The Home as the Centre of Care: A Case Study on Moving Healthcare Services into Homes

Abstract

Population ageing and demographic change pose a challenge to the delivery of healthcare services. In light of this development, new care models and the use of digital tools are reshuffling traditional healthcare settings. This is particularly apparent in the trend of moving healthcare activities out of hospitals, and technology plays a central role. The shift of healthcare services into homes opens up a set of sociotechnical challenges worth our attention. This thesis investigates the shift of healthcare services into the user’s home by means of technology. Specifically, the thesis answers two research questions: (i) How are systems that support remote care shaped for their users across different contexts? and (ii) How is care at a distance realised, and what role does technology play in this? Theoretically, the thesis is situated at the intersection of information systems (IS) and computer-supported cooperative work (CSCW). Moreover, the thesis’ theoretical framework includes theories and concepts from neighbouring fields such as participatory design (PD) and science and technology studies (STS). Through a four-year embedded multiple-case study, the thesis provides a detailed account of what is entailed in moving healthcare services into homes. The two cases have been selected to provide a complementary picture of the phenomenon. Case 1 focuses on welfare technology (WT), a service where technology supplements healthcare services at home. Case 2 on mental health home treatment (HT) follows how severe mental health crises are treated at home by home treatment teams supported with technology. In addition to moving healthcare services into homes, the two cases have in common a level of maturity. Both cases have moved away from the piloting phase and are on the brink of becoming an established healthcare service. Hence, they provide exceptional insights. Based on detailed accounts of the two cases, this thesis contributes to a better understanding of what is entailed in moving healthcare services into homes. The ethnographic description of work in HT and the conceptualisation of proximity and distance contribute to the growing body of literature on home care in CSCW. Furthermore, platforms play a central role in disseminating digital healthcare services. The thesis contributes to the theoretical body of platforms in IS by describing the tailoring and shaping of a platform in a fluid environment. Moreover, this thesis offers a methodological contribution by discussing a strategy to scale user participation as understood in the field of PD. Together, these contributions provide a coherent image and advocate a deeper understanding of a healthcare area in motion.