The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakin

Actor-Network Theory (ANT) is an increasingly influential, but still deeply contested, approach to understand humans and their interactions with inanimate objects. We argue that health services research, and in particular evaluations of complex IT systems in health service organisations, may benefit from being informed by Actor-Network Theory perspectives. Despite some limitations, an Actor-Network Theory-based approach is conceptually useful in helping to appreciate the complexity of reality (including the complexity of organisations) and the active role of technology in this context. This can prove helpful in understanding how social effects are generated as a result of associations between different actors in a network. Of central importance in this respect is that Actor-Network Theory provides a lens through which to view the role of technology in shaping social processes. Attention to this shaping role can contribute to a more holistic appreciation of the complexity of technology introduction in healthcare settings. It can also prove practically useful in providing a theoretically informed approach to sampling (by drawing on informants that are related to the technology in question) and analysis (by providing a conceptual tool and vocabulary that can form the basis for interpretations). We draw on existing empirical work in this area and our ongoing work investigating the integration of electronic health record systems introduced as part of England's National Programme for Information Technology to illustrate salient points. Actor-Network Theory needs to be used pragmatically with an appreciation of its shortcomings. Our experiences suggest it can be helpful in investigating technology implementations in healthcare settings.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The emergence of robotics is transforming industries around the world. Robot technologies are evolving exponentially, particularly as they converge with other functionalities such as Artificial Intelligence to learn from their environment, from each other, and from humans. Objective: To understand the emerging role of robotics in healthcare and identify existing and likely future challenges to maximizing the benefits associated with robotics and related convergent technologies. Methods: We conducted qualitative semi-structured one-to-one interviews exploring the role of robotic applications in healthcare contexts. Using purposive sampling, we identified a diverse range of stakeholders who were involved in conceiving, procuring, developing and/or using robotics in a range of national and international healthcare settings. Interviews were digitally recorded, transcribed verbatim and analyzed thematically, supported by NVivo 10 software. Theoretically, this work was informed by the sociotechnical perspective, where social and technical systems are understood interdependent. Results: We conducted 21 interviews and these accounts suggested that there are significant opportunities of improving the safety, quality and efficiency of healthcare through robotics, but our analysis identified four major barriers that need to be effectively negotiated to realize these: 1) no clear pull from professionals and patients; 2) the appearance of robots and associated expectations and concerns; 3) disruption of the way work is organized/distributed; and 4) new ethical and legal challenges requiring flexible liability/ethical frameworks. Conclusions: Sociotechnical challenges associated with the effective integration of robotic applications in healthcare settings are likely to be significant, particularly for patient facing functions. These need to be surfaced and tackled for effective innovation and adoption. Clinical Trial: N/A

Background: There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. Objective: The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. Methods: We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. Results: TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. Conclusions: The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value.