113 Barriers and Facilitators Associated with the Implementation of Technical Improvements in Medical Beds 4 one sheet on the bed. In all other cases, nurses had to remove objects from the bed that could affect the weight measurement. Another factor that may have impacted the implementation was the frequent turnover of key stakeholders within our own organization, particularly in the facility department and the contract manager responsible for contact with the bed manufacturer. Additionally, there were frequent changes among important stakeholders on the manufacturer’s side, including the clinical advisor. The company was also taken over by another company during this period. Discussion This case study demonstrated that the smart functions in medical beds showed promise and were generally seen as an improvement over the previous beds. However, full integration of these smart functions into daily practice was not achieved. Fidelity, in terms of both self-reported adherence and observed usage, remained below 80%. Several determinants hindered effective implementation, including concerns about the perceived reliability and ease of use of the smart functions. Contextual challenges, such as limited connectivity and frequent changes among key stakeholders, further impacted the practical use of these features. The implementation of the smart beds would have benefitted from a more comprehensive approach. At the time of creating the implementation plan, no context analysis had been conducted, and no key determinants were identified. We observed that the implementation did not follow the initial plan, and there was no follow-up or reevaluation, despite indications of limited success. A more iterative process, with ongoing analysis and adjustment, would likely have been more effective. One contributing factor to this oversight was the lack of clear and well-defined implementation goals from the outset. The implementation plan involved deploying key users and education, where deploying key users was the primary strategy. To this aim, the manufacturer suggested the train-the-trainer principle [16]. The deployment of key users, or local champions, is a frequently applied implementation strategy, Santos, Graham [17] underscored that describing the activities of key users is essential to assess the effectiveness of this type of implementation strategy. Interviews with stakeholders made clear that nurses being motivated to perform the role of key user – and not just being appointed as such – is an essential prerequisite. Key users’ sense of responsibility might be heightened through explicit expectations about this role. Managers requesting updates on their activities
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