From “Plug” to “play” : Making established technology innovations work in caring services

Abstract

The overall aim of this article-based thesis is to develop the knowledge base of public service innovations as a way of understanding established technology innovation in municipal caring services. More precisely, the objective is to increase our understanding of the complex reality of technology in use in caring practices by focusing on the interactions between the technology and humans involved. Policy documents describe a demand for increased technology innovations in community care services to meet perceived challenges in the services caused by a “silver tsunami” and to facilitate independent living. However, the integration of technologies has proven to be difficult, and many projects never integrate into regular use after the pilot stage. Research in the wake of these pilots seeking to identify drivers and barriers to technology innovations in caring practices does not capture the technology innovations that are actually integrated and used in regular caring practices, and what it takes to make them work. To understand these public service innovations we need a knowledge base incorporating the complex and diverse experiences with established technologies, and an understanding of the interactions between people and the technology involved. This thesis contributes towards a more comprehensive understanding of the “workings” of technology innovations when exploring the social alarm, which is a widely established and adopted technology innovation in caring practices. Public service innovation is a developing field of exploring public services. More recent public service innovation has mainly studied public innovations on an organisational level. However, this thesis utilises the concept of co-production to explore the practice of the social alarm in use on a micro level. The concept of co-production is further developed by utilising aspects of science and technology studies as theoretical tools for exploring public service innovations. A systematic integrated review was conducted aiming to scope the research history of the social alarm in use from a user perspective. Furthermore, a combination of participant observations, 22 in-depth interviews and a study of documents related to the use of the social alarm were conducted within the home care service in two municipalities in Norway. Consequently, the thesis is based on descriptive and explorative qualitative designs. The empirical data were analysed using a stepwise, deductive, inductive method. Through empirical analysis, the overall findings indicate the need to add theoretical tools for understanding these innovations. By utilising the metaphor of script and domestication from science and technology studies, this thesis contributes a theoretical framework for exploring the co-production of expectations and experiences related to technology in use in caring practices. Thereby it further develops the understanding of the field of public service innovation within caring practices. This thesis demonstrates empirically how people involved with the social alarm utilise the technology. The results describe complex and multiple caring practices with divergent results related to its use. This promotes an increased understanding of how even rather simple and well-established technologies are unpredictable and work differently in different contexts when interacting with different people. The focus is directed to efforts to make it work and to enable older people to live independently and safely at home. The study also illustrates how technology innovations change the dynamics between the people involved, rearranging caring practices, and opening up for bricolages as an integrated part of established technology innovations.