinge Institute of Technology, Faculty of Engineering, Department of Applied Signal Processing.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Hofflander, Malin
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Borg, Christel
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Transforming Healthcare Delivery: ICT Design for Self-Care of Type 2 Diabetes2014Conference paper (Refereed)
    Abstract [en]

    In this position paper we present an on-going case study where the aim is to design and implement mobile technologies for self-care for patients with type 2 diabetes. The main issue we are addressing in this paper is how to bridge clinical and non-clinical settings when designing self-care technologies. Usability, User Experience and Participatory Design are central aspects of our research approach. For designing with and for patients in home settings and everyday life situations, this approach has so far not been problematic. However, when it comes to designing with and for user groups located within a large healthcare organization, in a highly institutionalized clinical setting, the situation is different. We have recently introduced the Health Usability Maturity Model (UMM) to our project partners as a potential tool for bringing usability and participa-tory design issues to the fore as strategic assets for transforming healthcare delivery with ICT.

  • 3.
    Hofflander, Malin
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Implementing video conferencing in discharge planning sessions: leadership and organizational culture when designing IT support for everyday work in nursing practice2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis has been to study the implementation process concerning the use of video conferencing in discharge planning, during and after a development project in a region in southeast Sweden. The research approach has been developed within a new interdisciplinary research area, Applied Health Technology. The main focus of the research has been on how the new IT solution has affected everyday work, and in what ways management supported staff during the implementation process. The study design has a qualitative approach. Phenomenological hermeneutics, content analysis and Participatory Action Research (PAR) have been used in the analysis process. Study I aimed to describe  primary healthcare nursing staff’s experiences of discharge planning, along with their concerns about using video conferencing in discharge planning sessions. It was found that there is need for improvement in communication and understanding between nursing staff working in hospitals and in primary healthcare, and need for nursing staff to obtain more information about how IT solutions could support their work. The aim of Study II was to examine the implementation process of using video conferencing in discharge planning, according to a theoretical framework composed from theories about implementation processes. It was found that implementation frameworks can be useful, and that framing the implementation process supports the exposure of factors and highlights relationships and states of dependency between those factors which may affect implementation. Study III set out to describe managers’ reflections about leading the implementation process of using video conferencing in the discharge planning session. The results indicate that managers experienced two leadership perspectives when they reflected on the implementation process. On one hand, they described a desired way of leading implementation, on the other hand they described an actual way of leading implementation. The aim of Study IV was to describe the reflections of professionals about what is needed in order to create what should become a new best practice using videoconferencing in the discharge planning sessions. The results indicate that the professionals experienced lack of knowledge and understanding about each other’s everyday work and that the absence of well-functioning common routines obstructed the process. The results also indicate that there is a lack of common arenas to enable discussions, negotiations and agreements about adopting new routines as the discharge planning process changes over time. This thesis contributes to the much-needed discussions about how to manage the many ongoing IT implementation processes in Swedish healthcare organizations, by highlighting challenges and difficulties that both healthcare professionals and managers have experienced during an implementation process. The results indicate that implementation frameworks can be useful when new IT solutions are introduced in healthcare, and that there is a need for dedicating time, space and support for involved professionals in designing their everyday work.

  • 4.
    Hofflander, Malin
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Lina, Nilsson
    Blekinge Institute of Technology, School of Health Science.
    Sara, Eriksén
    Blekinge Institute of Technology, School of Computing.
    Christel, Borg
    Blekinge Institute of Technology, School of Health Science.
    Discharge planning: Narrated by nursing staff in primary healthcare and their concerns about using video conferencing in the planning session – An interview study2013In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 1, p. 88-98Article in journal (Refereed)
    Abstract [en]

    Background/Objective: This paper sets out to describe experience-based reflections on discharge planning as narrated by nursing staff in primary healthcare, along with their concerns about how the introduction of video conferencing might influence the discharge planning situation. Methods: Interviews were conducted with nursing staff working at a primary healthcare centre in South East Sweden. Each interview took place was conducted on a one-to-one basis in dialogue form, using open questions and supported by an interview guide. It was then analysed using a phenomenological hermeneutic method. Participants were eligible for the study if they had given their informed consent and if they worked with discharge planning and home-based healthcare provision. In total, 10 of the 30 persons working at the primary healthcare centre participated in the study. Results: It was found that nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterised by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers and nursing staff the winners. Conclusions: It is suggested that there is a need for improvement in communication and understanding between nursing staff at the hospital and nursing staff in primary healthcare in order to develop discharge planning. There is also a need for the nursing staff in primary healthcare to obtain more information about how Information Technology (IT) solutions could support their work and help them to find ways to collaborate.

  • 5.
    Hofflander, Malin
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Borg, Christel
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Eriksén, Sara
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Video Conference as a Tool to Enable Participation in Discharge Planning – Experiences From Implementers about the Implementation Process2014Conference paper (Refereed)
    Abstract [en]

    The problems and challenges that arise in the task of improving discharge planning have been an area of concern for many years, including problems related to the lack of time for professionals to participate. In a county council area in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation. As part of a larger research study of the implementation process, interviews were conducted with two of the implementers. The interviews were analysed qualitatively, using directed content analysis with a deductive approach to considering a framework developed by Nilsen et al. The results of this study are consistent with the actual framework but with the addition of time, i.e. time to prepare, time to understand, time to run through and time to reflect. Further research is proposed to focus more on leadership during the implementation process and its influence on the meaning of time.

  • 6.
    Hofflander, Malin
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Eriksén, Sara
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Borg, Christel
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Framing the Implementation Process of Video Conferencing in Discharge Planning: According to Staff Experience2016In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 41, no 2, p. 192-209Article in journal (Refereed)
    Abstract [en]

    Challenges of improving discharge planning have been an area of concern for many years, including problems related to lack of time for professionals to participate. In a county in South East Sweden, video conferencing was implemented in discharge planning sessions to enable distance participation of the professionals. To examine the implementation process, interviews were conducted with the implementers, who were project leaders, discharge planning coordinators in the hospital, and in home-care. The interviews were analysed qualitatively, using directed content analysis with a deductive approach to a theoretical framework that was composed from theories about implementation processes to be suitable for the healthcare sector, consisting of the factors: implementation objects; implementation actions; actors; users; inner context and outer context. The results of this study are consistent with the framework but with the addition of a new dimension – time, i.e. time to prepare; time to understand; time to run through and time to reflect. It is suggested that implementation frameworks are useful when IT is introduced in healthcare. Framing the implementation process supports the exposure of factors and highlights relationships and states of dependence between those factors which may affect implementation.

  • 7.
    Hofflander, Malin
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Nilsson, Lina
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Eriksén, Sara
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Borg, Christel
    Healthcare managers’ experiences of leading the implementation of video conferencing in discharge planning sessions: An interview study2016In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 3, p. 108-115Article in journal (Refereed)
    Abstract [en]

    This article describes healthcare managers’ experiences of leading the implementation of video conferencing in discharge planning sessions as a new tool in everyday practice. Data collection took place through individual interviews and the interviews were analyzed using qualitative content analysis with an inductive approach. The results indicate that managers identified two distinct leadership perspectives when they reflected on the implementation process. They described a desired way of leading the implementation and communicating about the upcoming change, understanding and securing support for decisions, as well as ensuring that sufficient time is available throughout the change process. They also, however, described how they perceived that the implementation process was actually taking place, highlighting the lack of planning and preparation as well as the need for support and to be supportive, and having the courage to adopt and lead the implementation. It is suggested thatmanagers at all levels require more information and training in how to encourage staff to become involved in designing their everyday work and in the implementation process. Managers, too, need ongoing organizational support for good leadership throughout the implementation of video conferencing in discharge planning sessions, including planning, start-up, implementation, and evaluation. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

  • 8. Nilsson, Lina
    et al.
    Borg, Christel
    Hofflander, Malin
    Eriksén, Sara
    PD 3.1 to the rescue: Challenges for Participatory Design in a health care context2010Conference paper (Refereed)
    Abstract [en]

    A National Strategy for E-health has been introduced in Swedish county councils. The strategy indicates that health care needs to become more accessible. To generate usable and sustainable e- Health solutions in Swedish health care, Participatory Design (PD) was introduced as a working method in an e-Health project in the south of Sweden. The project has met with opposition; e-health solutions are not exactly what Swedish health care wanted at the same time as different arenas within the health care organization have difficulties understanding each other. The aim of this study is to find work methods that result in applicable, usable, and sustainable ICT- solutions in every day work within Swedish health care. The study suggests that a modification of third generation of PD may be one way to the challenges PD has come across in the health care context.

  • 9.
    Nilsson, Lina
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Hofflander, Malin
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    What if it was like a departure lounge at an airport?: eHealth for healthcare staff in a Swedish healthcare organization, a participatory design study2016In: Studies in Health Technology and Informatics, IOS Press, 2016, Vol. 225, p. 923-924Conference paper (Refereed)
    Abstract [en]

    EHealth is implemented in everyday work practice as a tool to improve accessibility and patient participation as well as healthcare efficiency. The aim of this study was to explore healthcare staff’s experiences and ideas about how eHealth ought to be designed to be a useful tool in everyday work practice in a Swedish healthcare organization. Healthcare staff (n= 7) at the micro level in a Swedish healthcare organization, participated in four Participatory Design workshops about eHealth design. eHealth could be a more useful and efficient tool in everyday work practice if it were designed more purposefully for its local setting and intended users, like the information system in ’a departure lounge of an airport’. Including healthcare staff in design discussions concerning eHealth tools for everyday work practice may improve the efficiency of eHealth as an everyday tool and support for healthcare staff.

  • 10.
    Nilsson, Lina
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Hofflander, Malin
    Blekinge Institute of Technology, School of Health Science.
    Eriksén, Sara
    Blekinge Institute of Technology, School of Computing.
    Borg, Christel
    Blekinge Institute of Technology, School of Health Science.
    The importance of interaction in the implementation of information technology in health care: A symbolic interactionism study on the meaning of accessibility2012In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 37, no 4, p. 277-290Article in journal (Refereed)
    Abstract [en]

    A challenge when groups from different disciplines work together in implementing health information technology (HIT) in a health-care context is that words often have different meanings depending upon work practices, and definition of situations. Accessibility is a word commonly associated with HIT implementation. This study aimed to investigate different meanings of accessibility when implementing HIT in everyday work practice in a health-care context. It focused on the perspective of nurses to highlight another view of the complex relationship between HIT and information in a health-care context. This is a qualitative study influenced by institutional ethnographic. District nurses and student nurses were interviewed. The results indicate that when implementing HIT accessibility depends on working routines, social structures and patient relationship. The findings of the study suggest that interaction needs to take on a more important role when implementing HIT because people act upon words from the interpreted meaning of them. Symbolic interactionism is proposed as a way to set a mutual stage to facilitate an overall understanding of the importance of the meaning of words. There is a need for making place and space for negotiation of the meaning of words when implementing HIT in everyday work practice.

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