Why Care Technology Adoption Fails: Seven Influences Every Care Provider Should Understand
Updated: Oct 20
"Funding creates opportunities for technology adoption. Turning those opportunities into sustainable improvements in care requires considerably more."
Across Australian aged care and disability services, providers are investing in digital platforms, remote monitoring, assistive technology and connected care solutions. These technologies promise safer care, greater independence, more effective workforces and improved operational efficiency.
Yet technology that performs well during a demonstration or pilot does not necessarily become part of everyday care. Solutions can be technically sound, appropriately funded and supported by a compelling business case, but still struggle to achieve widespread adoption.
The challenge is rarely technology alone. It is the complexity of the people, organisations and care environments into which technology is introduced.
Understanding that complexity is essential to making better digital investment decisions.
WHY FUNDING AND TECHNOLOGY ARE NOT ENOUGH
Australia's Support at Home arrangements, including dedicated Assistive Technology and Home Modifications funding, have created opportunities to improve access to technology-enabled care.
However, financial accessibility does not automatically translate into effective adoption.
Consider a remote monitoring solution introduced to support older people living independently. The technology may reliably detect changes in activity or potential safety concerns. But what happens when an alert is generated? Who receives it, who determines its significance, and who is accountable for responding?
If these responsibilities are unclear, technology can introduce additional operational risks rather than reduce them.
Similarly, a digital care management platform may promise substantial efficiency improvements. Yet those benefits can disappear when frontline workers must maintain duplicate records, navigate disconnected systems or work around processes that have not been redesigned.
In both cases, the technology may function exactly as intended. What is missing is the organisational and operational capability required to translate functionality into sustainable value.
The critical question is not simply whether technology works, but whether it can work effectively within the realities of care delivery.
UNDERSTANDING THE SEVEN INFLUENCES OF TECHNOLOGY ADOPTION
The NASSS framework - Non-adoption, Abandonment, Scale-up, Spread and Sustainability - provides a useful way to understand why health and care technologies succeed, struggle or fail.
Developed by Greenhalgh and colleagues, the framework identifies seven interacting domains that influence technology adoption and sustainability.[1]
Rather than assessing technology in isolation, NASSS examines the broader conditions that determine whether a solution can become an effective and enduring part of care delivery.
1. THE CONDITION - UNDERSTANDING CARE NEEDS
Technology adoption begins with understanding the people receiving care and the circumstances in which support is provided.
Older people and people living with disability may have multiple conditions, changing functional capabilities, different levels of digital confidence and individual preferences about technology.
A solution appropriate for someone living independently with strong family support may be unsuitable for another person with cognitive impairment or limited informal support.
Providers must therefore consider individual needs, care complexity and the diversity of circumstances in which technology will operate.
The question: Are we designing around genuine care needs or assuming that one solution will suit everyone
2. THE TECHNOLOGY - FIT FOR REAL-WORLD CARE
Technology must be reliable, accessible and appropriate for the environments in which it operates.
This extends beyond functionality to include interoperability, connectivity, usability, data quality, vendor support and ongoing maintenance.
A sophisticated monitoring solution offers limited value if its information cannot be interpreted or integrated into care workflows. Similarly, technology requiring extensive technical support may be difficult to sustain across geographically dispersed services.
Providers need to understand the complete operating requirements of a solution, not simply its advertised capabilities.
The question: Can this technology operate reliably within our actual care environment?
3. THE VALUE PROPOSITION - BENEFITS FOR WHOM?
Technology creates different forms of value for different stakeholders.
For care recipients, value may mean greater independence, safety or confidence. For families, it may provide reassurance. For frontline workers, it may reduce administrative effort or improve access to information.
For providers, value may involve better care outcomes, reduced operational risk, improved workforce productivity or more sustainable service delivery.
These benefits are not necessarily aligned. A solution that reduces organisational costs but increases the workload of care workers may struggle to achieve adoption.
Successful investment decisions therefore require a balanced understanding of costs, benefits and trade-offs.
The question: Have we defined measurable value for everyone expected to benefit from or use the technology?
4. THE ADOPTERS - PEOPLE DETERMINE SUCCESS
Technology adoption depends on the people expected to use, support and respond to it.
Care workers, clinicians, consumers and families bring different expectations, capabilities and concerns. Their willingness to engage is influenced by trust, perceived usefulness, confidence and the extent to which technology supports their needs.
Training is important, but training alone does not create adoption.
People need to understand why change is necessary, how it affects their responsibilities and whether the technology genuinely improves their experience.
Engagement must begin before implementation rather than becoming an activity immediately preceding go-live.
The question: Have we involved the people whose behaviour must change for the technology to succeed?
5. THE ORGANISATION - READINESS TO IMPLEMENT
Organisational readiness is frequently underestimated in technology investment decisions.
Successful adoption requires leadership commitment, effective governance, workforce capacity, process redesign, integration capability and clearly assigned operational responsibilities.
A provider may have the funding and technical infrastructure to introduce a new solution but lack the internal capacity to support implementation across multiple services.
Technology also changes established routines. Unless those changes are understood and managed, staff may develop workarounds or return to previous practices.
The organisation must be prepared to change alongside the technology.
The question: Are our people, processes, governance and operating model ready to support this investment?
6. THE WIDER SYSTEM - EXTERNAL CONDITIONS MATTER
Care providers operate within a broader environment of government policy, regulation, funding arrangements, professional expectations and industry relationships.
These conditions can enable or constrain technology adoption.
Funding eligibility may influence which technologies are accessible. Privacy and information-sharing requirements affect how data can be collected and used. Workforce arrangements and relationships between service providers influence how technology-supported care is coordinated.
Even a well-designed solution supported by a capable organisation can struggle when external conditions are not aligned.
The question: Have we considered the policy, regulatory and sector dependencies that could affect implementation and sustainability?
7. EMBEDDING AND ADAPTATION OVER TIME
Implementation is not the endpoint of technology adoption.
Care needs change, technology evolves, workforce capabilities develop and organisational priorities shift. A solution that initially delivers value may become less effective unless it is continuously reviewed and adapted.
Sustainability requires ongoing monitoring, feedback, improvement and accountability.
This is particularly important when moving from a successful pilot to deployment across different locations, care settings or consumer groups.
The question: Have we established the capability to adapt the technology and associated care practices over time?
THE SEVEN INFLUENCES MUST BE MANAGED TOGETHER
The real strength of NASSS is not simply identifying seven domains. It is recognising that they are interconnected.
A technically capable solution may fail because workforce practices were not considered. Strong staff engagement may be undermined by inadequate integration. An effective implementation may become unsustainable when funding arrangements or care requirements change.
These relationships explain why technology adoption cannot be reduced to procurement, project delivery or change management alone.
Providers need to consider the seven influences throughout the investment lifecycle, from identifying care needs and evaluating solutions to implementation, adoption, scaling and continuous improvement.
WHAT THIS MEANS FOR PROVIDER LEADERSHIP
The seven influences are relevant across residential aged care, in-home care, independent living and disability services. Although care environments, operating models and funding arrangements differ, the underlying challenge remains the same: introducing technology into complex environments where people, processes and care outcomes must remain central.
For executives and boards, sustainable technology adoption requires a broader investment perspective. Technology selection must extend beyond functionality and cost to consider organisational readiness, workforce implications, integration requirements, governance arrangements and long-term operational sustainability.
In practical terms, provider leadership should:
Assess organisational readiness alongside technical capability, including workforce capacity, processes and governance.
Engage stakeholders early, particularly care recipients, frontline workers and operational leaders whose participation determines successful adoption.
Define measurable benefits for different stakeholders, linking technology investments to care outcomes, workforce effectiveness and operational performance.
Consider the full investment lifecycle, including integration, implementation, ongoing support and the total cost of ownership.
Establish ongoing accountability for adoption, benefits realisation and continuous improvement beyond initial implementation.
Ultimately, technology adoption should be treated as an organisational capability rather than an isolated project activity. Success depends not simply on implementing a solution, but on creating the conditions in which it can deliver sustained value.
Before committing to the next technology investment, provider leadership should ask:
Are we investing only in the technology, or are we also investing in the conditions required for people to adopt it successfully?
Funding creates the opportunity. Technology provides the capability. People, processes and organisational readiness determine whether that opportunity becomes lasting value.
ABOUT THIS SERIES
Part 1 of eight in the eHomeCare series exploring the seven influences on care technology adoption.
Based on the NASSS framework, this series examines the factors influencing whether technology is adopted, abandoned, scaled or sustained in real-world care environments. Each subsequent article explores one of the seven domains and its implications for Australian aged care and disability providers.
Next article: Article 2 - The Condition
Hubert van Dalen is the founder of eHomeCare, providing independent digital strategy, governance, technology and transformation advisory services to Australian aged care and disability providers.
References:
[1] The NASSS model (for Non-adoption, Abandonment, Scale-up, Spread, and Sustainability)
Greenhalgh, T., Wherton, J., Papoutsi, C., et al. (2017). Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. Journal of Medical Internet Research, 19(11), e367.
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