Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study

Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Sue Llewellyn [verfasserIn] Rob Procter [verfasserIn] Gill Harvey [verfasserIn] Gregory Maniatopoulos [verfasserIn] Alan Boyd [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2014

Schlagwörter:	technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging

Übergeordnetes Werk:	In: Health Services and Delivery Research - National Institute for Health Research, 2017, 2(2014), 23
Übergeordnetes Werk:	volume:2 ; year:2014 ; number:23

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc Journal toc

DOI / URN:	10.3310/hsdr02230

Katalog-ID:	DOAJ033127611

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520			\|a Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
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allfields	10.3310/hsdr02230 doi (DE-627)DOAJ033127611 (DE-599)DOAJa845bef7be83414b9b1aca745284110f DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Sue Llewellyn verfasserin aut Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging Public aspects of medicine Medicine (General) Rob Procter verfasserin aut Gill Harvey verfasserin aut Gregory Maniatopoulos verfasserin aut Alan Boyd verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 2(2014), 23 (DE-627)1760647098 20504357 nnns volume:2 year:2014 number:23 https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/article/a845bef7be83414b9b1aca745284110f kostenfrei https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 2 2014 23
spelling	10.3310/hsdr02230 doi (DE-627)DOAJ033127611 (DE-599)DOAJa845bef7be83414b9b1aca745284110f DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Sue Llewellyn verfasserin aut Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging Public aspects of medicine Medicine (General) Rob Procter verfasserin aut Gill Harvey verfasserin aut Gregory Maniatopoulos verfasserin aut Alan Boyd verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 2(2014), 23 (DE-627)1760647098 20504357 nnns volume:2 year:2014 number:23 https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/article/a845bef7be83414b9b1aca745284110f kostenfrei https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 2 2014 23
allfields_unstemmed	10.3310/hsdr02230 doi (DE-627)DOAJ033127611 (DE-599)DOAJa845bef7be83414b9b1aca745284110f DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Sue Llewellyn verfasserin aut Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging Public aspects of medicine Medicine (General) Rob Procter verfasserin aut Gill Harvey verfasserin aut Gregory Maniatopoulos verfasserin aut Alan Boyd verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 2(2014), 23 (DE-627)1760647098 20504357 nnns volume:2 year:2014 number:23 https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/article/a845bef7be83414b9b1aca745284110f kostenfrei https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 2 2014 23
allfieldsGer	10.3310/hsdr02230 doi (DE-627)DOAJ033127611 (DE-599)DOAJa845bef7be83414b9b1aca745284110f DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Sue Llewellyn verfasserin aut Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging Public aspects of medicine Medicine (General) Rob Procter verfasserin aut Gill Harvey verfasserin aut Gregory Maniatopoulos verfasserin aut Alan Boyd verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 2(2014), 23 (DE-627)1760647098 20504357 nnns volume:2 year:2014 number:23 https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/article/a845bef7be83414b9b1aca745284110f kostenfrei https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 2 2014 23
allfieldsSound	10.3310/hsdr02230 doi (DE-627)DOAJ033127611 (DE-599)DOAJa845bef7be83414b9b1aca745284110f DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Sue Llewellyn verfasserin aut Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme. technology adoption nhs technology adoption centre payment by results insulin pump therapy breast lymph node assay ultrawide field retinal imaging Public aspects of medicine Medicine (General) Rob Procter verfasserin aut Gill Harvey verfasserin aut Gregory Maniatopoulos verfasserin aut Alan Boyd verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 2(2014), 23 (DE-627)1760647098 20504357 nnns volume:2 year:2014 number:23 https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/article/a845bef7be83414b9b1aca745284110f kostenfrei https://doi.org/10.3310/hsdr02230 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 2 2014 23
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title_auth	Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study
abstract	Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
abstractGer	Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
abstract_unstemmed	Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
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title_short	Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study
url	https://doi.org/10.3310/hsdr02230 https://doaj.org/article/a845bef7be83414b9b1aca745284110f https://doaj.org/toc/2050-4349 https://doaj.org/toc/2050-4357
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author2	Rob Procter Gill Harvey Gregory Maniatopoulos Alan Boyd
author2Str	Rob Procter Gill Harvey Gregory Maniatopoulos Alan Boyd
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doi_str	10.3310/hsdr02230
callnumber-a	RA1-1270
up_date	2024-07-03T15:58:34.404Z
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