Hospital contextual factors affecting the implementation of health technologies: a systematic review

Abstract

Background To keep a high quality of assistance it is important for hospitals to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though guidance exists on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs. Methods We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs. PubMed, Scopus, Web of Science, Econlit and Ovid Medline electronic databases were searched to retrieve articles published in English and Italian from January 2000 to January 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Programme checklist for qualitative studies, Newcastle-Ottawa Scale for the cross-sectional studies and the Mixed Methods Appraisal Tool for mixed method studies. Results We included 33 articles, which were of moderate to high methodological quality. The included articles mostly addressed the contextual factors that impact the implementation of information and communication technologies (ICTs). Overall, for all HTs, the hospital contextual factors were part of four categories: hospital infrastructure, human resource management, financial resources and leadership styles. Conclusion Our systematic review reported that the contextual factors influencing the HTs utilization at hospital level are mainly explored for ICTs. Several factors should be considered when planning the implementation of a new HTs at hospital level. A potential publication bias might be present in our work, since we included articles published only in English and Italian Language, from January 2000 to January 2019. There remains a gap in the literature on the facilitators and barriers influencing the implementation and concrete utilization of medical and surgical HTs, suggesting the need for further studies for a better understanding.

The “Lazio ADVICE” telemedicine platform: First results of general practitioners’ usage, facilitators and barriers in the Local Health Authority Roma 1

“…Although digital tools (such as telemedicine, patient portals, and smartphone applications) aim to improve the quality of care, the contextual factors, such as infrastructures, human resource management, financial resources, and leadership styles, influence the utilization of these technologies 27 and impact on health outcomes, system efficiency, and patient satisfaction. 28 , 29 The COVID-19 pandemic showed the need to use these tools, which should be completely integrated into healthcare systems.…”

Factors influencing patient experience in hospital wards: a systematic review

“…Numerous studies have con rmed the positive impact of appropriate healthcare sta ng on outcomes, such as mortality, readmission rates, and staff burnout [169,170], indicating that both patients and staffs could bene t from effective sta ng. Therefore, future research should strive to explore mechanisms to match staff numbers and skill sets with patient needs in a complex and dynamic hospital context to improve clinical outcomes [171].…”

Expectation and acceptance of clinical decision support systems: A survey study among nephrologist end-users

“…Another important aspect of this module was the resistance to change of a nephrologist's workday. Here, 40% of all participants were opposed to any changes, an aspect that has been seen during the implementation process of CDSS before [44], bringing up the necessity to carefully describe and collect contextual factors important for practice changes before CDSS implementation [45,46]. Overall, nephrologists did recognize the usefulness of CDSS, which is a common theme on the perception of CDSS by health care professionals [47].…”