The descriptive statistics include the answers on questions about access to equipment, experience in using different modes of communication, and potential in using ICT. The answers to the open-ended questions include views on possible and meetings not possible to transform as well as hindrances in transforming meetings.
Access to ICT and potential to use ICT
Overall, access to different types of equipment for communication was good; all respondents reported access to at least one piece of technical equipment that allowed digital communication. Eighty-one (99%) respondents had access to a smartphone, 63 respondents (64%) had access to a laptop, 34 respondents (41%) had access to a stationary computer, 33 respondents (40%) had access to a telephone by landline.
All professionals had access to some type of communication software; we found the type varied across participants.
One such is Microsoft Outlook for daily use of communication via email and calendar bookings and another is Skype for business. The latter had been available for more than 4 years and Microsoft Teams had begun being used during 2019. The professionals used the software Procapita for internal communication regarding care planning.
A larger proportion of the respondents had experience in using Microsoft Teams than Skype: for verbal calls 23 vs. 2 (altogether 30%), for video calls 38 vs. 4 (altogether 51%), and for written communication 50 vs. 2 (altogether 61 %).
In relation to the question about sufficient knowledge, 28 respondents (34%) consider that they lacked sufficient knowledge about ICT, 22 (27%) that they had sufficient knowledge whereas 31 (38%) had good or very good knowledge. Twenty-nine respondents (35%) considered that they did not have access to the equipment required whereas 53 (65) considered that they had sufficient, good or very good access to the equipment required. Thirty-two respondents (39%) considered that they did not have access to sufficient support, 25 (30%) that the support was sufficient and 25 (30%) that access to support was good or very good.
Views on possibilities and challenges
The qualitative analysis illustrates a clear difference between possible meetings and non-possible meetings. The proposals for possible meetings from each respondent clearly exceed the meetings viewed as not possible to digitize. The suggestions for possible meetings are mainly internal meetings, where the suggestions include follow-ups, planning, and consultations. The limitations described are about the citizen not having access to the right technology, if the citizen is suffering from cognitive impairment or that the home visit includes some form of physical activity such as taking care of wounds.
Meetings viewed as possible to digitize
The answers to the questions which meetings could be digitized cover all of the described meeting categories, such as internal or external personal meetings, staff meetings concerning citizens, or meetings with citizens. Many of the respondents expressed answers related to three or four categories in their answers, implying that the respondents have a solution-oriented attitude towards digital meetings. Some of them even describe how they are conducting such meetings, where one example is assessments:
…It doesn't go as fast or with the same fingertip feeling, but everyone gets help. Assessments are done via photo; I write what angles I need and body parts that need to be included in the picture. Since "my" staff at all the accommodations understands and appreciate that I do this, it has been very good.
Among the number of meetings that are listed as digitizable, most are meetings where citizens are not a participant in the meetings, such as interprofessional meetings without citizens or professional meetings (only one profession). After that, many of the respondents’ state that meetings where citizens are discussed, so-called care planning, case meetings or follow-up, can be digitized. Even meetings that could be considered to need physical interaction, home visits, are listed as possible digitizable meetings. The conditions specified in the opportunity to digitize home visits and other visits with citizens are that everyone has access to and knowledge of digital aids and that the citizen does not have a hearing impairment or suffers from cognitive impairment. Some respondents also stressed that meetings with citizens with dementia also can be digitized, with help from relatives or home care staff.
Citizens who do not have a long-time dementia / cognitive impairment and can handle a phone. In some cases, this can be solved with the help of home care staff.
Several respondents state that there must not be too many participants included in internal meetings, regardless of whether they are focused on issues related to citizens or purely staff meetings, if these meetings should be possible to digitize.
Meetings viewed as impossible to digitize
When it comes to meetings that are viewed as impossible to digitize, these mainly relate to meetings with citizens where the physical meeting must take place. The respondents emphasize several such meetings, like palliative care, taking care of wounds, injections, sampling, or testing of technical aids at home. In all these meetings, the physical meeting was considered a prerequisite for the task to be performed and completed satisfactorily for the citizen.
The meetings that were considered to be somewhat possible to digitize were those that were about trying out or changing something in relation to technical aids needed in the home. The reasoning around these issues indicate that it was both a question about assessing practical situations related to the home care staff´ tasks as well as the opportunity to try out the technical aid itself. Despite the challenges described, one respondent has resolved the need for physical meetings during the pandemic as follows:
“I have solved individual settings for technical aids "semi" - I meet the staff at the entrance with current aids, set up the wheelchair based on the staff's description and supervise how the leg rests are to be adjusted. I follow up from home, if something needs to be fixed, we decide the time at the entrance when staff comes with the aid in question […] The staff is so much better now and observant of good/bad sitting, for example than ten years ago."
Another respondent describes that there is a need for other routines during, for example, delivery of technical aids in order to be able to digitize home visits:
Testing of aids can be more difficult. This includes the delivery of aids that today cannot be made to the citizen's home but are delivered to the prescriber. Sees a potential that some testing can take place in the home environment depending on; what type of aid it is, the support around the person and change in delivery options for aids.
Other meetings that are viewed as difficult to digitize are those where the citizen suffers from cognitive or hearing impairments. Several respondents are frank on the difficulties to digitize such meetings. Another perspective is that some respondents view internal staff meetings as not suitable to digitize and relate it to the importance of the physical contact during and after a meeting. Several respondents emphasize education as hard to digitize, both for newcomers and education for experienced colleagues. One respondent expresses it like this:
Training where practical method teaching needs to take place, e.g. training for substitutes regarding transfer and nursing in general, as well as training at lifting, product display from companies where practical screwing, adjustments and settings are to be tested.
Challenges while digitizing meetings
The respondents emphasize several challenges with digitizing meetings, where some of them are technical challenges, lack of knowledge, both own knowledge and in the citizen, work assignments that cannot be digitized, and security.
Technology problems arise when access to the “right” technology is missing. Examples are that the technology the user is equipped with is too old and heavy, or a limited access to critical documentation systems from outside the workplace, that the network fails on a regular basis, etc. Sometimes, these problems force users to find workarounds:
“I come across small things every day at work from home that get frustrating about technology or anything else that limits. For example, I can't get video calls on teams via my laptop but I had to download teams on the mobile for that bit. "
Another challenge is related to the lack of knowledge of how to use technology. Quite a few communicate uncertainty when it comes to their own knowledge of technology, and that this is a challenge for digitalization. Another aspect of lack of knowledge is related to a shifting knowledge level within work groups. This causes an imbalance between individuals, which hampers efficient use of digital technology. A third aspect is citizens’ lack of knowledge in combination with a lack of resources, especially when it comes to older citizens. They often lack resources, such as internet connection or the hardware such as a computer or tablet.
Some respondents especially point on older citizens who have dementia or other cognitive impairment. These impairments cause problems with managing technology or even understanding that it is an ongoing meeting when no one else is physically present. The quality of the meeting is viewed as decreasing and the care workers are afraid of losing or misunderstanding important information from the citizens.
“In a profession where a lot is about dialogue and getting the citizen's perspectives and involving them, it is a challenge to get good communication and good meetings through distance independent technology. This is primarily due to the fact that the target group of older people generally does not feel comfortable with technology, and because of some functional impairments make it difficult to communicate as it is.”
More often did the respondents describe the physical meetings as the basis for their work and that these cannot be changed to digital meetings. The challenges presented are mainly two aspects of the physical meeting that it is difficult to transfer to the digital meeting. The first is that it is challenging to create confidence in digital meetings; for example, the body language does not proceed in the same way. One respondent frame it like this:
Being able to establish a good and trusting relationship is a fundamental factor in my work, and it can be challenging to instill confidence and incorporate nuances and people's small and physical reactions through video and conversation when you have not met them.
Some of the respondents refer to security as a challenge. They refer both to the content of the meeting, such as personal information, and to the security requirements regarding privacy that software must fulfil. Often, they referred to colleagues’ statements, preferable safety officers, while discussing security.