mHabitat has been working with Professor Trisha Greenhalgh (University of Oxford) to develop and promote a new toolkit based on the NASSS framework. The aim is to help innovators as well as implementers assess and deal with complexity in technology supported health and social care projects.

Nasss Framework


An estimated 80 percent of technology projects in healthcare fail to be implemented successfully.

Professor Greenhalgh and colleagues set out to find out why through a systematic review and empirical case studies. The resulting NASSS Framework (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) includes seven domains: 

  • the condition/illness
  • the technology
  • the value proposition
  • the adopters
  • the organisation(s)
  • the wider context
  • changes over time.

Each domain can be rated from simple to complex, with more complex projects being associated with higher failure rates. The NASSS framework can be applied to technologies in health and care either prospectively (to guide design and implementation) or retrospectively (to learn from failure).

Learning points

mHabitat tested Prof Greenhalgh’s initial questionnaire with four teams in various stages of development and implementation of their digital tool. Teams were positive about the concept of the tool, saying it was a good opportunity to reflect and it helped flag up issues and risks they hadn’t considered. They also made numerous suggestions to improve the content, such as improving the instructions, terminology and scoring system.

We used these insights to generate a new version, which was tested at a workshop for innovators. Twelve participants provided feedback and five were interviewed in more depth. Overall, the innovators were very positive: they liked the tool, thought it was useful, relevant and easy to understand.

The team is currently exploring further improvements to the tool’s content as well as a digital implementation. mHabitat also work with a range of collaborators to support innovators to use the toolkit.  


Some feedback from the innovators after the workshop:

“The NASSS structure is really valuable, being able to score it and focus on high risk areas quickly. It’s good to be able to put a framework on the experience I gathered in the past eight years.”

“The NASSS questionnaire was invaluable. Made me feel reassured; we're doing better than we think we are! It was good to be able to tick [the different topics]. It's great it's specific to digital health” “t puts structure in place and allows us to reflect on where we are, and where we should be, allows us to set priority levels. It's simple, straightforward”

“It is useful to demystify [this field/process]; I was quite naive!”

“When I listened to the talk [about the academic paper], I thought this is all a bit far away [not directly relevant to me], but then the assessment tool put it into practise and it was a bit of a wake up call - I knew about some of these issues but hadn't really asked [myself to respond to the issue]”

Trish Greenhalgh - Professor of Primary Care Health Sciences:

“I’ve been really impressed with the wisdom, enthusiasm and energy of the mHabitat team as we’ve worked together on the NASSS-CAT tool. Watch this space for more developments!”

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Kirstin Blackwell BSc

Design and Delivery Team Manager

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