JMIR Publications

ABSTRACT

Background:

A growing body of literature exists on the drivers and barriers to innovation in the public sector. However, there is an incomplete understanding of the actors involved in innovation processes and how they overcome barriers. This article explores the work of actors involved in 3 different innovation processes attempting to implement and sustain eHealth solutions in healthcare.

Objective:

Our study aims to investigate the actors involved in innovation processes and explore how they overcome barriers, transforming them into drivers of innovation.

Methods:

We conducted a multiple-case study involving 5 semi-structured interviews, 13 focus groups with healthcare professionals, management, trainers, and policy makers, participant observations of training sessions, and document analysis to understand the roles of various actors in the innovation process and to investigate their strategies for overcoming barriers. The research design employed an abductive approach. An iterative process led us to integrate the dramaturgical approach with the concept of bricolage as a sensitising concept, which subsequently guided the directed content analyses for this study.

Results:

The results of our study reveal that structural factors determine which roles actors can assume during innovation processes and which strategies it is possible to pursue to overcome barriers. Barriers such as departmental collaboration issues, the COVID-19 pandemic, 24/7 operational demands, inadequate information and communication technology infrastructure, and staff resistance were mitigated through adaptation, creative measures, and resourceful improvisation. The findings indicate that these bricolage strategies were enabled due to several key factors: (1) the technology was deployed at the exact location as the project manager and assistant, ensuring direct oversight; (2) the project management team was consistently available, offering continual support; (3) regular evaluations were conducted to assess progress and effectiveness; and (4) a diverse group of superusers was accessible to provide specialised assistance and support. These favourable conditions facilitated the practical overcoming of barriers, in contrast to the other 2 cases where such supportive elements were absent.

Conclusions:

This study contributes to our understanding of public sector innovation by highlighting the complex interplay between actors and structural factors. We found that mediators and service specialists, through their presence in day-to-day activities and geographical proximity, can create communication channels that yield critical insight into staff interaction, instances of silent resistance, and the challenges faced with eHealth solutions. These insights empower actors to employ bricolage strategies that effectively mitigate complexity and transform barriers into drivers of innovation. The theoretical blending highlights the limitations of relying solely on one perspective and emphasises the capacity for actors to negotiate and transform their environments.