DEPARTMENT OF TECHNOLOGY MANAGEMENT AND ECONOMICS 

DIVISION OF ENTREPRENEURSHIP AND STRATEGY 

 

CHALMERS UNIVERSITY OF TECHNOLOGY 

Gothenburg, Sweden 2023 

www.chalmers.se 
Report No. E2023:016 

Organizational Barriers to the 
Adoption of New Digital 
Technologies in Public Healthcare  
A Case of Citizen-initiated Remote Monitoring at 

Sahlgrenska University Hospital  

 
Master’s thesis in the Master Degree Program Management and Economics of 

Innovation 

 

GUSTAF SVENNUNG 

OLLE MUNKEVIK 

 

 



 
 
 
 
 

 
 
1 
 

  

 



 

 
REPORT NO. E2023:016 

 

 

 

 

 

 

 

 

 

Organizational Barriers to the Adoption of New 

Digital Technologies in Public Healthcare  

 
A Case of Citizen-initiated Remote Monitoring at Sahlgrenska 

University Hospital  

 

GUSTAF SVENNUNG 

OLLE MUNKEVIK 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department of Technology Management and Economics 

Division of Entrepreneurship and Strategy 

CHALMERS UNIVERSITY OF TECHNOLOGY 

Gothenburg, Sweden 2023  



 

 

 

 

 

 

 

 

 

 

 

 

Organizational Barriers to the Adoption of New Digital Technologies in Public Healthcare  

A Case of Citizen-initiated Remote Monitoring at Sahlgrenska University Hospital  

GUSTAF SVENNUNG 

OLLE MUNKEVIK 

 

 

© GUSTAF SVENNUNG, 2023. 

© OLLE MUNKEVIK, 2023. 

 

 

Report no. E2023:016 

Department of Technology Management and Economics 

Chalmers University of Technology 

SE-412 96 Göteborg 

Sweden 

Telephone + 46 (0)31-772 1000 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gothenburg, Sweden 2023



 

Organizational Barriers to the Adoption of New Digital Technologies in Public 

Healthcare  

A Case of Citizen-initiated Remote Monitoring at Sahlgrenska University Hospital  
 

GUSTAF SVENNUNG 

OLLE MUNKEVIK 

 

Department of Technology Management and Economics 

Chalmers University of Technology 

 

 

 

SUMMARY 

 

Swedish healthcare is facing a huge increase in demand for care due to demographic changes in the 

nation. With the number of healthcare workers not increasing at the same pace, there is an imminent 

issue that will keep getting worse over time. In order to help solve this problem, adoption of digital 

technologies and more efficient ways of working are needed. However, in public healthcare, different 

barriers exist which hinder the adoption of digital technologies in different ways. Significant additional 

value could be attained if these barriers are identified and overcome.   

 

The aim of this study is to identify organizational barriers to adoption of digital technologies in Public 

Healthcare in Sweden, and provide recommendations to help overcome them. The research approach 

used in this study is a qualitative study of a single case organization, Sahlgrenska University Hospital. 

Academic literature was identified and analyzed, and empirical data was collected through semi-

structured interviews with employees at the case organization, as well as individuals from Region Västra 

Götaland. The empirical data was then contrasted and analyzed in relation to the academic literature.  

 

The findings show several organizational barriers that affect the organization. These barriers cover a 

wide range of issues; the absence of a clear career path for innovation, limitations in value realization 

regarding the Innovation Platform, short-term savings having precedence over long-term innovation 

effects, insufficient information diffusion and collaboration, the dilemma of research evidence, complex 

and unclear decision paths, and varying visions and priorities of managers. To be able to overcome the 

barriers and foster a more innovative culture, improving the adoption of digital technologies, some 

recommendations have been proposed. First, establishing a defined career path within the organization 

for working with innovation could improve the innovation culture, by creating a more structured way of 

working with innovation. Further, creating an environment for facilitating more collaboration between 

healthcare workers and developers of new technologies and solutions is of importance. This would ensure 

solutions meet the users’ needs and are more user-friendly, hence improving adoption and easing 

implementation. Creating an innovation culture throughout the organization that mirrors the high 

importance the top management has on innovation is of huge importance, in order to align the 

organization. Establishing an innovation forum including information sharing, collaboration, joint 

problem-solving, and examples of successful innovation projects could help facilitate this. Also, aligning 

all levels of management on the importance of innovation in the organization is also crucial, since 

department managers have a high influence on their operation, and hence how much focus is on 

innovation.  

 

By addressing the identified barriers and working within the organization to overcome them, the adoption 

of new technologies and solutions has great potential to improve. This would improve responsiveness 

within public healthcare, making it more susceptible toward new and improved technologies and 

solutions, which would improve patient care and thereby increase societal value.  

 

 

 

 

Keywords: telemedicine, remote monitoring, mHealth, health data, organizational barriers, public 

healthcare, digital technologies, adoption, implementation  



 

 
 

 
  



 
 
 
 
 

 
 
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Acknowledgements 
 
First, we would like to thank our supervisor from Chalmers University of Technology, 

Ida Eyi Heathcote-Fumador, for her support and guidance throughout the entire process 

of the thesis. 

 

Also, we would like to thank our supervisors at Sahlgrenska University Hospital, Jonas 

Landahl and Max Olofsson, for their guidance. Thank you for your commitment 

throughout the process and for contributing with your insights. Your input has been 

very valuable.  

 

Lastly, we would like to thank everyone who participated in the interviews and 

contributed with their time and valuable information. It would not have been possible 

without your contributions.   

 

A big thanks to you all! 

 

Gustaf Svennung & Olle Munkevik 

Gothenburg, June 2023 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  

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Table of Contents 

Acknowledgements                             i 

Table of Contents              ii 

List of Tables and Figures                                                                                                                      iv 

1. Introduction ........................................................................................................................................................ 1 

1.1 Background ..................................................................................................................................................................... 1 

1.2 Aim ...................................................................................................................................................................................... 3 

1.3 Limitations ....................................................................................................................................................................... 3 

1.4 Specification of issue under investigation.......................................................................................................... 4 

2. Literature Review ............................................................................................................................................. 5 

2.1 The Healthcare Industry in General .................................................................................................................... 5 

2.2 Digitalization in the Healthcare Industry in General ................................................................................... 5 

2.3 Telemedicine in Sweden............................................................................................................................................. 7 

2.4 Organizational Barriers to Adoption of digital technologies in the Healthcare Sector ................. 8 
2.4.1 Structural Barriers ............................................................................................................................................ 8 
2.4.2 Managerial Barriers ...................................................................................................................................... 10 
2.4.3 Individual & Cultural Barriers ................................................................................................................ 11 

2.5 Overcoming Organizational Barriers to Adoption of digital technologies in the Healthcare 

Sector .......................................................................................................................................................................................14 
2.5.1 Structural Barriers ......................................................................................................................................... 14 
2.5.2 Managerial Barriers ...................................................................................................................................... 15 
2.5.3 Individual & Cultural Barriers ................................................................................................................ 16 

3. Methodology .....................................................................................................................................................19 

3.1 Research Design ..........................................................................................................................................................19 

3.2 Case Description .........................................................................................................................................................19 

3.3 Case Organization ......................................................................................................................................................20 

3.4 Data Collection ............................................................................................................................................................21 

3.5 Data Analysis ................................................................................................................................................................23 

3.6 Research Quality .........................................................................................................................................................24 
3.6.1 Reliability ............................................................................................................................................................ 24 
3.6.2 Replicability ....................................................................................................................................................... 24 
3.6.3 Analytical Generalization ........................................................................................................................... 25 

3.7 Ethical Considerations .............................................................................................................................................25 

4. Empirical Findings .........................................................................................................................................26 

4.1 Structural Barriers .....................................................................................................................................................26 
4.1.1 Organization ...................................................................................................................................................... 26 
4.1.2 Standardization & Evidence ...................................................................................................................... 36 
4.1.3 Processes & Routines .................................................................................................................................... 40 
4.1.4 Teamwork & Collaboration....................................................................................................................... 42 

ii 



 
 
 
 
 

 
 
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4.2 Managerial Barriers ..................................................................................................................................................44 
4.2.1 Management Support & Leadership ..................................................................................................... 44 

4.3 Individual & Cultural Barriers .............................................................................................................................47 
4.3.1 Individual ............................................................................................................................................................ 47 
4.3.2 Culture .................................................................................................................................................................. 50 

5. Discussion ..........................................................................................................................................................52 

5.1 The Innovation Culture is Hampered by Insufficient Innovation Career Opportunities ...........52 

5.2 The Positive Effects of the Innovation Platform may not be Captured to the Full Extent .........53 

5.3 Healthcare Workers must be Supported regarding New ways of Working .......................................54 

5.4 A Tough Environment shifts the focus from Long-term Investments toward Short-term 

Savings ....................................................................................................................................................................................55 

5.5 An Innovation Forum could give several Positive Effects ........................................................................55 

5.6 The Dilemma of Research Evidence ..................................................................................................................56 

5.7 Resistance to Change can be tackled through Collaboration and Participation ............................56 

5.8 Visions and Priorities of Managers form Innovation in the Organization .......................................57 

5.9 Potentially valuable Innovation Projects often stay Local ........................................................................58 

5.10 Unvalidated Tools and Resource Deficiencies can influence the Adoption of New 

Technologies negatively ..................................................................................................................................................58 

6. Conclusions .......................................................................................................................................................60 

6.1 Research Contribution and Future Research ................................................................................................61 

References ..............................................................................................................................................................63 

Appendix A: Interview Guide ..........................................................................................................................70 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

iii 



 
 
 
 
 

 
 
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List of Tables and Figures  
 

Table 1. Summary of interviews ................................................................................ 22 

Table 2. Summary of categorized barriers from the empirical data ........................... 26 

 

Figure 1. Visualization of barrier interrelations ......................................................... 52 

 

 

 

   

iv 



 

   

v 



 
 
 
 
 

 
 
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1. Introduction 

 

The following chapter describes the background of the study and why it is important. 

Further, the problem discussion is presented, followed by the aim, limitations, and 

research question.  

 

1.1 Background 

 

Sweden has an aging population, meaning that a higher percentage of the population 

will be older in the future relative to the population of working-age citizens (SCB, 

2022a). Further, the Public Health Agency of Sweden predicts that future demand for 

healthcare will grow (Folkhälsomyndigheten, 2022). Also, there is currently a shortage 

of healthcare workers, which is expected to persist or worsen in the future (SCB, 2020). 

This indicates that in the future, fewer healthcare workers need to provide care for a 

larger number of citizens. Due to these difficulties, the role of healthcare workers, as 

well as their methods and tools, likely need to adapt and change.  

 

Digitalization and digital technologies play large roles in the Swedish healthcare sector, 

by creating new possibilities as well as new expectations and needs from citizens (SKR, 

2021). With changing expectations and needs, the healthcare must also change (SKR, 

2021). Digital technologies and solutions enable new ways of working and give patients 

a larger influence over their own healthcare, as well as contribute to a more accessible 

healthcare with higher medical quality and reduced costs (McKinsey, 2016). 

Systematic use of digital technology in healthcare can come with numerous advantages. 

For instance, the use of advanced analytical tools helps doctors diagnose patients and 

create individualized care programs and improved access to patient data (McKinsey, 

2016). This allows for the effectivization of care processes and avoids mistreatment, 

and patients can get new tools for self-care for treating existing conditions as well as 

for preventative care (McKinsey, 2016). Although digitalization and digital 

technologies have the potential to improve healthcare, many actors have difficulties 

adopting these technologies in an efficient way.  

 

With demographical changes and a lack of healthcare workers, new technologies are 

needed in order to be able to provide good healthcare to everyone (Läkartidningen, 

2014). A concept that could help cope with the increased future healthcare demand is 

telemedicine. Telemedicine lets doctors monitor patients remotely using different 

monitoring tools, increasing the self-care of citizens (HRSA, 2022). There are a few 

different remote patient monitoring (RPM) devices, for example: blood pressure (BP) 

monitors, pacemakers, and glucose meters (HRSA, 2022). Remote monitoring is 

categorized into three categories; ordinated, recommended, and citizen-initiated (SKR, 

2021). Ordinated means physicians decide that the patient needs to remote monitor 

themselves, recommended means physicians recommend that the patient should remote 



 
 
 
 
 

 
 
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monitor themselves, and citizen-initiated, means that the patient or just a citizen decides 

to remote monitor themselves. By being able to monitor patients remotely, many 

positive effects can be found, such as less transportation and fewer travels for patients, 

decreased number of costly physical meetings, and increased patient coverage 

geographically (HRSA, 2022). 

 

The market for consumer goods with integrated sensors, such as smartwatches, is 

growing quickly, and is forecasted to continue growing at a fast pace (Statista, 2022). 

In a report covering 19 out of the 21 Swedish regions, it is stated that the use of 

ordinated and recommended remote monitoring will be expanded (SLIT, 2022). As of 

now, many regions have made it possible for patients to monitor diseases such as 

diabetes, and COPD (chronic obstructive pulmonary disease), and are planning to 

expand the self-monitoring into other diseases and diagnoses such as Parkinson, IBD, 

and others. However, there is no plan to implement citizen-initiated remote monitoring, 

even though the citizens to some extent already have the means (sensors and watches) 

to do it. The use of telemedicine today is often for specific diagnoses with the use of 

specific equipment, but multiple Swedish regions have expressed the need for a more 

general system to handle data from patients independent of diagnosis or equipment 

(SKR, 2021).  

 

Many actors in the healthcare industry have difficulties adopting digital technologies 

in a good way due to different kinds of barriers (Alvarado et al., 2017). There have been 

many studies exploring barriers to adoption of digital technologies, but many studies 

are conducted in countries with quite different healthcare systems than Sweden, see for 

instance, Dixon (2007), Luciano et al. (2020), and Wall et al. (2022). For example, 

many articles that are focusing on implementation and barriers to adoption of 

telemedicine are conducted in developing countries, where the main focus and barriers 

lie within lacking infrastructure and technology (Sagaro et al., 2020; Dodoo et al., 

2021). The main barriers that are raised are related to internet connection and the 

availability of equipment. However, in Sweden where this study will be conducted, 

these barriers can be seen as non-existent. For example, 83% of Sweden’s population 

had access to and could use the internet already in 2009 (Reisdorf, 2011), and internet 

access is predicted to reach 98% by 2025 (Swedish Ministry of Enterprise and 

Innovation, 2016). Having access to the internet means that current interactive 

telemedicine solutions such as remote video and communication meetings can be held 

(Carter, 2014). 

 

Furthermore, Dunn et al. (2018) describe the current healthcare system as reactive, 

meaning patients seek care when symptoms have clearly arisen. However, with the use 

of telemedicine, healthcare could become more proactive through remote monitoring 

by continuously evaluating patient data even before symptoms arise, thereby possibly 

changing this paradigm (Asthana et al., 2017). Proactive monitoring can avoid serious 

diseases and better maintain the patient’s well-being (Asthana et al., 2017). Also, the 

proactive approach can allow for increased patient focus, which Luxford et al. (2011) 



 
 
 
 
 

 
 
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explain can lead to better care. Hence, adoption of telemedicine could lead to improved, 

more proactive, and patient focused care. Barriers to adoption are therefore relevant to 

study.  

 

This study will focus on organizational barriers. As defined by Lluch (2011) this 

involves five different categories: Structure of healthcare organizations; representing 

how team members or tiers of care are organized and how they coordinate and work 

together. Tasks; representing how work is organized. People policies; representing 

healthcare workers´ accountability, training, and career development. Incentives; 

representing reward systems to influence individuals´ behavior, both in monetary 

means but also development opportunities, recognition, and job satisfaction. 

Information and decision processes; representing how information is shared and how 

decision processes are structured.  

 

Further, throughout this study, the main categories; Structural, Managerial, and 

Individual & Cultural have been used to differentiate between and capture the different 

vertical levels of the organization. Structural includes aspects on an overall 

organizational level, Managerial includes aspects on a managerial level, mainly on the 

level of department managers, and Individual & Cultural includes aspects on an 

individual level, mainly healthcare workers, and cultural includes the overall culture in 

the organization. 

 

 

1.2 Aim 

 

This Master Thesis aims to find and study organizational barriers to why new digital 

technologies are seldom adopted at a competitive pace in public healthcare, and 

specifically at Sahlgrenska University Hospital.  

 

 

1.3 Limitations 

 

A limitation made is to generally process and study literature published after 2010. This 

is due to the rapidly changing environment around digital technologies, making older 

literature less relevant. However, an evaluation of relevance and fit will be made, so 

that older, yet very relevant literature is included.  

 

A limitation is made to only study organizational barriers. Because of this, apparent 

barriers such as for example legal barriers and technical barriers are excluded. These 

barriers are obvious and also highly studied by other researchers (Stanberry, 2006; 

Cohen et al., 2020; Nittari et al., 2020; Sagaro et al., 2020; Dodoo et al., 2021).  

 



 
 
 
 
 

 
 
4 
 

During the initial interviews it was found that budgets and reimbursement can be a 

barrier to new digital technologies because of limitations in the budget; however, 

because budgets are dependent on politicians, aspects such as financial incentives were 

disregarded in the empirical research. 

 

Telemedicine includes several different aspects, for example; remote monitoring of 

patients, storage and forwarding of data, and digital meetings with patients. This study 

is limited to only studying remote monitoring of patients.    

 

 

1.4 Specification of issue under investigation 

 

Many actors in the healthcare industry have difficulties adopting digital technologies 

in a good way due to different kinds of barriers (Alvarado et al., 2017). These barriers 

can in different ways hinder the development of the healthcare sector. However, if these 

hindrances are overcome, it will lead to higher quality and less expensive care, as a 

result (Christodoulakis et al., 2017). 

 

The issue of internet connectivity and availability of equipment is non-existent in 

Sweden, but still, the adoption of new digital technologies, including telemedicine, in 

Swedish Public National Healthcare is slow. In a report made by the Swedish Social 

Welfare Board (2019) they highlight the problem of Inadequate changes within the 

organization at implementation. Derived from that statement, a hypothesis is that 

organizational barriers may pose a major challenge in the Swedish market and are 

therefore vital to study.  

 

Furthermore, few studies regarding remote monitoring in Sweden seem to have been 

conducted when reviewing existing literature. It is, therefore, necessary to study the 

organizational barriers in the Swedish healthcare sector since barriers may differ 

compared to previously studied countries. A case study of the large Swedish public 

hospital Sahlgrenska University Hospital is therefore conducted.  

 

Barriers may differ depending on the type of actor, for example private or public, 

hospital or primary care etc. A large part of the Swedish healthcare sector is comprised 

of public national hospitals, whereby this is an interesting part of the sector to study. 

This results in the following research question: 

 

- What organizational barriers exist in the adoption of citizen-initiated remote 

monitoring in public national hospitals?  
 

o  How can the barriers be overcome?  

 

 

  



 
 
 
 
 

 
 
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2. Literature Review 
 

In this section, a literature review is conducted to explore what previous research have 

found. First, a chapter describing the healthcare industry. Second, a chapter on 

digitalization in the healthcare industry. Third, a chapter on telemedicine in Sweden. 

Fourth, a chapter describing organizational barriers. Lastly, a chapter on how to 

overcome these barriers.   

 

2.1 The Healthcare Industry in General 
 

Over the last few years, the healthcare industry has experienced the emergence of a new 

type of actor; digital tech companies, such as Apple, Google, IBM, and Microsoft 

(Powles & Hodson, 2017). These giants see potential in various fields of the global 

healthcare industry, often with the use of data-driven tools and techniques such as 

Artificial Intelligence and Machine Learning (Powles & Hodson, 2017). DeepMind, a 

subsidiary of the Google conglomerate Alphabet, has for instance initiated a 

collaborative project with the Royal Free London NHS Foundation Trust, to work with 

acute kidney injury (Powles & Hodson, 2017). Further, the Google conglomerate 

Alphabet had already in the first half of 2022 invested $1,7 billion into different 

healthcare initiatives, the highest investment by any tech giant (The Economist, 2022). 

This shows how the healthcare sector is evolving, with new capital-heavy actors 

entering the sector, possibly changing the narrative. 

 

The healthcare industry is characterized to a large extent by reactive care, meaning care 

is given when symptoms have arisen (Marcusson et al., 2019; Waldman & Terzic, 2019; 

Wehde, 2019). Waldman & Terzic (2019) describe how new technology and solutions 

give opportunities to provide proactive care, to prevent diseases before they arise. 

Wehde (2019) argues that a fundamental shift will reshape the healthcare industry with 

healthcare moving away from the clinic-centered care model toward a more seamless 

continuum care, with focus on prevention and early detection. Wehde (2019) describes 

how this shift is crucial to combat the issue of costs rising at an unsustainable rate, 

partly due to the fast evolution of medicine and science which drives prices up. 

Waldman & Terzic (2019) describe how proactive healthcare extends past individual 

patients to the entire population, independent of geography, and optimizes health across 

the lifespan. Proactive prevention will thereby maximize the returns of society and 

create the greatest benefits for the most amount of people globally (Waldman & Terzic, 

2019). Prevention has also proved to be a very cost-effective approach to improve the 

health of the population (Waldman & Terzic, 2019).  

 

 

2.2 Digitalization in the Healthcare Industry in General 
 



 
 
 
 
 

 
 
6 
 

Fast-paced technological progress during the 21st century has allowed for a high level 

of digitalization throughout many industries. However, digitalization in the healthcare 

industry is still at an early stage and has not seen the rapid development of many other 

industries (Gastaldi & Corso, 2012; Hansen et al., 2019; Wehde, 2019; Burmann et al., 

2021; Östlund, 2021). There may be several reasons for this. Wehde (2019) describes 

how healthcare is highly regulated, capital intensive, and has high educational 

requirements. Gastaldi & Corso (2012) describe how many healthcare actors do not 

prioritize digitalization as a source of innovation, and also that hospitals fail to 

adequately analyze the organizational changes that would be required to realize the 

benefits of digitalization. Hansen et al. (2019) describe how physicians can exert a 

negative attitude toward digitalization, especially when technology would limit or 

replace their activities. Hansen et al. (2019) argue that this is especially problematic 

because physicians miss the opportunity to contribute with their experience, actively 

participating and enhancing new technologies, to achieve higher quality care for 

patients. Burmann et al. (2021) describe a lack of noticeable time-saving and 

insufficient digital literacy as dominant factors. Also, insufficient system 

interoperability was identified as a major obstacle (Burmann et al., 2021).  

 

Glauner et al. (2021) describe that the transformation of the healthcare industry is still 

at the very beginning, with new radical technologies such as Big Data, Artificial 

Intelligence, Robotics, and Telemedicine starting to be implemented in health sciences 

and the clinical setting. Hansen et al. (2019) argue that many digital technologies have 

been successfully applied in clinical studies but that the effect on the overall healthcare 

system is limited so far. Hansen et al. (2019) describe how healthcare actors are 

struggling to keep rising costs under control while having only modest clinical 

improvements, but argue that digitalization using technologies like Artificial 

Intelligence and Machine Learning might address this issue. Further, the digitalization 

of the healthcare industry is considered the most effective approach to improving 

quality while simultaneously reducing costs (Gastaldi & Corso, 2012). Compared to 

tangible technological items such as physical equipment, digital investments are 

typically cheaper and have a shorter payback time, which can reduce healthcare costs 

by 7 to 11 percent (Moro Visconti & Morea, 2020).  

 

Digitalization of the healthcare industry also offers opportunities to have the capability 

of exploiting current assets while also having the capability to shift away and explore 

new and better ways of providing value (Gastaldi & Corso, 2012). Also, digital 

healthcare is a major driver of innovation, growth, and competitiveness (Moro Visconti 

& Morea, 2020). Glauner et al. (2021) argue that digital technologies will accelerate 

the pace of knowledge gaining and lead to an extended range of possibilities and 

services within the healthcare industry. Further, Glauner et al. (2021) argue that the 

rapid digital development of both scientific findings and clinical structures will lead to 

a shift in the view of healthcare workers and patients, with changed patient interactions 

and changed ways of working for physicians. Digitalization therefore has the potential 

to fundamentally redefine the understanding of healthcare (Glauner et al., 2021). 



 
 
 
 
 

 
 
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Digitalization, technical advancements in devices, advancements in broadband and 

satellite technology resulting in an increasing number of connected users, and also a 

healthcare model shifting to a more patient-centric design, have all allowed for the 

introduction of telemedicine (Bhavnani et al., 2016; Moro Visconti & Morea, 2020). 

Moro Visconti & Morea (2020) describe how this allows for the transformation of non-

acute hospitalized patients into home patients, reducing time spent hospitalized, thereby 

saving time and resources. Bhavnani et al. (2016) describe how using telemedicine 

changes healthcare delivery from a health-systems-generated approach to a remote and 

patient-generated approach, which the authors argue creates great opportunities to 

increase patient engagement, reduce healthcare costs, and improve outcomes. By 

monitoring and continuously evaluating patient data before symptoms arise, 

telemedicine can make healthcare more proactive, which can avoid serious diseases and 

help maintain patients’ well-being (Asthana et al., 2017). Luxford et al. (2011) also 

describe how this proactive approach can allow for increased patient focus, which can 

lead to better care. Moro Visconti & Morea (2020) describe that telemedicine has 

enormous potential to improve healthcare by enhancing effectiveness, efficiency, 

accessibility, safety, and personalization.  

 

 

2.3 Telemedicine in Sweden 
 

In Sweden, telemedicine gained attention in the 1990s, to address patient demands for 

improved healthcare while also trying to keep costs down (Petersson, 2011). During the 

mid 1990s, the government emphasized the transformative potential of telemedicine, at 

a time when healthcare was moving towards patient-centered care (Petersson, 2011). 

Another important factor accentuated by the government regarding telemedicine was 

the way it could offer increasingly scarce specialist resources to the entire country 

(Petersson, 2011). During the 2000s, telemedicine for home-based treatment of 

chronically ill patients, web-based psychiatric treatment, and computerized clinical 

decision support systems (CDSS) to aid telephone triage was introduced (Glock et al., 

2021). In the 2010s digital consultations were introduced, and commercial app-based 

actors complementing primary care were established in 2016 (Blix & Jeansson, 2019). 

These actors have grown rapidly since and were further catalyzed by the Coronavirus 

pandemic (Blix & Jeansson, 2019). Although telemedicine has existed since the 1990s, 

adoption is, as previously described, slow and non-widespread. Ordinated and 

recommended remote monitoring initiatives exist for some diseases, but citizen-

initiated remote monitoring does not yet exist in the Swedish National Public 

Healthcare. Alvarado et al. (2017) describe how this is due to different kinds of barriers, 

which in different ways hinder development. 

 



 
 
 
 
 

 
 
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2.4 Organizational Barriers to Adoption of digital 

technologies in the Healthcare Sector 
 

In this section, different barriers to adoption of digital technologies are presented, 

categorized into Structural Barriers, Managerial Barriers, and Individual & Cultural 

Barriers. First on a higher level in the healthcare sector, and then going more into 

depth on telemedicine. Important to note however is that many barriers are 

interrelated. 

 

2.4.1 Structural Barriers 

 

Structural Barriers are divided into three sub-categories; Teamwork & Collaboration, 

Processes & Routines, and Financial Incentives. 

 

2.4.1.1 Teamwork & Collaboration 

 

Lack of teamwork is identified as a barrier to new technologies (Lluch, 2011; Konttila 

et al., 2019). New technologies influence teamwork because responsibilities and team 

dynamics change (Konttila et al., 2019). Also, the structure of healthcare organizational 

systems does not encourage teamwork including different levels of the organizational 

system (Lluch, 2011). Further, Lluch (2011) argues that the use of digital technologies 

has led to even larger inefficiencies in the cooperation between organizational units. 

Teamwork and cooperation between healthcare professionals require information 

sharing (Lluch, 2011). The introduction of new digital technologies can lead to changes 

in information sharing and decision processes, impacting healthcare workers with a 

heavier workload, which creates resistance towards these innovations (Lluch, 2011).  

 

Lack of collaboration between developers and physicians is identified as a barrier to 

adoption of digital technologies (Cresswell & Sheikh, 2013; Gleason, 2015). Cresswell 

& Sheikh (2013) describe that this can lead to a solution that may not fit the users´ 

needs. They also highlight that the complexity of a system can become too high, which 

decreases the usability of the technology for the end user. However, the authors also 

describe the opposite, that the technology might not include important features, limiting 

the technology’s possibility to meet the users’ needs. This is also something Smuck et 

al. (2021) raise in a case of wearables regarding telemedicine, that the focus of the 

technology must lay on the end-user experience. The authors explain how a barrier to 

usage of the technology can be that physicians do not get relevant data from the sensors 

or that it is difficult to gain access to the data. Further, Gleason (2015) describes how 

different remote monitoring tools, for example, stethoscopes, sleep analyzers, and 

cardiac monitors, capture different types of data that are structured in different ways. 

Due to a lack of collaboration between developers and physicians, this data can be 

structured and presented in ways that may not fit with how physicians can actually use 



 
 
 
 
 

 
 
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the data. Data overload of different inputs from the devices can therefore arise and 

affect physicians´ adoption (Gleason, 2015).   

 

 

2.4.1.2 Processes & Routines 

 

The implementation of digital technologies often requires changes in work processes 

and routines, which can become a barrier to adoption (Landaeta et al., 2008; Lluch, 

2011; Iyanna et al., 2022). New digital technologies can change healthcare workers´ 

workflow, increasing time spent on tasks, introducing tedious documentation 

requirements, and creating challenges integrating paper and online records (Iyanna et 

al., 2022). The implementation of telemedicine requires significant changes to existing 

workflows, which therefore can influence the efficiency of implementation of the 

technology and act as a barrier (Kruse et al., 2018; Sagaro et al., 2020). Kruse et al. 

(2018) describe how healthcare workers have to invest time in training for new 

workflows and techniques, which is identified as a barrier to adoption.  

 

Healthcare is becoming more patient-focused, and because of that processes may need 

to change. Sustaining a process-oriented approach can act as a barrier to adoption, and 

there is a need for shifting to a patient-oriented approach, with healthcare episodes 

being the focus, instead of viewing tasks separately and missing the overall picture 

(Lluch, 2011).  

 

As healthcare shifts more towards digital solutions, the work of a physician moves away 

from patient meetings and towards more administrative tasks, which proves to be a 

barrier towards implementation and change, since physicians often prefer patient 

interactions (Cresswell & Sheikh, 2013). Also, in telemedicine specifically, there is a 

perception of telemedicine not being personal care due to less personal communication, 

which further acts as a barrier due to a preference for personal communication (Kruse 

et al., 2018). This is also argued by Mohammadzadeh & Safdari (2014), who describes 

how a decrease in face-to-face communication between doctors and patients is a barrier 

to adoption of telemedicine.  

 

 

2.4.1.3 Financial Incentives 

 

Lack of financial incentives for healthcare actors adopting new technology is identified 

as a barrier (Kruse et al., 2016; Gleiss & Lewandowski, 2021). Gleiss & Lewandowski 

(2021) describe how there is a general lack of external financial incentives for 

implementation and use of new digital technologies. However, Kruse et al. (2016) argue 

that there may exist financial incentives on a national or local level but that despite this 

the initial cost may be too large, therefore acting as a barrier. For healthcare workers, 

lack of financial incentives is identified as a barrier, due to healthcare workers´ 



 
 
 
 
 

 
 
10 
 

inadequate compensation (Lluch, 2011; Lin et al., 2012; Lavallee et al., 2020). 

Healthcare workers can feel that the extra effort of adopting a new technology is not 

reflected in their income, leading to feelings of inequality (Lin et al., 2012). 

 

In the adoption of telemedicine, lack of financial incentives is identified as a barrier 

(Tanriverdi & Iacono, 1998; Al-Samarraie et al., 2020; Lavallee et al., 2020; Sagaro et 

al., 2020). Implementation and maintenance of telemedicine is costly, and a lack of 

adequate financial funding is therefore a barrier to adoption (Al-Samarraie et al., 2020). 

Tanriverdi & Iacono (1998) argue that standard healthcare financing models, for 

example, fee-for-service and capitated models, are problematic and not suitable for 

telemedicine. Lavallee et al. (2020) also describe that current payment models do not 

support telemedicine, and that the lack of reimbursement mechanisms and supporting 

healthcare policy hinders the technology. Sagaro et al. (2020) describe that there is no 

reliable reimbursement system for telemedicine. Al-Samarraie et al. (2020) argue that 

there are several reasons: a lack of sponsorship, a lack of feasibility studies, and a lack 

of capital expenditure. The lack of stable funding and sponsorship has been seen as the 

main cause of failure in many telemedicine projects (Al-Samarraie et al., 2020). 

 

 

2.4.2 Managerial Barriers 

 

Managerial Barriers are presented under Management Support & Leadership. 

 

2.4.2.1 Management Support & Leadership 

 

A lack of management support has been identified as a barrier to adoption of digital 

technologies (Callen et al., 2008; Lluch, 2011; Konttila et al., 2019; Bidmead & 

McShane, 2021; Kruszyńska-Fischbach et al., 2022). Kruszyńska-Fischbach et al. 

(2022) describe how constant change makes ownership and responsibility unclear, 

leading to a lack of management support and therefore being a barrier to adoption of 

new digital technologies. Further, a lack of support from management in integrating the 

new technology into the healthcare workers´ daily practice, their professional role, and 

service delivery affects the adoption negatively (Lluch, 2011). Another difficulty 

identified by Bidmead and McShane (2021) is that although top-management support 

may be present and satisfactory, this may not always trickle down to the middle and 

lower-level management, and therefore hinders adoption.  
 

A lack of leadership is identified as a barrier to adoption of digital technologies (Laukka 

et al., 2020; Fernando & Purva, 2023). Laukka et al. (2020) describe how leaders are 

not always aware of what their role is in the implementation or who is responsible. With 

rapid changes and advances in healthcare technology, the role of a leader has expanded, 

with leaders having to possess new knowledge and skills, thereby affecting their ability 

to lead (Laukka et al., 2020; Fernando & Purva, 2023). Fernando & Purva (2023) 



 
 
 
 
 

 
 
11 
 

describe that the traditional role of leaders is not suitable for the implementation of 

digital technologies due to a rapidly changing environment within healthcare. Also, 

leaders may not be able to prioritize leading in an implementation project due to them 

having to prioritize other health services (Laukka et al., 2020).   

 

Lack of leadership is identified as a barrier to the success of implementation of 

telemedicine solutions (Stumpf et al., 2002; Carter, 2014). Stumpf et al. (2002) point 

out the need of a project coordinator who has knowledge and a holistic view of the 

project, I.e., knowledge within the technology, but also what the healthcare workers 

need. If the leadership is not defined and shared between members in the project, the 

project will have difficulties to form (Stumpf et al., 2002).  

 

 

2.4.3 Individual & Cultural Barriers 

 

Individual & Cultural Barriers are divided into three sub-categories; Healthcare 

Workers’ Resistance to Change, Buy-in, and Competence & Training. 

 

2.4.3.1 Healthcare Workers´ Resistance to Change 

 

Resistance to change is a major barrier to the adoption of digital technologies in 

healthcare (Kan & Parry, 2004; Landaeta et al., 2008; Lluch, 2011; Amarantou et al., 

2018; Kulkov et al., 2021). Kulkov et al. (2021) describe how adherence to old, long-

established values and standards forms a barrier to implementing and adopting new 

technologies. Landaeta et al. (2008) elaborate on this and describe that resistance to 

change can arise because healthcare workers perceive the current systems and processes 

as efficient, and therefore do not see the value in implementing or adopting new 

technology. This is further exemplified and strengthened by Lluch (2011) who 

describes that new technologies which change the previously manual processes using 

pen and paper to computer systems affect healthcare workers. These changes can be 

perceived negatively by healthcare workers, as systems can be seen as slow without 

previous user experience and the same tasks can therefore take more time to complete 

(LeTourneau, 2004; Lluch, 2011). When the technology demands extra work or is not 

seen as part of the principal work, resistance to change increases (Konttila et al., 2019). 

Also, the individual healthcare worker often evaluates if they possess the right skills to 

be able to make the transition without slowing down their work and becoming 

inefficient (LeTourneau, 2004). If the healthcare worker perceives their skills as 

inadequate, embarrassment and fear may arise, and the worker would more likely resist 

the change (LeTourneau, 2004).  

 

Healthcare workers´ previous experiences and confidence using technology influence 

their attitude towards using new technology, but also the ability to learn to use new 

technology (Konttila et al., 2019). Little previous experience and confidence can lead 



 
 
 
 
 

 
 
12 
 

to resistance to change (Konttila et al., 2019). In adoption of telemedicine, healthcare 

workers were identified having low confidence in the accuracy of the technology and 

that it would be easy to use, leading to resistance to change (Tanriverdi & Iacono, 

1998). Also, healthcare workers not participating and being involved in decision-

making regarding changes lead to resistance to change (Kan & Parry, 2004; 

LeTourneau, 2004; Amarantou et al., 2018). When healthcare workers feel as though 

they are uninformed and unable to leave their input on the development of the change, 

they are less accepting and understanding of why it is needed and therefore resist 

adoption (LeTourneau, 2004).  

 

Amarantou et al. (2018) argue that healthcare workers perceive change as a process that 

disrupts and makes them lose control over how they work. This perception makes the 

healthcare workers more likely to resist change, since experiencing these negative 

emotions wants to be avoided (Amarantou et al., 2018). Letourneau (2004) elaborates 

further on this and describes how healthcare workers often feel a lack of familiarity 

when proposed with change, which can lead to negative emotions around being 

perceived as uninformed or incompetent. Resistance to change can therefore arise as 

the healthcare workers would rather do what they know best and focus on what they 

are an expert at, which they are often accustomed to (LeTourneau, 2004). The 

perception from healthcare workers of how beneficial a change would be to themselves, 

the patients, and the hospital also affects resistance to change (Lin et al., 2012; 

Amarantou et al., 2018). In the adoption of telemedicine, healthcare workers tend to be 

nervous and anxious, resulting in a negative attitude toward the technology and 

therefore resistance to change (Sagaro et al., 2020). Further, Al-Samarraie et al. (2020) 

describe how some healthcare workers were overwhelmed when telemedicine projects 

were introduced.  

 

 

2.4.3.2 Buy-in 

 

Lack of buy-in is identified as a barrier to adoption of telemedicine (Stumpf et al., 2002; 

Dodoo et al., 2021). Stumpf et al. (2002) argue that endorsement from local healthcare 

workers is an absolute requirement for adoption. If local healthcare workers are 

insufficiently empowered in the process, thereby having lacking buy-in, the adoption 

will be left to fend for itself without support and therefore risk cancellation (Stumpf et 

al., 2002). Further, Dodoo et al. (2021) describe how lack of help and engagement from 

stakeholders and medicinal institutions affect physicians’ initial buy-in into 

telemedicine since they see the technology as a hindrance or something not worthy of 

their time. The authors continue by stating how lack of management and consultation, 

leads to low motivation for healthcare workers to use the technology. Furthermore, 

Jannett et al. (2003) highlights the point that lack of buy-in is a barrier to adoption, and 

that this barrier arises because pressure from the outside is the reason to implement 

telemedicine, and not that it is based on clearly articulated needs. In other words, 

telemedicine should be implemented when a clear need is shown, and not just be 



 
 
 
 
 

 
 
13 
 

implemented because of the sake of implementing something new. If telemedicine is 

not based on actual needs, the equipment could be used in a bad way or be abandoned 

(Jannett et al., 2003).   

 

Simblett et al. (2018) describe that lack of buy-in for telemedicine can arise over time, 

with healthcare workers becoming bored, having to put more effort into the work over 

time, or if the technology does not meet expectations. Lack of trust and motivation 

between doctors and patients in telemedicine is also identified as a barrier to adoption 

(Al-Samarraie et al., 2020). Also, if doctors and patients can´t see the potential benefits 

of telemedicine, the adoption of the technology will be limited (Al-Samarraie et al., 

2020).  

 

 

2.4.3.3 Competence & Training 

 

Lack of competence and training is identified as a barrier to adoption of digital 

technologies (Lluch, 2011; Konttila et al., 2019). Lluch (2011) describes how 

healthcare workers´ lack of knowledge regarding new digital technologies is a major 

barrier and that healthcare workers can feel the need for training to be able to adopt the 

new technology. However, Konttila et al. (2019) argue that many healthcare workers 

have a negative attitude toward technology education, finding it pointless due to poorly 

understood benefits, time-consuming, and inadequately resourced, creating even larger 

barriers. 

 

Dodoo et al. (2021) describe that physicians are lacking knowledge within telemedicine 

and its applications and that this poses a barrier to implementation. Sagaro et al. (2020) 

strengthen this point by implying that technically challenged staff is a critical barrier. 

This knowledge gap in how to use the technology leads to unstandardized ways of using 

the applications and systems, and big changes within the workflow, which can lead to 

a non-efficient work-structure (Dodoo et al., 2021; Sagaro et al., 2020). Therefore, the 

quality and equality may vary in the service, which can influence the success of the 

implementation of telemedicine (Dodoo et al., 2021).  

 

Another aspect of implementing telemedicine is that new knowledge is needed, with 

users of the technology, the physicians, requiring a higher degree of IT competence, 

which reduces the autonomy of the physicians, and telemedicine is becoming a “threat” 

(Sagaro et al., 2020; Dodoo et al., 2021). The lack of training and education of IT can 

decrease the confidence of the users, but also the lack of knowledge of how to find your 

way and navigate in the health technology leads to resistance (Al-Samarraie et al., 2020; 

Dodoo et al., 2021). A lack of training programs on telemedicine for healthcare workers 

was also identified, which could be because of a lack of widespread dissemination of 

information regarding telemedicine (Al-Samarraie et al., 2020).  

 



 
 
 
 
 

 
 
14 
 

 

2.5 Overcoming Organizational Barriers to Adoption of 

digital technologies in the Healthcare Sector 
 

In this section, how to overcome the barriers is presented, using the same structure of 

Structural Barriers, Managerial Barriers, and Individual & Cultural Barriers.  

 

2.5.1 Structural Barriers 

 

Structural Barriers are divided into three sub-categories; Teamwork & Collaboration, 

Processes & Routines, and Financial Incentives. 

 

2.5.1.1 Teamwork & Collaboration 

 

Lluch (2011) argues that team-based care strategies are vital for successful 

implementation of new technologies. Teamwork between different organizational units 

is necessary and effective ways of coordinating this in the organization need to be found 

to overcome inefficiencies (Lluch, 2011). Konttila et al. (2019) argue that with new 

technologies changing healthcare workers´ responsibilities and team dynamics, 

collegial support is crucial to positively influence values and nurture the climate for 

teamwork.   

 

The lack of collaboration between stakeholders such as physicians, nurses, 

management, and technical staff leads to barriers to adoption of new digital 

technologies. However, Kho et al. (2020) explain how strategic planning can solve the 

collaboration problem between the different stakeholders. The authors explain that 

collaboration is a major success factor in implementation and adoption of a new 

technology and that regular ongoing meetings have a big impact during the planning 

stage. Further, for a technology to fit the physicians´ needs, collaboration between 

developers and users is crucial (Cresswell & Sheikh, 2013). This type of collaboration 

is also crucial for overcoming the issue of collecting and structuring data in a way that 

does not fit how the physician can use it (Gleason, 2015). The data should be structured 

in a way that makes sense to the physician (Gleason, 2015).   

 

 

2.5.1.2 Processes & Routines 

 

The increased workload for individuals when implementing a new technology or 

system into their daily work can be seen as disruptive, when staff and organizations try 

to make sense of how it works (Cresswell & Sheikh, 2013). The authors state that it is 

of great importance to create time and ease the burden of other workloads for the staff, 

to enable them to familiarize themselves with the technology. Kruse et al. (2018) 



 
 
 
 
 

 
 
15 
 

describe how changes in existing workflows require healthcare workers to invest time 

into training on the new workflows and techniques for the change to work well. Another 

aspect Cresswell & Sheikh (2013) describe is the timing of the implementation, an 

introduction of a new technology could go smoother if there are no other major 

happenings in the organization, i.e., the staff have more time to understand the 

technology. 

 

An important point argued by Bidmead & McShane (2021) is that stakeholders 

involved in change must thoroughly understand the existing processes and practices to 

be able to change them in a good way. What healthcare workers routinely do may not 

always be the same as how the work is described in flow charts or descriptions, and 

time must therefore be put on pilot projects to allow for a deep understanding of the 

actual processes and practices and then be able to make viable and sustaining changes 

(Bidmead & McShane, 2021). 

 

 

2.5.1.3 Financial incentives 

 

Lluch (2011) argues that the issue of healthcare workers not being adequately 

compensated should be overcome by implementing a broadly composed reward system, 

including direct monetary compensation, benefits packages, and bonus incentive plans. 

Lluch (2011) also argues for other non-monetary rewards such as career development 

opportunities and more intrinsic motivation from job satisfaction. This broad reward 

system can result in faster adoption (Lluch, 2011). Further, Sagaro et al. (2020) argue 

that governments should invite other stakeholders, for example nongovernmental 

organizations, to overcome the issue of lacking financials in the initial phase. To 

overcome the issue of non-suitable financing models, Tanriverdi & Iacono (1998) argue 

that new business models need to be developed.   

 

 

2.5.2 Managerial Barriers 

 

Managerial Barriers are presented under Management Support & Leadership. 

 

2.5.2.1 Management Support & Leadership 

 

Konttila et al. (2019) describe that a supportive manager can reduce the uncertainty 

healthcare workers may feel regarding changes, thereby improving the adoption. 

Kruszyńska-Fischbach et al. (2022) describe how managers can take the role of 

Innovator and highly endorse the new technology, thereby motivating and encouraging 

others. This can be done by a single manager, as a social opinion leader, or a group, 

spreading information on the benefits and success of a solution (Kruszyńska-Fischbach 

et al., 2022). Kruszyńska-Fischbach et al. (2022) argue that this type of endorsement is 



 
 
 
 
 

 
 
16 
 

often essential to successful adoption. Bidmead & McShane (2021) argue that it is not 

enough for managers to simply provide the necessary equipment and then expect 

changes to happen naturally, managers should instead be involved in the process and 

initiate smaller step changes to allow for a gradual rollout. Also, management support 

can improve the adoption of digital technologies by encouraging healthcare workers to 

see the changes as long-term investments (Bidmead & McShane, 2021). To overcome 

the difficulty of management support not trickling down to middle and lower-level 

management, it is vital for organizations to ensure that all levels of management are 

aligned, and that support is present throughout the whole organization (Bidmead & 

McShane, 2021). 

 

Laukka et al. (2020) describe that lack of leadership can be overcome by providing 

leaders with support and training to raise the competence regarding digital technologies, 

and thereby the ability for the leaders to support others. The leader should also 

communicate clear visions and goals regarding the implementation, establish a 

governance structure, and provide training for healthcare workers (Laukka et al., 2020). 

It is also important for the leader to follow up after some time, to make sure that 

adoption is going as planned (Laukka et al., 2020). Also, scholars argue that 

management should have a transformational leadership style, including enthusiasm, 

participation, opinion leadership, and vision, and that this is critical for creating an 

environment where employees are motivated (Kumar, 2013; Weintraub & McKee, 

2019; Fernando & Purva, 2023). Kumar (2013) describes how a transformational 

leadership style engages and involves healthcare workers, providing a sense of 

ownership of the implemented technology and thereby improving adoption. Fernando 

and Purva (2023) emphasize the importance of flexibility and adaptability towards new 

ideas, curiosity, change-oriented, and open-mindedness as some important traits for a 

leader to possess in today’s rapidly changing environment.  

 

 

2.5.3 Individual & Cultural Barriers 

 

Individual & Cultural Barriers are divided into three sub-categories; Healthcare 

Workers’ Resistance to Change, Buy-in, and Competence & Training. 

 

2.5.3.1 Health Care Workers’ Resistance to Change 

 

Tanriverdi and Iacono (1998) argue that to overcome resistance to change, healthcare 

workers need to be convinced that the new technology would be easy to use and 

accurate. Also, healthcare workers need to be convinced that the new technology would 

not disrupt their daily routine (Tanriverdi & Iacono, 1998). Konttila et al. (2019) 

elaborate on this and argue that the emphasis should be on how the technology can 

improve the daily work. Amarantou et al. (2018) argue that improvements should be 

communicated to healthcare workers, because the more beneficial a change is perceived 



 
 
 
 
 

 
 
17 
 

the less resistance is shown. Further, ownership of change through being part of the 

decision-making process tends to lead to much less resistance from healthcare workers 

(LeTourneau, 2004; Amarantou et al., 2018). Also, awareness of negative emotions 

from resistance to change can help in going through and handling changes better, which 

is especially important in healthcare, where changes are occurring often to improve the 

quality of care (Amarantou et al., 2018). 

 

To improve healthcare workers´ willingness to use new technology, thereby lowering 

the resistance, it is important to allow sufficient time and resources to adapt (Konttila 

et al., 2019). This is also emphasized by Tanriverdi and Iacono (1998) who argue that 

an iterative approach with revisions, new models, and new routines can ease the change 

for healthcare workers, thereby leading to less resistance.  

 

 

2.5.3.2 Buy-in 

 

A new technology needs to be accepted by the users, i.e., physicians, and nurses in 

order to get adopted. Kho et al. (2020) describe how with increased familiarity and 

confidence in the system, the workers were more likely to accept the technology. 

Making people accept the system will increase the likelihood of buy-in and willingness 

to use it. Kho et al. (2020) continue by stating that ongoing meetings and evaluations 

of the system, where the users can state their concerns, are good ways to gain 

acceptance, trust, and buy-in to the technology or system. 

 

To overcome the issue of lack of trust and motivation between doctors and patients, as 

well as the perceived benefits of telemedicine, increasing overall awareness through 

continuous information sharing is crucial (Sagaro et al., 2020). Increased overall 

knowledge of the benefits of telemedicine can increase the overall buy-in for the 

technology, thereby increasing adoption (Sagaro et al., 2020).  

 

 

2.5.3.3 Competence & Training 

 

Konttila et al. (2019) argue that learning to use new technology and devices should be 

integrated into the healthcare workers´ daily work. Stumpf et al. (2002) argue that 

implementation is different across multiple sites and that each site must be viewed 

individually as a unique system. Competence may differ largely across multiple sites 

and individualized training may be necessary to reach a sufficient competence level 

(Stumpf et al., 2002). Konttila et al. (2019) describe how training increases safe use of 

technology but emphasize that the organization should carefully evaluate competency 

levels and developmental needs when planning training, to maximize the benefit for 

each individual. Al-Samarraie et al. (2020) argue that relevant training should be 

provided, as well as workshops, seminars, conferences, and market campaigns, to raise 



 
 
 
 
 

 
 
18 
 

competencies broadly. Also, healthcare workers should be motivated to attend various 

training programs through direct and indirect incentives (Al-Samarraie et al., 2020). 

Further, regular training over time is also required to allow for appropriate and 

successful use of the technology (Konttila et al., 2019).  

 

  



 
 
 
 
 

 
 
19 
 

3. Methodology 
 

The following chapter outlines the methodology used for conducting the study, the 

chosen research design, and the steps for gathering empirical data. Further, a critical 

discussion of the research quality is made, and ethical considerations are presented. 

 

3.1 Research Design 

 

This study is of a qualitative, abductive approach, with the purpose of exploring and 

describing barriers to adoption of digital technologies in the healthcare sector. Ellram 

(1996) describes explorative research as a way of finding answers to questions such as 

“why” or “how” something is occurring.  

 

The choice of conducting a qualitative study is based on the explorative nature of the 

study and that barriers to adoption of digital technologies are hard to quantify. 

Therefore, it is necessary to attain qualitative data and get the members of the 

organization’s own views on the subject to reach the aim of the study and answer the 

research question.  

 

Abductive reasoning is a combination of inductive and deductive reasoning, with the 

aim to discover new or unexpected insights, test old theories, as well as form new 

theories (Wallén, 1996). This is an appropriate approach due to the study being 

explorative and descriptive.  

 

The study is based on primary data collected through interviews and secondary data 

collected through a literature review. Research is conducted at a single case 

organization; Sahlgrenska University Hospital, which allows for an in-depth analysis 

of the studied problem (Bryman & Bell, 2019).  

 

 

3.2 Case Description  

 

In Sweden, the three independent levels of the government; national, regional, and 

municipal, are all involved in the healthcare system (Glenngård, 2019). The same 

author also describes how Sweden has a long history of strong self-government locally. 

Organization and provision of healthcare services are done by the 21 country councils, 

and at the local level, 290 municipalities are responsible for their citizens (Glenngård, 

2019). There are 77 hospitals nationally, of which seven are university hospitals 

(Glenngård, 2019). Glenngård (2019) describes how counties are grouped into six 

different healthcare regions to facilitate cooperation as well as maintain a high level of 

advanced medical care to patients. Further, Glenngård (2019) describes how highly 

specialized care which requires the most advanced equipment is concentrated at the 



 
 
 
 
 

 
 
20 
 

seven university hospitals to allow for greater efficiency and higher quality care, as well 

as create opportunities for research and development.  

 

Healthcare can be provided by either public or private healthcare providers, or a 

combination of both (Basu et al., 2012). In Sweden, the national healthcare services are 

provided by both public and private actors, where the private actors can either have a 

contract with the country council, local authority, or municipality, or act on their own 

(Socialstyrelsen, 2020). In Sweden, the majority of healthcare is public but about 40 

percent of primary care practices are private and there are six private hospitals 

(Glenngård, 2019). Burström et al. (2017) describe that healthcare is a tax-funded 

welfare service in Sweden, meaning the healthcare system must gain legitimacy from 

the people in order to function. Sweden is widely known for its good care, which goes 

hand in hand with that Sweden is one of the countries that spend the most on healthcare, 

looking at cost per capita or as a share of GDP (Blixt & Jeansson, 2019). On the other 

hand, Sweden is ranking low in terms of quality based on patients’ experience and 

waiting times (Blixt & Jeansson 2019). 

 

The public national healthcare is decentralized in Sweden and is managed by either the 

country council, local authority, or municipitality (Socialstyrelsen, 2020). By having 

decentralized healthcare, it is up to the different actors to manage and prioritize its 

resources as they seem best fit, which can lead to varying healthcare services 

throughout the country (Glenngård, 2019; Socialstyrelsen, 2020). However, there are 

some things that apply to all healthcare in Sweden, for instance, the so-called AAAQ 

criteria; availability, accessibility, acceptability, and quality (Regeringen, 2011). 

Healthcare must be available to all citizens, it must be accessible for all citizens, it must 

be run in an acceptable way, and it must be of good quality (Regeringen, 2011). There 

are also the three basic principles that apply to all healthcare providers:  

 

“Human Dignity: all human beings have an equal entitlement to dignity and 

have the same rights regardless of their status in the community.  

Need and solidarity: those in greatest need take precedence in being treated.  

Cost-effectiveness: when a choice has to be made, there should be a reasonable 

relationship between healthcare costs and benefits measured in terms of 

improved health and quality of life” (Glenngård, 2019, p. 133).   

 

 

3.3 Case Organization 

 

The case organization Sahlgrenska University Hospital is Sweden’s largest hospital and 

treats 350 000 patients every year (Sahlgrenska University Hospital, 2022). The 

hospital is also one of Europe’s largest hospitals (Sahlgrenska University Hospital, 

2022). Sahlgrenska University Hospital consists of over 17 000 employees 

(Sahlgrenska University Hospital, 2022). The hospital conducts highly specialized care 



 
 
 
 
 

 
 
21 
 

and the organization is also acknowledged as leading in clinical research (Sahlgrenska 

University Hospital, 2022). Sahlgrenska University Hospital is a part of Region Västra 

Götaland, which has the overall responsibility for healthcare in the region. Region 

Västra Götaland consists of 56 000 employees in total, of which 48 000 work within 

healthcare (Region Västra Götaland, 2023a). The healthcare is managed and controlled 

by elected politicians and two regional committees are responsible for long-term 

strategic work and coordination throughout the region (Region Västra Götaland, 

2023b). Further, five committees are responsible for local coordination between 

municipalities in the region (Region Västra Götaland, 2023b).  

 

 

3.4 Data Collection 

 

Secondary data is collected through a literature review to create an understanding of 

the subject and evaluate what is already known in the field. Based on the background 

and aim of this study some overall keywords could be identified; “Telemedicine”, 

“Remote Monitoring”, “Digitalization”, “Organizational”, “Healthcare”, “Barriers”, 

“Innovation”, “Digital technologies”, “Adoption”, “Patient-generated data”, and 

“Implementation”. These keywords were used individually and in different 

combinations to form key phrases, to find relevant literature. The collection of literature 

was done by using the databases; Google Scholar, Scopus, and ScienceDirect. Further, 

additional keywords were identified and used during the collection of literature, for 

example; “mHealth”, “Health Data”, and “Wearables”. Interviewees with relevant 

knowledge in the field also provided recommendations on relevant literature to review. 

The literature was structured using the Reference Manager program Mendeley to allow 

for sorting and grouping on different subjects, which simplified and clarified later 

analysis.  

 

The primary data is collected through in-depth, semi-structured interviews. This means 

interview questions are formed prior to the interviews, but the questions could change, 

and follow-up questions can be asked depending on the interviewee's responses 

(Gilham, 2008). By having more flexible follow-up questions, the atmosphere in the 

interview can become more relaxed, and the probability of getting relevant answers is 

higher (Virginia Tech, 2018). Further, the semi-structured approach allows for an open 

mind about what needs to be known, so that theories and concepts can surface from the 

interviewee’s answers (Bryman & Bell, 2019).  

 

Initially, a purposive sampling strategy was used, starting with the organizations’ 

understanding of members with appropriate knowledge on the subject. Purposive 

sampling involves selecting interview participants strategically based on their relevance 

to the research subject (Bryman & Bell, 2019). In parallel with the purposive sampling, 

it was also further expanded through snowball sampling. This strategy allows for 

finding additional potential respondents through recommendations from respondents in 



 
 
 
 
 

 
 
22 
 

the purposive sampling (Bryman & Bell, 2019). The sampling continued until sufficient 

data was acquired and theoretical saturation was met, meaning no new themes were 

generated from the data (Bryman & Bell, 2019). 

 

The interviews were conducted via video call using Microsoft Teams due to time 

efficiency, preference, and flexibility. An interview guide (See Appendix A) was 

formed after a comprehensive literature review and the interviews were audio-recorded 

and transcribed verbatim for later analysis. Before the interviews, participants were 

provided with the topic, aim, and the interview questions of the study. The purpose of 

this was to prepare the respondents to allow for the best contribution to the study, as 

well as strengthen the dependability of the study (Bryman & Bell, 2019). The 

respondents were also informed that the interviews are anonymized and that they will 

not be able to be identified. They were also asked to give their consent to being audio 

recorded and informed that the recording would be transcribed. The language used in 

the interviews was Swedish, as this was the preferred language of all the interviewees. 

Using the interviewees’ preferred language removed any potential language barrier, 

thereby allowing for more comfortable discussions, attaining information in a better 

way. It is important to note that the information provided in the interviews was 

translated into English, whereby some possible interpretations could have been made 

by the authors.  

 

A summary of the interviews that have been conducted is presented in Table 1. In total, 

18 interviews have been conducted with 21 participants. The interviewees are affiliated 

with either Sahlgrenska University Hospital or Region Västra Götaland, with different 

roles within the organizations. 

 

Interviewee Organization Role Duration (min) 

1 
Sahlgrenska 

University Hospital 
Manager for Competence 

Center Artificial Intelligence 
60 

2 
Sahlgrenska 

University Hospital 
Digitalization Officer 60 

3 
Sahlgrenska 

University Hospital 
Digital Development 

Strategist  
60 

4 
Sahlgrenska 

University Hospital 
Business Developer & System 

Specialist 

5 
Sahlgrenska 

University Hospital 
Project Lead 

60 

6 
Sahlgrenska 

University Hospital 
Project Lead 

7 
Sahlgrenska 

University Hospital 
Intrapreneur & Project Lead 60 

8 
Sahlgrenska 

University Hospital 
Research Coordinator & 

Physician  
60 

9 
Sahlgrenska 

University Hospital 
Physician 60 

10 
Sahlgrenska 

University Hospital 
IT Coordinator & Strategist 40 



 
 
 
 
 

 
 
23 
 

11 
Sahlgrenska 

University Hospital 
IT Coordinator & Strategist 

12 
Sahlgrenska 

University Hospital 
Physician (ST Innovation & 

Teknik residency) 
60 

13 
Sahlgrenska 

University Hospital 
Development Strategist 60 

14 
Sahlgrenska 

University Hospital 
Physician (ST Innovation & 

Teknik residency) 
45 

15 
Sahlgrenska 

University Hospital 
Physician 60 

16 
Region Västra 

Götaland 
Innovation Platform Project 

Lead 
60 

17 
Region Västra 

Götaland 
Digitalization Strategist 60 

18 
Region Västra 

Götaland 
Digitalization Strategist 60 

19 
Region Västra 

Götaland 
Digitalization Strategist 60 

20 
Region Västra 

Götaland 
Digitalization Strategist 60 

21 Private Actor 
Former Sahlgrenska 

University Hospital employee 
20 

Table 1. Summary of interviews 

 

 

3.5 Data Analysis 

 

To organize and analyze the data from the interviews and enable a deep understanding 

of the studied problem, a thematic analysis was conducted. This method involves 

searching for themes in the data by looking for repetitions, indigenous typologies or 

categories, metaphors and analogies, and differences and similarities (Bryman & Bell, 

2019). Guest et al. (2012) elaborate on this and describe that the focus is to identify and 

describe both implicit and explicit ideas from the data. Repetition is used as a common 

criterion for evaluating if a pattern can be considered a theme, both within a data source 

and across different data sources (Bryman & Bell, 2019). However, to be considered a 

theme it must also be relevant to the research questions.  

 

The thematic analysis process was conducted in four stages, as described by Guest et 

al. (2012). The first stage, coding the data, involves, in our case, coding based on 

patterns relevant to barriers to adoption of digital technologies. To guide the coding 

process, the interview questions in the semi-structured interviews were of an 

explorative nature. In the second stage, the codes generated initial themes for various 

barriers found in the data. This involved comparing how frequently factors were raised, 

identifying co-occurrence in the data, as well as identifying relationships between the 

initial themes. In the third stage, the initial themes were reviewed by evaluating 

consistency and rigor. This then resulted in the final themes. Lastly, in the fourth stage, 

the final themes were defined and named with regard to existing literature, to allow for 



 
 
 
 
 

 
 
24 
 

comparison. Differences and similarities between the final themes and existing 

literature could then be analyzed and compared, which is presented in the Discussion.  

 

 

3.6 Research Quality 

 

Bryman & Bell (2019) describe reliability, replicability, and analytical generalization 

(also referred to as validity) as three of the most important criteria for evaluating 

research. Reliability is about whether the results of a study are repeatable and consistent 

(Bryman & Bell, 2019). Replicability is closely related to reliability but is instead 

characterized by if the process of the research can be replicated, therefore being able to 

be made again by another researcher (Bryman & Bell, 2019). Finally, analytical 

generalization, often seen as the most important criterion, concerns the integrity of the 

conclusions that are generated from a study (Bryman & Bell, 2019). 

 

 

3.6.1 Reliability 

 

A factor that may affect the reliability of the study negatively is the risk of bias from 

the interviewees. Since the interviewees are working for the studied organization, 

answers that would leave the organization in a negative light might expose the 

interviewee. The interviewee may therefore be unwilling to answer some of the 

questions and important information might be withheld. To mitigate this, the 

interviewees were anonymized, with the purpose of being able to answer questions 

more freely. To further ensure reliability in this study, good practice is followed, and 

data collection was made until theoretical saturation was satisfyingly met.  

 

 

3.6.2 Replicability 

 

Although the need for replicability is more common in quantitative research, it is also 

highly relevant in qualitative research (Bryman & Bell, 2019). This study researches a 

single case organization, which influences the outcome of the study. If this study would 

be replicated at a later stage, it may include other organizations or parties, and thereby 

may have a different outcome. The studied organization is seen as a representative 

public national hospital, and the outcome of a replicated study with another case 

organization in the form of a large public Swedish hospital can probably lead to quite 

similar outcomes. However, it is not likely to be similar in the entire national healthcare 

sector. To allow for a high degree of replicability, the processes are described and 

documented in detail, allowing readers and future researchers wanting to replicate the 

study to understand exactly what has been done and in what way.  

 

 



 
 
 
 
 

 
 
25 
 

3.6.3 Analytical Generalization 

 

An aspect that is also important to discuss regarding the research quality is analytical 

generalization, also referred to as transferability, similar to external validity in 

quantitative research (Bryman & Bell, 2019). Several aspects may affect the integrity 

of this study's conclusions. For instance, as discussed above, although the selected case 

organization can be identified as representative of national public hospitals, this single 

case study is not likely to provide a representation for the entire national healthcare 

sector, also including public and private primary care, public and private dental care, 

and private hospitals. Therefore, any potential results or conclusions made regarding 

the entire healthcare sector should be seen as indications. Apart from this, to allow for 

a high degree of integrity in the study overall, the collected primary data is triangulated 

with previous research, in the form of secondary data from the literature review.  

 

 

3.7 Ethical Considerations 

 

Bryman & Bell (2019) describe issues involving confidentiality and anonymity as 

major ethical difficulties in research. Due to the qualitative nature of this study, with 

the use of interviews, this is especially important to address. This was done by 

informing the interviewees about the topic and aim of the subject, the interviewee’s role 

in the study, and that the interviewees and their answers will be confidential. Further, 

interviewees were asked to consent to be audio-recorded and informed that the 

recording will be transcribed.  

 

The Swedish Research Council (VR, 2021), lists four different personal ethics in order 

to remain professional integrity; Reliability, Honesty, Respect, and Accountability. 

Firstly, reliability means that the research must be of quality which can be done by 

having a fitting and proper design and methodology. Secondly, throughout the entire 

research, honesty is a must, where reporting and communication must be transparent, 

unbiased, and fair. Thirdly, there has to be respect towards everyone involved in the 

research, everything from colleagues to the society and environment. Fourth and last, 

is the accountability for the research. The researchers have to be accountable for the 

study.   

 

  



 
 
 
 
 

 
 
26 
 

4. Empirical Findings  
 

In this chapter, data collected from the semi-structured interviews will be presented. 

The interviewees are individuals who possess high knowledge about the organization 

(SU), telemedicine, or both.    

 

Presented below in Table 2 are the 19 barriers identified from the empirical findings. 

These have been categorized into seven sub-categories and three main categories. The 

19 barriers are described further in this chapter under its subsequent title.  

 

Category (3) Sub-category (7) Barriers (19) 

Structural 

Organization 

Lack of resources 

Balancing innovation and producing healthcare  

Complex and unclear decision paths 

Insufficient innovation support 

Need for driven and motivated individuals 

Lack of information diffusion 

Complexity of broad implementation 

No clear innovation career path 

Standardization & 
Evidence 

Lack of clear benefit and value 

Standardization and validation 

Lack of research evidence 

Processes & Routines 
New ways of working 

Lack of clear innovation processes 

Teamwork & 
Collaboration 

Lack of collaboration 
 

Managerial 
Management Support 

& Leadership 
Lack of clear support and guidance  

Different visions and priorities  

Individual & 
Cultural 

Individual 
Resistance to change  

Physicians' authority, autonomy & responsibility  

Culture Insufficient innovation culture  

Table 2. Summary of categorized barriers from the empirical data  

 

 

4.1 Structural Barriers 
 

The main category Structural is divided into four sub-categories; Organization, 

Standardization & Evidence, Processes & Routines, and Teamwork & Collaboration 

 

4.1.1 Organization 

 

The sub-category Organization is divided into eight barriers; Lack of Resources, 

Balancing Innovation and producing Innovation, Complex and unclear Decision Paths, 

Insufficient Innovation Support, Need for Driven and Motivated Individuals, Lack of 



 
 
 
 
 

 
 
27 
 

Information Diffusion, Complexity of Broad Implementation, and No clear Innovation 

Career Path. 

 

4.1.1.1 Lack of Resources 

 

A lack of resources was identified by several respondents as a major barrier, in the form 

of time, healthcare staff, and funds. Many interviewees described lack of time as 

hindering innovation opportunities. One interviewee described it as “The healthcare is 

overwhelmed by the main care responsibilities that are more urgent”. Other 

respondents also described how healthcare workers generally have no spare time to 

work with innovation. This is further discussed under Balancing Innovation and 

Producing Healthcare. 

 

One respondent described that although healthcare workers may not be opposed to 

using new technology, a lack of time can lead to the workers being stressed and 

therefore feeling that they cannot start using new technologies due to, for instance, the 

time it takes to understand and learn a new technology. Therefore, what can be thought 

of as resistance towards new technologies may in some cases not be because of 

unwillingness from the healthcare workers, but rather the issue of lack of time. A 

respondent raised an example regarding how healthcare workers are educated on new 

solutions. There is currently an approach where ‘super users’, a certain designated 

person in different departments, are educated first so that this individual then can share 

this knowledge throughout the department to act as an information carrier towards their 

colleagues. However, the respondent described how there are huge difficulties to find 

the time for the ‘super users’ to be educated, showcasing issues that lack of time brings.  

 

To combat the issue of lack of time, one interviewee described how many of the digital 

solutions that actually provide large benefits can be quite easy solutions, and not so 

fancy. The interviewee raised an example of online check-in and how the 

implementation of that digital solution created more time for healthcare workers to 

work with patients instead of doing administrative work:  

 

“These digital solutions are not getting so much attention, but they give a lot of 

effect”  

 

Another respondent raised a similar point, how fundamental things outside of the 

healthcare production, such as scheduling of healthcare workers, also can have major 

effects. More efficient scheduling of healthcare workers has the potential to save huge 

amounts of time, while simultaneously possibly giving workers a better work-life 

balance. The current solution involves physicians having priority in scheduling, then 

nurses, and lastly assistant nurses. This means that scheduling is sub-optimized for the 

different roles. Changing this to instead optimize the scheduling across all roles can 

save huge amounts of time. However, the workers that now have priority, mainly 

physicians, lose this benefit of priority, leading to changes in the profession: 



 
 
 
 
 

 
 
28 
 

 

“This might redefine and almost municipalize the medical profession, similar 

to what happened to the teachers in the 1990s, which led to a devaluation of the 

occupation”  

 

To be able to overcome the issue of lack of resources, one respondent described “You 

must try and find ways around it. The closest manager might say no but there may be 

another department that is willing to pay for the time, or in some way find a solution. 

Then you might be able to work with it there”. 

 

A lack of resources was described as affecting the success of the development of a 

certain new digital technology. One example of this was suggested by an interviewee 

in that the implementation of the digital technology was successful in hospitals that put 

aside time for healthcare workers to be involved in the development. However, at 

another hospital, the department manager said that they do not have the resources to 

spare, which led to unsuccessful implementation. A possible reason for this was raised 

by the interviewee by describing that “The person in charge could feel worried that 

healthcare workers would quit if more stress would be put on them through being part 

of a project in an already busy and stressful environment”. Further, the interviewee 

stated that once the solution was developed, the hospitals that managed to set aside time 

for their employees each week to go through and plan how to work with the newly 

implemented solution. This led to the solution being integrated into the way they work, 

easing adoption. On the other hand, the healthcare workers at the other hospital did not 

have any time set aside, which led to the new solution being an add-on to their existing 

way of working, thereby not being implemented in a good way, leading to limited use. 

This was a major factor in the different success rates of the project in the different 

hospitals. 

 

Another issue where lack of staff affected an innovation project negatively was 

described by one of the respondents “All was going well in the project and there was a 

lot of commitment from the people involved, but due to some people involved quitting, 

partly because of high work burden, there was nobody to lead the project forward, so 

it sort of stopped. The new employees replacing the others then did not have the time 

to familiarize themselves with the project, as they were focused on the main care 

production”. 

 

A respondent described how innovation generally involves 80% change and 

development in the different functions, and 20% technology, but that Sahlgrenska 

University Hospital generally puts most of its resources on technology, as it is 

extremely difficult to find time for healthcare workers to join and work with changes 

and development. This is further highlighted by another respondent “Even though I 

have lots of funds and can pay for healthcare workers, it is very difficult for me to find 

people in the organization that can be involved in projects due to an overall lack of 

staff”. Another respondent also described issues when trying to find staff to be involved 



 
 
 
 
 

 
 
29 
 

in projects “There are a lot of temporary solutions and rearranging of healthcare 

workers’ schedules that are not ideal, so it is a major problem that we have a lack of 

staff”. 

 

One of the interviewees described how an overall lack of funds is a huge problem 

regarding innovation projects “I have been in meetings where it is discussed whether a 

new system should be implemented, however, due to the overall lack of funds, 

implementing this system would mean one less ambulance in the region, or that one 

department may have to close”. Another example of an issue with the overall lack of 

funds suggested by the interviewee is that applications to the Innovation Platform, 

which provide monetary resources for innovation projects, get applications regarding 

pure operation development projects. Normally, this should be conducted within the 

individual function with its own budget but due to a lack of funds, project leads often 

need to find funds elsewhere. Another respondent described that one possible reason 

for why the digitalization rate is slow in healthcare is because the IT budget is low 

compared to other public agencies with similar characteristics, for instance, personnel-

intensive.  

 

 

4.1.1.2 Balancing Innovation and Producing Healthcare 

 

A barrier that is highly related to lack of resources in the form of time and staff is 

Balancing Innovation and Producing Healthcare. Several respondents described how 

department managers are under pressure to meet production demands, stay within 

budget and handle budget cuts, and keep their staff, while at the same time trying to 

meet innovation goals. This is described by one of the interviewees “A department 

manager who is behind on their production will be affected by this, creating difficulties 

and stopping innovation”. Further, another respondent described how department 

managers are unlikely to approve innovation projects requiring resources if it affects 

the main care production negatively. A third respondent described “Department 

managers need to put aside time for healthcare workers to work with different 

innovation initiatives, but these might not yield anything for several years, if at all. It 

is difficult to manage these types of urgent care needs and long-term goals”. A fourth 

respondent also described that this dilemma affects how innovation is viewed within 

the organization “A large majority of departments in healthcare are highly focused on 

production, compared to other types of industries, and I think there is an overall feeling 

that innovation does not fit within the current system”. 

 

One respondent described how there is a tradition within the organization to build and 

shape managers to focus on ensuring the daily operational duties, such as scheduling 

and staffing, rather than working with strategic development of the department. This is 

described by respondents as a natural structural aspect, due to care production being the 

main responsibility, but it creates issues regarding short-term and long-term aspects for 

department managers. Another respondent described that it is easy for department 



 
 
 
 
 

 
 
30 
 

managers to discontinue innovation projects to attain short-term monetary benefits, 

especially in the tough financial environment the healthcare sector is in.   

 

A point raised by another respondent is that the importance of innovation seems to be 

different at different levels: 

 

“I feel that higher up in the organization there is high awareness and a sense 

of importance regarding innovation, and that it is hugely important and quite 

urgent to work with. But the lower you get in the organization, and the closer 

you get to care production, the more remote these aspects become. When 

choosing between care production or working with a project that potentially 

might not lead to anything, it is very difficult for managers to allocate resources 

from care production to innovation” 

 

This is further elaborated by another interviewee from the perspective of healthcare 

workers. With innovation projects potentially leading to fewer submitted patients later 

on in time, it may require more resources now. From a healthcare worker's perspective, 

this is not even a discussion because many are drowning in work already.  

 

One respondent raised that to improve the situation regarding the dilemma between 

innovation and producing healthcare, the Innovation Platform plays a role “The goal is 

that the Innovation Platform should reimburse departments for the time their 

healthcare workers are working with innovation, and free up resources in that way”.  

 

 

4.1.1.3 Complex and unclear Decision Paths 

 

A barrier that several respondents raised are issues regarding decision paths in the 

organization. The respondents described how decision paths are generally long, 

involving several different levels and stakeholders. One respondent described how this 

is a major issue when trying to implement something broadly “It is a huge process 

involving several committees, boards, and key stakeholders, and it can therefore take 

forever. Because of this, many projects stay local and do not spread”. Another 

respondent highlighted that this is partly due to the size of the organization ”Sometimes 

it seems as though it is much easier to implement new technologies in other regions, 

for example, region Halland, and of course there is a natural explanation for this; 

region Halland is very small compared to region Västra Götaland, they have much 

shorter decision paths”. Another respondent described: 

 

“Sahlgrenska University Hospital is a giant colossus of an organization so 

when I was trying to get something through, I could speak to several people who 

have their own thoughts and feelings. Some are in favor and some are against, 

but in the end not that much happens. There is no clear path forward and 

therefore it instead revolves around knowing the right people”  



 
 
 
 
 

 
 
31 
 

 

Other respondents also highlight that there are many deciding stakeholders, both in the 

organization and regionally, that need to be anchored and give their thoughts. A 

respondent described how in some cases the people deciding may not have any 

experience nor knowledge on the subject, but still, these people have a large saying 

regarding the continuation of the project. The decision makers’ own opinions and 

personal thoughts may also influence the decisions “It does not matter how amazing 

we believe it works in our department, on a regional level they might have different 

opinions”. 

 

Something that several respondents also raised is how it is not always clear who owns 

the decision. As one respondent put it “Organizationally it should be