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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote,
Martha L P Macleod1, Anurag Singh2, Erin Barker1
1School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada.
Journal of Evaluation in Clinical Practice
|July 8, 2026
Summary
Implementing virtual kidney care in rural areas is an ongoing, relational process, not a project. Understanding the
Area of Science:
- Healthcare delivery innovation
- Rural health services research
- Implementation science
Background:
- Traditional healthcare implementation focuses on 'what' rather than 'how'.
- Understanding the practical unfolding of change in diverse settings is crucial for success.
- Implementation failure is often poorly understood due to a lack of contextual insight.
Purpose of the Study:
- To explore the lived experiences of implementing virtual kidney care.
- To understand the engagement of providers, IT staff, and patients in a rural region.
- To identify how practices evolved during virtual kidney care implementation.
Main Methods:
- Qualitative study using interviews with kidney care providers, IT specialists, and patients.
- Conducted in a large, sparsely populated rural and remote region of northern British Columbia, Canada.
- Employed inductive, reflexive analysis and hermeneutic interpretation.
Main Results:
- Identified six hermeneutic principles of implementation: acknowledging concerns, creating common understandings, collective action, surfacing tensions, contextual responsiveness, and ongoing dialogue.
- Implementation is an evolving, relational, generative, and iterative process, deeply connected to context.
- The process is ongoing and never truly ends, challenging discrete project-based views.
Conclusions:
- Implementation practice dimensions are revealed by focusing on the 'how'.
- A hermeneutic sensibility (openness, humility, dialogue) is vital for successful implementation.
- Hermeneutic approaches are valuable for implementing and sustaining innovations in dynamic rural healthcare systems.
Keywords:
health serviceshermeneuticsimplementation scienceorganizational innovationqualitative researchrural health servicestelemedicineMore Related Videos
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