Organizational Tensions in the Implementation of Modifiable Off-the-Shelf Technologies (MOTs) in a University Hospital: Qualitative Multimethod Study (Preprint)

<sec> <title>BACKGROUND</title> Hospitals face increasing pressure to accelerate digital transformation. Modifiable off-the-shelf technologies (MOTs) combine standardized products with limited adaptability, offering promising opportunities for rapid digitalization. However, implementing MOTs in complex hospital settings involves multiple barriers, facilitators, and organizational dynamics that require deeper investigation. </sec> <sec> <title>OBJECTIVE</title> This study aimed to identify barriers and facilitators in the implementation of MOTs in hospitals and to explore how organizational dynamics, conceptualized as tensions, emerge throughout this process. </sec> <sec> <title>METHODS</title> Guided by a constructivist-interpretivist paradigm, the study followed a collaborative action research approach. A qualitative multi-method design was used, including observations, workshops, and focus groups with clinical and project management staff. Data were analyzed using deductive-inductive qualitative content analysis following Kuckartz’s approach. </sec> <sec> <title>RESULTS</title> We analyzed 12 de-identified researcher protocols from five observations, three workshops, and four focus groups. Across these activities, 129 individuals from various wards and departments participated . Barriers and facilitators were clustered into six categories representing inhibiting and enabling conditions of MOT implementation. Barriers included Product Limitations (22.6%, 88/390), Misaligned Implementation Process (4.4%, 17/390), Absence of Available Individuals (3.8%, 15/390), Structural Challenges (2.8%, 11/390), and Resource Constraints (2.8%, 11/390). Facilitators included Orchestrated Implementation Process (13.8%, 54/390), Product Alignment (14.4%, 56/390), Effective Coordination and Communication (9.2%, 36/390), Presence of Available Individuals (6.7%, 26/390), Available Resources (3.1%, 12/390), and Structural Assets (1.8%, 7/390). These categories were conceptualized in three organizational tensions: Limited relative advantage of generic systems; structured participation challenges in complex settings; constrained engagement despite motivation due to limited resources. </sec> <sec> <title>CONCLUSIONS</title> Tensions in MOT implementation reflect organizational misfits that go beyond concrete barriers or facilitators and instead require systemic and agile organizational structures. The analysis introduces the concept of user:ability as an organizational capacity for enabling engagement with MOTs. We derive three tailored strategies to mitigate the tensions: ensuring relative advantage through IT integration and learning; empowering user participation through digital transformation, and communication; and enabling clinician engagement through dedicated resources and systematic implementation. This study advances prior work by deepening the understanding of implementation determinants into organizational tensions and offering actionable strategies to address them. It also illustrates how collaborative, agile research approaches can illuminate complex organizational dynamics and support hospitals during transformative change. </sec> <sec> <title>CLINICALTRIAL</title> <p/> </sec>