An Extension of the Technology Acceptance Model in Hospital-in-the-Home Units

Introduction

The Spanish health care system has undergone important changes, particularly in the development of new hospital services. The Hospital-in-the-Home Unit (HHU) is an innovation that delivers acute hospital services to appropriate patients in their own homes (Ridao et al., 1997). The benefits of HHUs are numerous; if the patient stays at home, hospital admissions decrease, and more importantly, infections are avoided (Planas et al., 2005). Home healthcare also increases patients' quality of life as it reduces the care needed from their families and prevents risks associated with hospital admissions (Gideon et al., 1999), translating into greater patient satisfaction with home treatment (Brown, 1993). Home healthcare can also improve hospital performance (Carr-Hill, 1992). However, a HHU requires a change of attitude from health care practitioners for several reasons: Firstly, part of the HHU´s strategy involves carrying out care practices outside the hospital, which provides a new framework for practitioners who are still influenced by their previous experiences. These care practices have been developed within traditional frameworks (inside hospitals). Secondly, the implementation of a HHU involves a change in the healthcare services, moving towards the development and application of technologies adapted to ensure and improve the quality of care.

The key benefits of the use of technologies in HHUs are clear; it enables them to identify and replace poor practices and also avoids the reinvention of the wheel (e.g. by minimizing unnecessary work caused by the use of ineffective methods), reduces costs through better productivity and efficiency (improving services to patients) and increases profitability (Thouin et al., 2008). However, despite the opportunities the health sector will offer as a result of the design and development of a technology infrastructure, the fact is that hospitals have been slow to adopt information technology (Menachemi et al., 2008) largely because very few organisations are prepared to face this challenge (Brakensiek, 2002). For example, several state members of the European Union have already established the failure in the application of certain technologies in their health systems. Regarding this, previous studies in business management confirm that the numerous failures in the implementation of technologies are a consequence of the fact that the majority of companies have only introduced technologies without modifying the existing prevalent culture in the company (Cegarra et al., 2007). It is difficult to detect an improvement in the results after the introduction of technological systems if the same set of values, rules, and habits are maintained, since staff members will soon act in the same way as they did before the implementation (Stefl, 2002).

The considerations set out above lead us to expect the development of new knowledge in response to the HHU's external interactions with the patient and the use of new technologies in different settings. In this regard, Gold et al. (2001) draw attention to the fact that technologies cannot predefine and predict who is the right person, what is the right time or what constitutes the right information; only individuals can apply their own experience and contextual understanding to interpret the details and implications of a particular situation, subsequently determining the appropriate action to take. Therefore, in order to deliver the full benefit of a technology system, it must be implemented in a manner that takes into account the process by which HHU practitioners deploy new technologies into routine medical practice. In an attempt to meet this target, this chapter proposes a theoretical model based on Davis’ Technology Acceptance Model (Davis, 1989), one of the most frequently employed methodologies for studies on the adoption of new technologies. The aim is to identify key success factors for the acceptance of technology systems in HHUs. We provide an overview of current literature in the areas of technology below, including the potential factors that may enable the implementation of technology.