Elsevier

Health Policy and Technology

Volume 2, Issue 4, December 2013, Pages 216-221
Health Policy and Technology

Adoption in practice: The relationship between managerial interpretations of evidence and the adoption of a healthcare innovation

https://doi.org/10.1016/j.hlpt.2013.07.004Get rights and content

Highlights

  • We explore how managers interpret and construct evidence to inform practice.

  • This longitudinal study examines the adoption of remote care (telecare).

  • Managerial interpretations of evidence were negotiated through interlinked frames of practice.

  • These frames aligned evidence with existing practice and mobilised collective decision-making and strategic action.

  • The degree to which managerial practice was consistent with aims and objectives of the recipient organisation mediated innovation spread.

Abstract

Objectives

Our work explores the gap between evidence, management practices and the adoption of innovations. The article draws on the results of a longitudinal study examining the adoption of remote care (telecare) services.

Method

Five UK organisations form purposively chosen case studies. In the process of adoption, we explore how managers interpret and construct evidence to inform practice.

Results

Managerial interpretations of evidence are negotiated through a series of interlinked frames of practice. These frames align evidence with existing professional practices and needs, and mobilise collective decision-making and strategic action.

Conclusions

The degree to which resulting managerial practice is consistent with aims and objectives of the recipient organisation serves to mediate innovation spread.

Introduction

The added value of an innovation over previous technologies has long featured in adoption and diffusion models [1], and there are studies which allude to the role of evidence in the adoption of medical technologies [2]. The role of evidence, however, has generally been downplayed in innovation research. The lack of attention has left a layer of complexity in the innovation process out of explanatory models. Evidence of benefits is of growing importance, with the recent financial crisis, resulting in governments seeking to control expenditure on healthcare and other public sector goods.

Currently, little direct empirical research exists linking the use of evidence to adoption decision-making by healthcare organisations, and the subsequent strategic embedding of the innovation into practice. The existing body of research on innovation adoption and diffusion has tended to focus on the introduction of new products, on the aggregate effect of individual adoption decisions by many independent decision makers, and on situations where individual users adopt a simple, well-defined innovation. Such an approach can and has been applied to healthcare, e.g. examples of MRI scanning [3] or polio vaccine [2]. The common feature of such innovations is the unambiguous evidence of their benefits, with early feedback available to potential adopters, so that rapid adoption and diffusion can be driven by rational choices.

However, this type of scenario is exceptional in the context of health services innovation, where innovations are often unbounded [4]. More typically, innovation within this context is a process, unravelling over a period of time, and where objective performance criteria or benefits evidence is unclear. To address these limitations more recent work has focused on addressing the complexity of adoption and diffusion of innovations within healthcare [5]. Increasingly research considers how adoption decisions are made across multi-professional groups, within large complex organisations [5], and draws together the existing research on health services innovation [6] to identify key components of successful innovation. They suggest the components and constituent parts do not exist in isolation but in dynamic relation to the system as a whole. These models re-position adoption as a dynamic, altogether messier process, critically influenced by context [7], [8].

From this work we know that innovations are more easily adopted within discretely bounded communities of practice [8], but there are still limitations to our knowledge, around the interpretative processes in evaluating evidence for the benefits of an innovation. Of particular interest is the role of managers, who by the virtue of their strategic position have the power to facilitate interpretations and change in others [9].

Managers potentially help overcome resistance by demonstrating commitment to the new scheme, and going on to promote this with passion and persistence. Managers build informal networks to coalesce and support them in their role [10] and act as boundary spanners between the top management and other staff [11]. Importantly, managers communicate meanings and actions attached to the innovation to others and involve and motivate others to do the same.

The empirical question remains; how do managers construct and use evidence; specifically how does evidence interact and become adapted to other demands within the organisational context in which managers work, to inform strategic decision-making and adoption practice. Although, our focus is on managers' own use and construction of evidence, our question also relates to the ways in which managers support and encourage the use of evidence by others.

Section snippets

The research context

To answer our research questions we need to consider an innovation where managers are required to interpret and construct evidence and make strategic adoption decisions about future practice based on these deliberations. The implementation of remote care fits well. This involves monitoring frail or sick patients at home with the use of new sensor technologies. In the UK, approximately £150 million was allocated to health and social care services to introduce remote care services into UK homes

Methods

We undertook purposive sampling to identify five comparative, longitudinal cases studies of health and social care organisations attempting to develop remote care services during the funding period of the Preventative Technologies Grant (April 2006–2009). Sites were identified through a national sample of 151 local authorities in England. Because we were interested in managers' interpretations of evidence, case study sites needed to have gathered some evidence about the efficacy of previous

Results

Research on managerial change suggests that as change unfolds, managers will need to significantly alter their beliefs and actions, so their frame of reference about how they view events shifts [19]. Our analysis suggests that managers' construction and engagement with remote care evidence unfolded over time, thorough the development of a series of interlinked frames of practice. The constructed reality, interpretations and associated tasks that triggered actions and development of the new

Discussion

Our research set out to examine the practiced reality of how evidence in constructed and adapted to fit with existing practice and how the nature of this adaptation process impacts on the adoption of an innovation, remote care. We found that the process of interpretation of evidence was active, contextualised and personalised and unfolded through a series of negotiated interlinked frames. Different frames shape managerial behaviours and interactions, the product of which was collective actions

Conclusions

Our research suggests that the nature of evidence does play a role in the acceptance of innovation in healthcare, and supports past work showing that the criteria for assessing evidence are socially constructed by differing professional, disciplinary and social groups within health and social care. The existence of the right kind of evidence for different decision makers, combined with coalition building across groupings of stakeholders, was an important factor influencing the adoption of

Ethical approval

Central Manchester Research Ethics Committee REC ref no.: 06/Q1407/264.

Funding

This project is funded through the EPSRC's Health and Care Infrastructure Research and Innovation Centre (HaCIRIC). The funding source has no involvement in the authors' work.

We thank the participating case study organisations for their help, and to individual interviewees for their time and interest. They are not named to preserve anonymity. We are also grateful to the telecare community for their continuing support. We

Acknowledgements

We are extremely grateful to the participating case study organisations for their help, and to individual interviewees for their time and interest in the study. They are not named to preserve anonymity. We are also grateful to members of the remote care community for their continuing support.

References (22)

  • J. Hendy et al.

    The role of the organizational champion in achieving health system change

    Social Science and Medicine

    (2012)
  • J. Barlow et al.

    Implementing complex innovations in fluid multi-stakeholder environments: experiences of ‘telecare’

    Technovation

    (2006)
  • E. Rogers

    Diffusion of innovations

    (2003)
  • R.R. Nelson et al.

    Why and how innovations get adopted: a tale of four models

    Industrial and Corporate Change

    (2004)
  • J. Grigsby et al.

    The diffusion of telemedicine

    Telemedicine Journal and e-health

    (2002)
  • S. Dopson et al.

    The active role of context

  • B. Dattée et al.

    Complexity and whole-system change programmes

    Journal of Health Services Research and Policy

    (2010)
  • Robert. G, Greenhalgh T, MacFarlane F, Peacock R. Organisational factors influencing technology adoption and...
  • T. Greenhalgh et al.

    If we build it, will it stay? A case study of the sustainability of whole-system change in London

    Milbank Quarterly

    (2012)
  • E. Ferlie et al.

    The nonspread of innovations: the mediating role of professionals

    Academy of Management Journal

    (2005)
  • S.A. Birken et al.

    Uncovering middle managers' role in healthcare innovation implementation

    Implementation Science

    (2012)
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