RQ 3: How do practitioners’ innovation-values fit influence the implementation process?

between the other actors in the management group and the practitioner group (Birken et al., 2013, p. 31). Secondly, Informant 7 can be perceived as an innovation champion that supports the implementation process by motivating and encouraging practitioners to use Braive

(Helfrich et al., 2007; Klein & Sorra, 1996). Through the analysis, we have seen that Informant 7 is viewed by the management group as a valuable resource contributing to pushing forward the implementation process by disseminating their own experiences of technology use in clinical practice. Moreover, it becomes apparent that Informant 7 has influenced the process positively by functioning as a supporter of the practitioners when facing doubts and uncertainties. It would have been interesting to see how a champion might have influenced such an implementation process if the champion were one of the practitioners and not in the management group.

6.3 RQ 3: How do practitioners’ innovation-values fit influence the implementation process?

It becomes apparent in the analysis that none of the included informants from the practitioner group had any previous experiences with practically using digital psychotherapy or Braive.

According to the theoretical argumentation, in light of innovation implementation, employees are likely to experience uncertainty and form judgments about the extent

to which the given innovation is compatible with their existing beliefs and values (Hurst, 1982; Jalonen, 2011; Rogers, 2003). Indeed, the latter was predominant in the respective implementation process too.

On the one hand, the innovation-values fit between the management group and Braive, as well as between clinic B practitioners and Braive mirror a solid innovation-values fit in the sense that both these groups perceive digital psychotherapy as something that supports the

fulfillment of their professional values, and also support the broader vision of a more accessible mental healthcare (Helfrich et al., 2007; Klein & Sorra, 1996). The fit between management groups’ values and Braive becomes evident in their descriptions of the perceived relative advantages of the innovation, as well as in their commitment to implement this service by establishing IP&Ps that contributed to the innovation specific implementation climate, and accordingly, reflected the center’s vision of a long-term investment in digital

psychotherapy. Furthermore, the fit between clinic B practitioners and Braive appear when they expressed their belief in the service and indicated a consistent innovation use as they both achieved the 40% goal of using Braive. However, it should be noted that the

management group does not supervise how often the practitioners’ practice in Braive, or the status of how many Braive patients the practitioners have.

On the other hand, the innovation-values fit between clinic A practitioners and Braive seem vaguer, as this group’s views indicate more doubt. The innovation theory suggests that healthcare professionals work evidence-based in almost everything they do. Through the analysis, we have seen that the evidence-base supporting digital psychotherapy has increased all informant’s belief in such a treatment method. However, we have also seen that scientific evidence support alone is not sufficient alone in terms of motivation to further drive the organizational innovation implementation process. As stated by Ramanujam and Rousseau (2006), healthcare challenges are “organizational not just clinical”.

It is interesting to see that the same IP&Ps established by the management group influence the implementation process differently at clinic A and clinic B. However, such differences

between organizational groups are expected, as recognized by Klein and colleagues (1996) and supported by Helfrich and colleagues (2007). In this case, we have seen in the analysis that one explanation of the difference can be that these underlying clinics treat different patient groups. For example, while clinic A practitioners deal with a more ill patient group that is understood as more “complex cases” that require more time, clinic B practitioners, on the other hand, have more time at hand as their patients have milder symptoms. In addition, it becomes clear that it is more challenging to motivate patients with heavier symptoms to work independently in a digital platform. Another explanation of the differences between clinic A and clinic B is that these groups were introduced to Braive at different times in the

implementation process.

While included practitioners from clinic B were involved in the ALEC-project from the start, clinic A practitioners got recruited to the e-health team later in the process and earlier than planned due to the occurrence of Covid-19. In this way, it makes sense that clinic B

practitioners had more experience using Braive, which made them more used to the new roles, routines, and practices that came with the innovation. Although it does not show in the raw data nor the analysis, I believe that it can be likely that clinic B practitioners experienced

uncertainty in the very beginning at the implementation too. However, when asked about the latter, clinic B practitioners did not provide any fruitful descriptions, perhaps because they have been influenced by their fresh and positive experiences with Braive, and that those memories of what they felt in 2018 naturally fade.

Clinic B practitioners view the relative advantage of the innovation as something that helps overcome the barriers to face-to-face interventions related to time and accessibility.

Moreover, they also emphasize the design of Braive as organized, practical, and clear.

Interestingly, through the analysis, it becomes clear that the fit between the given innovation and practitioners’ values can be understood in many layers.

The first layer is digital psychotherapy, the relatively novel psychological treatment method that Braive represents. Clinic A practitioners generally emphasize the value of digital psychotherapy in expanding access to mental healthcare. However, in the local

implementation process at Lovisenberg, such a method is rather perceived as challenging to utilize due to the struggle of motivating the more complex patient groups. The second layer is cognitive-behavioral therapy (CBT), the grounded psychological approach that Braive is built on. Clinic A practitioners recognize such an approach as beneficial in general; however, they believe a more relational approach is often more valuable for their lower functioning patient group.

Given the challenge to motivate their patients, the current situation is that they often have to combine face-to-face interventions with Braive, which is rather perceived as exhausting. The third layer, interlinked to the two others, is the new tasks that comes with delivering treatment online. For example, the practitioners have to become familiar with text-based feedback, which is quite discontinuous with their previous practice. As stated by one of the informants, they are trained in verbal communication, and not structured text-based comments. Again, as clinic B have practiced the latter since 2018, they seemed comfortable with such practice at the time when the interviews took place. However, for clinic A practitioners, these new roles, tasks and responsibilities that comes with Braive is still perceived as new. The latter in turn influence their innovation-values fit, which again, influence the implementation process in the way that they use the innovation less frequently than what the management group anticipates.

Again, it should be noted that the balance between what is required and what should remain flexible seem essential to consider.

It should also be noted that innovation-values fit is dynamic because the perception of the innovation’s relative advantage changes much determined by patients’ experience and feedback. When patients indicate positive recovery progress using Braive, all practitioners seem to become more motivated to recommend such treatment method to future patients.