The NASSS-CAT tools for supporting technology projects in health and social care: co-design of tools and protocol for further testing (Preprint)

BACKGROUND Health technology projects are typically ambitious and complex. Many fail. Greenhalgh et al’s NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to analyse their varied fortunes. OBJECTIVE We sought to extend the NASSS framework to produce practical tools for policymakers, project planners, implementation teams and evaluators. METHODS Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT was developed (in different formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, patients). 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 invites 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 for identifying different kinds of complexity; it also includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semi-structured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always overcome, contradictions and conflicts that block projects’ progress. CONCLUSIONS The NASSS-CAT tools, designed to help teams understand, reduce and respond to complexity in their technology implementation projects, are a useful addition to existing tools and frameworks. They are currently being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context and project goals. Further support of those projects is ongoing. We plan to establish an online community of practice for people interested in using and improving the NASSS-CAT tools, and hold workshops for building cross-project collaborations. CLINICALTRIAL Not applicable