BOUNDARIES OF INNOVATION IMPLEMENTATION IN PATIENT SUPPORT PROGRAM

1.      Introduction

Modern medicine is continuously looking for new ways to improve patients’ health and quality of life. Continuous improvements in the health care system have increased life expectancy significantly – from the global average age of 45.7 years in 1950 to average age of 72.6 years in 2019 (Roser, Ortiz-Ospina, & Ritchie, 2019). Fast-paced lifestyles, aging society, and an increasing number of chronic conditions challenge health care systems to innovate due to sustaining emerging patients’ needs.

Changes in populations’ longevity led to the worldwide pandemic of chronic conditions. Chronic conditions exceed 70 % of all disease burden globally, and it is estimated that chronic conditions are accountable for about 40 % of deaths every year (WHO, 2017) (Harris, 2019) (Ritchie & Roser, 2019 ). Chronic conditions last over an extended period of time. In most cases, these conditions require sophisticated treatment methods. Complicated pharmacotherapy may require co-administration of few medicinal products or unusual drug administration timing. With more complex treatment methods, patients’ will to comply with prescribed treatment decreases. About half of patients receiving treatment, fail to follow treatment regimens; thus, patients are not improving their health and life quality. Failing to adhere to treatment causes negative clinical and economic outcomes. Also, it is difficult to tell whether therapy or medicine is working. Multiple factors influence non-adherence to medicines – patients simply forget to take medicine or lack health literacy, physicians do not communicate the importance of the therapy in an understandable way for the patient, health care system is not able to ensure proper compliance due to shortages in resources (Brown & Bussell, 2011). Patient support programs as an additional tool to routine regimens were introduced to help patients to follow complex treatments and ease the burden of chronic disease.

Patient support programs are designed to help patients to comply with their treatment. European Medicine Agency guidelines (2011) describe patient support programs as an “organized system” (p. 39), allowing companies to collect data related to the administration of medicinal products. Companies sponsoring patient support programs declare it as tools assisting patients in improving treatment outcomes via adherence to medication, education, and awareness of the disease. Moreover, patient support programs are beneficial to health care specialists – using the programs they can provide better care to their patients. Some patient support programs provide financial aid to patients to ensure better adherence to the treatment (Portnoff & Lewis, 2017). The tools provided to the patient vary depending on the specific patient support program. Patient support programs started with tools like a calendar with stickers to mark next medicine administration, leaflet on disease awareness, or with an educational purpose. Also, a patient support program can be carried out as additional communication alongside regular treatment – reminders from a call center or a nurse to use medicine on time. With nowadays, digital innovations, patient support programs can provide more sophisticated tools to track correct medicine dosage and timely administration time through various mobile applications, wearables, and smart devices.

Pharmaceuticals and biotechnology industry investments in research and development are increasing. Pharmaceuticals and biotechnology industry globally spend approximately 160 billion dollars in 2018 and consequently, 177 billion dollars in 2019 on research and development and ranked as the second-biggest investor in research and development after the information technology industry (Skillicorn, 2019) (WIPO, n.d.). Despite huge investments into innovative solutions to provide better treatment outcomes, there is a substantial gap between innovation development and its market presence, and there is also a difference between awareness and its application and the dissemination of innovation (Berwick, 2003) (Technology, 2019). The literature points out main innovation implementation theories and models applicable to the health care sector – theory of disruptive innovation, technology acceptance model, diffusion and dissemination of innovation theories by (Rogers, Diffusion of Innovations, 4th Edition, 1995). Theoretical frameworks suggest that successful implementation is defined by characteristics of the innovation. The health care system is a sophisticated organization operating in a complex environment; therefore, innovation implementation is conditioned by external and internal environmental factors.

Patient support programs are a relatively new concept and have not been implemented widely in health care settings; thus there are limited attention and knowledge about innovation implementation within these programs. The main research question of this thesis is focused on the following: “what are the main barriers to innovation implementation in patient support programs”?

The aim of this thesis is to explore the main barriers of innovation implementation in patient support programs. Main objectives of the thesis are the following:

1.  An extensive review of literature related to patient support programs, existing theoretical frameworks of innovation implementation with the focus on the health care system to identify boundaries in implementation of innovation.
2.  Empirically evaluate obstacles in innovation implementation in patients support programs in the health care sector.
3. To stipulate managerial implications for health care managers and health care policymakers.
4. To mitigate barriers of innovation implementation in patient support programs.

This is exploratory research to gain comprehensive insights into innovation implementation in the patient support programs. For this type of research, a qualitative research design is pursued to get a broader understanding of the topic. Interviews with health care professionals and industry representatives are considered keeping in mind that they are the main stakeholders and subject matter experts in patient support programs. Interviews with health care sector professionals provide valuable insights, experience, and challenges within the innovation implementation process in patient support programs.

Structure of the thesis is as follows:

1. Literature review. This part is dedicated to an academic literature overview in order to define the implementation and dissemination of innovation, identify barriers to innovation implementation diffusion. Also, the relevance of the research is described.
2. Research methodology. In this part of the thesis, research design, and theoretical methods/frameworks are described.
3. Empirical Research Results. This part of the thesis is dedicated to the analysis of empirical research findings.
4. Discussion. The thesis is finalized with the results of empirical research and managerial implications for health care managers and policymakers.

2.      Literature review

This section was aimed at analyzing and reviewing the existing literature concerning support programs for patients, models, and theories of implementation and is the spread of innovations focusing on the health care field. It was essential to review academic articles to get the understanding and theoretical background of the innovation’s imperative parts spread and the application in the support programs for patients. The focus of this thesis was an exploration of implementation for the innovations seen in the support programs for patients. Innovation barriers identification assisted implications din forming management for health care policymakers and managers. Again, barriers identification in the implementation of innovation served as a basis for constructs mitigations.

2.1.Adherence

Annually, new, more effective, and more innovative pharmaceutical products are introduced to treat disease, enhance different adverse conditions, and in fulfilling medical needs that are unmet. Each treatment that is prescribed is required to give favorable results on a given patient. To accomplish the needed results with certain forms of treatment, one more vital element exists. According to Brown and Busell (2011), the element referred to as adherence, illustrated in the middle, is the most significant the section among the three, as shown in Figure 1 below.

Figure 1. Treatment scheme- simplified (Brown & Bussell, 2011).

For a given treatment to function or gain the needed results, treatment prescription regimens adherence should be enforced. The WHO refers to adherence as the will by the patients to follow the guidance of health care physicians with restrictions tuto dietary or pharmacological regimens (Sabat, 2003). The review of literature indicates that adherence process as the being divided into three sections: a) Initiation starting with the initial prescription or the first initiation and treatment as agreed mutually with the clinician involved; b) Implementation where the patients follow the accepted method and schedule of administration for the product of medicine; c) Discontinuation or persistence that is the treatment remaining as illustrated by the professional or therapy termination with no initial consultation to the professional (Vrijens, Geest, & Hughes, 2012; Feldman et al., 2017).

It is vital to adhere to every regimen of treatment, but a significant role is played in chronic condition treatment among patients. There can be the management of chronic conditions for a given time but would need complex treatment and attention. Hence the role of adherence is more important in chronic conditions treatment among patients. There are several complex recommendations that can be challenging for patients in real life. Currently, studies have shown that adults possessed a lower rate of adherence to treatment schedules compared to children, which is 70.7% for children and 55% for adults (Yang et al., 2018).

Other studies have researched on the causes of patients ignoring adherence to the given treatment plan, and the result was that the main component for this was non-intentional like being forgetful and treatment complexity (Barfod, Sørensen, Nielsen, Rodkjær, & Obel, 2006; Julian et al., 2009; Lam & Fresco, 2015; Demoly, Passalacqua, Pfaar, Sastre, & Wahn, 2016), but still there were some few cases of intentional aspects. The causes of intentional aspect involved side effects’ anxiety, and factors that were psychological like inadequacy of health care professional and related to the patients, history of previous failure, mental well-being, condition denial were some other factors involved (De (Demoly, Passalacqua, Pfaar, Sastre, & Wahn, 2016; Arlt, Nestoriuc, & Rief, 2017).

Concerning the increased cases of non-adherence, scholars have commenced questioning treatment’s ineffectiveness on patients’ non-adherence and the patient leading being ineffective (Lam & Fresco, 2015). It has been agreed that the behavior of taking medication is a complex process, and it is essential to address it to accomplish the needed results for treatment (Sabat, 2003; Brown & Bussell, 2011; Khan & Michael Kohn, 2019).

2.2.Patient support program  

A vital part of clinical therapy is adherence to the treatment prescription. There are ways of tackling non-adherence to treatment, like the introduction of support programs for patients. This has been defined European Medicine Agency for guidelines for good pharmacovigilance as a system organized in that a marketing authorization holder collects and receives data and information concerning the use of products, medicinal (Sabate, 2003, p. 29). The patient support program s is a tool that assists in the enhancement of the experience of patients and the results of the treatment. Several researchers describe the programs as interventions for motivation (Gerega et al., 2016) to comply with the treatment prescription.

The design of the support programs is for a few purposes, like assisting the patient in adhering to the treatment prescription regime, aid in the management of the disease they possess, and service provision. Mainly, the patient support program is aimed at chronic conditioned patients (Demoly, Passalacqua, Pfaar, Sastre, & Wahn, 2016; Schwarz, Freiberg, Sprick, & Thiele, 2016), since they have an extended treatment regime and which are usually sophisticated compared to the normal treatment prescriptions. There has been a case study carried out on if the programs enhance adherence to treatment and the persistence they have as performed by Zhou, Yeaw, Karkare, DeKoven, Berhanu & Reid (2018). The involved comparison was between diabetes, type 2, about patients in support programs, and the ones outside the programs. For a period of about one year, the determination was that enrolled patients had higher adherence to treatment prescription in comparison to the one outside the programs together with the rate of persistence. Again, Gerega et al. (2016) stated that in the first year period of treatment, statistic importance increase existed in adherence accrued to patients calling by the nurses.

Severals indicate that (Sackett et al., 1978; Yang et al., 2018) approximately fifty percent of the chronic conditioned patients ignored to comply with the regime of treatment, hence, ignored compliance with the treatment prescription increasing the complication risks, reducing life quality, and increased patient’s healthcare expenditure. Referring to WHO’s report, by 2020, 65% of the global total medical conditions would be as a result of chronic diseases. Enhancing adherence by patients to treatment improves the safety of the patient, clinical efficacy is improved, and expenditure on healthcare section is reduced (Sabaté, 2003).

2.2.1.      Economic value of patient support programs.

The benefits of results for clinical treatment from the programs are broadly reported, although it is essential to note that the said support programs have an economic value creation. The evaluation by Ostor, Garg, Yang, Chamberlain & Skup (2018), was the patient support program utilized for the curing of Rheumatoid Arthritis in the UK. The estimation was that about ten thousand people enrolled in the support programs were associated with about two million pounds of savings per year. The larger percent of the saving was by the hospitalization of the patients. The patient support program has aided in complying with the recommendations of the given treatment by the professionals of the healthcare, therefore, resulting in several hospitalizations as they related to decreasing their conditions enormously and leading to about two million as savings. The other larger percent, about thirty percent and amounting to about 0.7 million pounds, was as a result of work productivity seen in the support programs for the patients. The other savings were segregated between joint assessment of images (about 1.70%) and in reduced visits by the specialists (about 1.90%) (Ostor et al., 2018).

Table 1. Enrollment patient support program estimated annual savings Ostor, A., Garg, V., Yang, M., Chamberlain, C., & Skup, M. (2018).

There have been studies about programs designed for patients with conditions of immunology by researchers in the UK, aimed at determining the adherence by the patients to products (medical) and medical cost direct evaluation. It has been stated that enrolled patients in the support programs had reduced direct conditions as relating to cost with about twenty percent as compared to the out of the program patients. The conclusion of several other support programs for patients’ evaluation was that on top of improving the health, the support programs had a significant role to play in financial savings as they related to direct cost of medication (Ganguli, Clewell, & Shillington, 2016; Martinez-Sesmero et al., 2017). Again, in accordance with the European Federation of Pharmaceutical Industries and Associations (EFPIA, 2013), the data presented was that the government (European) was losing about 124 billion euros annually following non-adherence to the treatment prescription. The review of the existing literature indicates that the patient support program was a beneficial financial, personal, and clinical point of view.

2.2.2.      Patient Support Programs Innovations

The description of innovation is mainly novel, like new processes, behavior, and technologies (Nolte, 2018). As explained by (West, 1990) innovation is the intentional application and introduction within an organization, group, or role of ideas, which are unique to the relevant adoption units, aimed at enormously assisting people, individuals, or the higher society (p. 16). (Thakur, Hsu, & Fontenot, 2012) assessed different possible definition of innovation focusing on health care innovation setting and the conclusion was that in the health care field, the consideration was any change that assists practitioners in health care aim at the patients through assisting the professionals in health care perform their duties better, cost-effectively, faster, and smarter (p. 564).

The support programs for the patients could be as easy as a patient’s handout, stickers on calendars, automatic messages, or calls that act as reminders for medication administration. Regarding the advancement in technology, it has been seen that the programs end up as more sophisticated and innovative. Currently, the involved in the programs are able to be trained and educated concerning drug administration and diseases, are able to participate in platforms for digital social networking for patients, assess to support of clinics, and management of side effect of their treatment in an effective manner (Ocvirk, 2016). Again, they can assess smart devices, for instant, innovative medication or tablets containers to aid in treatment prescription adherence (Demoly, Passalacqua, Pfaar, Sastre, & Wahn, 2016).

Modern technologies and innovations are a current issue in the field of health care.  Innovations and modern technologies are emerging in the healthcare industry. The American Food and Drug Administration (FDA), in 2017, allowed aripiprazole pill containing sensors that could be digitally tracked and recorded utilizing smartphones on a wearable patch, whether the ingestion of the medication by the patient was for adverse mental illness (FDA press release, 2017). The award-winning, in 2018, for the most innovative patient support program conditioned with an inoperable brain tumor or the glioblastoma multiforme was a device (wearable) that transmits low electric signals reducing the proliferation of cells. On the same note, the device, when combined with various treatment prescriptions, raised the program participates’ life span with about fifteen months to five years (Chapman, 2018). Modern technology applications in the programs could aid, especially in delicate or chronic conditions.

There are arguments by researchers in that the current advancements in digital world and tools could help in decreasing the rate of non-adherence to treatment prescription but create less value, the solutions given are temporary, and the extra challenge is created for the professional in the health care (Mierlo, Fournier, & Ingham, 2015). The conclusion of researchers is that the digital programs are designed aimed at the different needs of the patients, different patterns of adherence to treatment prescription instead of the systematic approach. However, there are criticisms about the programs being inflexible, asking for personalization for the personal adjustment in non-adherence patterns in treatment prescription. The clinical value for the support programs for the patient was not dismissed.

The use of the ICBT- internet-delivered cognitive behavior therapy has increased in interest as an alternative to CBT- cognitive behavior therapy that is face-to-face (Swati Mehta, 2019). For the ICBT, the treatment of the patients utilizing online materials on the basis of CBT designed and manual self-help in the provision of similar information as in CBT like relapse prevention, behavioral skills, cognitive restructuring by psychoeducation. Also, for the treatment materials that are core, ICBT could involve supplementary materials concerning common conditions like sleep disturbance; hence comorbidities are addressed in the process of treatment.

Again, researches on patients with musculoskeletal measured the level of adherence to regime exercise through comparison of paper sheet exercise version to the motivational text and mobile application. However, clinical importance was not vivid in the involved research following non-pharmacological regimen study, and digital devices indicated higher adherence to regiment paper version comparison (Lambert et al., 2017). It is clear that support programs have an additional economical and clinical value to the general healthcare system and the patients involved. The current advancement in technology has rendered the support programs more innovative, and the patient support program could enormously enhance the quality of life for the patient. The expectation is that the innovations are to make the programs more desirable to the involved patients and the professionals at health care. Innovation implementation and diffusion are slow in the sector of health care.

2.3.Implementation Framework in Healthcare

Retrospective researches have utilized frameworks (theoretical) like the Middle Manager, Barriers Scale, and Implementation Frameworks together with others to attain insight into major drivers of innovation implementation success. This is especially at the level of organization involving: a) management support; b) financial resources availability; c) fit innovation values; d) champion’s presence; e) practices IPP and implementation policies; f) and climate of implementation. At the level of clinic, retrospective researches have utilized different frameworks like diffusion innovation and the theory of disruptive innovation that enables change in behavior and implementation of innovation among clinician frontlines.

Again, prospective researches about the implementation of innovation, have leveraged the framework of the Professional Complex System in designing interventions for successful implementation of innovation. This is carried out by allowing the tacit exchange of knowledge among subgroups of different professions in fostering collective education (practice on gaps and gaps’ consequences); in facilitating a changed practice (a new of care provision through shared comprehension among the clinicians involved. By achieving that, the research assisted in highlighting the major drivers of success in the implementation of innovation (from retrospective research) like the innovation-value fit, and the presence of champion could be accomplished. Accordingly, prospective researches have assisted in context-sensitive strategies development for innovation implementation success at clinical and organizational levels.

In the level of organization, insight is provided by the involved efforts into the content and structure of effective communication for hospital units’ innovation implementation. The suggested efforts topping down periodic communication proactively by the hospital leaders (seniors) may allow the exchange of tacit knowledge across various subgroups enabling change at the next level and collective learning. The major insight from a given study is that implementation is not translated by awareness. There are various framework implementations at the clinical level. Disruptive innovation framework has been adopted in the health care setting, for instance, in the United Kingdom, together with modern services for telehealth. The description of telehealth is an online consultation video acting as a compliment service to hospital-based practice or regular ambulatory. This theory has, for a while, transformed the environment of health care. Incorporation of the theory makes the patients concerned about the privacy of their data, as providers of healthcare have tremendous paperwork awaiting. The expectation is that quality will be improved in the future by telehealth, improving equitability, the spread of innovation. To embed the theory into the health care setting, the innovation is to transform processes and technologies together with the environment of healthcare.  In order to disruptive innovations to be embedded into healthcare, the innovation itself should be changing existing technologies or processes; at the same time healthcare environment – business model and regulatory should be able to accommodate rapid changes.

This theory involves innovations that replace previous habits or supersede the previous technology. When introduced in the market with lower profits, disruptive innovation was cheaper at the beginning compared to the alternative, although not satisfying the needs of the customer. With time, the theories are expected to improve in that it will be possible to compete with established products or technologies. In the theory of disruptive innovation, for its implementation into the health care system, there are several aspects that are to be satisfied. It is essential to simplify and regulate reform whenever new technology is being launched or market processes. Also, there is a need to put in place various business models that are suitable. There has been an enormous investment in the health care field building the new therapy advancements, a huge gap between innovation creation, the attained knowledge, and practical implementation exist. Implementation of innovation into the service of a health care setting is a sophisticated process. There are several major phases that are involved, like the adoption of innovation or innovation implementation, innovation sustainability, innovation spread, and innovation scale-up. Several researchers consider the process of implementation as a measure of post-adoption (Nolte, 2018). For this research, implementation and adoption will be utilized as the process’ phase.

2.3.1.      Implementation.

Interest in the advancement implementation has risen in science, and this has reduced the difference between evidence-based approach and knowledge-based approach at the same time increasing sustainability and adoption of the process involved (Nilsen, 2015; Darnell et al., 2017).  According to Nilsen (2015), the study by (Eccles & Mittman, 2006) described the act of implementation as the study (scientific) of techniques to enhance the uptake of systematic research results into recurring practice to enhance effectiveness and quality of care and health services (p.2). The United States National Institute of Health, Fogarty International Center (n.d.) describes the implementation process essence in playing an essential role in barriers identification to effective health policymaking and programming globally, and knowledge leverage in developing evidence-based innovations in efficient and effective approaches for delivery. The process is a planned and determined attempt in innovation standardization and included in the processes that are recurring (Greenhalgh et al., 2004). Implementation adaptation of innovations is a heterogeneous and complex process. Various researchers state that the science of implementation as transdisciplinary, interdisciplinary, and multidisciplinary. For the purpose of structure and clarity in the process of implementation and adaption, Greenhalg et al. (2004) separated factors into the ones related to the outer context and the ones related to the inner context.

The cultural environment of an organization and organizational structure are aspects the are the inner context. The incentives (structural) to innovation implementation are connected to the size of an organization, maturity, size, differentiation in function and specialization, resources available, and possess decentralized making of a decision in structure. Current research undertaken by (Dearing & Cox, 2018) shows the importance of resources in the adoption behavior of innovation. Communities with rich resources tend to implement innovations earlier compared to the ones with poor resources (p.185). Considering the cultural environment of an organization, the essential aspect is competence in understanding and obtaining knowledge. It is one of the vital determinants of the implementation process. There other determinants that are cultural, like the willingness of an organization to change and innovation assessment ability to evaluate the value of innovation. Again, it is essential for innovation to serve the norms and values of an organization, and there will be the assimilation of innovation better with advocacy and support for it (Greenhalgh et al., 2004).

Environmental factors affecting the abilities and decisions to implement and adapt innovation and relation of an organization with innovation are examples of external context. The decision of an organization either to adapt innovation or otherwise is largely affected by informal networking for inter-organization. Again, innovation uncertainty is reduced by the spread of knowledge utilizing networking channels that are formal. The timing and current politics are the main examples of environmental determinant. There infrequent environmental factors in the health care field; hence the effect on innovativeness in an organization is taken as a minute (Greenhalgh et al., 2004). The decision to implement innovation and its adaption are similar phases. The phases are critical variables and heterogeneous for innovation to be implemented and adopted by an organization.

2.3.2.       Sustainability.

The successful implementation of the continuum is the sustainability of innovation. The perception of innovation is as sustained whenever it is recurrent. When innovation reached the recurrent or routine stage, it must have undergone perpetual strain for a period (Martin, Weaver, Currie, Finn, & McDonald, 2013). According to Buchanan, Fitzgerald, and Ketley (2007), when efforts sustaining innovation are absent, there is the occurrence of evaporation in improvement. Greenhalgh et al. (2004) discovered that sustainability of innovation is accomplished whenever the following are observed: widespread and early involvement of staff, the structure of the organization, ongoing and dedicated funding, management and leadership, adaptation, and feedback, inter-organizational network, and intra-organizational communication. Current research by (Lennox, Maher, & Reed, 2018) upon review of existing literature established current constraints as demonstrating effectiveness, general resources, progress monitoring over time, stakeholder participation, capacity building and training, and policies and existing programs integration as illustrated in Table 2.

Table 2. Constraints for sustainability Greenhalgh, T., Robert, G., Bate, P., Kyriakidou, O., Macfarlane, F., & Peacock, R. (2004).

Later in time, constraints reduced and are inclusive of engagement of stakeholders, communication, and resources found. Again, (Lennox, Maher, & Reed, 2018), on top of the discussed feature, indicate effectiveness demonstration importance in innovation implementation, ensuring sustainability benefits and health benefits assessment. The improvement in sustainability has fewer challenges as opposed to before. There is the absence of a common approach in the literature review for constraints, for which are faced by the improvements, to ensure the stated innovations, there is a need for a strategy at the commencement of the roll-out phase for innovation. The innovation spread literature; researchers have illustrated several models and theories that are utilized in spreading innovation in the concerned sector like health care. The theories are inclusive of the theory of model of technology acceptance and disruptive innovations, and theory of dissemination and innovation diffusion.

On the basis of Roger’s framework of innovation diffusion, the framework is utilized in the spread of innovation in the health care field, particularly technology. The model focuses on individual processes and aspects of decision entirely on the adoption of technology for further utilization. The model was introduced, and the suggestion was two vital components affecting the intention of utilizing innovation. Perceived usefulness was the first component, which was a person’s degree of believing that the utilization of a certain system would improve the performance of the job. The second component was ease-of-use as perceived, which is the person’s degree of believing that the utilization of a certain system would be effort-free. The model with the approach ease-of-use mitigates the physician’s doubts and skepticisms regarding the new technology resulting in the tool’s adoption. This behavior has let to innovative ideas spread in the organization involved (Thakur, Hsu & Fontenot, 2012).

2.4.Characteristics of Innovation

New products are not automatically adopted but require a decision of conscience towards whether or not to utilize the product or service. The implication is that innovation acceptance is intentional. Therefore, designers are to proactively address the innovation for people to make long-term use decisions of the product and service. The main innovation characteristics that have been identified, contributing to the increase of the diffusion process areas discussed.

2.4.1.      Simplicity

Simplicity- the illustration was that easy and simple to use innovations diffused faster (Dearing & Cox, 2018). The progress is mainly slowed down by complexity; hence innovations that are complex tends to be difficult for use by the user. A lot of time is not utilized by adopters is learning the way of using the innovation. Instinctive innovations are preferred in adoption. Simplicity can be referred to as the perceived innovation’s degree of difficulty in using and understanding.

2.4.2.      Relative Advantage

Relative advantage- the ability of innovation to give benefits or add value facilitated faster diffusion (Cain & Mittman, 2002; Barnett, Vasileiou, Djemil, Brooks, & Young, 2011). This has been stated as the perceived innovation’s degree of being better the one superseded. The extent to which the innovation is more effective, productive, less cost, or enhances various manner upon the practice existing. Various improvements can be in the form of better service, improved interface, multiple functions alliance into one device, reduced need for supplies and equipment, users empowerment, increased productivity, longevity, and save space, storage, money, and time.

2.4.3.      Trialability

Trialability- diffusion if increased with the chance to test an innovation without liabilities (Dearing & Cox, 2018). The degree to which a given innovation could be tested without incurring limits. Innovations that are easier to try are easily adopted, easily dispensed with after trial, or on a temporary basis. Each exploration of innovation can be referred to as availability. Most of the adopters want to understand and feel how life could be upon the implementation of the product.

2.4.4.      Compatibility

Compatibility- The ability of innovation to relate with the existing technology in social context increases adoption and innovation diffusion (Cain & Mittman, 2002; Dearing & Cox, 2018). The perceived innovation’s consistency with the values existing, the adopters’ needs, and the past experience. It is important that innovation is considered as acceptable socially before implementation. In some cases, some innovations take long upon acceptance. The relationship harmony, which innovation possesses with people as perceived mentally. Lifestyle should be a major consideration during the implementation and confirmation of innovations. The success of innovation can be measured when people smoothly adopt the innovation.

Others were inclusive of the following.

2.4.5.      Communication Channel

Communication channels- The assimilation of information is increased by proper channels for communication. There is increased innovation diffusion as reach is improved by key leaders in opinion (Dearing & Kreuter, 2010).

2.4.6.      Norms, Roles, and Social Network

Norms, roles, and social networks- there is more inclination to innovation diffusion for health care professions with social alignment with innovation (Cain & Mittman, 2002). Following Dearing and Cox (2018), the ones without social norms constraints are mainly to adopt novelties.

It has been explained by (Rogers 2003) that the process of innovation-decision as a knowledge-based task, in a person tends to reduce doubts in terms of possible innovation loss and gain. The process of innovation-decision has five sections that are inclusive of persuasion in that a person creates opinion the value of innovation on innovation characteristics; knowledge which is gathering of information concerning innovation; decision to reject or adopt an innovation and as illustrated by Dearing & Cox (2018) to extend accessibility and ramp up adoption in health care innovation, diffusion principles are to be operating; implementation is putting the innovation into practice; and confirmation where a person seeks verification, and it is the discontinuation of an innovation or ultimate adoption (Sahin, 2006; Ward, 2013). The theory by Roger is among the widely utilized. It is utilized as the basis of other theories as it has a tremendous contribution to innovation diffusion comprehension.

3.      Research methodology

This chapter of the thesis is dedicated to research methodology.

3.1.Research aim and objectives

The aim of this research is to explore barriers to innovation implementation in patient support programs. Objectives of this thesis are the following:

1. To conduct empirical research to determine obstacles in innovation implementation in patients’ support programs in the health care sector and test hypotheses.
2. Based on gathered data, provide managerial implications for health care managers and health care policymakers.
3. Based on empirical research mitigate barriers to innovation implementation in patient support programs.

3.2.Research theoretical model and hypotheses

3.3.Research design

3.4.Research sample

3.5.Data collection method, research instruments, and process

3.6.Data analysis methods

4.      Empirical research results

5.      Discussion

6.      Conclusions

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Appendices