Exploring the Configuration of Institutional Practices—A Case Study of Innovation Implementation in Healthcare

Abstract

In this study we provide a fine-grained description of the micro-processes of innovation through a qualitative study of the implementation of telemedicine innovation in a healthcare organization. Our qualitative analysis uses a mix of participant interviews, observation techniques and archival data sources. We use the concept of translation to describe the movement of ideas and practices through social interrelationships. Our results suggest that the implementation of innovation involving changes in extant institutional practices is a result of a translation during which actors assess not only their specific role within a given institutional practice but also how their actions influence the broad outcome. Our results bring to the fore the role that interactions between organizational actors and institutional practices play in the implementation of innovation. Consistent with the translation perspective, our results suggest that the implementation of innovation is mainly an organizational change process facilitated by a concurrence of meaning or the lack of it lack among organizational actors. Our study provides new evidence on the institutional practices that are created, maintained, modified as well as disrupted during the implementation of externally developed innovation.

Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers

“…Problems associated with Internet access and connectivity ( 17 , 19 - 21 , 23 , 26 ), the need for specialized equipment and software (e.g., smartphone, camera, among others) ( 16 , 21 , 26 , 29 , 32 ), as well as having the technical skills in the use of technological tools to provide and receive virtual service delivery ( 17 , 22 , 25 , 30 , 33 ) were the main barriers associated with the care process in the studies analyzed (n=14). Although the lack of connectivity during virtual care was a recurring complaint among patients, non-attendance at virtual appointments did not exceed 5% of cases ( 20 ), but it was recognized as a factor that increases the perception of poor clinical care ( 21 , 28 ).…”

“…Although the lack of connectivity during virtual care was a recurring complaint among patients, non-attendance at virtual appointments did not exceed 5% of cases ( 20 ), but it was recognized as a factor that increases the perception of poor clinical care ( 21 , 28 ). From the point of view of healthcare workers, the lack of specialized software and equipment for the correct professional practice and issues of interoperability with existing institutional programs were identified as factors that affect productivity and generate the perception of work overload due to the additional procedures required compared to face-to-face care ( 21 , 26 , 29 ). Additionally, because it is not common to receive training in telemedicine during professional training ( 33 ), the requirement for additional specialized courses during professional practice was perceived as a constraint to adoption and willingness to adopt the virtual model ( 30 ).…”

“…The limitation of performing a complete and exhaustive physical examination was identified as a barrier in five studies ( 16 , 22 , 29 , 32 , 34 ) mainly when virtual care was used in patients with neurological pathologies, older adults, and in those requiring a physical rehabilitation process. During the diagnostic process of most pathologies, performing a physical examination is important, both to confirm and to rule out suspicion.…”

“…For example, some authors believe that the use of the virtual care model should not be used initially in the diagnosis of neurological disorders due to the need for physical and cognitive testing to confirm the condition and to evaluate the evolution of patients during follow-up ( 16 , 34 ). In addition, it was also reported that gynecology and dentistry services may be limited during routine practice ( 21 , 29 ). From the patient’s perspective, this barrier also meant that the virtual care model was perceived as insufficient, requiring a complementary face-to-face consultation ( 22 ).…”

“…Four studies identified barriers to the use of the virtual care model associated with healthcare personnel’s beliefs or perceptions about service delivery ( 18 , 28 , 29 , 32 ). Among clinicians, a concern about the benefit or effectiveness of the care model in treating patients’ health conditions was identified ( 28 ), which consequently led to an increased perception of the risk of committing medical malpractice and jeopardizing patient safety ( 33 ).…”