The role of information infrastructures in scaling up video consultations during Covid-19: a mixed-methods case study into opportunity, disruption and exposure (Preprint)

Background

Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a “burning platform” for scaling up such services. As health care organizations look to expand and maintain the use of video in the “new normal,” it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward.

Objective

This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19.

Methods

A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al’s 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure).

Results

Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an “organizing vision” for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use.

Conclusions

For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.

Digitalization Business Strategies in Energy Sector: Solving Problems with Uncertainty under Industry 4.0 Conditions

Digital transformation is a concept based on the use of digitalization and digitization. Digitalization leads to change of business models and provides a competitive advantage also in the energy sector. The process of change towards a digital business requires a specific strategy type, aimed to solve problems with uncertainty caused by Industry 4.0 implementation. This paper aims to propose a theoretical model combining different digitalization strategies and business models. Their theoretical foundations were discussed in the literature review part and related empirical research questions were attempted to be answered by the reference method analysis. The quantitative method of analysis was based on the secondary data from Eurostat for all EU member states and backed the theoretical part in terms of ICT variables. The novelty of this research is based on Hellwig’s reference method used in management sciences and the presented managerial implications. The discussed challenges of the energy sector are related to the digital strategy implementation, relationships between digital transformation and business models, and solutions for such issues as strategy communication and new roles for managers, who should become digital leaders in the energy sector organizations. The main consequence of the proposed model in this study, for the energy sector companies’ managers, is that uncertainty in modern energy sector organizations is more related to employees and their technical skills than implemented ICT itself.