Sociotechnical Misalignments in Hospital AI System Implementation: Qualitative Case Study

Area of Science:

• Healthcare Informatics
• Artificial Intelligence in Medicine
• Sociotechnical Systems Theory

Background:

• Implementing artificial intelligence (AI) in healthcare presents significant challenges, particularly in integrating AI tools into existing clinical knowledge, practices, and procedures.
• Understanding the contextual embedding of AI is critical for successful implementation, resource planning, and maximizing the impact of AI tools.

Purpose of the Study:

• To examine the contextual challenges of implementing an AI chatbot (ChatAI) in a tertiary government hospital.
• To analyze the impact of sociotechnical factors on the sustained use and adoption of the AI chatbot.

Main Methods:

• An instrumental case study approach was employed, utilizing interviews and meeting minutes.
• 16 semistructured interviews were conducted with the implementation team and hospital staff.
• Sociotechnical Systems (STS) theory, specifically Davis et al.'s (2014) framework, was adopted to analyze the implementation and use of ChatAI.

Main Results:

• Misalignments in sociotechnical elements (goals, people, processes, technology, infrastructure) limited user adoption and sustainability of ChatAI.
• Contextual changes, including new regulatory mandates and evolving stakeholder practices, introduced further misalignments, leading to the chatbot's discontinuation.
• Initial attempts by the innovation center team to address misalignments were insufficient against ongoing contextual shifts.

Conclusions:

• Sociotechnical misalignments can significantly undermine the sustained use and success of large-scale AI implementations in healthcare.
• Future AI implementations require careful alignment of sociotechnical dimensions: goals, people, processes, technology, and infrastructure.
• Aligning evolving infrastructure and regulatory requirements presents a particularly challenging aspect for AI sustainability in healthcare settings.