The organising vision for telehealth and telecare: discourse analysis
The organising vision for telehealth and telecare: discourse analysis
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DOI：
10.1136/bmjopen-2012-001574
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发表时间：
2012-01-01
期刊：
影响因子：
2.9
通讯作者：
Shaw, Sara
中科院分区：
文献类型：
--
作者：
Greenhalgh, Trisha;Procter, Rob;Shaw, Sara
目的：（1）绘制不同利益相关者如何理解远程保健和远程护理技术的地图，（2）探索远程保健和远程护理服务的发展和实施的影响。设计：话语分析。样本：68份代表不同观点的出版物（学术、政策、服务、商业和非专业）关于远程保健和远程护理的资料，加上10次知识共享活动的实地说明。在熟悉阶段（浏览和非正式访谈）之后，我们详细研究了文本的系统样本。通过反复的仔细阅读，我们确定了假设、隐喻、故事情节、场景、实践和修辞立场。主要发现：远程医疗和远程护理技术在关于慢性病和老龄化的文本中占有突出地位。没有连贯的组织愿景。相反，四个相互冲突的话语是明显的，只有最低限度地参与彼此的论点。现代主义话语提出了一种未来主义的乌托邦愿景，其中大规模实施的辅助技术将使社会能够通过创造一个安全的“智能”家庭环境来履行其对老年人的道德义务，在这种环境中，帮助总是在手边，同时产生效率节约。人文主义论述强调个人的独特性和道德价值，并根据个人和家庭的情况进行调整;它认为技术只是有时适合目的，可以创造和解决问题。政治经济学话语设想了一个由强大的既得利益者组成的技术经济复合体，推动医疗保健的商品化和公共资金向私营企业的转移。变革管理的话语认识到大型技术方案的复杂性，并强调良好的项目管理和organizational processes.Conclusion：引进远程医疗和远程护理是阻碍，因为不同的利益相关者持有不同的假设，价值观和世界观，“谈过去”对方和竞争的认可和资源。如果对这些技术的投资要取得成果，就必须进行更有效的利益相关者之间的对话，以建立一个更好地适应竞争话语的组织愿景。
Objective: To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services.Design: Discourse analysis.Sample: 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events.Method: Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole.Main findings: Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes.Conclusion: Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.