Investigating Technology Implementation in a Canadian Community Hospital

Abstract

The integration of technology into healthcare has witnessed significant advancements. However, the widespread adoption of such technologies may not be uniformly positive. While highest levels of adoption are typically found in densely populated urban areas, community healthcare facilities face challenges due to insufficient resources, like infrastructure, funding, and specialized staff, exacerbated by their remote locations. This is cause for concern as community hospitals account for 90% of all hospitals in Canada. This reveals a major opportunity to improve technology adoption and implementation at community hospitals, to aid their existing challenges, increase equity in healthcare, and improve generalizability of healthcare technologies.

This research aims to uncover the perceptions, expectations, cultural nuances, and barriers to technology adoption at a community-level hospital in Ontario, Canada. The study began with a contextual inquiry approach, incorporating semi-structured interviews and surveys. Data was collected from nine clinical and managerial staff members whose workflows were impacted by three pilot technology projects. The interviews aimed to explore staff expectations and experiences with how these pilot projects impacted their workflows, patient care, and the overall technology implementation process. The survey included demographic questions and items based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model, designed to predict factors influencing technology acceptance. The pilot technologies included a discharge planning tool, a portable X-ray scanner, and a digital pathology tool.

A thematic analysis of the qualitative data was conducted, followed by affinity mapping to identify overarching themes. The Functional Resonance Analysis Method (FRAM) was also used to understand and model the impact of integrating the pilot technologies into preexisting, variable workflows. Finally, survey results were analyzed using frequency distributions to identify trends and triangulate findings.

Overall, most staff reported a high level of technology use in both their work and daily lives. They also acknowledged that technology breakdowns at the workplace were inevitable, often resulting in time-consuming, manual workarounds. As well, for all pilot projects, staff felt overburdened by the additional workload required to manage the pilots alongside their regular duties. However, despite these challenges, all staff expressed an appreciation for innovation and a strong willingness to try new tools to improve their work.

The discharge planning and X-ray scanner tools did not integrate well into existing workflows or provide additional value. Both tools performed inconsistently and failed to meet expectations for streamlining processes, leading to reluctance and distrust among staff. Additionally, change management planning was insufficient for both tools, with staff experiencing abrupt workflow changes, limited training, and a lack of clarity on project timelines or statuses. As a result, neither tool was requested for purchase following pilot testing.

Conversely, staff decided to purchase the digital pathology tool, despite the disruptions to existing workflows, as the perceived benefits to both staff and patient care outweighed these challenges. Staff were excited about the tool’s potential and engaged in close collaboration with the manufacturer and project team. Furthermore, change management was carefully planned, with a phased implementation approach. The pilot was also driven by strong advocacy from a pathologist, which ensured alignment with clinical needs.

Based on these findings, several recommendations were uncovered to improve the technology implementation process. First, the challenges with change management highlight the need for better resource allocation. This includes providing sufficient time for introducing new tools, clearly explaining the reasons for their selection, offering personalized training that covers tool usage, troubleshooting, and its impact on existing processes, and ensuring staff have the necessary bandwidth to manage change without disrupting daily operations. Second, communication channels should be improved. Startup companies should collaborate closely with the hospital during the development and testing phases to better understand staff needs and workflows, while also providing tailored support throughout the implementation process. Additionally, communication with hospital leadership must be strengthened to secure strong support, allocate resources effectively, and incorporate feedback on the challenges staff encounter, fostering a more collaborative environment that is better equipped to drive innovation. Finally, it is crucial to define and share specific success metrics for pilot projects. These metrics will help staff assess the technology's impact, make informed decisions about its use, evaluate the implementation process, identify lessons learned, and pinpoint areas for improvement, all of which can refine future technology adoption strategies.

Overall, technology implementation and adoption are influenced by a variety of factors, which are further compounded by the high workload, staffing shortages, and unpredictable environments commonly found in community hospitals. By addressing these recommendations, health organizations can enhance the adoption and effectiveness of new technologies, ultimately improving staff workflows and patient care.