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Cited by 199Telemedicine and Telehealth ImplementationTechnology Use by Older AdultsSocial Policies and Healthcare Reform

The DOI matches its Crossref record; 44 of the 45 references it cites were found in a registry or an index.

The organising vision for telehealth and telecare: discourse analysis

Open access
Greenhalgh, Trisha, Procter, Rob, Wherton, Joe, Sugarhood, Paul, Shaw, Sara·2012·BMJ Open
DOI 10.1136/bmjopen-2012-001574PMC PMC3401833
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Abstract

OBJECTIVE: To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. DESIGN: Discourse analysis. SAMPLE: 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. METHOD: Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. MAIN FINDINGS: Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. CONCLUSION: Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.

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  1. Davidson E Reardon J . Organizing Visions for IT Healthcare: Analysis of Discourse Surrounding Electronic Health Records. Honolulu, Hawaii: Academy of management conference, 2005.

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Metadata

Authors
Greenhalgh, T., Procter, R., Wherton, J., Sugarhood, P., & Shaw, S.
Affiliations
  • University of London (GB)
  • University of Manchester (GB)
  • Barts Health NHS Trust (GB)
Corresponding author
Greenhalgh, Trisha
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2012
Volume
2
Issue
4
Pages
e001574
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2012-001574
PMC
PMC3401833
OpenAlex
W2098025845
Cited by
199
References
45
Citations by year
2026: 6 · 2025: 10 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 20 · 2020: 19 · 2019: 15 · 2018: 20 · 2017: 19 · 2016: 16 · 2015: 14 · 2014: 22 · 2013: 10
FWCI
14.04
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Open (London South Bank University) (acceptedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion, cc-by-nc)
Funders
Queen Mary University of London
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Geriatrics and Gerontology › Technology Use by Older Adults
  • Social Sciences › Health › Social Policies and Healthcare Reform
Keywords
telemedicine, telecare, organizational vision, stakeholder perspectives, competing discourses, modernist discourse, humanist discourse, change management, assistive technology, older adults, chronic disease, home automation, commodification of health care, technology implementation

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