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
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Abstract
Background: Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. Objective: We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. Methods: Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. Results: The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress. Conclusions: The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID): DERR1-10.2196/16861
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Related complexity assessment tools (NASSS-CAT) were developed in 2020 to enhance understanding, guide monitoring, and facilitate research on technology projects in healthcare or social care settings through collaborations.
“Related complexity assessment tools (i.e., NASSS-CAT) were developed in 2020 to enhance understanding, guide monitoring, and facilitate research on technology projects in healthcare or social care settings through collaborations [11].”
From The NASSS (Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability) framework use over time: A scoping review (2025) · cites this paper as [11]
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- Authors
- Greenhalgh, T., Maylor, H., Shaw, S., Wherton, J., Papoutsi, C., Betton, V., Nelissen, N., Gremyr, A., Rushforth, A., Koshkouei, M., & Taylor, J.
- Affiliations
- University of Oxford (GB)
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Greenhalgh, Trisha
- ORCID
- Venue
- JMIR Research Protocols
- Publisher
- JMIR Publications Inc.
- Published
- 2020-05-13
- Volume
- 9
- Issue
- 5
- Pages
- e16861
- ISSN
- 1929-0748 (ISSN-L)
- PMC
- PMC7254278
- OpenAlex
- W3024056635
- Cited by
- 152
- References
- 44
- Citations by year
- 2026: 25 · 2025: 30 · 2024: 35 · 2023: 34 · 2022: 14 · 2021: 11 · 2020: 3
- FWCI
- 9.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Research Protocols (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome Trust (WT104830MA, 104830/Z/14/Z)
- National Institute for Health and Care Research (13/59/26)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- NASSS framework, technology implementation, healthcare innovation, social care, implementation complexity, co-design, implementation tools, project monitoring, stakeholder engagement, implementation evaluation, complexity assessment, action planning
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