title: Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands.
abstract: This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.
authors: Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands. Electronic address: pabrishami@zinl.nl.
authors: Payam
authors: P
authors: Abrishami
authors: National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands; Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: bboer@zinl.nl.
authors: Albert
authors: A
authors: Boer
authors: Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: k.horstman@maastrichtuniversity.nl.
authors: Klasien
authors: K
authors: Horstman
mesh_terms: D003142:Communication; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D006801:Humans; D008389:Marketing of Health Services / Q000191:economics; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009426:Netherlands; D036301:Qualitative Research; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data*
keywords: Affordance; Decision-making; Qualitative ethnographic evaluation; Science, Technology and Society Studies; Surgical device; Technology adoption; The Netherlands; da Vinci robot