A case study of collaborative dynamics in the design and evaluation of a diabetes web based care plan

Background Collaboration between software companies, universities, and general practice, has been identified as central to developing new eHealth services for chronic disease management. However, most of the research evidence suggests that eHealth projects often fall short of their objectives. There has been limited exploration of the nature of collaboration between multistakeholder partnerships in the design, implementation and evaluation of eHealth technologies despite Greenhalgh’s assertion that ‘conflicts among the different parties are inevitable and should be treated as data and as opportunities for reflection’. The chronic disease management network (cdmNet) project, which aimed to introduce a diabetes web based care planning service into general practices in Geelong, Australia, provided an opportunity to explore the collaboration in an eHealth project. Aims and objectives To understand, from the perspective of implementing stakeholders, (a) the sociotechnical barriers to the introduction of a diabetes web based care planning tool into general practices in Geelong and (b) the dynamics (conflict and tension) of collaboration within the cdmNet project. Methods A theoretically informed single case study design was used to explore collaboration within the cdmNet project team. Participants were purposefully sampled to reflect those closely involved in the design, implementation and evaluation of the diabetes web based care planning tool. In depth interviews were conducted with 25 recruited participants and supported by examination of project documents and participant observation. The data obtained were analysed and the results interpreted using both sociotechnical and systems psychodynamics theories developed by the Tavistock Institute of Human Relations in London. Results The sociotechnical challenges encountered in general practice by the cdmNet project team contributed to difficulties in recruiting general practitioners into the project. Subsequently, failure to resolve the recruitment difficulties fuelled conflict and tension between the commercial and evaluation agendas, represented by software developers and health service researchers respectively. In addition, there was dispute around the roles of project management and the frontline researchers. Stakeholders blamed each other for the recruitment failures but worked together to bring the project to reasonable completion. Interpretation, discussion and conclusion The in-depth examination of the conflict within the cdmNet project, demonstrated the presence of ‘dysfunctional group’ behaviour that often co-existed with ‘work group’ behaviour, particularly at the outset of the project. The ‘dysfunctional group’ behaviour was characterized by black and white thinking, scape-goating and blaming of others for recruitment failures that occurred. The ‘work group’ behaviour provided an optimistic outlook of the challenges encountered and was geared towards project completion in order to satisfy the various funding partners. Stakeholders should be mindful of these issues in order to enhance the cooperation between community-based organizations working on new eHealth services for general practice. Future research should examine the role a consultant might play in managing the conflict and tension that may arise in multistakeholder collaboration on eHealth projects.