Beyond Barriers: The role of the implementation process in shaping technology innovation outcomes in healthcare

Healthcare systems and organizations have been slow to adopt and implement many effective clinical, administrative and technological interventions. Understanding the factors that determine successful implementation in healthcare organizations is essential to accelerating the translation of effective interventions into practice. We report on a field study investigating 34 technology implementation journeys in infection prevention and control across 12 NHS Trusts. All hospitals studied operated in the same policy and institutional environment of the National Health Service in England, had comparable reputation and patient outcomes in infection management, and were provided with similar funding by the Department of Health with free reign to select and implement technologies to help them tackle healthcare associated infections. Yet they exhibited striking differences and considerable variance in implementation success. Even within the same Trust there was success in some cases and failure in others. The same technology failed to be implemented in some cases, yet implementors succeeded in others. The implementation of relatively simple technologies failed, while significantly more complex technologies were successfully put into use. Analysis of qualitative data suggests a number of situated factors at individual, organizational and collective levels that shaped implementation processes and differentiated between successful and unsuccessful outcomes. Applying Qualitative Comparative Analysis, we singled out among other factors that a more organic and bottom up approach was linked to significantly higher levels of success. User feedback, involvement in technology selection, participation in trials and customization was linked with semiotic, political and technical implementation advantages that determined successful outcomes.