Innovative technologies and care professionals

Why does implementation of
innovative technologies matter
for care professionals?

A new multi-professional collaborative
research project assessing the impact of
transfer robots in Toyota Memorial Hospital

Pourquoi la mise en œuvre de technologies innovantes est-elle
importante pour les professionnels de la santé?
Un nouveau projet de recherche collaboratif multiprofessionnel
évaluant l’impact des robots de transfert au Toyota Memorial
hospital

Naonori KODATE

2023/09/27

Introduction

The relationship between innovative technology and care has long been a focus of debate, discussion, and collaborative research in academia, government, industry, and professional societies. The recent announcement of the successful funding application for a project "INNOVCARE" (2024-2028), coordinated by the FFJ (selected under the Priority Research Programme (France 2030): “Autonomy: ageing and disability”) is a testament to such efforts, and there are many other initiatives.

In care settings, innovative welfare technologies are increasingly visible and expected to perform a broader set of functions and roles. In addition, the Covid-19 pandemic has accelerated development and deployment of many of these technologies and opened the door to adopting products and services that had previously been deemed unsuitable for care settings.

This alternative technology-supported care delivery model has become a critical public policy issue in many advanced industrial economies due to care workforce shortages, super-aging, and decline of the population. There is currently no clear evidence, however, to suggest that specific technologies can reduce the workload, meet users’ needs, and therefore augment human capability and potential (not replacing humans).

Furthermore, even where there are benefits provided by technology, implementation of a novel or new technology in the medical field still faces many barriers and challenges, including risk and safety regulation, accountability, health service procurement rules, and professionals’ attitudes and skillsets (Loh, 2018; Turja & Oksanen, 2019). Therefore, despite significant media attention, utilization of care robots (for example) has been limited in care settings, especially in comparison to industrial settings. Accessibility, ethically aligned design, usability, social acceptance, user experience and societal impact are considered critical for a broader adoption of care robots (Heerink et al., 2010; IEEE, 2018; Ide et al., 2023; Kodate et al., 2023).

Against this background, researchers in France, Ireland and Japan came together and embarked on this new international and multidisciplinary research project (Establishing Toyota-style Person-centered, Robotics-aided Care System (T-PRoCS)), in partnership with Toyota’s Frontier Research Center and Toyota Central R&D Labs., Inc. While the team members come from diverse disciplines (engineering, nursing, economics, applied social sciences), we all share the same research question; how we can better implement innovative technologies in various settings and decided to collaborate. We all believe that the core mission of successful implementation should lie in improvement in care quality, safety and wellbeing of all those involved.

In Japan, while the government's New Robot Strategy (Prime Minister’s Office of Japan, 2015) and Society 5.0 (Prime Minister’s Office of Japan, n.d.) have focused on developing the technical aspects of robots and setting a vision for their future, specific applications and their impact have been treated as a black box. Therefore, the main purpose of T-PRoCS project is to understand and assess the impact of assistive robots in the healthcare field, with a view to identifying an optimum implementation model for such technologies in care settings. The objective (for the first phase of this research project) is to collect and analyze both qualitative and quantitative evidence on the process of implementing an assistive and autonomous robot in a newly renovated hospital. Toyota Memorial Hospital (TMH) has 527 beds, with perinatal medical center, and emergency and critical care center.

Behind the project's research methodology reside the guiding concepts of the Toyota Production System (TPS/Kaizen) together with models from areas such as implementation science, systems (resilience) engineering, and human-robot interaction (HRI) research. These concepts and models are included to examine the relationship between the development and introduction of transport robots, and their impact on how healthcare practitioners work in different sections of the hospital.

This project aims to seek views and work pattern changes among care professionals (e.g., nurses, pharmacists and medical technologists) following the introduction of the transport robots called POTARO (see the pictures below) which are originally designed and developed by Toyota's Frontier Research Center. The robots were created specifically for use at the TMH, whose new building was opened in May 2023. The first phase of the project occurs between June 2023 and March 2024, but the research team wishes to build a (better) social implementation model and test it in the natural (acute care and other care) settings in the long run.

A: POTARO on standby - pharmacy storage room	B: POTARO on standby - pick-up point in a ward
C: POTARO in action - leaving charging points	D: POTARO in action - using an elevator/going to a ward

(Photos by NK)

Theoretical Background and Research Methodology

As an example of implementation science applied to healthcare, we adopt the ARCHIE framework proposed by the research team of Prof. Trisha Greenhalgh in the U.K. for this study. ARCHIE stands for “Anchored, Realistic, Co-creative, Human, Integrated, Evaluated”, and the following six points are key to successful implementation of telemedicine (telehealth/telecare) in society: (1) Design and development are rooted in a shared understanding of what is important to users; (2) Understanding the natural history of the disease and the disabilities that come with it (often progressive), with a realistic recognition that it is not something that can be solved by technology or care; (3) Continuously seek co-creative, evolutionary, and adaptive solutions with users, utilizing practical reasoning and common sense; (4) The human element (relationships, social networks) determines the success of technology solutions; (5) Technology-enabled services need to be integrated by maximizing mutual recognition, coordination, and mobilization of expertise; and (6) Continuous evaluation will be conducted to promote system learning. In the initial first phase of the project, (4), (5) and (6) will be particularly pertinent, as we delve into how workflows and work patterns (of nurses and allied health professionals) change over the period of 6-12 months, with the support of roboticists and other support workers on site.

From systems (resilience) engineering, the model introduced by Dr Avedis Donabedian, who applied systems thinking to the evaluation of healthcare quality, will be used as a guide. In the Donabedian model's three distinctions of "structure," "process," and "outcome," "structure" is defined as the "work system," which in the project in question refers to the department (unit) or the entire hospital where the transport robot is installed.

This project also seeks to capture how the introduction of POTARO (technology/tools) to the existing "work system" has changed the process (and outcomes). We will examine how the parties involved perceive the return (feedback loop) from the outcomes, given time.

In relation to outcomes, data on workplace culture will be collected and analyzed to consider adjustments where the system is working well and where it is not, and to consider risk management considerations (such as what to do if the robot malfunctions) after the system has been implemented. Finally, based on the interview method used in HRI (Human-Robot Interaction) research, we will investigate how each user perceives the transport robot and his/her perception of its usability, utility, and other aspects (e.g., aesthetics, scope for improvements) after working with the robot in his/her unit.

Conclusion

The significance of this project will be to provide evidence on how assistive robots such as POTARO can benefit professionals working in acute care settings in the short-, medium- and long-term and eventually contribute to enhancement of care quality and safety in the hospital that is serving the local community. Through this unique international, academic-industry-professional collaborative project in the natural environment, the project team seeks to find a better way of augmenting human capability and potential.

About the research team

Assoc. Prof. Naonori Kodate (EHESS, Paris & University College Dublin, Ireland), Prof. Sebastien Lechevalier (EHESS, Paris) and Prof. Mayuko Tsujimura (Shiga University of Medical Science) joined forces and launched the research project “Establishing Toyota-style Person-centered, Robotics-aided Care System (T-PRoCS)” in collaboration with engineers at Toyota’s Frontier Research Center and Toyota Central R&D Labs., Inc. and care professionals at Toyota Memorial Hospital.

References