It is Not Because You Have Tools That You Must Use Them: The Difficult Domestication of a Telemedicine Toolkit to Manage Emergencies in Nursing Homes

Abstract

We conducted a retrospective study on the experimental deployment of a telemedicine toolkit in ten nursing homes. The purpose of the experiment was to see whether the use of these toolkits could allow for better cooperation between nursing homes and the local emergency medical dispatch center to avoid sending costly vehicles and having elderly people unnecessarily discharged at the hospital. We investigated the domestication process of these toolkits by nurses and orderlies from the nursing homes. Our findings show different levels of domestication: for some of the nursing homes, the lack of practical relevance of the toolkit in emergencies and the difficulty to borrow artifacts from doctors prevented complete adoption. For three nursing homes, domestication occurred in an unexpected way in the sense that the objective of the domestication changed. These findings led us to provide recommendations for projects aimed at improving inter-organizational cooperation through artifacts.