L'assimilation des systèmes de télésanté une approche multiniveau
The purpose of this study is twofold. First, it seeks to understand the process of assimilation of telehealth systems when telehealth is brought out of experimental settings into mainstream clinical care. Second, it seeks to determine the factors that influence this process. Borrowing from institutional, structuration and social cognition theories, a comprehensive research model is proposed to explain the nature of the process of assimilation of telehealth systems in healthcare organizations and the factors that affect it. We adopted a qualitative research methodology.The first phase is devoted to testing of the theoretical propositions of the research model. Since some propositions failed this test, we conducted a second phase which consisted of building a grounded theory of the assimilation of telehealth systems. In terms of research strategy, we used a single case study. Data were obtained from 23 semi-structured interviews, documentation was used as secondary source. For data processing, grounded theory analysis techniques along with Atlas.ti were used. The research findings show that the assimilation process as it emerged from the data is more complex than the a priori research model that we developed. For example, individual-level assimilation follows two alternative routes and is influenced by at least four factors.The perceived usefulness of telehealth, aspirations and attributes of individual users which lead to the adoption of organizational citizenship behaviors.The first refers to the usefulness of telehealth with the problems that confront both patient and clinician. Two other conditions refer to personal aspirations and to user's individual attributes. However, the influence of personal aspirations and individual attributes does not happen directly. Rather, it leads to the adoption of specific behaviors that positively influence the assimilation of telehealth. For instance, altruism, civility, professionalism, and tolerance are examples of behaviours that illustrate organizational citizenship. In addition, the new model makes explicit the dynamic between the phenomena underlying the assimilation process, the action/interaction strategies between actors, and the contextual, causal and intervening conditions of the process, including the consequences. This research expands on previous work by examining the process of assimilation from a multilevel perspective. Earlier studies on organizational assimilation of information technologies considered assimilation as an exclusively organizational phenomenon.The result, they have undoubtedly overshadowed more micro or meso explanations that could enrich our understanding still more. Unlike prior studies, our model proposes a detailed account of the assimilation process by clarifying both the structure and the functional relationships of assimilation. Put simply, the model accounts for how individual, group and organization characteristics interact to structure assimilation. Briefly, the adoption of a multilevel perspective resulted in a more comprehensive understanding of how the assimilation process unfolds across organizational levels. Our study also has implications for practice. In particular, it helps understand why managerial actions meant to facilitate assimilation should be employed as early as the adoption phase. For instance, issues related to the systems' compatibility with the organization's work infrastructure should be managed during the development phase. Even though routinization and infusion are post-implementation behaviors, factors that are likely to influence them should be taken into consideration before systems are acquired.
Analyse multiniveau, Innovation technologique, Assimilation, Systèmes de télésanté, Télésanté
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