3.1 Model description
The holistic model aims to provide a comprehensive representation and an overview of factors, that might be relevant and are worthy of consideration for different stakeholders, such as nursing home staff or strategic decisionmakers in care. Thus, the model addresses researchers and practitioners. For example, its intent is to provide an overview of relevant aspects for nursing home managers, who are considering purchasing a robot. Furthermore, it is the first model that sums up relevant constructs and aspects that have been investigated separately for the specific type of service robots in the specific context of stationary elderly care. Each level of SeRoNus’ composing factors (and subfactors) will be explained briefly.
Science. Research on robots comes with challenges, e.g. there is competition for research funds and often developments do not make it into practice. There is also a desire for interdisciplinary research that also involves users.
Market Conditions: Robotics. For manufacturers, the robot’s development for inpatient elderly care is very complex and is cost- and time-intensive. Multifunctional robots that can be used in different areas/sectors are found more attractive from the manufacturer’s point of view.
Market Conditions: Care. The market environment for care is characterised by competition for skilled workers. Robots could influence competition between facilities through effects on the quality of care and/or the price.
Legislation (Data protection, Liability). Data protection is a topic that is considered particularly relevant. It covers various aspects—the collection, storage, access, use and general security of data. Liability issues are relevant for stakeholders and have not yet been legally clarified from their perspective. It is unclear who is accountable for any damage that could be caused by the robot, because robots themselves cannot be held liable. There may also be damages to the robot that someone will be required to pay for. In addition, there are various laws and regulations that may be applicable regarding the use of robots.
Politics (Political Guidelines, Financial Support). In recent years, various laws have been created that have brought changes in inpatient elderly care in Germany. Politics could also influence the development of robots in care, in particular by providing research funds and financial support. However, funding opportunities are limited. In the long term, robots would have to be included in SGB XI (regulations of the social long-term care insurance) in order to be financed.
Ethics. Another relevant topic is the question of ethical compatibility of various applications of robots with respect to users (residents and employees). In principle, the use of robots in secondary activities (e.g. documentation) is often considered less objectionable.
To summarize, the range of factors on the inter-company level emphasize the diverse scope for development and use of robots in care lying in society. Robots can only be used successfully in nursing homes if the appropriate framework conditions are in place.
Innovation features. An innovation, such as the use of a robot in an inpatient care facility, is characterised by several features. One is the underlying trigger and motive of the innovation. Another is the extent of the innovation and the actual novelty of the robot. Furthermore, the temporal scope of the process characterises the innovation.
Planning (Implementation Planning, Technical and Spatial Requirements). When planning a robot deployment, there are various aspects that should be considered: Objectives & benefits of the robot, responsibilities, pilot run possibilities, project planning, legal certainty, existing expertise, information & decision paths, and promoters & multipliers. In addition to the basic technical requirements, structural conditions (e.g. sufficient space in corridors and residents’ rooms) should be suitable for the use of robots.
Personnel (Qualification, HR Management). Depending on the type of robot, there are different qualification requirements, that range from short instructions for individual employees to extensive training of all employees. There is a wide variety of effects on human resource management (e.g. changes in gender ratio, fluctuation, working time models) that could be expected as well.
Analysis & Evaluation. Various analyses should capture the situation before the robot is used. For example, a team, technique profile or a load and stress profile can be created. It is recommended to repeat the analyses after the robot deployment, in order to evaluate the success of the project.
Quality & Process Management. In quality management, adjustments may be necessary in standards, documents or the organisation chart. Effects on quality improvement, certifications and possibly on audit regulations should be assessed. The robot also imposes demands on process management. Processes need to be recorded before the robot is used and re-planned for its introduction. After the introduction of the robot, processes should be further reviewed and must be kept in view.
Financing. Federal funding opportunities and funding opportunities including health and long-term care insurance funds should be examined by the facility. If these are not available, the robot must be financed by the facility’s own financial resources. The expected usage time, utilisation and amortisation time should be considered, as well.
Marketing. The robot can be a unique selling point of an institution and therefore could be used for marketing purposes.
Corporate Culture & Strategy. A comparison of the corporate values and the corporate philosophy with the use of robots should be carried out. The robot should also be included in strategic considerations.
In conclusion, the multitude of factors on the company level indicate, that the use of robots in nursing homes requires extensive preparation in various areas within the nursing home as a company.
Feelings & Needs. Various feelings can be triggered by the use of the robot, including fear. The possible influence that the robot may have on the user’s individual needs must also be examined.
Voluntariness. Self-determination of employees and residents regarding the use of robots is desirable but can only be implemented to a limited extent depending on the type of robot.
Requirements. Depending on the type of robot, different work demands may be placed on employees. Control and supervision of the technology use by employees will be necessary to varying degrees. Technological failures should be dealt with as well as additional tasks instead of ones that are conducted by the robot.
Design. Relating to the design of robots, there are many possibilities. The appearance can be designed to resemble a human or an animal, for example. There are also different design options in terms of size, language and voice of the robot.
Benefits & Aims. Depending on the type of robot and its functions, robots can provide different benefits. Often, the main goal is to support and relieve employees. Mainly, physically and mentally demanding work should be taken over. Robots also provide benefits with the removal of routes at work and documentation. There are also benefits for the residents in therapy and care services, or increased safety.
Risks. Risks of using robots can consist of various safety issues. A risk of fragmentation and clustering of care processes is possible. Another concern is that this could lead to additional workload for employees, job loss, or that robots will ultimately take centre stage at the nursing home instead of human care.
Technical Maturity. At the moment, there are still few technically mature care robots in the market. Quality features could be: practicability, durability, sensitivity, multifunctionality, compatibility or reliability.
Consequently, the factors on the work system level indicate how robots should be created and behave in order to be accepted by the users in accordance with their individual characteristics, experiences, feelings and needs.
Communication. Across all levels, communication is important—from the communication of research results to the public, to the communication with employees, residents and their relatives in a facility.
Participation. On one hand, participation should be possible for users in the development of the robots. Care representatives should also be able to participate in policy and committee decisions regarding robotics. In the institution itself, participation should be enabled in the decision to deploy a robot, while planning the design of its use, and in its evaluation.
User & Societal Acceptance. The acceptance of robots by users and society is an important aspect. Users’ feelings can vary between enthusiasm for technology and fear/resistance. In addition, previous experience with technology and personal preferences can have an influence on user acceptance. Depending on the type and design of the use of a robot, there are also different degrees of acceptance. In society, there often is a lack of information on how robots can be used in care, which initially leads to scepticism. However, robots are already used as a matter of course in industry. Ultimately, societal acceptance of robots is likely to increase when successful use of robots in care is observed. Simultaneously, user acceptance could be influenced by attitudes within society, especially by those of their relatives. Furthermore, acceptance can be viewed both as a prerequisite for and result of successful robot use.