Technology as change agent? (Why introducing technologies in the hope of driving change almost never works)
The George Institute, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ
Professor Trish Greenhalgh
Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at organisation or system level.
This talk will present a new evidence-based, theory-informed, and pragmatic framework which was developed to help predict and evaluate the success of technology-supported health or social care programmes. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework is based on a systematic literature review and an extensive empirical dataset including more than 400 hours of ethnographic observation, 165 semi-structured interviews and 200 documents.
Findings indicate that technology rarely if ever ‘drives’ change (in the deterministic, plug-and-play sense). Rather, technologies should be conceptualised as components of complex systems that are unstable, dynamically changing and (to some extent) unpredictable.
Achieving widespread, sustainable change requires ongoing effort and resource at many levels and attention to the overall narrative (the ‘organising vision’ for the technology). Because (and to the extent that) the system is complex, the success of a change effort will depend on human agents (champions, change agents, street-level bureaucrats, expert patients, technical trouble-shooters) to keep the show on the road despite multiple contingencies and unforeseen events. Written reports of technology projects (whether “successes” or “failures”) should seek to capture and celebrate this human element – and policymakers should ensure that they acknowledge, value and resource the hidden human work on which “technological” innovation depends.
Trish Greenhalgh, Professor of Primary Care Health Sciences at the University of Oxford, is an internationally recognised academic in primary health care and trained as a GP. As co-Director of the Interdisciplinary Research in Health Sciences (IRIHS) unit, Trish leads a programme of research at the interface between social sciences and medicine, with strong emphasis on the organisation and delivery of services. Her research seeks to celebrate and retain the traditional and humanistic aspects of medicine while also embracing the unparalleled opportunities of contemporary science and technology to improve health outcomes and relieve suffering. Trish is also our inaugural Distinguished Fellow and has a focus on Transforming Health Systems.