Revisiting the innovation journey. Organizational, technology and policy perspectives on complex innovations

Abstract

This dissertation covers a neglected area of innovation theory and empirical research that is now subject to growing interest, the de-adoption or abandonment of innovation by organisations. Most research on innovation implementation concentrates on early phases immediately post-adoption. It is unclear how organizations behave when technologies evolve over time and decisions are made to abandon an innovation. It is still less clear what happens when organizations maintain an old innovation while simultaneously adopting an alternative, or they abandon an innovation only to readopt it later. Renal replacement therapy is a field where competing dialysis technologies have emerged since the 1970s and healthcare organizations display a variety of adoption, abandonment and re-adoption behaviours. Chapter 2 investigates the innovation trajectory of home-based dialysis – adopted, diffused, gradually abandoned and now experiencing re-adoption. It combines multiple perspectives to integrate field-level analysis of the technology evolution with the study of different factors expected to influence diffusion, and global, national and local diffusion data for competing forms of dialysis. The three main contributions of this chapter relate to: the meaning of ‘abandonment’, a much broader concept than technology substitution as it includes several routes towards the decline of an innovation; a better understanding of abandonment drivers; and lastly the importance of accounting for significant local variations in diffusion, even in mature technological fields. Chapter 3 shifts attention to the organizational level. It investigates how organizations cope with implementing competing innovations through a comparative case study of two hospitals that adopted and implemented competing dialysis technologies. Using a qualitative approach, it investigates the organizational implications of implementing competing traditional and innovative technologies. The chapter firstly enriches the understanding of innovation, showing how competition between alternative innovations does not necessarily resolve with one replacing the other. Secondly, it conceptualizes the internal consequences of implementing competing solutions, showing how the competition between technologies translates into competition among their users. Lastly, it provides a dynamic representation of the influences of competing innovations on organizational structures and professional experiences, in contexts of different managerial approaches and leadership styles. Chapter 4 maintains the organizational focus, analysing different sets of professionals and the evolution of their jobs as different dialysis technologies were implemented. Focusing on the interactions among physicians and nurses in four hospitals, it explores whether and how innovative technologies and their use impact on these professionals and their professional boundaries and, vice versa, how the experiences and activities of professionals at their boundaries impact on the implementation of innovations. The study confirms mutual influences between innovation, professionals and professional boundaries, and it also shows how the organizational context shapes the direction and possible results of these mutual changes, with implications also for the stability, or resistance, of innovation. The final chapter draws conclusions and summarizes the main contributions to theory, practice and possible research extensions.