BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

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Citation for published version (APA): van der Laan, M. R. (2015). The feasibility of modularity in professional service design: Towards low cost person-centred care [Groningen]: University of Groningen, SOM research school

Telecare is the use of information and communication systems to facilitate care delivery to individuals in their homes. Although the expectations of telecare are high, its implementation has proved complex. This case study demonstrates this complexity through a structurational analysis of a telecare implementation process. The paper shows how structuration concepts enable a combined analysis of actors' interactions with a technology and of the interaction among these actors from different institutional contexts. In this example, fragmented multi-actor agency induced an inconsistent implementation mode, leading to unsuccessful telecare appropriation. This paper concludes with a preliminary proposal for more consistent telecare implementation modes. These modes may better support the actors' reflexive monitoring and dialogue and inform further research.

Governing IT while incorporating stakeholders with diverse institutional backgrounds remains a challenge. Stakeholder groups are typically socialized differently and may have different perspectives on IT governance dilemmas. Yet, extant literature offers only limited insight on socialized views on IT governance. This study uses an institutional logics lens to examine how competing institutional logics get connected in IT governance practices through dominant stakeholders' enactment patterns and how these enactment patterns may affect the organization's IT performance. We find that logics were coupled to the three dominant stakeholder groups, but only loosely so. Congruence between the three logics they enacted depended on the IT governance dilemma at hand. Our findings demonstrate how within a triad of competing logics, switching rivalry among hybrid logics may develop. Here, the enactments led to two hybrid logics, none of which became dominant. Remarkably, the IT professionalism logic accommodated polarization between medical professionalism and the managerial logic, causing unstable IT governance. We propose that IT professionalism offers room for agency and is crucial in determining the resulting enactment patterns: polarizing, compromising or even synthesizing. This study may raise managers' awareness of the competing logics underlying IT governance practices and clarify the pivotal role of IT professionalism in IT governance debates.