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Innovative Technology Adoption in the Norwegian Healthcare System: a Case Study from the Personalized Cancer Medicine Msc in Innovation and Entrepreneurship

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Innovative Technology Adoption in the Norwegian Healthcare System: a Case Study from the Personalized Cancer Medicine Msc in Innovation and Entrepreneurship Innovative Technology Adoption in the Norwegian Healthcare System: A Case Study from the Personalized Cancer Medicine MSc in Innovation and Entrepreneurship Xiaolin Wang 21.05.2013 “Getting a new idea adopted, even when it has obvious advantages, is often very difficult.” By Everett M. Rogers Diffusion of Innovations II Acknowledgments This thesis is a partial fulfillment for the MSc degree in “Innovation and Entrepreneurship” at the University of Oslo. The research subject is proposed by the Oslo Cancer Cluster. First of all, I would like to thank my supervisor associate professor Tor Borgar Hansen for interesting discussion, critical comments and professional guidance. I also would like to thank Anders Tuv and Jutta Heix, my internal co-supervisor at the Oslo Cancer Cluster, for giving me valuable suggestions and additional help through the whole study. I am indebted to all of the informants. Thanks for your valuable time and sharing your experience and insights with me. Without your contribution, the study would not be possible. I am grateful to Birthe Soppe for so many interesting discussions. Your passion for research has been always inspiring. At last, I would like to thank my family and friends for your love and encouragement, especially to my dearest Tao. Thanks for always being beside me, trusting me and supporting me! To my dear Anton and Alex, you are such wonderful understanding kids. Thanks for giving me time and space for this study. I feel sorry for not being able to playing with you so much in the past few months. Xiaolin Wang 21.05.2013, Oslo III List of Abbreviations COP: Clinicians, Oncologist, Pathologists HIIP: Highly Integrated Informatics Platform NCGC: Norwegian Cancer Genomics Consortium NCS: Norwegian Cancer Society NRC: Norwegian Research Council NSG: Nasjonalsatsgruppe NTNU: Norges Teknisk-Naturvitenskapelige Universitet i Trondheim OUS/UiO: Oslo University Hospital PCM: Personalized Cancer Medicine PEOU: Perceived Ease of Use PU: Perceived Usefulness (PU) TAM: Technology Acceptance Model UiB: University of Bergen UiT: University of Tromsø WHO: The World Health Organization IV Table of Contents Acknowledgments............................................................................................................. III List of Abbreviations ........................................................................................................ IV Abstract ............................................................................................................................ VII 1. Introduction ................................................................................................................. 1 1.1 Background about the Norwegian Healthcare System ......................................... 1 1.2 Introduction to the Case of Personalized Cancer Medicine (PCM) ..................... 2 1.2.1 The Biology Context ..................................................................................... 3 1.2.2 Current Cancer Medicine .............................................................................. 3 1.2.3 The Personalized Medicine and Technology ................................................ 4 1.2.4 The Personalized Cancer Medicine (PCM) Status Quo in Norway .............. 5 1.3 Research Questions and Objectives ..................................................................... 6 1.3.1 Research Questions ....................................................................................... 6 1.3.2 Research Objectives ...................................................................................... 7 2. Theoretical Grounding ................................................................................................. 8 2.1 Innovation and Entrepreneurship ......................................................................... 8 2.2 Technology Adoption ......................................................................................... 11 2.3 Technology Acceptance Model .......................................................................... 13 2.4 Fit of Human, Organization and Technology Factors (HOT-fit) ....................... 15 2.5 Stakeholder Theory ............................................................................................ 16 2.6 Development of Propositions ............................................................................. 19 2.7 Summary of the Theoretical Framework ........................................................... 20 3. Methodology .............................................................................................................. 21 3.1 Research Design ................................................................................................. 21 3.1.1 Research Paradigm ...................................................................................... 21 3.1.2 Research Method ........................................................................................ 22 3.2 Selection of Participants and Data Collection .................................................... 23 3.3 Data Analysis ..................................................................................................... 25 3.4 Validity and Reliability ...................................................................................... 26 4. Results ....................................................................................................................... 27 4.1 Decision-making for PCM Technology Adoption ............................................. 27 V 4.1.1 The Initiative from Entrepreneur-Oriented Researchers ............................. 27 4.1.2 Governmental Support ................................................................................ 29 4.1.3 The Norwegian Approach to the PCM Adoption in Practice ..................... 30 4.2 The PCM Technology Acquisition/Development in Norwegian Healthcare ..... 34 4.2.1 Technology ................................................................................................. 34 4.2.2 Human ......................................................................................................... 37 4.2.3 Organization ................................................................................................ 41 4.2.4 Fit between Human, Organization and Technology ................................... 44 4.2.5 Broad Context ............................................................................................. 46 4.3 Roll Out-Cross the Chasm.................................................................................. 47 4.4 Facilitators and Barriers ..................................................................................... 49 5. Discussion and Conclusions ...................................................................................... 50 6. Implications ............................................................................................................... 61 6.1 Theoretical Implications ..................................................................................... 61 6.2 Practical Implications ......................................................................................... 61 7. Further Research and Limitations .............................................................................. 62 8. References ................................................................................................................. 63 9. Appendix ................................................................................................................... 66 VI Abstract Health sector faces increasing pressure to provide quality service with limited budget. Adoption of innovative technology is a powerful solution to the problem. Technology adoption encompasses a range of inter-related complexity between technical, human and organizational factors involving multiple stakeholders. Different technologies may be adopted through different pathways in a specific healthcare system. There is not much empirical data and theoretic findings regarding how innovative technology is adopted in Norwegian specialist health care. Personalized Cancer Medicine (PCM) is an innovative technology transforming cancer patients’ care, which is currently adopted in Norway. PCM adoption represents a typical case for technology adoption in the Norwegian specialist health care and it is worth documenting and analyzing. We have conducted a descriptive and exploratory single qualitative case study about this contemporary project in its real-life context. Through conducting in-depth interviews with stakeholders, participating meetings/debates, and analysis of documents and scientific publications, we provide an in-depth longitudinal description of PCM adoption in Norway. In this thesis, we find evidence supporting that new technology adoption in healthcare is in response to both exogenous and endogenous stimulus and actions. The user perceived usefulness of this technology for resolving an important societal problem stays centrally for the possibility of adoption. The nature of the technology concerned and its intersecting with the specific local adoption system largely influence the adoption trajectory. Researchers with high entrepreneurial-orientation (EO) in healthcare system have an indispensable role in decision-making, strategy articulation and implementation as both managers and technology champion. A top-down, coordinated program with public fund can be an effective strategy for adoption of innovation towards a high-end use in the Norwegian
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