Introduction: The Danish healthcare system is in crisis. Staff shortages and a population which is expanding, ageing, and becoming more sick, result in reduced quality and efficiency in treatment and care, as well as overburdened staff. One type of illness that occurs frequently is stroke. A lot of proposed solutions take the form of new technology such as robots to “lift” the increasing burdens that the healthcare system faces. This study investigates a rehabilitative robot at a stroke ward.
Research question: How does an emergent robot practice reconfigure therapy and care at a Danish stroke ward, and how can anthropology-driven participatory design be used to generate local as well as general recommendations about implementation of healthcare technology?
Methods: An ethnographic study was conducted at a Danish stroke ward, where practices of using ROBERT were investigated through participant observations, shadowing, and ethnographic interviews of occupational therapists, physiotherapists, care personnel, a development therapist and their manager. In addition, a participatory design workshop was facilitated to create local recommendations for future processes. We employed a theoretical framework that combined practice theory, domestication theory and participatory design as a way to understand local practices and their relation to the new robot-practice, and to utilise these understandings as democratic design elements.
Results: We found that the robot in the case has catalysed a number of conflicts surrounding proper use as well as professional boundaries, and that while the technology is broadly considered promising to patients, this has not been sufficient to fully fit it into existing practices, nor fully reconfigure these practices to fit the robot. We argue that the missing piece is the implementation process itself, as it has required more resources than the larger healthcare system has provided, and the ward currently lacks the structural support to fund and facilitate the adoption of complex technology. Further, we show merits of participatory design as a way to create locally meaningful principles for implementing technology, but also shortcomings of participatory methods in a volatile field such as healthcare.
Discussion: We discuss the issues of technology implementation as issues of organisational structures that do not embrace the diversity of professional identities during large changes. Furthermore, we discuss issues of design and implementation processes that do not manage to understand the real needs and practices of the intended users. Finally, we discuss how these issues might relate to a lack of available data and experiences of such implementation processes. We present recommendations to mitigate some of these issues through practice-level democratic engagement with healthcare professionals, as well as through better knowledge sharing in the healthcare system at large, and adopting new ways of conceptualising healthcare change.
Conclusion: The report concludes that the implementation of new healthcare technologies is a very complex matter which is not grasped by the knowledge, structures and organisational support currently available to local sites with specialised needs, which results in resource waste and worker frustrations, as well as the persistence of the problems that the technology was intended to solve. We conclude that solving the complexities of these challenges requires engaging and involving the local experts who are tasked with adopting new technologies to save the healthcare system.