Exploring the impact of telehealth videoconferencing services on work systems for key stakeholders in New Zealand : a sociotechnical systems approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Albany, New Zealand

Abstract

This thesis explores how the impacts of telehealth videoconferencing services (THVCS) on work systems are perceived by key stakeholders in New Zealand. Telehealth - the use of information and communications technologies to deliver healthcare when patients and providers are not in the same physical location - exemplifies how technological developments are changing the ways in which healthcare is provided and experienced. With the objectives of improving access, quality, and efficiencies of financial and human resources, THVCS use real time videoconferencing to provide healthcare services to replace travel to a common location. Despite the benefits of telehealth reported in the extant literature, there continues to be difficulties with developing and sustaining services. The aim of this inquiry is to understand how THVCS impact key stakeholders in the work system. Specifically, it seeks to examine the characteristics of THVCS in the New Zealand context, identify the facilitators and barriers to THVCS, and understand how the work system can adapt for THVCS to be sustained practice. The research design is framed by a post-positivist approach and underpinned by sociotechnical systems (STS) theory. STS theory and a human factors/ergonomics design approach inform the methodology, including the use of the SEIPS 2.0 model. Forty semi-structured qualitative interviews and contextual observations in a two-phase methodology explore the perceptions of an expert telehealth group, and providers, receivers, and decliners of THVCS. These data are analysed using the framework method of thematic analysis. The key findings suggest that to enable sustained THVCS in New Zealand, factors such as new ways of working; change; human connection; what is best for patient; and equity need to be recognised and managed in a way that balances costs and consequence and ensures fit across the work system. Theoretical contributions to knowledge are made through the development of a conceptual model from the literature, exploring THVCS with an STS theory lens and developing SEIPS 2.0. Methodologically, this inquiry contributes a theory-based, qualitative approach to THVCS research and draws on the perceptions of unique groups of participants. Significantly, the findings make practical contributions to the design of the THVCS in the New Zealand context.