Organizational factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework

Abstract

Objective

The paper presents an application of the “Fit between Individuals, Task and Technology” (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain.

Method

The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete.

Results

The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use.

Conclusion

The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.

Introduction

Healthcare is a sector that currently experiences a number of pressures, both from inside and outside. The continuing innovation in medicine and technologies result in new methods and tools in healthcare. The demographic changes of an ageing European population, combined with citizen empowerment, stretch the limits of what countries can afford to offer as services of their national health systems. As a result, governments are confronted by the urgent need to find means to limit the rise in healthcare costs without compromising quality, equity and access. Consequently, new ways to organize and deliver health services are being investigated and experimented with. Citizens and patients are given more responsibility in the management of their own health and chronic illnesses, leading to the gradual creation of a more informed citizen.

As a consequence of this gradual re-organization of healthcare, hierarchies are giving way to partnerships; process-centered healthcare is becoming patient-centered care; and consumer healthcare is emerging as a significant driver in the sector [1]. In today's challenging, dynamic, information and knowledge-intensive environment, it is not surprising that information and communication technologies (ICT) are viewed as central to any strategy aimed at raising productivity, controlling costs and improving care. In addition, integration of the various organizations delivering health and/or social care into Regional Health Information Networks (RHIN) is a central objective of many national and regional healthcare administrations. Central to these efforts is the provision of innovative eHealth services. Several studies and research efforts have documented eHealth “best practice” examples¹ and the adoption patterns.

However, little attention has been paid, in our view, to the considerable risk arising from not taking into account the organizational and social context of ICT implementations that often fail to reach initial objectives.

Effective technology adoption or diffusion requires adaptation of work practices, reorientation, and organizational change far beyond what is initially apparent [2] especially in the knowledge-intensive sector of medical practice. The various units of healthcare organizations have a substantial degree of autonomy, and established professional practice that are difficult and expensive to replace. In organizations that typically have strong central control, such as banking, IT is usually uniform and centralized. In healthcare organizations, where strong peripheral initiative is allowed or even encouraged, there is much less central control and a significant diversity of practice. Attempts to achieve common systems create tension between central interests in uniformity and local sensitivity to operational priorities.

The task of introducing or transferring information technology in large, complex organizations reliant on highly professional workers, such as doctors and nurses, requires an in depth analysis of organizational factors that influence implementation. Several theoretical models have been used to explain the factors that influence implementation of IT in organizations. However, frameworks, such as the Technology Acceptance Model [3] or the Technology-Task Fit [4] model often neglect to account for the interaction between user and task, failing to address a very important aspect of fit within organizations.

The “Fit between Individuals, Task and Technology” (FITT) [5] framework is based on the idea that IT adoption in a clinical environment depends on the fit between the attributes of the individual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability, functionality, performance), and attributes of the clinical tasks and processes (e.g. organization, task complexity). The inclusion of the user-task dimension renders the FITT model as a useful framework to analyze technology adoption in organizations.

This paper applies the FITT model in the retrospective analysis of HYGEIAnet, a 15-year implementation effort of eHealth services in the RHIN on the island of Crete. The objectives of the case study are to (a) show the usefulness of the FITT framework in explaining the observed implementation successes and failures, and (b) the identification of factors that influence the adoption and diffusion of innovative ICT throughout a distributed health. The paper does not attempt an exhaustive review of either the technology evaluation or management literature or an in depth analysis of the medical informatics aspects of the systems implemented. It focuses on the analysis of success and failure in technology adoption and transfer using a specific conceptual framework as a way of gaining greater understanding of the complexity of the process.