Technology Adoption in Care – What Are the Success Factors?(Part 3)

What conditions must be met for nurses to adopt technology, integrate it into their daily routines, and use it consistently? Researchers at BFH Health explored this question as part of an Innosuisse project named RAMOS. In a three-part series of articles, the research team provides insights into topics such as data utilisation, process design and technology adoption in practice.

In the first and second articles, we presented the technology (QUMEA) and how it works (part 2) as well as the opportunities and challenges associated with the introduction of QUMEA (part 1). In this third part, we will give you an insight into the results of the study, namely how the technology adoption of nursing staff in hospitals is demonstrated using the example of QUMEA and how their technology adoption can be even more successful in the future.

Understanding technology adoption – the theory

Technology adoption refers to the process by which a new technology is adopted, accepted and integrated into the daily routines of users. The theoretical frame of reference for the study was based on Everett Rogers’ diffusion theory (2008). In brief, this describes a multi-phase process through which different user groups either adopt or reject technological innovations. This adoption process is influenced by a wide variety of factors, such as social networks (advertising, peers), how the innovation is communicated about and the communication, opinions and experiences of others (Dykes et al., 2020; Rogers, 2008). Consequently, social, communicative and interactive processes are of particular interest when it comes to technology adoption among nurses.

From theory to practice: approach in the RAMOS project

The study considered both end-users working directly with the technology and those supporting its implementation. Between September 2023 and June 2024, 29 participants took part in a one-off interview or focus group. The study included 26 registered nurses from eight hospitals in German-speaking Switzerland who had been working with QUMEA for at least three months, as well as three customer advisors from QUMEA who supported the nurses and hospitals in the introduction of this system. All interviews and focus groups were transcribed and analysed using Braun and Clarke’s thematic analysis (2006).

This article focuses on four conditions for successful technology adoption using the example of QUMEA for nurses in acute care hospitals, see Figure 1.

Figure 1: Four conditions for successful technology adoption using the example of QUMEA in acute hospitals

The four conditions for success

1. Trust needs to be built, then the technology can lead to more relief, as it is trusted to provide ‘real’ support and ‘tasks’ can be handed over. For example, a nurse relies on the system at night and feels more secure because she has experienced in everyday clinical practice that a QUMEA alarm is triggered when a patient at risk of falling tries to get up. Thanks to this trust, the nurse avoids unnecessary rounds, which can also have a positive impact on the patient’s sleep.
2. Knowledge influences trust: Trust in a technology such as QUEMA depends heavily on how well nurses understand how it works. If they know how a technology works, there are fewer errors in its use. However, if this knowledge is lacking, errors occur more frequently, which impairs trust in the reliability of the technology, as illustrated by an illustrative example: a nurse did not know that moving the patient’s bed could result in the patient being outside the area detected by the sensor, meaning that meaningful monitoring is no longer possible. As a result, the alarm failed to sound when the patient got up. The nurses’ confidence in the system was weakened. As a result, nurses may tend to resort to using additional systems, such as a bell mat, to check the ‘new’ technology in terms of patient safety. If, on the other hand, the necessary knowledge is built up and confidence grows steadily, the next step can be to recognise the benefits of a technology in everyday life, such as a reduction in workload.
3. Relief – The benefit of QUMEA lies particularly in the perceived relief for nurses. During night shifts, for example, when fewer staff are available, the system provides information about restless patients who are at risk of falling due to unaccompanied mobility, e.g. standing up. Nurses intervene in a targeted manner if a corresponding alarm has been set for such patients. However, the qualitative analysis clearly showed that this perceived relief is not a matter of course, but has to be worked for. This means that a greater burden was initially perceived, as the number of alarms was high at the beginning and it first had to be understood how knowledge and trust could be built up in everyday life so that the relief could outweigh the additional burden of introducing technology.
4. The fourth condition for success relates to the relationship between the nurses, the QUMEA customer advisors and the technology, referred to as The customer advisors are the link between the technology and the users, and their relationship with the nurses has a strong influence on building and consolidating trust in the system. Their communication skills, their constant availability and their ability to empathise are useful and necessary strategies in the adoption of QUMEA.

These four conditions for success show that the functionality and technical quality of a technology, using QUMEA as an example, is not enough. The triad of building and maintaining knowledge, building trust through knowledge and application and the subjectively perceived relief in everyday clinical practice is central. However, this triad can only be successful if the technology provider works closely with the nursing staff and is present and interacts over a longer period of time.

In future, it will be necessary to clarify how training formats and structures should be optimised in practice in order to promote both technology adoption and the long-term use of technology by nursing staff and management. Only in this way can the utilisation potential of technological support by care professionals be fully exploited and used in the interests of patients.

Literature

• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
• Dykes, P. C., Lowenthal, G., Faris, A., Leonard, M. W., Hack, R., Harding, D., Huffman Whnp, C., Hurley, A., & An, P. (2021). An Implementation Science Approach to Promote Optimal Implementation, Adoption, Use, and Spread of Continuous Clinical Monitoring System Technology. Journal of Patient Safety, 17(1), 56-62. https://doi.org/10.1097/PTS.0000000000000790
• Rogers, E. M., Singhal, A., & Quinlan, M. M. (2008). Diffusion of Innovations. In An Integrated Approach to Communication Theory and Research (2nd ). Routledge.