Expectations are high for digital technologies to address sustainability related challenges. While research into such applications and the twin transformation is growing rapidly, insights in the actual daily practices of digital sustainability within organizations is lacking. This is problematic as the contributions of digital tools to sustainability goals gain shape in organizational practices. To bridge this gap, we develop a theoretical perspective on digital sustainability practices based on practice theory, with an emphasis on the concept of sociomateriality. We argue that connecting meanings related to sustainability with digital technologies is essential to establish beneficial practices. Next, we contend that the meaning of sustainability is contextspecific, which calls for a local meaning making process. Based on our theoretical exploration we develop an empirical research agenda.
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Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (–) of and facilitators (+) to implementation were identified in all 5 CFIR domains: “digital health characteristics” (ie, commercial neutral [+], privacy and safety [–], specificity [+], and good usability [+]), “outer setting” (ie, acceptance by stakeholders [+], lack of health care guidelines [–], and external financial incentives [–]), “inner setting” (ie, change of treatment routines [+ and –], information incongruence (–), and support from colleagues [+]), “characteristics of the healthcare professionals” (ie, health care professionals’ acceptance [+ and –] and job satisfaction [+ and –]), and the “implementation process” (involvement [+] and justification and delegation [–]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context
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Technological developments go fast and are interrelated and multi-interpretable. As consumer needs change, the technological possibilities to meet those needs are constantly evolving and new technology providers introduce new disruptive business models. This makes it difficult to predict what the world of tomorrow will look like for an organization and that makes the risks for organizations substantial. In this context, it is difficult for organizations to determine what constitutes a good strategy to adopt digital developments. This paper describes a first step of a study with the objective to design a method for organizations to formulate a future-proof strategy in a rapidly changing, complex and ambiguous context. More specifically, this paper describes the results of a sequence of three focus groups that were held with a group of eight experts, with extensive experience as members of the decision making unit in organizations. The objectives of these sessions were to determine possible solutions for the outlined challenge in order to provide direction for continuation and scoping of the following research phases.
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The importance of leadership is increasingly recognized in relation to digital transformation. Therefore, middle management and top management must have the competencies required to lead such a transformation. The purpose of this paper is to investigate the relationship between the digital leader competencies as set out by the European e-competence framework (e-CF) and the digital transformation of organizations. Also, the relationship between digital leadership competency (DLC) and IT capability is examined. An empirical investigation is presented based on a sample of 433 respondents, analyzed using PLS-SEM. The results strongly support our hypotheses. DLC has a strong impact on organizational digital transformation. A post-hoc analysis showed this is predominantly the case for the e-CF competencies of business plan development, architecture design, and innovating while business change management and governance do not seem to affect organizational digital transformation. This is the first empirical study to conceptualize, operationalize and validate the concept of DLC, based on the e-competence framework, and its impact on digital transformation. These findings have significant implications for researchers and practitioners working on the transformation toward a digital organization.
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Digitization of activities in hospitals receives more attention, due to Covid-19 related regulations. The use of e-health to support patient care is increasing and efficient ways to implement digitization of processes and other technological equipment are needed. We constructed a protocol for implementation and in this study, we evaluate this protocol based on a case to implement a device in the OR. We used various data sources to evaluate this protocol: semi-structured interviews, questionnaires, and project documents. Based on these findings, this protocol, including identified implementation activities and implementation instructions can be used for implementations of other devices. Implementation activities include setting up a project plan, organizational and technological preparation, maintenance, and training. In future research, these activities and instructions need to be evaluated in more complex projects and a flexible tool needs to be developed to select relevant activities and instructions for implementations of information systems or devices.
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The COVID-19 pandemic led to an accelerated implementation of digital solutions, such as online proctoring. In this paper we discuss how the use of an ethical matrix may influence the way in which digital solutions are applied. To initiate an ethical discussion, we conducted an online workshop with educators, examiners, controllers, and students to identify risks and opportunities of online proctoring for various stakeholders. We used the Ethical Matrix to structure the meeting. We compared the outcome of the workshop with the outcomes of a proctoring software pilot by examiners. We found that the two approaches led to complementary implementation criteria. The ethical session was less focused on making things work and more on transparency about conditions, processes, and rights. The ethical session also concentrated more on the values of all involved rather than on fraud detection effectiveness
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Background Literature on self-management innovations has studied their characteristics and position in healthcare systems. However, less attention has been paid to factors that contribute to successful implementation. This paper aims to answer the question: which factors play a role in a successful implementation of self-management health innovations? Methods We conducted a narrative review of academic literature to explore factors related to successful implementation of self-management health innovations. We further investigated the factors in a qualitative multiple case study to analyse their role in implementation success. Data were collected from nine self-management health projects in the Netherlands. Results Nine factors were found in the literature that foster the implementation of self-management health innovations: 1) involvement of end-users, 2) involvement of local and business partners, 3) involvement of stakeholders within the larger system, 4) tailoring of the innovation, 5) utilisation of multiple disciplines, 6) feedback on effectiveness, 7) availability of a feasible business model, 8) adaption to organisational changes, and 9) anticipation of changes required in the healthcare system. In the case studies, on average six of these factors could be identified. Three projects achieved a successful implementation of a self-management health innovation, but only in one case were all factors present. Conclusions For successful implementation of self-management health innovation projects, the factors identified in the literature are neither necessary nor sufficient. Therefore, it might be insightful to study how successful implementation works instead of solely focusing on the factors that could be helpful in this process.
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Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects.
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Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
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It has become a topic at Dutch educational institutes to feel not only responsible for improvement of theoretical and practical skills, but also of 'competences' in a broader sense. The curriculum of the Electrical and Electronic (E&E) Department has been changed enormously in the past decade. Fewer lessons and many more projects were introduced. We have choosen to let the students work on competences especially in the projects they are in. With the introduction of competences and the aid of a student portfolio we have given the tools to the students to improve their competences in a broader way. At the E &E department we introduced two different ways of working on competences. In the first years of their study students choose different roles in our projects every time. We have described all the roles and the related tasks for each specific role. While working on a role, the students indirectly work on different competences. This way of working inforces a broader educational level (a student shouldn t work on things he already knows or is able to handle) and the hitch hiking behaviour is banned out. Students now do take responsibility while contributing to the project teams. Inquiries amongst the students confirm these results. The second way is working on the specific competences in their traineeship and thesis work in the last part of their study. This will be introduced in autumn 2004 in the E&E department. In this paper we will show you how we are implementing the integration of competences, like the E&E department did, for IPD projects as well. This implementation is planned to start in autumn 2004.
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