Organizational Tensions in the Implementation of Modifiable Off-the-Shelf Technologies in a University Hospital: Qualitative Multimethod Study.

backgroundHospitals face increasing pressure to accelerate digital transformation. Modifiable off-the-shelf technologies (MOTs) combine standardized products with limited adaptability, offering promising opportunities for rapid digitalization. However, implementing MOTs in complex hospital settings involves multiple barriers, facilitators, and organizational dynamics that require deeper investigation.

objectiveThis study identifies barriers and facilitators in the implementation of MOTs in hospitals and explores how organizational dynamics, conceptualized as tensions, emerge throughout this process.

methodsGuided by a constructivist-interpretivist paradigm, the study followed a collaborative action research approach. A qualitative multimethod design was used, including observations, workshops, and focus groups with clinical and project management staff. Data were analyzed using deductive-inductive qualitative content analysis following Kuckartz's approach.

resultsWe analyzed 12 deidentified researcher protocols from 5 observations, 3 workshops, and 4 focus groups. Across these activities, 129 individuals from various wards and departments participated. Barriers and facilitators were clustered into 6 categories representing inhibiting and enabling conditions of MOT implementation. Barriers included product limitations (22.6%, 88/390), misaligned implementation process (4.4%, 17/390), absence of available individuals (3.8%, 15/390), structural challenges (2.8%, 11/390), and resource constraints (2.8%, 11/390). Facilitators included orchestrated implementation process (13.8%, 54/390), product alignment (14.4%, 56/390), effective coordination and communication (9.2%, 36/390), presence of available individuals (6.7%, 26/390), available resources (3.1%, 12/390), and structural assets (1.8%, 7/390). These categories were conceptualized into 3 organizational tensions: limited relative advantage of generic systems, structured participation challenges in complex settings, and constrained engagement despite motivation due to limited resources.

conclusionsTensions in MOT implementation reflect organizational misfits that go beyond concrete barriers or facilitators and instead require systemic and agile organizational structures. The analysis introduces the concept of user:ability as an organizational capacity for enabling engagement with MOTs. We derive 3 tailored strategies to mitigate the tensions: ensuring relative advantage through IT integration and learning; empowering user participation through digital transformation and communication; and enabling clinician engagement through dedicated resources and systematic implementation. This study advances prior work by deepening the understanding of implementation determinants into organizational tensions and offering actionable strategies to address them. It also illustrates how collaborative, agile research approaches can illuminate complex organizational dynamics and support hospitals during transformative change.