94 Chapter 4 Abstract Background Smart medical beds with functions like weight measurements and bed-exit alarms can enhance care quality and reduce healthcare providers' physical burden. This study evaluated the integration of these functions in practice. Methods Implementation was evaluated using the UK Medical Research Council’s process evaluation guideline for complex interventions at one- and four-years post-introduction. The study analyzed the implementation plan, reach, dose, fidelity, and mechanisms of impact, in terms of patients’ and nurses’ reactions to the smart functions, and contextual factors that might have influenced the implementation process. Data were collected through observations, questionnaires, and semi-structured interviews with managers, nurse champions, and nurses. Quantitative data underwent descriptive analysis, while qualitative data were analyzed with through content analysis. Results The study included 445 observations, 369 patients participated, 209 nurses completed the survey, and 12 interviews were conducted. The implementation plan was partially executed, with educational sessions reaching most nurses. The integrated weight function saw regular use, while the head-of-bed-angle alarm was rarely utilized. Self-reported fidelity was moderate to good but low fidelity was observed. Patients and nurses generally expressed positive remarks, though nurses highlighted barriers such as limited reliability, usability, and perceived value. Stakeholders mentioned key contextual factors, including connectivity issues, stakeholder turnover, and disappointment in other technologies. Conclusions This study identified three major barriers to successful implementation of smart beds: poor connectivity, overestimated added value, and insufficient adjustments during implementation. To improve the adoption of technological innovations like smart beds, healthcare organizations must carefully identify determinants and deploy a dynamic implementation process with regular adjustments to maintain confidence in the innovation and support future improvements. Keywords Process evaluation | Smart beds | Implementation | Implementation Science | Digital Health
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