eHealth e a adoção da inovação em assisted living technologies : o caso das demências

RESUMO - Assistimos hoje a um contexto marcado (i) pelo progressivo envelhecimento das sociedades ocidentais, (ii) pelo aumento da prevalência das doenças crónicas, de que as demências são um exemplo, (iii) pelo significativo aumento dos custos associados a estas patologias, (iv) por orçamentos públicos fortemente pressionadas pelo controlo da despesa, (v) por uma vida moderna que dificulta o apoio intergeracional, tornando o suporte proporcionado pelos filhos particularmente difícil, (vi) por fortes expectativas relativamente à prestação de cuidados de saúde com qualidade. Teremos assim de ser capazes de conseguir melhorar os serviços de saúde, ao mesmo tempo que recorremos a menos recursos financeiros e humanos, pelo que a inovação parece ser crítica para a sustentabilidade do sistema. Contudo a difusão das Assistive Living Technologies, apesar do seu potencial, tem sido bastante baixa, nomeadamente em Portugal. Porquê? Hamer, Plochg e Moreira (2012), no editorial do International Journal of Healthcare Management, enquadram a Inovação como “podendo ser imprevisível e mesmo dolorosa, pelo que talvez possamos não ficar surpreendidos se surgirem resistências e que, inovações bastante necessárias, capazes de melhorar os indicadores de saúde, tenham sido de adoção lenta ou que tenham mesmo sido insustentáveis”. Em Portugal não há bibliografia que procure caracterizar o modelo de difusão da inovação em eHealth ou das tecnologias de vivência assistida. A bibliografia internacional é igualmente escassa. O presente projeto de investigação, de natureza exploratória, tem como objetivo principal, identificar barreiras e oportunidades para a implementação de tecnologias eHealth, aplicadas ao campo das demências. Como objetivos secundários pretendemse identificar as oportunidades e limitações em Portugal: mapa de competências nacionais, e propor medidas que possa acelerar a inovação em ALT, no contexto nacional. O projeto seguirá o modelo de um estudo qualitativo. Para o efeito foram conduzidas entrevistas em profundidade junto de experts em ALT, procurando obter a visão daqueles que participam do lado da Oferta- a Indústria; do lado da Procura- doentes, cuidadores e profissionais de saúde; bem como dos Reguladores. O instrumento utilizado para a recolha da informação pretendida foi o questionário não estruturado. A análise e interpretação da informação recolhida foram feitas através da técnica de Análise de Conteúdo. Os resultados da Análise de Conteúdo efetuada permitiram expressar a dicotomia barreira/oportunidade, nas seguintes categorias aqui descritas como contextos (i) Contexto Tecnológico, nas subcategorias de Acesso às Infraestruturas; Custo da Tecnologia; Interoperabilidade, (ii) Contexto do Valor Percecionado, nas subcategorias de Utilidade; Eficiência; Divulgação, (iii) Contexto Político, compreendendo a Liderança; Organização; Regulação; Recursos, (iv) Contexto Sociocultural, incluindo nomeadamente Idade; Literacia; Capacidade Económica, (v) Contexto Individual, incluindo como subcategorias, Capacidade de Adaptação a Novas tecnologias; Motivação; Acesso a equipamentos (vi) Contexto Específico da Doença, nomeadamente o Impacto Cognitivo; Tipologia Heterogénea e a Importância do Cuidador. Foi proposto um modelo exploratório, designado de Modelo de Contextos e Forças, que estudos subsequentes poderão validar. Neste modelo o Contexto Tecnológico é um Força Básica ou Fundamental; o Contexto do Valor Percecionado, constitui-se numa Força Crítica para a adoção de inovação, que assenta na sua capacidade para oferecer valor aos diversos stakeholders da cadeia de cuidados. Temos também o Contexto Político, com capacidade de modelar a adoção da inovação e nomeadamente com capacidade para o acelerar, se dele emitir um sinal de urgência para a mudança. O Contexto Sociocultural e Individual expressam uma Força Intrínseca, dado que elas são características internas, próprias e imutáveis no curto-prazo, das sociedade e das pessoas. Por fim há que considerar o Contexto Específico da Doença, nesta caso o das demências. Das conclusões do estudo parece evidente que as condições tecnológicas estão medianamente satisfeitas em Portugal, com evidentes progressos nos últimos anos (exceção para a interoperabilidade aonde há necessidade de maiores progressos), não constituindo portanto barreira à introdução de ALT. Aonde há necessidade de investir é nas áreas do valor percebido. Da análise feita, esta é uma área que constitui uma barreira à introdução e adoção das ALT em Portugal. A falta de perceção do valor que estas tecnologias trazem, por parte dos profissionais de saúde, doentes, cuidadores e decisores políticos, parece ser o principal entrave à sua adoção. São recomendadas estratégias de modelos colaborativos de Investigação e Desenvolvimento e de abordagens de cocriação com a contribuição de todos os intervenientes na cadeia de cuidados. Há também um papel que cabe ao estado no âmbito das prioridades e da mobilização de recursos, sendo-lhe requerida a expressão do sentido de urgência para que esta mudança aconteça. Foram também identificadas oportunidades em diversas áreas, como na prevenção, no diagnóstico, na compliance medicamentosa, na terapêutica, na monitorização, no apoio à vida diária e na integração social. O que é necessário é que as soluções encontradas constituam respostas àquilo que são as verdadeiras necessidades dos intervenientes e não uma imposição tecnológica que só por si nada resolve. Do estudo resultou também a perceção de que há que (i) continuar a trabalhar no sentido de aproximar a comunidade científica, da clínica e do doente, (ii) fomentar a colaboração entre centros, com vista à criação de escala a nível global. Essa colaboração já parece acontecer a nível empresarial, tendo sido identificadas empresas Portuguesas com vocação global. A qualidade individual das instituições de ensino, dos centros de investigação, das empresas, permite criar as condições para que Portugal possa ser país um piloto e um case-study internacional em ALT, desde que para tal pudéssemos contar com um trabalho colaborativo entre instituições e com decisões políticas arrojadas.

Technology strategy : findings from adoption and adaptation of Japanese manufacturing management (JMM) to ASEAN and Australasian automotive manufacturers

The purpose of this study is to demonstrate the appropriateness of “Japanese Manufacturing Management” (JMM) strategies in the Asian, ASEAN and Australasian automotive sectors. Secondly, the study assessed JMM as a prompt, effective and efficient global manufacturing management practice for automotive manufacturing companies to learn; benchmark for best practice; acquire product and process innovation, and enhance their capabilities and capacities. In this study, the philosophies, systems and tools that have been adopted in various automotive manufacturing assembly plants and their tier 1 suppliers in the three Regions were examined. A number of top to middle managers in these companies were located in Thailand, Indonesia, Malaysia, Singapore, Philippines, Viet Nam, and Australia and were interviewed by using a qualitative methodology. The results confirmed that the six pillars of JMM (culture change, quality at shop floor, consensus, incremental continual improvement, benchmarking, and backward-forward integration) are key enablers to success in adopting JMM in both automotive and other manufacturing sectors in the three Regions. The analysis and on-site interviews identified a number of recommendations that were validated by the automotive manufacturing company’s managers as the most functional JMM strategies.

Adoption in the construction industry

This report draws together the key findings from six case studies on the subject of ebusiness Adoption in Construction conducted in Australia by the University of Newcastle (UON) and Royal Melbourne Institute of Technology (RMIT) from 2005 through to mid-2006 under the auspices of the Cooperative Research Centre for Construction Innovation (CRC_CI). Reference to this timing is important because one of the key themes to emerge from the study is that the take-up of e-business is a dynamic phenomenon within the construction industry.

E-business adoption in construction : international review on impediments

The adoption of e-business by the Australian construction industry lags other service and product industries. It is assumed that slow adoption rate does not reflect the maturity of the technology but is due to adoption impediments peculiar to the nature of construction. This chapter examines impediments to the uptake of e-business nationally and internationally. A systematic and extensive literature search of impediments (also referred to as obstacles, impediments or hindrances) to adoption has been undertaken and the findings discussed in this chapter. This review included more that 200 documents and these have been published in a searchable database as part of a larger research initiative funded by the Cooperative Research Centre for Construction Innovation. The influence of levels of e-business maturity seen in other sectors such as retail, tourism and manufacturing was also captured and a number of major impediments were identified some including: privacy, trust, uncertainty of financial returns, lack of reliable measurement, fraud, lack of support and system maintenance. A total of 23 impediments were assessed in terms of impact to organisational type and size across reviewed documents. With this information it was possible to develop a reference framework for measuring maturity levels and readiness to uptake e-business in construction. Results have also shown that impediments to e-business adoption work differently according to organisational type and culture. Areas of training and people development need to be addressed. This would include a more sensitive approach to the nature of construction organisations, especially to those small and medium enterprises. Raising levels of awareness and creating trust for on-line collaboration are other aspects that need attention, which current studies confirm as lacking. An empirical study within construction, to validate these findings, forms the subsequent phase of this research.

Barriers to e-business adoption in construction: international literature review

The adoption of e-business by the Australian construction industry lags other service and product industries. It is assumed that slow adoption rate does not reflect the maturity of the technology but is due to adoption barriers peculiar to the nature of construction. This paper examines impediments to the uptake of e-business nationally and internationally. A systematic and extensive literature search of barriers (also referred to as obstacles, impediments or hindrances) to adoption has been undertaken and the findings discussed in this paper. This review included more that 200 documents and these have been published in a searchable database as part of a larger research initiative funded by the Cooperative Research Centre for Construction Innovation. The influence of levels of e-business maturity seen in other sectors such as retail, tourism and manufacturing was also captured and a number of major barriers were identified some including: privacy, trust, uncertainty of financial returns, lack of reliable measurement, fraud, lack of support and system maintenance. A total of 23 barriers were assessed in terms of impact to organisational type and size across reviewed documents. With this information it was possible to develop a reference framework for measuring maturity levels and readiness to uptake e-business in construction. Results have also shown that barriers to e-business adoption work differently according to organisational type and culture. Areas of training and people development need to be addressed. This would include a more sensitive approach to the nature of construction organisations, especially to those small and medium enterprises. Raising levels of awareness and creating trust for on-line collaboration are other aspects that need attention, which current studies confirm as lacking. An empirical study within construction, to validate these findings, forms the subsequent phase of this research.

Developing an integrative model for understanding innovation adoption

We develop and test a theoretically-based integrative model of organizational innovation adoption. Confirmatory factor analyses using responses from 134 organizations showed that the hypothesized second-order model was a better fit to the data than the traditional model of independent factors. Furthermore, although not all elements were significant, the hypothesized model fit adoption better than the traditional model.

Advancing e-learning policy and practice : influences on academics’ adoption, integration and development of multimodal e-learning courses

Tertiary education is increasingly a contested space where advances in Information Communications Technologies and their application to technology-mediated e-learning environments have forced university administrators and educators to dislocate themselves from traditional correspondence modes of student engagement. Compounding this paradigmatic shift within the traditional sphere of distance education pedagogy are multiple and conflicting pressures on academics to develop flexible, engaging, cost-effective and sustainable interactive learning resources that incorporate both multimedia and hypermedia. This chapter reports on a study that examined factors that influence educators’ decision to adopt and integrate educational technology and convert traditional print-based distance education materials into interactive multimodal e-learning formats. Although the broader study was conducted in a single Australian university and investigated pedagogical, institutional and individual factors, this chapter restricts its focus to solely the pedagogical motivations and concerns of educators. It is argued that findings from the study have significance at the institutional level, particularly in terms of developing an underlying pedagogical rationale that can permeate the e-learning culture throughout the university, while at the same time, providing a roadmap for educators who are yet to fully engage with the e-learning format.

Building information modelling : an issue of adoption and change management

Building Information Modelling (BIM) is an IT enabled technology that allows storage, management, sharing, access, update and use of all the data relevant to a project through out the project life-cycle in the form of a data repository. BIM enables improved inter-disciplinary collaboration across distributed teams, intelligent documentation and information retrieval, greater consistency in building data, better conflict detection and enhanced facilities management. While the technology itself may not be new, and similar approaches have been in use in some other sectors like Aircraft and Automobile industry for well over a decade now, the AEC/FM (Architecture, Engineering and Construction/ Facilities Management) industry is still to catch up with them in its ability to exploit the benefits of the IT revolution. Though the potential benefits of the technology in terms of knowledge sharing, project management, project co-ordination and collaboration are near to obvious, the adoption rate has been rather lethargic, inspite of some well directed efforts and availability of supporting commercial tools. Since the technology itself has been well tested over the years in some other domains the plausible causes must be rooted well beyond the explanation of the ‘Bell Curve of innovation adoption’. This paper discusses the preliminary findings of an ongoing research project funded by the Cooperative Research Centre for Construction Innovation (CRC-CI) which aims to identify these gaps and come up with specifications and guidelines to enable greater adoption of the BIM approach in practice. A detailed literature review is conducted that looks at some of the similar research reported in the recent years. A desktop audit of some of the existing commercial tools that support BIM application has been conducted to identify the technological issues and concerns, and a workshop was organized with industry partners and various players in the AEC industry for needs analysis, expectations and feedback on the possible deterrents and inhibitions surrounding the BIM adoption.

Explaining International new venture internationalisation: an innovation adoption model

The increasing prevalence of International New Ventures (INVs) during the past twenty years has been highlighted by numerous studies (Knight and Cavusgil, 1996, Moen, 2002). International New Ventures are firms, typically small to medium enterprises, that internationalise within six years of inception (Oviatt and McDougall, 1997). To date there has been no general consensus within the literature on a theoretical framework of internationalisation to explain the internationalisation process of INVs (Madsen and Servais, 1997). However, some researchers have suggested that the innovation diffusion model may provide a suitable theoretical framework (Chetty & Hamilton, 1996, Fan & Phan, 2007).The proposed model was based on the existing and well-established innovation diffusion theories drawn from consumer behaviour and internationalisation literature to explain the internationalisation process of INVs (Lim, Sharkey, and Kim, 1991, Reid, 1981, Robertson, 1971, Rogers, 1962, Wickramasekera and Oczkowski, 2006). The results of this analysis indicated that the synthesied model of export adoption was effective in explaining the internationalisation process of INVs within the Queensland Food and Beverage Industry. Significantly the results of the analysis also indicated that features of the original I-models developed in the consumer behaviour literature, that had limited examination within the internationalisation literature were confirmed. This includes the ability of firms, or specifically decision-makers, to skip stages based om previous experience.