Electronic Individual Plans serving the person or the ideology?

Transcription

1 Electronic Individual Plans serving the person or the ideology? I have a plan Svein Ingve Nødland Mary Genevieve BIllington Brita Gjerstad 3rd Nordic Conference on Research and Patient Safety and Quality in Health Care, Octobre 2014, Stavanger, Norway

2 The Individual Plan (IP) a central legislated tool to increase co-ordinated help for people who need coordinated services from several agencies over time introduced in Norway in 2001 Empowerment personal needs, aims, wishes central Ownership user encouraged and entitled to formulate plan Local municipality obligated to establish the plan + coordinator Targets not achieved lack of engagement with 23 October established 2014 plans (other research)

3 Electronic/web-based Individual Plan Stavanger municipality introduced e-ip in 2012 Package of functions (as in EMR) customised to individual user Aim of making the plans more interactive and user friendly, thus servicing the plan owner better Implementation takes time: A small, but increasing share of the plan owners in Stavanger municipality have electronic plans

4 Research Questions What is the role of the users, the care providers, the administrators, the politicians, the suppliers in the implementation of welfare technology? Which factors, in the different phases, promote and/or hinder successful implementation of welfare technology What consequences has welfare technology for user satisfaction, resource use, cooperation and innovation?

5 Implementation Theoretical framework «Street level bureaucracy» (SLB), Lipsky, 1980, 2010 Policies applied at the street level may differ significantly from official policy Public service officers rarely have enough resources to satisfy demand They exercise discretion in decisions about clients with whom they interact ICT dimension «Affordances and constraints» Greeno Gibson 1977 Affordances are the attributes of the setting which provide potential for action Constraints are the conditions and relationships that provide structure and guidance for action

6 Context a widely held rather transparent ideology among politcal leaders that all technology is «good» strong policy regarding client rights and client participation steadily increasing demand for services provision of services faces limitations regarding costs and staffing technologies are commonly regarded as the solution perhaps the only

7 Methodology Multiple Case study Semi-structured interviews: audio taped and partly transcribed Plan owners (8), personel (5), administration (4 persons/3 interviews) and volunteer support organisation (1)

8 Finding: Users in the study had not actively engaged with the electronic plan «It is more than a year since I last looked at the e-ip. It was mostly used in the beginning. To be honest the plan is not used.» Technical difficulties: (constraint) «At a meeting we were told that now it was the electronic plan that mattered. We got passwords, but nobody was able to enter. The coordionator was told, but nothing happened»

9 Finding: Not prioritised by support teams «I rarely log on. I have writen some changes into it as I assume that should be done. I do not think that coordinators know what it should look like either. ««We logged on to the e-ip plan. The content from the paper IP was registered. We did not change or add anything. I don t think that other partners have logged into the plan either. «It is only the coordinator that uses the E-iP. Neither the school, nor the physioterapist log on. I put some information into it last month. But the coordinator does not put information where it should be placed.» «I know of the IP. But, electronic versus paper plan that is not my problem (leader)»

10 Finding: Clients think differently (SLB) Information rather than communication (affordance) «e-ip is an adequate tool to write goals, but not in daily work.» «The e-ip is a suitable tool to state objectives, but not for daily use.» «Months pass between every time I look into the plan. Typically I do it to pick out some information. Like now I have sent over a complaint, and I needed some information regarding my stated objectives.» The advantage of the IP is that everything is written there. But I do not need that because I know the girl. It is good for the personnel where she lives. There are so many different people and they need to know about her in order to do their job.

11 Finding: Other communication channels are more convenient, preferred (SLB) «The GP was sceptical. He did not want to publish his ID-number at the web». «I understand it is meant to be a tool for the client. However, we communicate directly. If a problem with, we address the...» «The kindergarden has an IP of their own. The school has its own IOP. What is the sense of one more?» «The meaning of the plan is to co-ordinate services that I need so that the responsible people can know about my goals. But I feel that cooperation works so well through personal relations.»

12 Finding: E- Plans not efficient use of resources There are maximum 10 e-ips at this office. We had to drop working with IPs. Some work has to be left, with so many on sick leave Before I brought the plan (on paper) with me to the meetings where some revisions were made. It is still like this with the electronic device. We have to do it. If you are in charge of 20 e-ips. It doesn t work. We don t have enough time. So far, I work mainly with the plan in the start-up phase. It is not very active really. In the plans that I am in charge of, I have done everything. The idea, we were told, was than when the plan became electronic, others should be more active. It has not happened.

13 Discussion and conclusion The e-ip is not making the IP-process more dynamic and/or empowering. Why? «Economy of practice» (Artigue, 2002) affordances not realized - bypassing the electronic planning medium, using more resource efficient and goal effective mediums Policy difficult to transpose into implementation (SLB) assumes commitment to the plan from all partners client and coordinator, but also the others (GPs, schools etc) To make progress, either the scope of the e-ip has to be simplified and/or its integration with other actors and systems has to be strengthened