From Episodes to Continuity of Care: a Study of a Call Center for Supporting Independent Living


Call centers are a central coordination hub for remote health services and telemedicine. Recently, also telecare providers use call centers to support the remote care of seniors living independently. Although we know that the quality of the interaction between caregiver and senior care recipient is important, there is a gap in our knowledge as to how ICT solutions can support this interaction through a call center model. In this paper, we describe a case study of a modern call center designed to provide services for independent living, primarily for seniors. The case study gives us new insight into how service providers envision ICT support for independent living in the future. We discuss our findings from interviews, observations and design workshops in light of relevant literature about independent living and call centers. We conclude with a set of directions for future ICT for call centers to support independent living of seniors. These tools should: 1) support continuity of care instead of episodes of care, 2) support caregiving activities in addition to medical triage activities, 3) support “technical caregiving” i.e. remote use, testing and maintenance of technology at home, and 4) support call center operators in leading ad hoc and emergent coordination in distributed teams.

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  1. 1.

    In this article we use the term senior to denote older adults who are the recipients of the services provided by the studied call center. This is a term used by the seniors themselves, e.g. in the titles of local senior associations such as “SeniorNett” and “SeniorIKT”. We use the term elderly care to denote the type of services provided by the studied call center.

  2. 2.

    The other mode of operation is “outbound”, used mainly to market and sell products to new customers, but also as a means to pro-actively maintaining an existing customer relationship.

  3. 3.

    Typically in terms of calls per day, length of call, customer satisfaction barometers.

  4. 4.

    In their study of day-to-day co-creation of care, Procter et al. (2014) propose a “Facebook for elderly care” as one technological approach.


  1. Abelsen, Birgit, Margrete Gaski, Svein Ingve Nødland, and Anne Stephansen. (2014). The Consequences of the Collaboration Reform for Municipal Nursing and Care Services (Norwegian: “Samhandlingsreformens Konsekvenser for Det Kommunale Pleie- Og Omsorgstilbudet”). Stavanger, Norway: NSDM/IRIS.

    Google Scholar 

  2. Ackerman, Mark S, and Christine Halverson (1998). Considering an organization’s memory. In Proceedings of the 1998 ACM Conference on Computer Supported Cooperative Work - CSCW’98, pp. 39–48. New York, New York, USA: ACM Press.

  3. Aksin, Zeynep, Mor Armony, and Vijay Mehrotra. (2007). The Modern Call Center: A Multi-Disciplinary Perspective on Operations Management Research. Production and Operations Management, vol.16, no.6, pp. 665–88.

  4. Bannon, Liam, and Susanne Bødker. (1997). Constructing Common Information Spaces. In Proceedings of the Fifth European Conference on Computer Supported Cooperative Work, pp. 81–96. Berlin, Heidelberg: Springer-Verlag.

  5. Berg, Neeltje van den, Maika Schumann, Kathleen Kraft, and Wolfgang Hoffmann. (2012). Telemedicine and Telecare for Older Patients-A Systematic Review. Maturitas, vol.73, no.2, pp. 94–114.

  6. Bjørn, Pernille, and Kjetil Rødje. (2008). Triage Drift: A Workplace Study in a Pediatric Emergency Department. Computer Supported Cooperative Work (CSCW), vol.17, no.4, pp. 395–419.

  7. Bowes, a., and G. McColgan. (2012). Telecare for Older People: Promoting Independence, Participation, and Identity. Research on Aging, vol.35, no.1, pp. 32–49.

  8. Braun, V., and V. Clarke. (2006). Using Thematic Analysis in Psychology. Qualitative Research in Psychology, vol.3, no.2, pp. 77–101.

  9. Bridges, Jackie, Mary Flatley, and Julienne Meyer. (2010). Older People’s and Relatives’ Experiences in Acute Care Settings: Systematic Review and Synthesis of Qualitative Studies. International Journal of Nursing Studies, vol.47, no.1, pp. 89–107.

  10. Broens, Tom H F, Rianne M H a Huis in’t Veld, Miriam M R Vollenbroek-Hutten, Hermie J Hermens, Aart T van Halteren, and Lambert J M Nieuwenhuis. (2007). Determinants of Successful Telemedicine Implementations: A Literature Study. Journal of Telemedicine and Telecare, vol.13, no.6, pp. 303–9.

  11. Brørs, Kirsti Fossland. (2013). Organization of Alarm Centers in Large Municipalities (Norwegian: “Organisering Av Alarmmottak I En Større Kommune”). Trondheim, Norway: Trondheim Municipality.

    Google Scholar 

  12. County administration. (2015). Audit Report for Emergency Clinics in Klaebu, Malvik, Melhus, Midtre Gauldal and Trondheim. Trondheim: County administration.

    Google Scholar 

  13. Dahl, Yngve, Babak Farshchian, Thomas Vilarinho, Jorunn L. Helbostad, Ather Nawaz, Arnhild J. Nygård, and Per Bendik Wik. (2015). Stakeholder Attitudes Toward and Values Embedded in a Sensor-Enhanced Personal Emergency Response System. Interacting with Computers, vol.28, no.5, pp. 598–611.

  14. Dourish, Paul, and Victoria Bellotti (1992). Awareness and coordination in shared workspaces. In Proceedings of the 1992 ACM Conference on Computer-Supported Cooperative Work - CSCW’92, pp. 107–14. New York, New York, USA: ACM Press.

  15. Faraj, Samer, and Yan Xiao. (2006). Coordination in Fast-Response Organizations. Management Science, vol.52, no.8, pp. 1155–69.

  16. Farshchian, Babak, and Yngve Dahl. (2016). Implementing a Location Tracking Service for People with Cognitive Impairment- A Qualitative Study. Trondheim, Norway: SINTEF.

    Google Scholar 

  17. Gans, Noah, Ger Koole, and Avishai Mandelbaum. (2003). Telephone Call Center: Tutorial, Review, and Research Prospects. Manufacturing and Service Operations Management, vol.5, no.2, pp. 79–141.

  18. Gauch, Susan, Mirco Speretta, Aravind Chandramouli, and Alessandro Micarelli. (2007). User Profiles for Personalized Information Access. In The Adaptive Web, 4321:54–89. Berlin, Heidelberg: Springer Berlin Heidelberg.

  19. Glaser, Barney G., and Anselm L. Strauss. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, New York, USA: Aldine de Gruyter.

    Google Scholar 

  20. Greenberg, Mary Elizabeth. (2009). A Comprehensive Model of the Process of Telephone Nursing. Journal of Advanced Nursing, vol.65, no.12, pp. 2621–29.

  21. Gross, Tom. (2013). Supporting Effortless Coordination: 25 Years of Awareness Research. Computer Supported Cooperative Work (CSCW), vol. 22, no. 4–6, pp. 425–74.

  22. Halldorsdottir, Sigridur. (2008). The Dynamics of the Nurse-Patient Relationship: Introduction of a Synthesized Theory from the Patient’s Perspective. Scandinavian Journal of Caring Sciences, vol.22, no.4, pp. 643–52.

  23. Hessels, Virginia, Glenn S. Le Prell, and William C. Mann. (2011). Advances in Personal Emergency Response and Detection Systems. Assistive Technology, vol.23, no.3, pp. 152–61.

  24. Holmström, Inger. (2007). Decision Aid Software Programs in Telenursing: Not Used as Intended? Experiences of Swedish Telenurses. Nursing and Health Sciences, vol.9, no.1, pp. 23–28.

  25. Johnson, Bill. (2014). Outsourcing Your Medical Practice Call Center: How to Choose a Vendor to Ensure Regulatory Compliance. Journal of Medical Practice Management, vol.30, no.2, pp. 124–27.

  26. Kastens, J. M. (1998). Integrated Care Management: Aligning Medical Call Centers and Nurse Triage Services. Nursing Economics, vol.16, no.6, pp. 320–29.

  27. Klein, Heinz K., and Michael D. Myers. (1999). A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Quarterly, vol.23, no.1, pp. 67–94.

  28. Koch, Sabine. (2006). Home Telehealth-Current State and Future Trends. International Journal of Medical Informatics, vol.75, no.8, pp. 565–76.

  29. Lee, Soyoung, Charlotte Tang, Sun Young Park, and Yunan Chen. (2012). Loosely formed patient care teams: Communication challenges and technology design. In Proceedings of the ACM 2012 Conference on Computer Supported Cooperative Work - CSCW’12, pp. 867–76. New York, New York, USA: ACM Press.

  30. Lindberg, Birgitta, Carina Nilsson, Daniel Zotterman, Siv Söderberg, and Lisa Skär. (2013). Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review. International Journal of Telemedicine and Applications, vol.2013, pp. 1–31.

  31. Malthouse, Edward C., Michael Haenlein, Bernd Skiera, Egbert Wege, and Michael Zhang. (2013). Managing Customer Relationships in the Social Media Era: Introducing the Social CRM House. Journal of Interactive Marketing, vol.27, no.4, pp. 270–80.

  32. Martin, David, Jacki O’Neill, Dave Randall, and Mark Rouncefield. (2007). How Can I Help You? Call Centres, Classification Work and Coordination. Computer Supported Cooperative Work (CSCW), vol.16, no.3, pp. 231–64.

  33. May, Carl R, Tracy L Finch, James Cornford, Catherine Exley, Claire Gately, Sue Kirk, K Neil Jenkings, et al. (2011). Integrating Telecare for Chronic Disease Management in the Community: What Needs to Be Done? BMC Health Services Research, vol.11, no.1, pp. 131.

  34. McLoughlin, Ian, Gregory Maniatopoulos, Rob Wilson, and Mike Martin. (2013). Inside a Digital Experiment: Co-Producing Telecare Services for Older People. Scandinavian Journal of Information Systems, vol.24, no.2, pp. 3–26.

  35. Millard, Nicola, Peter Fernando, Richard Kenny, Mark King, and Simon Angove. (2010). 2020 Vision: What Will the Call Centre Look like in Ten Years’ Time.,. November.

  36. Milligan, Christine, Celia Roberts, and Maggie Mort. (2011). Telecare and Older People: Who Cares Where? Social Science & Medicine, vol.72, no.3, pp. 347–54.

  37. Moss, Edtrina L. (2014). “Just a Telephone Call Away”: Transforming the Nursing Profession With Telecare and Telephone Nursing Triage. Nursing Forum, vol.49, no.4, pp. 233–39.

  38. Nguyen, Bang, and Dilip S. Mutum. (2012). A Review of Customer Relationship Management: Successes, Advances, Pitfalls and Futures. Business Process Management, vol.18, no.3, pp. 400–419.

  39. Normark, Maria, and Dave Randall. (2005). Local Expertise at an Emergency Call Centre. In ECSCW 2005: Proceedings of the Ninth European Conference on Computer-Supported Cooperative Work, pp. 347–66. Berlin/Heidelberg: Springer-Verlag.

  40. Norwegian Department of Healthcare. (2015). Architectures for Assistive Technologies (Norwegian “Arkitektur for Velferdsteknologi”). Oslo, Norway: Norwegian Department of Healthcare.

    Google Scholar 

  41. Norwewgian Medical Association. (2009). Norwegian Index for Medical Emergency Help (Norwegian: “Norsk Indeks for Medisinsk Nødhjelp”). 3rded. Stavanger, Norway: Laerdal Medical AS.

  42. Portigal, Steve. (2013). Interviewing Users: How to Uncover Compelling Insights. 1sted. New York, New York, USA: Rosenfeld Media.

  43. Prior, Lindsay F. (2003). Using Documents in Social Research. Thousand Oaks, California: Sage Publications Ltd.

    Google Scholar 

  44. Procter, Rob, Trisha Greenhalgh, Joe Wherton, Paul Sugarhood, Mark Rouncefield, and Sue Hinder. (2014). The Day-to-Day Co-Production of Ageing in Place. Computer Supported Cooperative Work (CSCW), vol.23, no.3, pp. 245–67.

  45. Procter, Rob, Joe Wherton, Trish Greenhalgh, Paul Sugarhood, Mark Rouncefield, and Sue Hinder. (2016). Telecare Call Centre Work and Ageing in Place. Computer Supported Cooperative Work (CSCW), vol.25, no.1, pp. 79–105.

  46. P A Consulting Group. (2014). Organization of Alarm Centers in Norway and Abroad- Mapping and Recommendations (Norwegian “Organisering Av Alarmmottak I Norge Og Utlandet -- Kartlegginger Og Anbefalinger”). Oslo: PA Consulting Group.

    Google Scholar 

  47. Ries, Eric. (2011). The Lean Startup: How Today’s Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses. 1sted. New York, New York, USA: Crown Business.

  48. Roberts, Celia, and Maggie Mort. (2009). Reshaping What Counts as Care: Older People, Work and New Technologies. ALTER - European Journal of Disability Research, vol.3, no.2, pp. 138–58.

  49. Roberts, Celia, M Mort, and C Milligan. (2012). Calling for Care: ‘Disembodied’ Work, Teleoperators and Older People Living at Home. Sociology, vol.46, no.3, pp. 490–506.

  50. Robertson-Steel, Iain. (2006). Evolution of Triage Systems. Emergency Medicine Journal, vol.23, no.2, pp. 154–55.

  51. Rowe, J W, and R L Kahn. (1997). Successful Aging. The Gerontologist, vol.37, no.4, pp. 433–40.

  52. Rutenberg, C D. (2000). What Do We Really KNOW about Telephone Triage? Journal of Emergency Nursing: JEN : Official Publication of the Emergency Department Nurses Association, vol.26, no.1, pp. 76–78.

  53. Schmidt, Kjeld, and Carla Simone. (2000). Mind the gap! Towards a unified view of CSCW. In The Fourth International Conference on the Design of Cooperative Systems COOP 2000, pp. 23–26. IOS Press.

  54. Stacey, Dawn, Ian D. Graham, Annette M. O’Connor, and Marie-Pascale Pomey. (2005). Barriers and Facilitators Influencing Call Center Nurses’ Decision Support for Callers Facing Values-Sensitive Decisions: A Mixed Methods Study. Worldviews on Evidence-Based Nursing, vol.2, no.4, pp. 184–95.

  55. Star, Susan Leigh. (1999). The Ethnography of Infrastructure. American Behavioral Scientist, vol.43, no.3, pp. 377–91.

  56. Star, Susan Leigh, and Anselm Strauss. (1999). Layers of Silence, Arenas of Voice: The Ecology of Visible and Invisible Work. Computer Supported Cooperative Work (CSCW), vol.8, no.1–2, pp. 9–30.

  57. The Norwegian Ministry of Health and Care. (2009). The collaboration reform- the right treatment in the right place at the right time (Norwegian: “Samhandlingsreformen- Rett behandling – på rett sted – til rett tid”). Oslo, Norway: The Norwegian Ministry of Health and Care.

    Google Scholar 

  58. Trondheim Municipality. (2011a). Municipal Plan for Services for Seniors over 67 (Norwegian “Kommunedelplan for Tjenester Til Eldre over 67 År”). Trondheim, Norway: Trondheim Municipality.

  59. ———. (2011b). Welfare Technology in Trondheim- an Action Plan (Norwegian: “Velferdsteknologi I Trondheim Kummune - Handlingsplan”). Trondheim, Norway: Trondheim Municipality.

  60. Walsham, Geoff. (1995). Interpretive Case Studies in IS Research: Nature and Method. European Journal of Information Systems, vol.4, no.2, pp. 74–81.

  61. ———. (2006). Doing Interpretive Research. European Journal of Information Systems, vol.15, no.3, pp. 320–30.

  62. Wherton, Joseph, Paul Sugarhood, Rob Procter, Sue Hinder, and Trisha Greenhalgh. (2015). Co-Production in Practice: How People with Assisted Living Needs Can Help Design and Evolve Technologies and Services. Implementation Science, vol.10, no.1, pp. 75.

  63. Witsil, Frank. (2014). Call Center Jobs Increase as More Return from Overseas. USA Today, August.

  64. Yin, Robert K. (2014). Case Study Research: Design and Methods. Fifth. Thousand Oaks, California: SAGE Publications.

  65. Zhou, Xiaomu, Kai Zheng, Mark Ackerman, and David Hanauer. (2012). Cooperative documentation: the patient problem list as a nexus in electronic health records. In Proceedings of the ACM 2012 Conference on Computer Supported Cooperative Work - CSCW’12, 911. New York, New York, USA: ACM Press.

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This research is funded by the EU FP7 projects FARSEEING (Grant Agreement No. 288940) and OPTET (Grant Agreement No. 317631), and by the Norwegian Research Council project ADAPT (Grant Agreement No. 317631). We thank the participants from the municipality, and Nils Brede Moe, Erlend Stav and Yngve Dahl from SINTEF for help with conducting workshops and interviews. We thank our anonymous reviewers and the editor of the CSCW Journal for constructive comments to the earlier versions of this article.

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Correspondence to Babak A. Farshchian.

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Farshchian, B.A., Vilarinho, T. & Mikalsen, M. From Episodes to Continuity of Care: a Study of a Call Center for Supporting Independent Living. Comput Supported Coop Work 26, 309–343 (2017).

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  • Call center
  • Independent living
  • Aging in place
  • Assistive technology
  • Quality of client provider interaction
  • Personalization
  • Caregiving
  • Emergent coordination in distributed teams
  • Remote technology maintenance
  • Continuous care