Scaling Ambient Assisted Living Systems in the Netherlands: An explorative study on the scarce scaling of AALs through a systems perspective

Abstract

This paper addresses the scaling of Ambient Assisted Living systems (AALs) in the Netherlands. The Netherlands faces the challenge of demographic aging and subsequently the challenge of a rising need for healthcare services. AALs are ICT-technologies can provide in-home support for people in need of thereby reduce the need for institutionalization or hospitalization them. Although AALs are generally perceived as promising developments in creating cost-effective solutions, there are considerable difficulties in scaling up AALs. There is little research conducted that aims understand these difficulties through a systems perspective. This research aims to do that through applying the PRactice-Oriented Multi-level perspective on Innovation and Scaling (PROMIS) framework. PROMIS provides an analytical framework to understand the symbiotic or conflicting nature of innovation and the system in which they need to become adopted. This research has as objective to understand the scarce scaling of AALs through the analytical approach of AALs and provided insight in which system dimensions and dynamics constrain responsible scaling. A qualitative case study was conducted where semi-structured interviews were done with key informants that represented the important stakeholders of the healthcare system and development of AALs. The interviews were structured on the theory of the PROMIS approach and revolved around both the current and anticipatory effects of developing and scaling AALs. These interviews were thematically analysed to differentiate factors that constrain the scaling of AALs. The findings of this research have shown that the main factors constraining the scaling of AALs are the financing of AALs innovations and implementation, the low technological readiness, inertia of healthcare providers, difficulties of building positive business cases and the absence of support networks. This research concludes that there is a need for an inclusive and collaborative scaling initiative that help overcome the system wide, cross-domain, cross-level level factors that constrain scaling. These collaborative efforts should predominantly focus on creating agreement on funding models of AALs, improving the regulatory conditions for the development of AALs innovations and supporting the creation of viable business cases. Without inclusive collaborative efforts, the developments and scaling of AALs will evolve slowly and hinder the transition to a sustainable healthcare system where healthcare services are provided in the home environment.