Paper short abstract:

This study engages with bottom up vs top down ideas in relation to healthcare efficiency. Smart community theory is developed through a framework that opens up divisions within top-down and bottom-up ideas. It concludes that the most desirable approach would focus on the collective bottom up ideas

Paper long abstract:

This critical sociotechnical study brings together insights from smart community, smart city and digital health literature to compare them with primary research. Smart community is defined as human and non-human agents collaborating with the stated aim of significant positive change. This definition emerged through mapping the evolution of the concept over the last three decades.

Whilst smart city and community literature has acknowledged differences between top down and bottom up approaches divisions within top down and bottom up approaches are rarely given much consideration. To address these limitations a framework was developed that subdivides top down into private vs government led and bottom up between individual and collective approaches. The study concludes that the most desirable approach to improving healthcare efficiency would be to focus on the collective bottom up sector of the framework.

The study's approach brought together ideas from literature and primary data through a process of theory informed critical reflexivity. The approach was driven by the research philosophy: critical systems thinking, and a critical systems heuristics methodology. At the methodologies core was the facilitation of 3 workshops that focussed on creating rich pictures of what future systems might look like based on the smart community concept. These were complimented by 30 semi-structured interviews. These resulted in the creation of 300 hours of interview transcripts, 8 rich picture diagrams and an asset map of the current system. The interpretation of this data applied Bourdieu's Practice Theory to help understand and highlight power dynamics in existing and proposed solutions.