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Purpose The COVID-19 pandemic caused rapid implementation and upscaling of video consulting. This study examined the perceived quality of care delivered through video consulting at a geriatric outpatient clinic, and how this related to adoption issues and barriers early adopting professionals found themselves confronted with. Methods We performed a qualitative study using semi-structured interviews with healthcare professionals complemented by the views of geriatric patients, family caregivers and medical secretaries. Participants from five academic centers and six teaching hospitals were included. Three researchers conducted the interviews, coded the data, and used thematic analysis. Results Interviews were conducted with 13 healthcare professionals, 8 patients, 7 family caregivers, and 4 medical secretaries. From these early adopters, we infer five criteria positively contributing to perceived quality of care provided by video consulting: (1) the patient has an intact cognitive function; (2) a family caregiver with digital literacy can be present; (3) doctor and patient already have an established relationship; (4) no immediate need for physical examination or intervention; and (5) the prior availability of a comprehensive and concise medical history. Overall, the uptake of video consulting in geriatric outpatient care appeared to be slow and laborious due to several implementation barriers. Conclusion The implementation of video consulting use among geriatricians and geriatric patients at the geriatric outpatient clinic was slow due to the absence of many facilitating factors, but video consulting might be offered as an alternative to face-to-face follow-up to suitable patients in geriatric outpatient clinics.

Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.

Older adults often struggle to adjust to the rapid changes in the digitizing media landscape. In this article, we study, first, how 10 older adults adapt new online media into their daily lives and, by doing so, adjust to the changing “rules of engagement” that guide online-media use in their social surroundings. Second, we analyze how this adaptation process generates change in older adults' social connectedness. Results suggest that older adults' non-use of popular online media results in social exclusion. Enhancing their social connectedness, requires older adults to (partially) conform to new communication norms and values. Based on our findings, we propose three adaptation strategies that enhance both offline and online social connectedness.

Background: Electronic Health Records (EHR) are integrated software applications used by healthcare providers to create, share, retrieve, and archive patients’ health status information. Especially for large healthcare organizations, implementing Electronic Health Records organization-wide is a complex endeavour. The EHR literature generally suggests that contextual factors play a major role in adoption. We demonstrate how the work context influences adoption at the departmental level in a situation where each department has its own medical specialty or patient stream, clinical authority, and accountability. Here, the achievement of full adoption by all departments is not self-evident. Drawing on EHR implementation in a Dutch hospital, this study explores how the clinical departments’ work context characteristics contribute to their pre-implementation intended adoption and their post-implementation EHR uptake. Methods: This embedded case study allowed us to examine the EHR adoption of eight diverse clinical departments in terms of their work and socio-political context. Data collection entailed semi-structured interviews, observing meetings, document analysis, and feedback sessions to check our interpretations. We examined the context and adoption intentions before implementation and the adoption level approximately half a year after the Go Live. The comparative case analysis iterated between holistic department-level descriptions and structured data displays based on inductive and deductive coding. Results: We identified three departmental types that varied both in adoption intention and post-implementation uptake: (1) departments oriented towards the organization with an enthusiastic or compliant adoption; (2) internal-oriented departments with a selective or conditional adoption; and (3) externally oriented departments with no or low adoption with workarounds. Conclusions: We conclude that work context characteristics contribute to individual departments’ adoption of an EHR. By acknowledging departmental types that will vary in adoption intention, and especially the underlying explanatory mechanisms, we recommend that implementers acknowledge these departmental types and differentiate their strategies towards clinical departments accordingly based on their observable work context characteristics. Based on these findings, we develop propositions that contribute to the development of a department-level EHR adoption theory.

An extended professional identity theory is proposed to enhance interprofessional collaboration. The purpose of this study is to investigate whether comparative feedback on interprofessional interaction can decrease the degree of profession-based dominance and general dominance in mixed profession groups. This observational study comprised a randomized double-blind pretest-posttest control group design with 19 mixed profession groups (10 intervention and nine control groups, each with three dental and three dental hygiene students). All groups received reflective feedback during two consecutive two hour team development meetings. Intervention groups also received comparative feedback. Profession-based dominance concerned the sum of three observation items (conversational turn-taking, dominance and contributing ideas) with a three-point scale: -1 = dental dominance, 0 = no dominance, +1 = dental hygiene dominance. Polychoric correlations confirmed positive associations with the latent trait and an unidimensional underlying structure. Observation items were internally consistent (alpha > .70). General dominance concerned the sum of absolute values of observation items with a minimum value of zero (no dominance) and the maximum value of three (strong dominance). A two-way factorial ANOVA was performed. The results revealed a significant interaction effect with regard to general dominance, F(1,17) = 6.630, p = 0.20 and large effect size (partial eta squared = 0.28). Comparative feedback on interprofessional interaction decreases general dominance in mixed profession groups.

Tendering legislation aims to enhance competitiveness by promotingequality, proportionality, transparency, and non‐discrimination. Suchlegislation applies to the procurement of software packages by publicinstitutions in many countries. This study explores how tenderinglegislation shapes a buyer's software selection process through thelens of competing decision‐making rationalities. From the literature,3 rationalities enacted in software selection are deduced that werelate to the software selection literature regarding tendering legislation.Through this lens, we subsequently examine how a large healthcare provider selected a supplier for an electronic health recordsystem after an extensive tendering process. Many health careprofessionals within this organization were in favour of a particularsoftware package. Yet, the organization purchased a different packagefrom a relatively unknown supplier, the implementation of whichfailed. The actors involved experienced shaping on 5 decisionmakingthemes, the implications of which are evaluated against thefunctional, economic, and political rationality norms derived fromthe literature. The findings suggest that compliance with tenderinglegislation over the public procurement of software results inincreased legal complexity, greater linearity and objectivity, moreextensive formalization, and less relational communication. Functionalnorms of rationality are stressed, seemingly to balance theenforced economic norms of rationality and to compensate for thedecreased room for political rationality. Even so, the shaping by thetendering legislation threatens functional rationality. Ultimatelyfunctional and economic norms of rationality win over politicalrationality, yet the latter still dribbles through, albeit in a differentguise than reported for software selection in general.

This article analyzes the tensions evolving from project management dilemmas and how they relate to stakeholders in large technology projects. The study addresses an organization-wide electronic health record implementation in a large hospital. It adopts a duality lens in exploring whether and how these tensions materialize through stakeholder voices. In contrast to traditional linear and unitarist thinking in project management, duality thinking may lead to project management practices that acknowledge, appreciate, and accommodate the tensions originating from dilemmas inherent in complex projects. We propose three stakeholder roles that can contribute to project managers’ tension awareness and inform duality management.

Purpose The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture. Design/methodology/approach Action design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them. Findings A wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept’s functionality with their professional norms, values and established practices. Originality/value The study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.

Purpose – In today’s aging world online communication is often viewed as a means to enhance social connectivity, and therefore well-being, of older adults. However, previous research on the influence of online communication on social connectivity largely disregards older adults, yields conflicting results and fails to assess the – debatable − causal direction of relationship. The purpose of this paper is to overcome these issues by developing four hypotheses related to who uses what, how, with whom. Design/methodology/approach – The authors use a panel data study to test the hypotheses, including 302 older adults. Response rates are between 62 and 75 percent. Findings – The authors find, first, that older adults differentiate between social connectivity with other village members, i.e., village connectivity, and connectivity with friends. Second, the impact of online communication varies among these two types of social connectivity. Where e-mail use has a negative impact on village connectivity, it does not affect connectivity with friends. Facebook use on the other hand has a negative impact on connectivity with friends, but not on village connectivity. The negative effects were not found among those older adults that were already well-connected on forehand, indicating a buffer effect. Practical/implications – Policy makers’ implementing online communication tools to strengthen social connectivity of older adults, may want to carefully select tools based on the type of connectivity they aim to enhance. Impact needs to be monitored. Originality/value – The authors contribute by analyzing how characteristics of online communication tools, i.e., information richness and privacy protection, as well as social connectivity, i.e., geographical proximity and emotional closeness jointly shape older adults’ social connectivity.

The stakeholders and the issues associated with a project are different concepts but closely interconnected. Despite this, the project stakeholder management literature falls short in analyzing the linkages between the stakeholders and the issues they bring. This paper develops a multilayered stakeholder–issue framework that makes the connections between stakeholders and issues explicit with the aim of helping project managers analyze and prioritize the issues that stakeholders confront them with. The framework's usability is preliminary evaluated through a case study of a multi-stakeholder implementation of an electronic health record (EHR) system in an institutionalized hospital environment. The framework enables a coherent assessment of stakeholders' issues. Using the case study, we discuss how such an assessment could improve the management of stakeholders' issues and their influence on a project's progress and outcomes.

BACKGROUND: In the Netherlands, the scope of dental hygiene practice was expanded in 2006. The objective of this study was to explore reasons among dentists and dental hygienists for supporting or opposing an extended scope of practice and to find explanatory factors. METHODS: A questionnaire containing pre-defined reasons and an open-ended question was distributed among 1,674 randomly selected members of two Dutch professional associations (874 dentists, 800 dental hygienists). Data were analyzed with binary logistic regression with Bayesian information criterion (BIC) model selection. RESULTS: Response were obtained from 541 practitioners (32.3%): i.e., 233 dentists (43.1%) and 308 dental hygienists (56.9%). Non-response analysis revealed no differences, and representativeness analysis showed similarities between samples and target populations. Most often, dentists reported flexible collaboration (50.2%) and dental hygienists indicated task variation (71.1%) as supportive reasons. As opposing reasons, dentists generally reported quality of care (41.2%) and dental hygienists' self-competence (22.7%). Reasons were explained by profession, gender, and new-style practitioners. CONCLUSION: Dentists and dental hygienists conveyed different reasons for supporting or opposing an extended scope of dental hygiene practice. Outcomes can be categorized as reasons related to economic, professional status, quality, job satisfaction, and flexible collaboration and are not only explained by profession.

Purpose – Applying “modularity” principles in services is gaining in popularity. The purpose of this paper is to enrich existing service modularity theory and practice by exploring how services are being decomposed and how the modularization aim and the routineness of the service(s) involved may link to different decomposition logics. The authors argue that these are fundamental questions that have barely been addressed. Design/methodology/approach – The authors first built a theoretical framework of decomposition steps and the design choices involved that distinguished six decomposition logics. The authors conducted a systematic literature search that generated 18 empirical articles describing 16 service modularity cases. The authors analysed these cases in terms of decomposition logic and two main contingencies: modularization aim and service routineness. Findings – Only three of the 18 articles explicitly addressed the service decomposition by reflecting on the underlying design choices. By unravelling the decomposition in each case, the authors were able to identify the decomposition logic and found four of the six theoretically derived logics: single-level process oriented; single-level outcome oriented; multilevel outcome oriented; and multilevel combined orientation. Although the authors did not find a direct relationship between the modularization aim and the decomposition logic, the authors did find that single-level decomposition logics seem to be mainly applied in non-routine service offerings whereas the multilevel ones are mainly applied in routine service offerings. Originality/value – By contributing to a common understanding of modular service decomposition and proposing a framework that explicates the design choices involved, the authors enable an enhanced application of the modularity concept in services.

Research highlights? We integrate work on strategic value configurations within the Strategic IS alignment model. ? A framework involving three distinct alignment configurations is developed for telecare. ? We use this framework to explain the contrasting outcomes of two Dutch telecare projects. ? The framework explains outcomes better than a 'value chain'- based alignment model would have done. In telecare adoption, the lack of a strategic vision and of consistency in design choices have been identified as critical problems. Existing IS alignment literature only offers limited answers to these problems and does not acknowledge the different value configurations that telecare technology can enable. This paper, therefore, integrates work on strategic value configurations with the strategic IS alignment model in order to widen the latter's applicability. Based on the value configurations and related service management literature, a framework involving three distinct alignment configurations is developed for telecare. An analysis of two Dutch telecare projects shows how the proposed alignment profiles can explain the contrasting project outcomes more effectively than the traditional strategic alignment model would have done. The discussion reflects on the generalizability and contribution of an extended strategic alignment model.

PurposeThis paper aims to investigate the forces that influence the shifting of professional boundaries on the entry of a new medical occupation in Dutch hospitals – non‐specialist emergency physicians.Design/methodology/approachFive case studies of Dutch hospitals were conducted and the emergency physicians' implementation process was analyzed by means of force field analysis.FindingsEmergency physicians were conceptualized as being the answer to unequivocal contextual changes. However, their contribution to better performance varies due to problems in the implementation process. Strong socio‐political forces between traditional specialties and these new doctors mediate the intended improvement. The emergency physicians aim to establish their own organizational‐, patient‐ and knowledge‐domain by redrawing professional boundaries but they are not on a par with the specialists who set these boundaries. Consequently, emergency physicians only gradually redraw the existing boundaries, resulting in limited added value. Their reaction is to obtain power by striving to develop into a recognized specialty; ironically, by becoming an additional layer in the traditional medical hierarchy they might lose their envisaged added value.Research limitations/implicationsThis paper is based on the first Dutch hospitals that implemented emergency physicians. The number of cases is therefore limited. Moreover, the study took place at an early stage of emergency physician implementation.Practical implicationsThe extent of successful redrawing depends on the implementation's transition logic, the existing degree of differentiation and boundary permeability and on the ideological power developed by the leaders.Originality/valueThe introduction of emergency physicians is currently being discussed in many countries worldwide, and some countries consider following the Dutch example of non‐specialist doctors. This paper supports health professionals and hospital managers in not falling prey to the same pitfalls as some Dutch hospitals.

Telecare is the use of information and communication systems to facilitate care delivery to individuals in their homes. Although the expectations of telecare are high, its implementation has proved complex. This case study demonstrates this complexity through a structurational analysis of a telecare implementation process. The paper shows how structuration concepts enable a combined analysis of actors' interactions with a technology and of the interaction among these actors from different institutional contexts. In this example, fragmented multi-actor agency induced an inconsistent implementation mode, leading to unsuccessful telecare appropriation. This paper concludes with a preliminary proposal for more consistent telecare implementation modes. These modes may better support the actors' reflexive monitoring and dialogue and inform further research.

Background: In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of future doctors are also changing.Objectives: We aimed to categorise medical students' prevailing career intentions and to examine to what extent newly proposed medical occupations that may be part of the transformation process correspond with these career intentions.Methods: We carried out expert interviews and a feedback round to gain input for a survey among students. From the demand perspective, 11 experts proposed non-traditional medical occupations and evaluated these on the basis of job characteristics relevant to a doctor's career choice. Subsequently, students from 5 universities filled out a questionnaire to rate these job characteristics by their importance and the proposed occupations' attractiveness.Results: Four different clusters of career intentions were categorised as patient-oriented expert, career-oriented specialist, lifestyle-oriented generalist, and balance-seeking realist. These clusters differ in terms of the ways in which students feel attracted to the proposed occupations. The career-oriented specialists feel least attracted and the lifestyle-oriented generalists most attracted to the occupations.Discussion: The experts' call for shorter postgraduate programmes to educate patient-oriented doctors partly matches students' career intentions. Most students share the intention of obtaining a direct care position that provides ample task variation, which may explain the appeal of the occupations 'emergency doctor' and 'basic specialist'. The limited interest in specific patient groups suggests a need for more exposure to the occupations linked to these groups.

Background. Most studies evaluating the roles of Nurse Practitioners have compared the care delivered by individual Nurse Practitioners with that provided by other professionals. These studies should be complemented by research focusing on a higher unit of analysis, namely the organization of the care process for a specific patient group. The most important reason is that Nurse Practitioners are increasingly involved in direct, multiprofessional care in complex health care organizations and networks. In these work settings, their roles may, in both positive and negative ways, lead to changes in the organization of the entire care delivery system. Aim. The aim of this paper is to stimulate awareness and evaluation of these organizational changes and their potential impact on the effectiveness of the care process. Approach. A conceptual model based on patterned systems contingency theory is proposed. With the help of this model, attention is drawn to issues at the level of the organization and the effectiveness of the care processes that merit attention when Nurse Practitioner positions are being introduced. These issues are derived from case studies in Dutch hospitals. Results. According to the model, a Nurse Practitioner position will change the work structure of the care process involved. Therefore, the effectiveness of a Nurse Practitioner position will be dependent on the changes realized in the work structure. The resulting structure should fit the task characteristics of the care services demanded by the specific patient group. On the basis of this model and the examples presented, questions for further study are formulated. Conclusions. Nurse Practitioner roles can only enhance the effectiveness of care processes when embedded in a work structure that is internally consistent and adjusted to the task environment and available skill-mix. A structural contingency framework may be helpful in identifying relevant organizational issues. To determine the effects of Nurse Practitioner roles, cross-sectional as well as longitudinal studies are needed.

The objective of this study was to make a contribution to the question how team learning can be studied. A model of the constituting activities of the team learning process was articulated, and it was explored whether the learning activities relate to learning outcomes. The sample consists of 29 teams of business students who were assigned to fulfill an assignment for a company. We asked them to fill out a questionnaire at the start and at the end of this project. The teams' performance was rated. The relationships between the learning activities reported, the diversity in attitude towards the task, the amount of team learning, and the team's performance were explored. The propositions were partly supported by the data. Central conclusions are that a higher diversity in attitude towards the task is related to a higher experienced amount of learning and that in projects of short duration it is especially storing and retrieving that leads to higher team performance.

Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption. Conclusions Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

This paper describes the empirical findings of a large-scale telecare pilot implementation, called KOALA. The pilot is based on video interaction of clients with a medical service centre of a home care provider. The purpose of the project was to gain experience with telecare and to measure the effects in terms of costs and perceived well-being. The expected effects were that clients’ well-being would be increased and overall costs of health care would be reduced. The results of this study are:• the positioning of the medical service centre in the care provider’s network and the organization of the centre are crucial for attaining acceptance and cost effectiveness;• introduction of a telecare program needs careful preparation with clients and employees, and alignment with existing care;• there is substantial difference in the use of telecare and its advantages for different groups of clients; this is especially relevant when using proprietary technology.