MMHA 6601 Week 8 NASSS Complexity Assessment Example

Simple, Complicated or Complex? A NASSS Assessment of Virtual Patient Observation, Domain by Domain

Student Name

Walden University

MMHA 6601: Technology and Innovations in Healthcare

Instructor Name

Month Day, Year

Simple, Complicated or Complex? A NASSS Assessment of Virtual Patient Observation, Domain by Domain

The Innovation and the Framework

Ridgeway Health Partners, the made-up primary care group behind this course's cases, admits most of its patients to one community hospital, and that hospital wants to introduce virtual patient observation on its medical and surgical units. Cameras with two-way audio in selected rooms would let a trained observer at a central station watch up to twelve patients at once and speak to a patient who tries to get out of bed, calling staff to the room when needed. The program would replace some one-to-one in-room sitters, who are expensive and often hard to staff, for patients likely to climb out of bed unaided or tug at their intravenous tubing. Falls in hospitals are common and harmful, and a national study found that rates remained substantial despite years of prevention efforts (Bouldin et al., 2013).

To judge how hard this will be, the paper uses the NASSS framework, which assesses the nonadoption, abandonment, scale-up, spread and sustainability of health technologies across seven domains (Greenhalgh et al., 2017). Each domain is rated simple, complicated or complex. Simple means few components and predictable; complicated means many components but still predictable with expertise; complex means many interacting, unpredictable parts. Programs with several complex domains are much more likely to fail, so the framework's value is in spotting complexity early and attaching a countermeasure to each complex barrier.

Domain-by-Domain Ratings

Table 1

NASSS Domains, Ratings and Reasons

Three domains are complex. Under the framework, that places the program at real risk, though not beyond reach.

Why Three Domains Are Complex

The value proposition is complex because different groups expect different value. Finance expects lower sitter costs. Nursing leaders expect fewer falls. Front-line nurses may see added work if the observer calls them constantly for minor movements. Patients and families may see either safety or surveillance. None of these is wrong, but they cannot all be satisfied in the same way, and a program sold mainly on savings may lose nurses if it feels like a cost cut.

Adopters are complex because each group has a different stake and power. Nurses decide whether to accept a camera instead of a sitter for a given patient. Observers, a new role, must be hired and trained to judge when to speak and when to call. Patients must consent, and some, especially those with delirium, cannot meaningfully do so, which shifts the decision to families. Privacy concerns are sharpest for patients who are undressing, toileting or receiving intimate care.

The organization is complex because the program changes established policy and roles. Sitter assignment is usually made by charge nurses using judgment; virtual observation requires criteria for who qualifies. Observers are a new job category. In a unionized workforce, replacing sitters, often nursing assistants, requires consultation. And each unit has its own culture; a program that works on one floor may meet resistance on another.

Countermeasures for Each Complex Barrier

The framework's authors have since developed tools for using NASSS to guide and monitor real projects, recommending that teams revisit the ratings as the program unfolds (Greenhalgh et al., 2020). That advice suits a program like this, where the organization and adopter domains may become simpler or more complex as staff gain experience.

Table 2

Countermeasures

Each countermeasure addresses one source of complexity rather than the program in general.

The Two Complicated Domains Worth Watching

Two complicated domains deserve attention even though they are not complex. Technology integration with the nurse call system is predictable but has many parts; if alerts from the observer do not reach the nurse's phone reliably, the program fails quickly. Embedding over time depends on staffing the observer station every hour of every day. Programs that rely on a new role often fade when that role is hard to fill, which is why offering positions to current sitters matters for both workforce and sustainability.

The condition domain also deserves a caution. Virtual observation can warn and redirect, but it cannot catch a falling patient. For patients at the highest risk, or those who are aggressive or attempting to harm themselves, in-room presence remains necessary. The criteria must say so clearly, so the program is not stretched beyond what cameras can do.

Recommendation

Proceed with a single-unit launch on the unit that requested the program, with the countermeasures in place before the first camera is turned on. Reassess all seven domains at three months, using the same ratings, and spread to a second unit only if no domain has moved toward greater complexity and nurses on the first unit support expansion. Report falls, sitter hours, observer call rates and patient and family feedback monthly.

Conclusion

Virtual patient observation is technically manageable but organizationally complex. NASSS shows where: the value it promises differs by group, its adopters have competing concerns and it changes roles and policy. None of these barriers is fatal if each has a specific countermeasure and an owner. Rating the domains again at three months will show whether the program is becoming simpler to sustain or harder.

References

Bouldin, E. L. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., Daniels, M. J., Mion, L. C., & Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13-17. https://doi.org/10.1097/PTS.0b013e3182699b64

Greenhalgh, T., Maylor, H., Shaw, S., Wherton, J., Papoutsi, C., Betton, V., Nelissen, N., Gremyr, A., Rushforth, A., Koshkouei, M., & Taylor, J. (2020). The NASSS-CAT tools for understanding, guiding, monitoring, and researching technology implementation projects in health and social care: Protocol for an evaluation study in real-world settings. JMIR Research Protocols, 9(5), e16861. https://doi.org/10.2196/16861

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775