The medical technological (MedTech) innovations by healthcare perform their tasks with greater efficiency and fewer errors. But how can we facilitate healthcare providers to adopt new MedTech innovations successfully? Focusing on the adoption behaviour of healthcare providers, we propose a contingency barrier framework to reduce hesitancy in technological innovation adoption.
Adoption and resistance of MedTech innovation by healthcare providers
Adopting new MedTech innovations significantly impacts every healthcare function, including prescription, diagnostics, surgery, and others. The COVID-19 pandemic also demonstrated the importance of quick adoption of revolutionary technology, as in the case of vaccination development. Despite the immense positive outcomes of MedTech innovations, research is limited on why healthcare professionals reject some MedTech innovations. Though there have been many studies on consumers, adoption by healthcare professionals has been limited. Since the scarce studies have investigated mainly enablers, we currently need more knowledge about barriers that can lead to non-adoption or contingent adoption of MedTech innovations, especially in the healthcare context.
The barriers in the healthcare multi-stakeholder context are complex and multi-dimensional because they also include hospital and patient perspectives in addition to the healthcare professional’s perspective. Further, healthcare professionals are complex and well-educated individuals with strong preferences and high personal and professional stakes. Therefore, healthcare professionals who are the key stakeholder in the adoption process can view and experience adoption barriers differently from patients and other stakeholders. Therefore, MedTech companies and hospital administration often struggle with successfully introducing MedTech innovations. Moreover, legislation in the hospital context can dictate technology adoption and force professionals to adopt MedTech innovations despite their unwillingness due to different barriers. This complex condition for adoption is succinctly summarized by the quote below by a C-level executive in a life science company.
Understanding barriers to the adoption of MedTech innovation
In our research, we studied the adoption of a complex experimental surgical-recording technology by surgeons in Swedish hospitals. The technology is complex, requires technological and surgical skills, and involves multiple healthcare stakeholders, including surgeons, operating theater staff, and patients. The primary data were collected via interviews with different stakeholders of the studied technology. The analyses revealed four categories of barriers that impact innovation adoption by healthcare professionals identified from the interviews:
“Human nature is always reluctant to change. Regardless of functional, behavioral, or user-oriented barriers, technological innovations must match an identified an unmet need. Failure to do so will lead to resistance in different layers of the decision-making process and, ultimately, prevent the adoption of innovations.”
• Functional barriers
These barriers are related to the perceived impact on performance or inability to perform tasks due to innovation characteristics. We identified two functional barriers: usage barriers (barriers related to the deviation between the value gained from the technology and the actual value gained from it) and privacy and legal barriers (barriers caused by the uncertain data storage and usage policies defined by the technology).
• Cultural barriers
The cultural barriers represented psychological barriers to the adoption due to changes being perceived as threats to existing traditions, and the way tasks are performed. The barriers include the threat of changing tradition, and new expectations and accountability.
• Institutional barriers
The institutional barriers at hospital level includes the lack of formal routines and policies on how the technology can be used and how the collected data can be controlled. These barriers included the lack of clear hospital-level policies regarding data usage and sharing and the lack of resources and infrastructural support for adoption and continued use.
• User-oriented barriers
These barriers are related to the user’s reaction to changes brought about by new technology. Users may react differently to barriers based on their idiosyncratic characteristics. These barriers can be classified into insufficient confidence in task-related skills and insufficient technological competence related to innovation.
A contingent framework for adoption and “hesitancy.”
The identified barriers affect resistance behaviors through multiple mechanisms and can interact with each other to influence a particular behavior intention. We also found a period of “hesitancy” when the user decided on their adoption behavior based on their perception of the identified barriers. This happens when barriers are not simultaneously high, and the user may engage in some form of adoption instead of outrightly resisting the MedTech innovation. We identified two adoption behaviors driven by hesitancy: uncensored and censored technology adoption. Uncensored adoption happens when users adopt the technology regardless of perceived barriers. We observed two types of uncensored adoption: enthusiastic technology adoption (when the user is aware of the barriers but is willing to adapt technology to secure the value of the technology use) and unwilling technology adoption (when the user is coerced into technology adoption by law or through social pressure). Censored adoption happens when users accept to use only that part of MedTech innovation that presents no barriers. This adoption can be case censored adoption (when users censor their adoption by restricting the frequency of technology use) or feature censored (when users accept certain technology functions that do not present barriers). Figure 1 provides a framework in which we summarize how barriers interact with each other and produce certain adoption behavior.
Implications for reducing barriers in MedTech innovation adoption
The adoption of new and complex technological innovations can bring several challenges for healthcare providers, especially surgeons, which can be managed proactively. Based on our research, we propose some practical implications and suggestions:
• A period of “hesitancy.”
Healthcare providers should be aware of the hesitancy-driven censored adoption behavior in MedTech innovation adoption. In this period, focusing on the barriers and risks perceived by healthcare professionals can encourage censored or even uncensored adoption of technological innovations.
• The contingency framework of barriers
Healthcare professionals can use the proposed contingency framework of barriers in technological innovation adoption to evaluate barriers related to adopting new and complex technological innovations and act proactively.
• The interaction of barriers
The identified barriers can interact with each other affecting resistance behaviour through multiple mechanisms. For example, when barriers are not simultaneously high, a lower level of one barrier can compensate for the higher level of another. This can help the user to engage in some form of technological adoption instead of resisting and can also serve as a basis for negotiating adoption with the hospital administration.
• Perception of other barriers and skills
Healthcare companies and hospital administrators should be aware that a high perception of barriers and low task-related skills can lead to the rejection of technology adoption. Therefore, highly skilled and experienced surgeons may be ideal targets for early adoption.