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Past Research Projects

PATH Project

Pathways to Adoption of Technology in Healthcare

Funder: UK’s National Institute of Health Research (NIHR) Service Delivery & Organisation Programme.
Timeline: May 2009 to October 2011.
Investigators: Dr A Faulkner (PI) at King's College London, Prof G Elwyn and Ms Z Tomlin at Cardiff University.

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 this 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, Evidence, Promotion, and Gatekeeping. 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' is compiled for each case. It documents retrospectively key events that have shaped the early pathway, then developments are being 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 datacollection: 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 datacollection (wider network and adoptive NHS site) are an organising principle of the analysis.

Mid-way through the project we present interim analysis and model development to select research users, to debate the evolving model. Both descriptive and explanatory analytic techniques are being 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 develop the conceptual model of the adoption space and strengthen its explanatory power for understanding the determinants of early adoption-evaluation pathways.

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