title: The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care.
abstract: Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of Troms&#248;, P.O. Box 35, N-9038 Troms&#248;, Norway. anne.granstrom.ekeland@telemed.no.|Telemedicine and e-health Research Group, Faculty of Health Sciences, UiT The Arctic University of Troms&#248;, N-9038Troms&#248;, Norway . anne.granstrom.ekeland@telemed.no.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Ekeland
keywords: emotional agency; improvement of care; innovation; professional relations; web-based ulcer record