Presentation
Investigating the Perceptions and Expectations of Technology Implementation in Community Hospitals: A Thematic Analysis
DescriptionIn recent years, the integration of technology into healthcare has witnessed significant advancements (Alotaibi & Federico, 2017). However, despite these promising developments, the widespread adoption of such technologies may not be uniformly positive, giving rise to disparities in healthcare access. Population density has been shown to affect health technology adoption, with the highest levels of adoption found in densely populated urban areas like Toronto, Vancouver, and Ottawa (Hamoni et al., 2021). Conversely, rural and community healthcare facilities face challenges due to insufficient resources, like infrastructure, funding, and specialized staff, exacerbated by their remote locations (Kijsanayotin et al., 2009). This is cause for concern as community hospitals represent 90% of hospitals nationwide, and 75% of hospitals in Ontario, delivering the majority of healthcare services to Canadians (Rego et al., 2024).
This study examines the perceptions, expectations, cultural nuances, and barriers to technology adoption at a community hospital in Ontario. Using a contextual inquiry approach, insights were gathered from nine participants whose workflows were impacted by three pilot projects. Most participants were female clinical managers aged 30–50, with more than 10 years of experience in their current roles.
Pilot projects are a form of testing the hospital undertakes before they submit a proposal to purchase a tool. The projects in this study included a discharge planning tool that uses machine learning to help prioritize patients for discharge, a portable X-ray scanner that can differentiate between bone and soft tissue through a single X-ray image, and a digital pathology tool that digitizes slides for pathologists. Out of the three, only the digital pathology tool ended up being purchased.
After getting ethics approval, participants were recruited through a poster and an email, both of which included a link to a survey. In the survey, they could provide their email address if they were interested in an interview, and all of them chose to participate. The survey captured demographic questions and items based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model, which predicts factors influencing technology acceptance (Venkatesh et al., 2003). Due to the small sample size, survey results were analyzed using frequency distributions to identify trends across the projects, and the findings were triangulated with interview results. The interview questions focused on understanding staff workflows before and after technology implementation, level of technology use, and perceptions of innovation. Interviews were semi-structured to allow for open conversation. A thematic analysis of the qualitative data (Braun & Clarke, 2006) was conducted, followed by affinity mapping to identify overarching themes related to perceptions, expectations, challenges, and attitudes toward innovative technologies.
To start, most staff reported a high level of technology use in both their work and daily lives. They also acknowledged that technology breakdowns are inevitable and often required time-consuming, error-prone manual workarounds. In high-pressure situations, these workarounds may not be feasible, adding unpredictability and stress into their workflows. However, despite these challenges, all staff expressed appreciation for innovation and a willingness to try new tools to enhance their work.
Staff decided against purchasing the discharge planning and X-ray scanner tools for several reasons. First, both technologies lacked EMR integration, did not fit into existing workflows or provide additional value. For instance, the discharge planning tool did not account for crucial barriers, such as patient and hospital resources, which staff needed to address as part of their workflow. the portable X-ray scanner had certain design weaknesses compared to the status quo, which hindered doctors' ability to make timely and accurate decisions. Both tools also performed inconsistently and failed to meet expectations for streamlining processes, leading to increased reluctance and distrust among staff. This created a negative culture surrounding the use of both the discharge planning and X-ray scanner tools, making staff feel uncomfortable promoting tools that hindered their colleagues' workflows.
Communication between staff, hospital administration, and the tool manufacturers needed improvement. Staff were unclear about the reasons for introducing the discharge planning and X-ray scanner tools, which led to suspicions that the pilots were more for the manufacturer's benefit, such as improving their product, rather than addressing hospital needs. Furthermore, after the pilots concluded, staff received no updates, leaving them uncertain about the tools' status, the project's outcomes, or any next steps. With the discharge planning tool, staff felt undervalued and pressured by the manufacturer to prove they were not responsible for the tool's inadequate performance. With the portable X-ray scanner, staff were frustrated by the manufacturer’s inability to resolve technical issues or to provide clear project timelines.
Finally, change management appeared poorly planned and under-resourced. Staff were not provided with adequate training, as the tools were presumed to be easy to use, leaving them unprepared to handle issues or incorporate the tools into their workflows. Moreover, many staff felt overburdened by the extra workload of managing the pilot projects alongside their regular duties, highlighting the need for better resource allocation and support for the change management process.
On the other hand, staff decided to purchase the digital pathology tool. Although the digital pathology tool introduced additional steps and adjustments to existing workflows, the perceived benefits to both staff and patient care outweighed the disruptions. Staff were excited about the tool’s potential and engaged in close collaboration with the manufacturer. Unlike the discharge planning and X-ray scanner tools, the digital pathology tool addressed a clear and genuine need recognized by the team, driven by strong advocacy from end-users of the digital pathology tool. Change management was a key focus, with staff conducting observational research at hospitals already using the digital pathology tool, analyzing workflows with frontline staff, and implementing a phased rollout that included training. However, similar to the other pilots, staff leading this project felt overworked and under-resourced.
Based on these findings, several recommendations have been formulated to enhance future pilot projects. First, staff faced significant challenges with change management, highlighting the need to allocate sufficient time for tool introduction, clarify the reasons for their selection, and provide personalized training that addresses their use, troubleshooting, and impact on existing processes. Second, communication channels with manufacturing companies can be improved. Companies should collaborate closely with the hospital during the development and testing phases to understand staff’s unique needs and workflows, providing tailored support throughout the implementation process. Strengthening communication with hospital leadership is equally important for securing mutual support, effectively allocating resources, and incorporating feedback on the real challenges and barriers staff encounter. Leadership must also ensure that sufficient bandwidth is available before initiating the project, including the allocation of dedicated resources to manage change without disrupting daily operations. Finally, it is important to define and share specific success metrics for the pilot projects to help staff assess the technology's impact and make objective decisions about its use. Conducting a thorough review after the pilot will allow staff to evaluate the implementation process, identify lessons learned, and highlight areas for improvement, which can refine future technology adoption strategies and keep staff informed about the status of the pilot project once it concludes.
In conclusion, the implementation of technology in community hospitals are influenced by various factors, further exacerbated by their unique challenges. By addressing the outlined recommendations, organizations can enhance collaboration among all stakeholders, hospital leadership, manufacturers, and frontline staff. These efforts will cultivate a culture of innovation, increasing project engagement, supporting effective planning, and ensuring that the goals and needs of all parties are met. Ultimately, this can facilitate the successful adoption of new technologies and potentially lead to improved staff workflows and better patient care outcomes.
This study examines the perceptions, expectations, cultural nuances, and barriers to technology adoption at a community hospital in Ontario. Using a contextual inquiry approach, insights were gathered from nine participants whose workflows were impacted by three pilot projects. Most participants were female clinical managers aged 30–50, with more than 10 years of experience in their current roles.
Pilot projects are a form of testing the hospital undertakes before they submit a proposal to purchase a tool. The projects in this study included a discharge planning tool that uses machine learning to help prioritize patients for discharge, a portable X-ray scanner that can differentiate between bone and soft tissue through a single X-ray image, and a digital pathology tool that digitizes slides for pathologists. Out of the three, only the digital pathology tool ended up being purchased.
After getting ethics approval, participants were recruited through a poster and an email, both of which included a link to a survey. In the survey, they could provide their email address if they were interested in an interview, and all of them chose to participate. The survey captured demographic questions and items based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model, which predicts factors influencing technology acceptance (Venkatesh et al., 2003). Due to the small sample size, survey results were analyzed using frequency distributions to identify trends across the projects, and the findings were triangulated with interview results. The interview questions focused on understanding staff workflows before and after technology implementation, level of technology use, and perceptions of innovation. Interviews were semi-structured to allow for open conversation. A thematic analysis of the qualitative data (Braun & Clarke, 2006) was conducted, followed by affinity mapping to identify overarching themes related to perceptions, expectations, challenges, and attitudes toward innovative technologies.
To start, most staff reported a high level of technology use in both their work and daily lives. They also acknowledged that technology breakdowns are inevitable and often required time-consuming, error-prone manual workarounds. In high-pressure situations, these workarounds may not be feasible, adding unpredictability and stress into their workflows. However, despite these challenges, all staff expressed appreciation for innovation and a willingness to try new tools to enhance their work.
Staff decided against purchasing the discharge planning and X-ray scanner tools for several reasons. First, both technologies lacked EMR integration, did not fit into existing workflows or provide additional value. For instance, the discharge planning tool did not account for crucial barriers, such as patient and hospital resources, which staff needed to address as part of their workflow. the portable X-ray scanner had certain design weaknesses compared to the status quo, which hindered doctors' ability to make timely and accurate decisions. Both tools also performed inconsistently and failed to meet expectations for streamlining processes, leading to increased reluctance and distrust among staff. This created a negative culture surrounding the use of both the discharge planning and X-ray scanner tools, making staff feel uncomfortable promoting tools that hindered their colleagues' workflows.
Communication between staff, hospital administration, and the tool manufacturers needed improvement. Staff were unclear about the reasons for introducing the discharge planning and X-ray scanner tools, which led to suspicions that the pilots were more for the manufacturer's benefit, such as improving their product, rather than addressing hospital needs. Furthermore, after the pilots concluded, staff received no updates, leaving them uncertain about the tools' status, the project's outcomes, or any next steps. With the discharge planning tool, staff felt undervalued and pressured by the manufacturer to prove they were not responsible for the tool's inadequate performance. With the portable X-ray scanner, staff were frustrated by the manufacturer’s inability to resolve technical issues or to provide clear project timelines.
Finally, change management appeared poorly planned and under-resourced. Staff were not provided with adequate training, as the tools were presumed to be easy to use, leaving them unprepared to handle issues or incorporate the tools into their workflows. Moreover, many staff felt overburdened by the extra workload of managing the pilot projects alongside their regular duties, highlighting the need for better resource allocation and support for the change management process.
On the other hand, staff decided to purchase the digital pathology tool. Although the digital pathology tool introduced additional steps and adjustments to existing workflows, the perceived benefits to both staff and patient care outweighed the disruptions. Staff were excited about the tool’s potential and engaged in close collaboration with the manufacturer. Unlike the discharge planning and X-ray scanner tools, the digital pathology tool addressed a clear and genuine need recognized by the team, driven by strong advocacy from end-users of the digital pathology tool. Change management was a key focus, with staff conducting observational research at hospitals already using the digital pathology tool, analyzing workflows with frontline staff, and implementing a phased rollout that included training. However, similar to the other pilots, staff leading this project felt overworked and under-resourced.
Based on these findings, several recommendations have been formulated to enhance future pilot projects. First, staff faced significant challenges with change management, highlighting the need to allocate sufficient time for tool introduction, clarify the reasons for their selection, and provide personalized training that addresses their use, troubleshooting, and impact on existing processes. Second, communication channels with manufacturing companies can be improved. Companies should collaborate closely with the hospital during the development and testing phases to understand staff’s unique needs and workflows, providing tailored support throughout the implementation process. Strengthening communication with hospital leadership is equally important for securing mutual support, effectively allocating resources, and incorporating feedback on the real challenges and barriers staff encounter. Leadership must also ensure that sufficient bandwidth is available before initiating the project, including the allocation of dedicated resources to manage change without disrupting daily operations. Finally, it is important to define and share specific success metrics for the pilot projects to help staff assess the technology's impact and make objective decisions about its use. Conducting a thorough review after the pilot will allow staff to evaluate the implementation process, identify lessons learned, and highlight areas for improvement, which can refine future technology adoption strategies and keep staff informed about the status of the pilot project once it concludes.
In conclusion, the implementation of technology in community hospitals are influenced by various factors, further exacerbated by their unique challenges. By addressing the outlined recommendations, organizations can enhance collaboration among all stakeholders, hospital leadership, manufacturers, and frontline staff. These efforts will cultivate a culture of innovation, increasing project engagement, supporting effective planning, and ensuring that the goals and needs of all parties are met. Ultimately, this can facilitate the successful adoption of new technologies and potentially lead to improved staff workflows and better patient care outcomes.
Event Type
Oral Presentations
TimeWednesday, April 28:30am - 8:52am EDT
LocationHarbour C
Hospital Environments (HE)