Leaders’ experiences of successfully implementing health and welfare technology in sparsely populated Nordic areas

Figures & data

Table 1. Examples of the analytic process, from interviews to codes and themes.

Example interview text/citation/meaning unit	Codes	Theme
“From a management perspective, the opposition to digital solutions is over; the hospital management are on the same wavelength as the regional management, and all parties want the digital solution to be maintained and further developed. The professional careers [care staff] are also positive about digital solutions, which has also led to their intensive testing. This was especially intensive during Covid-19, which reduced resistance” (DK2).	Willingness to change, adaptability/acceptance.	Positive attitudes towards and an understanding of the ongoing digital transformation
	Other codes: Experiences from a digital private life Culture Daringness and willingness to test Reduced fears and suspiciousness Positive expectations Changed mindset Reduced resistance
“It has become easier; the organisation is in continuous transformation with many tracks of change. People are more used to a dynamic workplace and project-based work” (NO1). “The hospital system is a conservative organisation that demands professional support to carry out the changed work, the changes. More and more people are coming up with good ideas for solutions to the demographic challenges. Workflows need to be cleaned up all the time so that they are efficient and innovative; this is a challenge and hard work” (DK4).	Digital, dynamic and distance work Hard work to change Change is a constant condition/normal condition.	Agreement on the challenge of changing the way of working/giving care supported by HWT
	Other codes: Digital-first attitude (remote caregiving; remote interaction; distance work; teleworking from fieldwork to screenwork, from paper to computer) Adaptability and insights that HWT simplifies for all parties Increased awareness and patient participation The beginning of the change and being in the change, Critical HWT users Reliable and functional HWT Consumes time and resources Changed ways of working means changed culture that is hard to execute Break in problems, initiation/implementation problems Older staff do not have the energy to change/be a part of the digital transformation
“The telemedicine solutions have very positive effects on the citizens, who feel secure with their own illness. To evaluate the effects, it is important to follow, though the effects of the telemedicine solutions are still difficult to identify, since it is not clear what to measure and how to measure them” (DK1).	Providing evidence of positive effects	Feedback loops, highlighting the effects and success factors
	Other codes: Expected constant feedback Result reports, effects and outcomes Success stories and user cases Explicit expectations from all involved (patients, staff, organisation, society)
“Managers in the organisation are often the driving factor driving transformation. The project managers who are working directly on implementing new solutions are also important in driving transformation” (NO5). “There is always a resistance to change, and it requires perseverance from the management and also the ability to deal with it and acceptance that it is a natural reaction to new things” (FI1). “Although digital care work is done alone, in the end, it is done as a team and not as an individual. This requires a lot of team spirit and attitude, working together and realising it is the key to success” (FI2).	Open minded leaders, listening leaders, project leadership, communicative/dialogue management, supportive management Teamwork, team spirit, commitment	Leadership in change management and the internal organisational conditions for handling change
	Other codes: An organisational strategy, a regional and national plan A society in change Pandemic effects Trust among those involved Common and shared goals and understanding Using forerunners Joint secretariat, support organisation Complex organisations and activities (logistics and procurements processes, information security) Economy aspects/resources Changing work consumes time Ongoing dialogue, close cooperation, study classes, talk, tell and show Proud of what we have done Collaborations consortiums Anchoring from the top to the bottom Doing it together Communication and dialogue Changed management requires an involved management Support needs at different levels
“We were allowed to try everything; through trial and error, we succeeded. The customers [patients] have been extremely satisfied” (FI2).	Self-learning and trial and error (learning by doing training programs).	Trust in the ongoing change and enabling the learning process
	Other codes: Learn and develop together Trust to handling the change Trust in the staff’s capability Time resources Patient and informal caregivers’ involvement in the learning process Map of in-house competences and list of needed competences Explicit vision and trust in a society in change Earning and using from the pandemic experiences

Figure 1. Intertwined and overarching themes illustrating the success factors when implementing HWT in sparsely populated Nordic areas.