Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul 31:11:178.
doi: 10.1186/1472-6963-11-178.

Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT) in Ontario, Canada

Kate Bak  1 , Mark J Dobrow, David Hodgson, Anthony Whitton
Affiliations

Factors affecting the implementation of complex and evolving technologies: multiple case study of intensity-modulated radiation therapy (IMRT) in Ontario, Canada

Kate Bak et al. BMC Health Serv Res. .

Abstract

Background: Research regarding the decision to adopt and implement technological innovations in radiation oncology is lacking. This is particularly problematic since these technologies are often complex and rapidly evolving, requiring ongoing revisiting of decisions regarding which technologies are the most appropriate to support. Variations in adoption and implementation decisions for new radiation technologies across cancer centres can impact patients' access to appropriate and innovative forms of radiation therapy. This study examines the key steps in the process of adopting and implementing intensity modulated radiation therapy (IMRT) in publicly funded cancer centres and identifies facilitating or impeding factors.

Methods: A multiple case study design, utilizing document analysis and key informant interviews was employed. Four cancer centres in Ontario, Canada were selected and interviews were conducted with radiation oncologists, medical physicists, radiation therapists, and senior administrative leaders.

Results: Eighteen key informants were interviewed. Overall, three centres made fair to excellent progress in the implementation of IMRT, while one centre achieved only limited implementation as of 2009. Key factors that influenced the extent of IMRT implementation were categorized as: 1) leadership, 2) training, expertise and standardization, 3) collaboration, 4) resources, and 5) resistance to change.

Conclusion: A framework for the adoption and implementation of complex and evolving technologies is presented. It identifies the key factors that should be addressed by decision-makers at specific stages of the adoption/implementation process.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cyclical adoption/implementation cycle for complex and evolving technologies (Adapted from Rogers 1995).
Figure 2
Figure 2
Summary of the IMRT implementation process for each centre. *The dates in these figures are estimates based on key informant's responses and do not correspond to specific boxes.
Figure 3
Figure 3
A framework for multifaceted adoption/implementation of complex and evolving technologies (Adapted from Rogers 1995).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Webb S. The physical basis of IMRT and inverse planning. Br J Radiol. 2003;76:678–89. doi: 10.1259/bjr/65676879. - DOI - PubMed
    1. Veldman L, Madani I, Hulstaert F, De Meerleer G, De Neve W. Evidence behind the use of intensity-modulated radiotherapy: A systematic review of comperative clinical trials. Lancet Oncol. 2008;9:367–75. doi: 10.1016/S1470-2045(08)70098-6. - DOI - PubMed
    1. Staffurth J. A Review of the Clinical Evidence for Intensity-modulated Radiotherapy. Clin Oncol. 2010;22:643–657. doi: 10.1016/j.clon.2010.06.013. - DOI - PubMed
    1. Whitton A, Warde P, Sharpe M, Oliver TK, Bak K, Leszczynski K, Ethridge S, Fleming K, Gutierrez E, Favell L, Green E. Organisational standards for the delivery of intensity-modulated radiation therapy in Ontario. Clin Oncol. 2009;21:192–203. doi: 10.1016/j.clon.2008.10.005. - DOI - PubMed
    1. Thwaites DI, Verellen D. Evolution, implementation, QA and safety of new technology in radiotherapy. Radiother Oncol. 2010;94:125–128. doi: 10.1016/j.radonc.2010.02.004. - DOI - PubMed

LinkOut - more resources