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The adoption space of early-emerging technologies: evaluation, innovation, gatekeeping (Pathways to Adoption of Technologies in Healthcare - PATH)

Tomlin, Zelda, Peirce, Susan Caroline, Elwyn, Glyn and Faulkner, Alex 2013. The adoption space of early-emerging technologies: evaluation, innovation, gatekeeping (Pathways to Adoption of Technologies in Healthcare - PATH). [Project Report]. Southampton: National Institute of Health Research. Available at:

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Aims: the research aims to provide an empirical, robust foundation for the broader task of identifying the factors involved in appropriate technology adoptive practice. It focuses on understanding and explaining adoptive behaviour in key early-emerging technologies. It provides a major set of documented case studies as resources for the NHS/Service Delivery & Organisation R&D community, and informs the development of a context-sensitive conceptual model for understanding and potentially planning adoption-evaluation pathways. It identifies alignments of factors in the early adoptive process that enable or control adoption in a variety of settings. This involves innovatory forces outside the NHS such as commercial device producers and the private healthcare sector. Methodology: in a 30-month multi-method project, we undertake a set of four detailed in-depth multi-method qualitative case studies (in wound care, chronic back pain, anticoagulation monitoring, and prostate cancer surgery), augmented by a further four less detailed case studies to extend generalisability. We will develop a typology of technologies, and in consultation with research-users and stakeholders, we will develop a new conceptual model of what we term the adoption space', validating it against the case study data. The model will identify the key parameters, and the salient drivers within them, through which early-emerging technologies take distinct pathways into healthcare. The initial conceptualisation of the model is based on actor-network theory/Science and Technology Studies and methodological health services research, and our own recent case studies of device innovation/governance. The model's core working parameters are: Technology, Network, Promotion, Gatekeeping, and Evidence. The research is distinct in giving artefactual technology itself due recognition as a factor shaping adoption pathways. Data collection: a baseline state of evidence and adoption' will be compiled for each case. It will document retrospectively key events that have shaped the early pathway, then developments will be tracked prospectively in real-time through the project's duration. A variety of ethnographic data-collection methods are used including observation, documents and semi-structured interviewing with key informants. There are two levels of data-collection: the technology-specific network', including extra-NHS actors, and the intra-NHS level, where fieldwork is undertaken in two separate organisational sites for each of the four technologies. For the additional four rapid appraisal' cases, key informant and documentary methods are used. Analysis: The key principle of the analysis is to provide for cycles of iteration between case study analysis and development of the adoption space model. The two levels of data-collection (wider network and adoptive NHS site) are an organising principle of the analysis. Mid-way through the project we will present interim analysis and model development to select research users, to debate the evolving model. Both descriptive and explanatory analytic techniques will be applied. We deploy standard qualitative case study data analysis techniques, and discourse analysis. The study design enables within-case and cross-case comparative analyses, including between organisational settings for the same technology; and inter-technology comparisons. Cross-case syntheses and comparisons will develop the conceptual model of the adoption space and strengthen its explanatory power for understanding the determinants of early adoption-evaluation pathways.

Item Type: Monograph (Project Report)
Date Type: Publication
Status: Published
Schools: Engineering
Subjects: R Medicine > R Medicine (General)
T Technology > TA Engineering (General). Civil engineering (General)
Additional Information: Final report for the project funders.
Publisher: National Institute of Health Research
Funders: NIHR Service and Delivery and Organisation Programme
Last Modified: 17 Jun 2017 08:57

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