Institutional logics and the adoption and implementation of remote patient monitoring

Remote patient monitoring (RPM) of chronic diseases represents a care modality with great potential to substantially improve outcomes and reduce hospital admission and costs to society. Empirical research has examined the processes of RPM adoption and implementation; however, implementation of RPM – a complex technological and health service innovation – remains challenging. Various analytical frameworks have tried to understand the conditions for successful adoption and implementation of RPM and other complex healthcare innovations. This conceptual study argues that incorporation of lessons from literature on institutional logics could enrich these frameworks. Healthcare is a domain influenced by multiple competing, collaborating or co-existing institutional logics such as professional, state, market, corporate and increasingly a community logic, expressed in patient-centred care principles. We outline the concept of patient-centred care as an emerging institutional logic and explore how to incorporate it into two widely used analytical frameworks, NASSS ('non-adoption, abandonment, scale-up, spread, and sustainability') and normalisation process theory (NPT). The main benefit of adding an institutional logics approach to the NPT framework is primarily to increase awareness of how institutional logics at meso-and macro-levels may affect the scope of implementation at a micro-level. In the case of the NASSS framework institutional logics provides a rationale for achieving cross-level alignment between domains.