title: Transforming chronic care management practices through telemedicine: an AR approach to multidisciplinary medical team innovation
Creators: name: Huniche, Mahad
Publisher: name: University of Reading
Year: 2030

description: This thesis chronicles the five-year development of PreCare, a telemedicine project, initiated 
by a Danish hospital from inception to completion, using a longitudinal Action Research (AR) 
approach. The project aimed to empower citizens living with chronic diseases to actively 
manage their conditions. 
The telemedicine process relocated care from hospitals to citizens’ homes, where they used 
digital devices to monitor their vitals and adjust behaviours in response to deteriorating 
conditions. The research team involved in PreCare, initially, emphasized empowering 
citizens to become more health-literate and autonomous, in line with prior research 
(Greenhalgh et al., 2017). However, unexpected findings emerged during intense reflection 
by the AR team, revealing that PreCare’s success relied on citizens becoming more 
dependent on healthcare services. This paradox highlighted a deeper societal issue: the 
challenge of understanding and harnessing innovations like PreCare within an individualistic 
framework. The thesis argues that PreCare’s success was due to a new, socially distributed 
system of enacting care, rather than transferring more capabilities to the individual (Mol, 
2008). This contrasts with prior person-centric research that attributes these outcomes to the 
personal attributes of nurses and citizens, such as the nurses’ compassion and expertise and 
the citizens’ growing autonomy and health literacy.
The abduction process as a method of inquiry enhanced the AR process, weaving data and 
theory into interpretations that continually propelled the project forward, demonstrating the 
dynamic nature of AR (Coghlan and Brannick, 2014). The abductive logic of inquiry used in 
AR makes it possible to draw on theory in the light of the evolving nature of the findings from 
practice. This encouraged everyone involved to reflect the assumptions framing their 
conceptualisation of the problem
The AR process facilitated the evolution of PreCare from a person-centric care model within 
the framework of biopsychological medicine to biopsychosocial medicine. This transition 
promoted an integrated care approach combining medical, psychological, and social 
interventions, leading to a more comprehensive, system-centric management of chronic 
conditions (Bolton and Gillett, 2019). AR challenged the decontextualized, biopsychological 
perspective, which conceptualized the person as an individualized set of experiences and 
preferences, in favour of socially patterned influences on the person and health in 
accordance with biopsychosocial medicine (Engel, 1977).
This innovative approach to socially distributed medical services is essential for exploring 
new methods of chronic care management. The thesis illustrates how citizens’ health 
outcomes improved by participating in a socio-material system that integrates nurses, 
technology, and citizens collaboratively working to prevent the worsening of their chronic 
conditions. This aligns with Foucault’s concept of biopower, where power and capability are 
distributed across a socio-material system (Lynch, 2016).
The thesis also explores how societal changes have transformed the home into a critical 
space for managing population health. Techniques used by nurses to create and maintain 
the revised chronic care included reframing patients to be “citizens,” conducting constant 
surveillance with pastoral power, leading to normalization of behaviours (Foucault, 1977).
The transformation relied on citizens internalizing PreCare standards by adopting the 
collective’s norms as their own. Consistent with Foucault’s ideas on biopower, this 
internalization occurs when individuals believe others have constant oversight, based on 
their self-reported data and frequently follow-up on non-compliance with prescribed 
behaviour. This exercise of biopower avoids deteriorating health conditions (Foucault, 1977).
One key finding was the use of constant surveillance, pastoral power, and normalization to 
follow collective behavioural prescriptions. This approach minimized healthcare costs 
(Foucault, 1977) and improved patient experiences. Another significant finding is that 
Precare reconceptualizes the nursing role by showing that caring and coercion are not 
mutually exclusive. Precare nurses' practice of "compassionate coercion" using disciplinary 
power to train citizens in self-regulation freed up collective resources and further transformed 
the role of doctors.
The biopower concept brought to light the political goals that motivated PreCare interventions 
(Foucault, 2003). Understanding these goals matters because it changes how power 
operates, including analytic attention to power’s productive and socially distributed aspects 
(Foucault, 2003).