Operationalization

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:

• Using the business model, input of the stakeholders, and implementation theory to create a plan to make sure that the technology is introduced and used in practice on the long term.
• Determining concrete activities to implement the eHealth technology in practice.

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.

References

[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.

What is creating a plan to make sure that the technology is introduced and used in practice?

In this sub phase of the CeHRes roadmap, the information collected in the previous development phases is relevant for the operationalization phase, since it contributes to the plan for the operationalization. First, the development team and stakeholders started developing the business model by filling in the business model canvas in the value specification. Consequently, the model was further specified alongside the development process, and is finalized and implemented in the operationalization phase. Concrete plans on how to deal with the nine blocks of the business model canvas have to be created in close cooperation with stakeholders. By means of methods like desk research, focus groups or interviews with stakeholders, the plan to implement the business model should be drawn up. Documented information from scientific or non-scientific literature on comparable operationalization processes might be used as well. Again, there are no concrete guidelines since the way to do this depends on the context, technology, and the preferences and competences of the team. This implies that the development team has to make deliberate, well-substantiated decisions, and constantly cooperate with stakeholders.

Implementation theory can also be used to guide the development of an operationalization plan. According to the Diffusion of Innovation theory, the attributes of the technology itself strongly contribute to whether or not implementation will be successful. If the prior development process was good, the following attributes of the technology will be present and should be emphasized [1, 2, 3]:

• Relative advantage. The development team should make clear that the advantages of a new technology outweigh the advantages of an existing approach.
• Complexity. Generally, simple technologies spread faster than complicated ones, so it should be clear to users that they won’t encounter a high level of difficulty.
• Compatibility. The development team has to make clear how the new technology should fit into the needs, values and routines of the user or organization.
• Trialability. Diffusion research has shown that it is beneficial for implementation when users can easily try out a technology without having to fully commit to it, so this has to be facilitated by the development team.
• Observability. The development team should make sure that potential users can see how an eHealth technology works by observing somebody else use it.

Furthermore, implementing an eHealth technology, it is important to account for the types of people that will be adopting and using it, since people differ in their willingness to use new technology. A useful way to do this is by accounting for how quickly they tend to adopt a new technology. The Diffusion of Innovation theory provides a categorization based on the innovativeness of adopters, which contains innovators (the quickest to adopt), early adopters, early majority, late majority and laggards. 

What is the aim of creating a plan to make sure that the technology is introduced and used in practice?

The aim of this sub phase is to create a plan to implement the business model  to make deliberate, well-substantiated decisions, and constantly cooperate with stakeholders.

References

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

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

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

What is determine concrete activities to implement the eHealth technology in practice?

The plan to operationalize eHealth should contain concrete methods. These methods can have different goals, for example, making potential users aware of the existence of the technology, persuading them to use it, and supporting them in continuing to use it. Some possibilities are:

• Pilot programs. A part of an organization starts using the eHealth technology. One aim of this is to make the entire organization aware of the existence and to show potential benefits of the technology.
• Advocates of the technology. During operationalization, it can be beneficial to have advocates of the technology who make their peers aware of and enthusiastic about the eHealth technology. Involving stakeholders in the development and implementation process are often committed to the technology and have much knowledge of it, which makes them good advocates.
• Presentations. The final eHealth technology can be introduced to the entire organization by means of presentations that provide potential users with information and the possibility to ask questions.

These methods are just some examples, but finding out the right implementation method requires some creativity and input from stakeholders who are acquainted with the context. Inspiration can also be gained from comparable projects, which can be found in literature, via desk research, or by contacting persons with relevant experience.

What is the aim of determining concrete activities?

The aim of this sub phase is to translate the plan for the operationalization in the previous phase to concrete activities to implement the eHealth technology in practice.