Technology acceptance, acceptability and appropriation in professional bureaucracies: The case of RFID for improving mobile assets management in hospitals

Hospitals, even small ones, handle on a daily basis several thousands of mobile and fixed assets. Mobile assets are very diverse, ranging from infusion pumps, surgical equipment, electrocardiograms, portable x-ray machines, defibrillators to wheelchairs and rotate constantly between different medical wards. Since virtually every patient depends on one or more mobile assets during his or her hospital stay, they are also indispensable in healthcare delivery. Clinical staff spends a significant share of their working time searching for these essential, but commonly misplaced assets. Locating mobile assets is not only a time consuming activity, but the inability to find them when needed is remarkably costly, and possibly life threatening.;RFID (Radio Frequency Identification) holds the potential to uniquely and seamlessly track and trace mobile assets and, thus, to improve mobile asset management in hospitals. Compared to other sectors, healthcare organizations adopt RFID at a much slower pace and only a limited number of empirical studies address RFID adoption and implementation in the context of healthcare. This thesis intends to contribute the research arena by analysing a real-life RFID implementation in order improve the management activities of one type of mobile assets, namely infusion pumps in hospital settings.;The research focuses on a real-life RFID implementation in one European hospital. Empirical data was collected for a 25 month period from the pre-feasibility stage to post-implementation stage from eight organizations (including the hospital as the main observation site) and from thirty-five participants. Research results can be summarized as follows.;To the question why RFID is implemented? The most straightforward answer is to reduce the existing inefficiencies related to mobile assets management. Technological preparedness and readiness drive RFID implementation: This includes familiarity with IT innovations within the hospital, compatibility with existing IT infrastructure (the hospital is almost 100% Wi-Fi enabled), and experience of technological partners with RFID implementation in various sectors.;How RFID implementation is carried out? The answer seems to be through a highly iterative five stage process where participants revisited and modified previously agreed steps. The continuous improvement of care services was without a doubt the superseding concern expressed by all participants from the hospital. However, expectations and requirements differ among different groups of participants. The empirical evidence demonstrates not only a cleavage between the administrative and clinical perspectives, but also within the clinical perspective. Divergences run deep within each perspective (for instance, nurses vs. doctors) and between the technologists in the hospital (ICT managers, biomedical engineers, and maintenance specialists) and the administrators. The most significant issues related to such implementation are not technological but are mainly organizational, as they seem to arise from the presence of diverging perspectives.;Does RFID really improve mobile assets management? Results suggest that the benefits identified and evaluated during the real life RFID implementation belong to the following broad categories: improving assets visibility, promoting operational efficiency, reducing costs and facilitating the emergence of intelligent processes. Intelligent processes are mainly derived from the RFID capabilities for auto-identification and context-awareness, process automatic status change, and automatic update in hospital's enterprise applications (i.e. WMS). Results further demonstrate that intelligent processes improve planning and decision-making.;Do the intrinsic characteristics of organizations play a role in RFID implementation? The very characteristics of hospitals, qualified as complex professional bureaucracies, constitute a unique set of constraints to be taken into account for RFID implementation. In particular, organizational inertia, complexity and inflexibility are not conductive to hospital-wide changes and affect how RFID is implemented. Moreover, the existence of a dual power structure and a tendency to culture entrapment may have a profound impact on the importance of the benefits derived from RFID.;Do technology acceptance, acceptability and appropriation represent key concepts that should be considered to understand the implementation of RFID? These three concepts were explored in the research. This leads to two main observations. First, it could be stated that if technology is accepted, acceptable and appropriated, then it is fully used. By extension, acceptance, acceptability and appropriation could be significant not only in explaining the extent of use of a technology (partial use vs. full use), but also the reasons why a technology was initially adopted and then discarded. Second, empirical results reject the presence of a chronological order between the three concepts. For instance, appropriation does not follow acceptance, even initially. Rather, acceptance, acceptability and appropriation coexist at any time during the implementation process. However, chronology still matters since the levels of acceptance, acceptability and appropriation vary over time. Furthermore, these three concepts are sensitive to both the technology (in this case RFID) and to the context where it is use (the hospital), which are also changing over time. (Abstract shortened by UMI.).