JMIR Publications

ABSTRACT

Background:

Public reporting systems are designed to enhance transparency, accountability, and informed decision-making by publishing comparative performance data on healthcare providers. Several high-income countries, including the United States, United Kingdom, Germany, Sweden, and the Netherlands, have successfully implemented such systems, thereby enabling patients and payers to make informed choices among healthcare providers. However, the nationwide implementation of public reporting systems remains challenging in other countries, and the barriers to their adoption are not well understood. The purpose of this study is to investigate the factors impeding adoption in Finland. Despite Finland’s longstanding tradition in the development of digital health solutions and electronic patient records, it has yet to establish a comprehensive public reporting system. Public reporting systems publish comparative performance about healthcare providers to improve transparency, accountability, and informed decision-making. Many Global North countries (e.g, the US, UK, Germany, Sweden, and the Netherlands) have implemented these systems, enabling patients and payers to compare provider, but other countries still struggle to implement them or to gain full benefit from them. National-level factors that prevent adoption and full benefits are still poorly understood; Finland is a useful case because, despite increasing use of digital solutions, it has not been able to implement a robust public reporting system.

Objective:

The aim of this study was to identify the factors that hinder public reporting systems adoption in Finland using organizational diffusion of innovation framework, specifically adapted to health care service context, expanded with a new ‘data regulation’ construct.

Methods:

This qualitative study is based on insights from expert stakeholders within the Finnish healthcare system. The data collection involved 24 in-depth interviews, each offering a unique perspective on the Finnish healthcare system. The data were analyzed using an abductive Gioia approach, generating first-order, informant-centric concepts, clustering them into second-order themes, and distilling aggregate dimensions.

Results:

The expert stakeholders described a strong need and readiness for public reporting systems, but the adoption is hindered by five interrelated factors: (1) political climate; (2) professional resistance, especially among doctors; (3) resource constraints that limit investment , including the ability to develop user-friendly public reporting systems; (4) information systems and data challenges, including fragmented and inconsistent systems, inconsistent documentation; (5) restrictive and burdensome data regulation (GDPR and Finnish privacy laws).

Conclusions:

This study shows that the adoption of public reporting systems in Finland is constrained less by lack of perceived need than by political, professional, resource, data-infrastructure and regulatory barriers. By extending Diffusion of Innovation (DOI) framework with data regulation construct. This extension helps explain how highly regulated environments can slow adoption of data-centric healthcare innovations even when benefits are recognized.