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Technology adoption and implementation in organisations: comparative case studies of 12 English NHS Trusts
  1. Yiannis Kyratsis,
  2. Raheelah Ahmad,
  3. Alison Holmes
  1. Department of Infectious Diseases, National Centre for Infection Prevention and Management, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Yiannis Kyratsis; y.kyratsis{at}


Objectives To understand organisational technology adoption (initiation, adoption decision, implementation) by looking at the different types of innovation knowledge used during this process.

Design Qualitative, multisite, comparative case study design.

Setting One primary care and 11 acute care organisations (trusts) across all health regions in England in the context of infection prevention and control.

Participants and data analysis 121 semistructured individual and group interviews with 109 informants, involving clinical and non-clinical staff from all organisational levels and various professional groups. Documentary evidence and field notes were also used. 38 technology adoption processes were analysed using an integrated approach combining inductive and deductive reasoning.

Main findings Those involved in the process variably accessed three types of innovation knowledge: ‘awareness’ (information that an innovation exists), ‘principles’ (information about an innovation's functioning principles) and ‘how-to’ (information required to use an innovation properly at individual and organisational levels). Centralised (national, government-led) and local sources were used to obtain this knowledge. Localised professional networks were preferred sources for all three types of knowledge. Professional backgrounds influenced an asymmetric attention to different types of innovation knowledge. When less attention was given to ‘how-to’ compared with ‘principles’ knowledge at the early stages of the process, this contributed to 12 cases of incomplete implementation or discontinuance after initial adoption.

Conclusions Potential adopters and change agents often overlooked or undervalued ‘how-to’ knowledge. Balancing ‘principles’ and ‘how-to’ knowledge early in the innovation process enhanced successful technology adoption and implementation by considering efficacy as well as strategic, structural and cultural fit with the organisation's context. This learning is critical given the policy emphasis for health organisations to be innovation-ready.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Kyratsis Y, Ahmad R, Holmes A. Technology adoption and implementation in organisations: comparative case studies of 12 English NHS Trusts. BMJ Open 2012;2:e000872. doi:10.1136/bmjopen-2012-000872

  • Contributors YK and RA conceived the idea for the paper, and collected and systematically analysed all data. All three authors interpreted the data. YK designed the initial study and drafted the article, RA contributed to study design and all three authors revised it critically for important intellectual content. All three authors approve the content of the manuscript submitted.

  • Funding This study is an independent study that was funded by the DH. The DH influenced the execution of the study as follows: the award from DH came with an agreement in principle with the trusts to participate in the study. Access to the participating trusts in the first instance was via DH by means of an introductory letter sent by Sue Smalley from DH. The trusts were then approached by a member of our research team. The researchers did provide update to DH on progress regards access and spend on technologies. The DH had no other interference in the design, execution and interpretation of findings.

  • Competing interests All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval Ethical approval was not required for the study under NHS research governance arrangements (letter dated 23 April 2009 by Hammersmith and Queen Charlotte's and Chelsea Research Ethics Committee). The research was classed as service evaluation by the chairman of the committee. Access to the participating trusts was via DH in the first instance through an introductory letter. The trusts were then approached by a member of our research team. The project lead and IPC teams in each trust further facilitated access to those involved in the decision-making, procurement and implementation of the selected technologies. Prior informed consent to join the study was obtained in writing by participating individuals. Yiannis Kyratsis (Author 1) and Raheelah Ahmad (Author 2) conducted the interviews, both experienced qualitative researchers with no prior relationship with the informants. Interviews were guided by a topic guide. All interviews, but one, were audio-recorded. Audio-recorded interviews were transcribed verbatim by professional transcribers and then checked by the researchers for accuracy. Primary data were anonymised and stored securely on password-protected computers prior to processing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data available.