# Quality Challenges in Municipal Telecare Call Center Services: Qualitative Evaluation Using the Anchored, Realistic, Cocreated, Human, Integrated, and Evaluated (ARCHIE) Framework

## TL;DR

This study evaluates the quality of municipal telecare call center services in Norway using the ARCHIE framework, revealing significant challenges in implementation and integration.

## Contribution

The study applies the ARCHIE framework to assess telecare call center quality, identifying normalization process theory constructs and suggesting policy improvements.

## Key findings

- None of the ARCHIE quality criteria were fully met in municipal telecare CCs.
- Telecare services lacked sufficient anchoring and integration into healthcare systems.
- Training for telecare operators and national standardization are needed to improve quality.

## Abstract

Telecare is seen as a promising technology aimed at enhancing the accessibility and efficiency of health care services. Although focus on quality has been highly prioritized within the health care services, there is a need to explore the quality of telecare services in general and municipal telecare call centers (CCs) in particular, as health and assistive technologies are increasingly being implemented in patients’ homes.

The study sought to explore which factors influence the quality of telecare services provided by municipal telecare CCs in Norway, evaluated through the anchored, realistic, cocreated, human, integrated, and evaluated (ARCHIE) framework.

The study had a multiple-case design. Interviews were the main source of data from 15 informants from 5 municipal telecare CCs across Norway. Observation and document studies were used for background and contextualization. To explore and evaluate quality, a combined deductive–inductive analysis was conducted.

Evaluated against the ARCHIE framework, none of the quality criteria were fully met. Due to the telecare service not being sufficiently anchored for all patients, it was challenging to provide realistic technologies. The collaborative work was difficult, with challenges in recruiting patients. The human principle was characterized by variation of knowledge and national guidelines. Municipal telecare CCs were not integrated into the health care services, and data must be used to a greater extent for evaluation and learning than is currently the case.

The findings suggest that municipal telecare CC services have several shortcomings in providing high-quality health care. Relating the quality principles identified by the ARCHIE framework to normalization process theory constructs indicates that the CC service remains in a transitional phase of normalization. To improve the telecare CC services and enhance communication and integration, policymakers need to reduce fragmentation in the broader health care system. Further national standardization to professionalize the telecare CC services should be developed. The telecare CCs need to improve their service related to all indicators of the ARCHIE framework. Training for telecare operators should be prioritized.