Gillner, Sandra (2024). Contextualising technology and practice adoption in healthcare settings. (Thesis). Universität Bern, Bern
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Abstract
This cumulative doctoral dissertation analyses the role of context for the adoption of new technology and practices in healthcare settings. Throughout the three included papers, my research explores why the introduction of a novel technology or practice may succeed in one environment or context while it fails in another. The papers included in this work take a multi-faceted approach to decipher and explore contextual opportunities and constraints, considering both organisational as well as systemic perspectives. To explore context in its diversity, my co-authors and I employ a range of qualitative and quantitative research methods. In paper 1, I examine the introduction of artificial intelligence-based diagnostics in complex healthcare systems. Complex systems theory is employed to capture the multidimensional nature and contingency of context for any actor and process situated in such systems. Semi-structured interviews with AI providers were used to investigate this area of research, whose role in perpetuating AI use in healthcare has previously been understudied. My results illustrate the role of stealth science, agility, and digital ambidexterity for AI providers to overcome the perceived challenges of operating across organisational boundaries and contexts when spreading AI in healthcare systems. Paper 2 reveals how a centrally coordinated quality improvement programme involving multiple German hospitals fails at ensuring the homogenous implementation of quality improvement measures across participating organisations. Its main theoretical contribution lies in the use of a social network approach to understand why some organisations progress further in their attempts of implementing quality improvement measures than other members of the collective. Finally, paper 3 offers a quantitative analysis of how submissions of marketing authorization applications for gene and cell therapies compare between two regulatory agencies in terms of timing and reporting of clinical trial data. Together with my co-authors, I analyse concordance of the evidence reported to the U.S. Food and Drugs Authority (FDA) and the European Medicines Agency (EMA) via descriptive statistics to show how drug sponsors present clinical evidence differently depending on the evaluating agency and timing of submission of their application.
| Item Type: | Thesis |
|---|---|
| Dissertation Type: | Cumulative |
| Date of Defense: | 22 August 2024 |
| Subjects: | 300 Social sciences, sociology & anthropology > 350 Public administration & military science 600 Technology > 610 Medicine & health |
| Institute / Center: | 11 Centers of Competence > Center of Comptetence for Public Management (KPM) 03 Faculty of Business, Economics and Social Sciences |
| Depositing User: | Hammer Igor |
| Date Deposited: | 16 May 2025 13:21 |
| Last Modified: | 16 May 2025 13:21 |
| URI: | https://boristheses.unibe.ch/id/eprint/6162 |
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