What is the operationalization phase?

Operationalization refers to the planning and actions for introduction, dissemination, adoption, and internalization of the technology in the intended context. In this phase, the technology is launched, marketing is set into motion, and organizational working procedures are put into practice. A concrete plan is made to achieve this implementation of eHealth in context. Overall, this phase consists of two sub phases, namely creating a plan and determining concrete activities

During the previous development phases, there has been a constant check with the context and stakeholders to ensure a good fit between technology and context. The better this fit, the higher the chances of a smooth operationalization. For example, because stakeholders have been involved from the start, they often feel more involved with the technology and thus start using, implementing or recommending it to their peers. Because of their knowledge of the context, they should be involved in developing a plan for operationalization as well. Furthermore, a business model that accounts for the stakeholders and context was created during the previous development phases as well. In the operationalization phase, this business model is finished and practical strategies for its execution are developed [1]. 

Besides using information from the context, stakeholders, and the business model, theory can be used during the operationalization phase as well. Implementation theories like the Diffusion of Innovation theory [2, 3, 4] can be of added value when planning for the implementation of a new eHealth technology in practice. These kinds of theories can be used to bring the development team’s attention to factors that are known to facilitate implementation. These factors can be accounted for and addressed by the team to ensure a smoother operationalization process.

Based on the business model, the gathered knowledge of the context and the input of its stakeholders, as well as a framework from an implementation theory, a realistic and comprehensive action plan for operationalization should be created [5]. This action plan prescribes how to roll out and implement the technology in the context that was described in the contextual inquiry. The plan consists of activities and resources for training, education, and financing the operationalization to enable the use of the eHealth technology. When the technology is operationalized in the most optimal way, it will be used in the most optimal way as well. This ensures that the users will be reached, that they use the technology as intended, and that the determined added value is achieved. A good operationalization also contributes to positive effects on the long term because it takes matters related to responsibility of technical support and financing into account. 

What is the aim of the operationalization phase? 

The operationalization phase has two main objectives:

What are the outcomes of the operationalization phase? 

The main outcome of the operationalization phase is the introduction, dissemination, adoption, and incorporation or internalization of the technology in practice. This is guided by a plan that is developed in close cooperation with stakeholders to make sure it fits the context. Previous activities like business modelling and the contextual inquiry are used as input for the plan and methods to execute the plan.

An important issue to keep in mind during the operationalization phase is that, once technology is used in practice, it doesn’t mean that the development process is finished. Changes to the content and form of technology can still be made, for example based on experience of stakeholders, changing practical demands, or evaluation outcomes. Technology is not fixed and can – and perhaps should – constantly be adapted to answer to the changing demands and possibilities of practice. Also, practical matters like financing and technical support of the technology keep on being relevant once it is implemented: constant attention has to be paid to these kinds of issues.


[1] Van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4): e111. 

[2] Berwick, D. M. (2003). Disseminating innovations in health care. JAMA, 289(15), 1969-1975.

[3] Cain, M., & Mittman, R. (2002). Diffusion of innovation in health care: California Healthcare Foundation. Oakland, CA. ISBN 1-929008-97-X.

[4] Rogers, E. M. (2010). Diffusion of innovations: New York, NY: Free Press.

[5] Van Limburg, M., Wentzel, J., Sanderman, R., & van Gemert-Pijnen, L. (2015). Business Modeling to Implement an eHealth Portal for Infection Control: A Reflection on Co-Creation With Stakeholders. JMIR Research Protocol, 4(3):e104.