Implementation of digital monitoring systems in nursing homes – Evaluating implementation resistance, facilitators and barriers

As a response to the growth in the very old age segment and the availability of cost-effective, sophisticated technology, national authorities are encouraged to implement a variety of technological solutions in the care sector. However, reviews of the literature have revealed a lack of knowledge about context-specific implementation challenges and further, about the impact of interventions on the quality of care, including clinical management, work-flow and patient-centered care.


This PhD-project assesses the implementation of digital monitoring and safety technology in eight Norwegian municipalities through mixed-methods research, guided by classic implementation of innovations theory, as well as a determinant framework.

The PhD consists of three parts:

1. Exploring resistance to implementation of welfare technology in municipal healthcare services – a longitudinal case study

When implementing innovative technology through co-creation into the care for older people, resistance to new technology and resistance to change rise from employees, care receivers and next of kin. Through qualitative methods, forms of resistance that emerged in five municipalities during implementation of monitoring technology in the night service, were identified and described: 1) organizational resistance, 2) cultural resistance, 3) technological resistance and 4) ethical resistance, each including several subforms. Resistance changed over time and even played a productive role in the co-creational design of the implementation. Clinical implications include the importance of organizational translation between professional cultures and focus on co-initiation of implementation projects in order to manage resistance in complex co-creation processes.

2. What are the facilitators and barriers in the implementation process - a qualitative exploration

In this longitudinal case study, we evaluated the adoption and implementation of digital monitoring technology in municipal care for persons with dementia who were night-wanderers.  Facilitators and barriers for successful implementation were identified through qualitative methods including deductive and inductive exploration of participants’ experiences. Their relative impact on the phases of implementation was evaluated. (In progress).

3. Evaluating the implementation of digital safety alarm systems in nursing homes using the Measuring Instrument of Determinants of Innovation (MIDI) - a questionnaire study

Determinant frameworks are commonly used in implementation science, providing an opportunity to design and modify implementation strategy. In this study, we evaluate implementation of digital safety systems in three municipalities using MIDI. (In progress).

Nilsen, Etty, Janne Dugstad, Hilde Eide, Monika Gullslett & Tom Eide (2016). Exploring resistance to implementation of welfare technology in municipal healthcare services – a longitudinal case study. BMC Health Services Research 16:657. DOI 10.1186/s12913-016-1913-5