Complexity assessment to inform development and deployment of a digital dashboard for schizophrenia care: a case study (Preprint)

BACKGROUND Healthcare is argued to grow increasingly complex, characterized by being unpredictable, dynamic, and more than its constituents. There are multiple challenges in enabling healthcare for people with chronic and severe illnesses like schizophrenia, e.g., care being compounded by poor adherence among both patients and health professionals to evidence-based treatment guidelines. New technologies hold promise in enabling decision support and feedback, but adoption, scale-up, and spread of new technologies in general often fail due to complexity. A dashboard to support patient coproduction at the point of care for people with schizophrenia was developed locally in the west of Sweden. Scale-up and spread proved difficult. Knowledge of complex systems has been used to create the non-adoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) framework and a complexity assessment tool (NASSS-CAT) supporting the use of principles or rules, in facilitating the development of technology-enabled support functions in complex contexts. We use the framework and tool to assess complexity as well as to look into the usability and usefulness of the tool in the dashboard deployment initiative to inform digitalization of schizophrenia care. OBJECTIVE The (NASSS) framework and a complexity assessment tool (NASSS-CAT) were used to address two questions: 1) How can development and deployment of digital dashboard for schizophrenia care be informed by an assessment of complexity? 2) What are stakeholders’ experiences of the usability and usefulness of NASSS-CAT in the dashboard project? METHODS This is a naturalistic case study of the dashboard deployment initiative. Complexity assessment was used to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We performed a thematic content analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on the tool’s usefulness. RESULTS Application of the NASSS framework revealed different kinds of complexity across multiple domains, including the condition, the technology, the value proposition, organizational tasks and pathways, and the wider system. These complexities consisted of interdependencies and uncertainties of which some had to be actively managed as the project unfolded – a process that was time-consuming and required resources. Resolving problems was often achievable but sometimes generated further problems elsewhere in the system. The NASSS-CAT tool was perceived by stakeholders as useful in getting perspective and new insights, covering areas that otherwise might have been neglected. CONCLUSIONS This case study shows how stakeholders can identify and plan to address complexities in the introduction of a technological solution to support coproduction. This suggests that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.