Exploring the Configuration of Institutional Practices—A Case Study of Innovation Implementation in Healthcare

Round 1

Reviewer 1 Report

The main problem of the article is that it has no novelty elements.

When we talk about telemedicine, the focus must be on the patient. The questionnaire does not contain questions related to the patient's satisfaction in terms of the quality of the medical act through telemedicine. There is only one mention related to the concern of the specialists for whom the responsibility will belong in the situation in which the general practitioners would omit something important about the patient that would lead the specialist to give a wrong diagnosis. The question addressed to the patients related to the differences identified between telemedicine and traditional consultation, but also those addressed to specialists related to similarities, respectively differences between the two practices did not reveal anything related to the quality of the medical act.  
For example, the authors can use the data they consulted to extract information about patients who returned or not to consultations with the same unresolved medical issues in previous consultations.

Author Response

Dear Reviewer, 

Thank you for your valuable comments and observations. Please find below our response.

1. Are the research design, questions, hypotheses and methods clearly stated? Must be improved.

Response: Due to the qualitative nature of study we have not stated the hypotheses and implicitly refer to it in the literature review section entitled “The Micro-process of Innovation Implementation” – Line 157-161. The research questions are in line 45-48 of the original manuscript. We have tried to articulate and provide a detailed explanation of the research design in the Research setting section.

2.The main problem of the article is that it has no novelty elements.

When we talk about telemedicine, the focus must be on the patient. The questionnaire does not contain questions related to the patient's satisfaction in terms of the quality of the medical act through telemedicine. There is only one mention related to the concern of the specialists for whom the responsibility will belong in the situation in which the general practitioners would omit something important about the patient that would lead the specialist to give a wrong diagnosis. The question addressed to the patients related to the differences identified between telemedicine and traditional consultation, but also those addressed to specialists related to similarities, respectively differences between the two practices did not reveal anything related to the quality of the medical act.  
For example, the authors can use the data they consulted to extract information about patients who returned or not to consultations with the same unresolved medical issues in previous consultations.

 

Response: The focus of the study is on the organizational adoption of innovation rather than individuals (patient) on which there is a wide literature in marketing and innovation studies. The innovation diffusion models has been also be studied at the organizational level, however what is missing are studies that takes into account the intra-organizational or micro-process of innovation adoption and diffusion within the organization which unlike the dominant model of innovation (Roger’s Innovation diffusion model, 2010) that emphasizes relative advantage, compatibility, complexity, trialability, and observability of the innovation as the determinant factors, our study focus on the organizational actors, both human and non-human designed (institutional practices) in influencing the implementation of innovation. Another important aspect of our study is in understanding the role of employees with different professional background (technical and non-technical) in the implementation of the telemedicine innovation. We understand your concern, but we mentioned previously the focus is the intra-organizational aspects of telemedicine innovation rather than the end user (patient).     

 

Bibliography: Rogers, E. M. (2010). Diffusion of innovations. Simon and Schuster.

3. English language and style are fine/minor spell check required.

Response: Thank you for your observations. We have now carried out a spell check and hope that this version does not have spelling errors.

We hope you are satisfied with our response. We again highly appreciate your time and observations.

 

With best regards, 

Reviewer 2 Report

As a qualitative study of descriptive nature the paper is relatively well developed. However, I would like the authors to deepen the discussion section. For example- how do the findings of the study help extend/contribute to the translation perspective of institutionalization? Would it be possible that the findings would be unique to a service firm setting or can one draw broader conclusions? While the text refers to the community of practice – and also argue “could depend on the understanding and agreement of diverse organizational actors (belonging to different professions) in translating an externally developed innovation within the framework of the extant institutional practices” – 1) Can innovation be easier to implement if actors belong to the same profession? What are the limitations of the study – the paper is completely silent on these important elements. The table 4 mentions an entity called “Colciencias”. There is no reference to it in the text.

• Take note of the sequence as point number 3 is missing (discussion section).
• Line 512 – the sentence is incomplete.
• The column heading in Table 4 should be institutional practices rather than practices.
• The paper should be proofread before resubmission – as the study’s subject were Spanish speakers there might be issues with the translation of the quotes from Spanish.

 

Author Response

Dear Reviewer, 

Thank you very much for your valuable comments and observations. We hope that we could respond satisfactorily to your concerns. Please find below our response.

1. As a qualitative study of descriptive nature the paper is relatively well developed. However, I would like the authors to deepen the discussion section. For example- how do the findings of the study help extend/contribute to the translation perspective of institutionalization? Would it be possible that the findings would be unique to a service firm setting or can one draw broader conclusions? While the text refers to the community of practice – and also argue “could depend on the understanding and agreement of diverse organizational actors (belonging to different professions) in translating an externally developed innovation within the framework of the extant institutional practices” – 1) Can innovation be easier to implement if actors belong to the same profession? What are the limitations of the study – the paper is completely silent on these important elements.

Response: Thank you very much for your comments. We apologize if we have not articulated the contribution of the study to the translation perspective of institutionalization. We use the translation perspective as an organizing framework by highlighting its difference from the technology adaptation perspective as we mention in the introduction “We use the translation perspective as the conceptual lens to situate the understanding of innovation implementation within an organization. By emphasizing the local context, the translation perspective proposes that innovations, especially those developed elsewhere are often subject to variation because of the way it is understood and ap-plied in a new setting [20, 31, 32]. This perspective is a significant departure from both the deterministic technology adaptation model and the institutional perspective that accords primacy to the macro-institutional factors in organizational change. By taking a more micro-view of change the translation approach allows us to understand the interactions that occur within intra-organizational settings when new practices, ideas, objects and technology are introduced in an organization [31]”. Thus, in terms of contribution our study highlights how translators as organizational actors belonging to different professions do translation work on the ground i.e how the organizational actors translate an externally developed innovation given the extant institutional practices. This way we advance the understanding of how translation occur as an organization goes through the process of implementing an innovation thereby suggesting the importance of separating the process aspects of translation and how ideas or more specifically innovative ideas are translated on the ground.     

 

Communities of practice: Thank you for the observation. Our position is that professional difference by which we mean the professions in which organizational actors are trained – in our case medical (doctors) and non-medicine (administrative professionals) could hamper innovation implementation because of the diverging perspective between communities of practice (individuals belong to the same profession) For instance – while medical professions might evaluate an innovation from a technical perspective, whereas non-medical professions (administrative/management) from a user/patient or management perspective. It is highly likely that such differences would not exist in homogeneous groups. Note that there could be other factors in play in homogeneous groups.  

 

Limitations: As our study is qualitative it has limitations of a qualitative research design (Pratt et al., 2020; Ochieng, 2009). Since, these limitations are well know we though that it is not necessary to be incorporated in the paper.

 

References:

Ochieng, P. A. (2009). An analysis of the strengths and limitation of qualitative and quantitative research paradigms. Problems of Education in the 21st Century, 13, 13

Pratt, M. G., Kaplan, S., & Whittington, R. (2020). Editorial essay: The tumult over transparency: Decoupling transparency from replication in establishing trustworthy qualitative research. Administrative Science Quarterly, 65(1), 1-19.

 

2. The table 4 mentions an entity called “Colciencias”. There is no reference to it in the text.

Colciencias is the administrative department of science, technology and innovation of the government of Colombia. Their mission is to foster innovation in the Colombian economy.  Colciencias fund technology/innovation projects that can be deemed too risky for investment by the private sector. In this study they appear as a regular because their approval is necessary if a Colciencia funded project requires a change(increase) in product/service price – the objective is that organizations receiving funding from Colciencias do not take undue advantage of the gains from innovation.   

 

1. Take note of the sequence as point number 3 is missing (discussion section). Thank you for the keen eye. We have taken note and revised it.
2. Line 512 – the sentence is incomplete. We have removed the words “ similar to” because it might create an incomplete sentence.
3. The column heading in Table 4 should be institutional practices rather than practices.Thank you for highlighting it. We have made the necessary correction.
4. The paper should be proofread before resubmission – as the study’s subject were Spanish speakers there might be issues with the translation of the quotes from Spanish. Thank you again for highlighting it. You are right. We did carry out a proof reading. It does seem that transcription from Spanish to English is leading to some quotes being not in the proper semantics. We believe that we should retain as much of the original as possible. 

 With best regards, 

Reviewer 3 Report

Innovations in themselves are very broad, and there are a variety of types of innovations.
Since you are considering a specific innovation - telemedicine - it would be better to clarify your understanding of "externally developed innovation" [44, 145], "innovation, especially those developed elsewhere" [84]

Author Response

Dear Reviewer, 

 

Thank you very much for your comments and observations. We hope our response is to your satisfaction . Thank you for your time in reading the manuscript. 

Innovations in themselves are very broad, and there are a variety of types of innovations.
Since you are considering a specific innovation - telemedicine - it would be better to clarify your understanding of "externally developed innovation" [44, 145], "innovation, especially those developed elsewhere" [84].

Thank you for your keen observation. You are right – the term externally developed innovation” could create confusion, especially since innovation research is familiar with other popular terms or there are multiple way of understanding and defining innovation. What we are referring to in this study is the classification between innovation adopting organizations (IAO) and innovation generating organizations (IGO). It is possible that most organizations are actually adopters of innovation, rather than generators of innovations (Damanpour & Wischnevsky, 2006). Such organizations or IAOs use innovations that are developed elsewhere or externally developed. Telemedicine is one such example. It was not developed by our case organization but adopted by it.

Hence regarding the role of patients, we believe that they are also important actors in the adoption of innovation – our focus being on the (organizational) actors leads to underemphasize the role of patients. I am sure future studies can focus on patients within innovation adopting organizations.   

 

Reference

Damanpour, F., & Wischnevsky, J. D. (2006). Research on innovation in organizations: Distinguishing innovation-generating from innovation-adopting organizations. Journal of engineering and technology management, 23(4), 269-291

 

With best regards

 

Round 2

Reviewer 1 Report

The emphasis on understanding the role of employees in implementing telemedicine innovation can be enhanced by using some data analyzed by authors related to the concern of the specialists related to the responsibility of the medical act, a concern inserted in the article. Specialists versus general practitioners  (both categories involved in implementation) and how to deal with this. After all, the implementation of innovation is not just for the sake of implementation, even if the research takes into account the intra-organizational or micro-process of innovation adoption and diffusion within the organization. 

Author Response

Answer: Thank you for your suggestion. We agree with your suggestion that one needs to look at this specialist versus generalist debate that occur in such settings. Accordingly, we have elaborated about this aspect a little bit in the section on modification of practices.

With regard your concern about the lack of patient data related – before and after telemedicine, we are unfortunately unable to furnish additional data at this time as our focus in this study is not on the patients, as evident from table 1. We do not gauge the efficacy of telemedicine from patient’s perspective. This could be considered as a limitation as well as opportunity for future studies.

Author Response File: Author Response.docx