A qualitative study of Municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation

A qualitative study of Municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A qualitative study of Municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation Sissel Pettersen, Hilde Eide, Anita Berg This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9095841/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Strategic leadership—including guiding, supporting, and directing staff—is a critical determinant of successful technology implementation. Having tech champions is a recommended measure for leaders to support staff adoption of technology in their everyday practice. However, there is limited research on leaders’ perspectives on tech champions’ role as a strategic measure in technology implementation processes. This study aimed to explore healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation processes in municipal healthcare. Methods Semi-structured interviews were conducted with ten healthcare leaders in municipal healthcare, representing six Norwegian municipalities. The data were analyzed using reflexive thematic analysis based on Braun and Clarke’s (2022) descriptions. Results The analysis of municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation revealed three interrelated themes: 1) leading the technology implementation process, 2) strategically allocating staff resources, and 3) seeking specific qualities in tech champions. Conclusions Healthcare leaders’ perspectives on tech champions are based on considerations regarding the type of technology, leaders’ own capacity and competences and those of their staff, and individual champion competencies. Tech champions are perceived as healthcare leaders’ representatives, performing transformative leadership roles without dedicated time, compensation, or job descriptions. Tech champions healthcare leaders municipal healthcare services technology implementation transformative leadership Background Healthcare systems globally are under increasing pressure to improve their performance, including their productivity, quality of care, and efficiency in service delivery [ 1 ]. This has led to high expectations of exploiting technology to enhance quality and capacity in healthcare services worldwide. Successful technology implementation is heavily dependent on staff and management’s willingness and capabilities to apply technologies in their practice and service provision. Generating knowledge of the human factors in successful technology implementation outcomes is imperative to ensure optimized use of technology and staff resources for sustainable healthcare services [ 2 ]. Healthcare systems are generally acknowledged as complex social systems [ 3 ]. Thus, successful implementation of technologies in healthcare depends on both the implementation approach [ 4 ] and the leadership provided [ 5 ] According to van Gemert-Pijnen [ 4 ] implementation can be defined as a process of several planned and guided activities to launch, introduce, and maintain technologies in a certain context to innovate or improve healthcare. Successful technology implementation, also referred to as digital transformation [ 6 ] requires healthcare professionals to be digitally ready and capable [ 7 ]. Healthcare leaders play a vital role in ensuring success when technology and staff meet. They serve in a middle position between staff and top management [ 8 ] and hold crucial nexus/hub positions in implementation processes. Navigating complex webs of actors (e.g., healthcare personnel, IT personnel, patients, and administrators), healthcare leaders strive to balance priorities, collaborations, and strategic direction to prioritize high-quality care provision, including by governing new technologies. This manifests in leaders playing highly contextual roles (depending on assigned responsibilities and the demands of healthcare environments) in which they serve as catalysts for change among healthcare personnel [ 9 ]. Leading technology implementation in healthcare Healthcare leadership refers to the practice of influencing and guiding individuals and teams within the healthcare sector toward achieving the collective goals of improving patient care, operational efficiency, and healthcare delivery [ 10 ]. Due to technological advancements, there is a need to focus on leading digital transformations in healthcare [ 10 , 11 ]. Healthcare leaders must support and encourage staff and act as cheerleaders in technology implementation [ 12 ]. According to Burgess and Honey [ 13 ], healthcare leaders’ mission is to connect the digital and clinical worlds by facilitating and empowering healthcare personnel to use technology in their practice. In terms of empowerment, giving other staff authority and responsibility and delegating tasks are elements of effective healthcare leadership [ 10 ]. Healthcare leaders play several interrelated roles, serving as supporters, change managers, advocates, project managers, decision-makers, facilitators, and champions [ 5 ]. These leadership roles in implementation processes exemplify the concept of transformational leadership [ 14 ]. Transformational leadership is the process of creating commitment to organizational goals and empowering people to fulfill those goals [ 15 ]. According to Crawford et al. [ 16 ] transformational leaders take charge of their organizations at the macro level and facilitate interpersonal changes at the micro level. Transformational leaders motivate staff to accomplish more than they planned to [ 17 ] and more than what is required according to their employment contracts [ 15 ]. Tech champions as an implementation measure Support from staff is essential for successful technology adoption in healthcare [ 18 ]. A recent review of Laukka et al. [ 5 ] found that healthcare leaders identifying and appointing champions is one of seven leadership behaviors associated with successful technology adoption. Champions are often referred to as key people in technology implementation [ 19 ]. However, champions’ role in technology implementation in healthcare services is still unclear [ 20 ]. Although tech champions are described as a beneficial measure in facilitating technology adoption (e.g., [ 21 – 25 ], studies have found that tech champions play an undefined role in terms of content and task descriptions, and that this role is highly context dependent [ 19 , 26 , 27 ]. Tech champions perceive their own mission to be to promote, adopt, and assist technology by playing different roles to help their colleagues implement technology in their practice, most often as a task on top of their ordinary duties [ 27 ]. Based on this backdrop, this study draws on healthcare leaders’ critical role in technology implementation, tech champions as a recommended measure, and the need to add knowledge from the frontline of contemporary healthcare services where humans and technologies meet. The aim of this study is to explore municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation. Methods According to Nevedal et al. [ 28 ], qualitative research provides rich contextual insight into the lived experiences of healthcare systems and complex implementation processes. This study employed a qualitative interview design [ 29 ] with semi-structured interviews [ 30 ] to explore municipal healthcare leaders’ considerations of tech champions’ role as a measure in technology implementation processes in Norwegian healthcare. Study setting In Norway, municipal healthcare services are provided free of charge and are publicly funded by the tax system. The right to these services is regulated by the Health and Care Services Act [ 31 ]. Since 2012, the Norwegian government’s policy has been that, as far as possible, inhabitants who need general healthcare services should be offered them through public municipal healthcare services, preferably in their own homes or alternatively in municipal healthcare institutions [ 32 ]. Norwegian municipalities are free to organize service provision in line with local conditions, such as geography, demography, number of inhabitants, and resources allocated to municipal healthcare services. The 357 Norwegian municipalities vary in size, although they are mostly rural, with a low number of inhabitants widespread geographically, and are home to ageing populations. An administrative leader usually assumes overall responsibility for municipal healthcare services. Depending on the size of the municipality, this leader is often supported by several sectors responsible for healthcare leaders working on site at primary healthcare service departments/units and overseeing staff and service quality and development. These healthcare leaders, who lead the healthcare personnel serving as tech champions, are the ones included in this study. Healthcare leaders may lead departments providing several types of healthcare organized in various ways, with differing numbers of staff, tech champions, and service users. Recruitment and participants We used purposeful sampling [ 33 ] to recruit leaders experienced with tech champions within municipal healthcare services. Drawing on the authors’ professional networks and information provided on municipalities’ webpages, the first author contacted municipalities known to use tech champions. The first author contacted municipal directors or employees responsible for digitalization in healthcare services to provide information about the study and ask them to invite healthcare leaders to participate in the study. These staff members acted as gatekeepers [ 34 ], distributing digital invitations to the study to potential participants based on the inclusion criteria provided. The inclusion criteria for the participants were as follows: 1) have at least one year of experience as a leader, 2) have one or more tech champions in their service, and 3) hold a minimum of a bachelor’s degree as a healthcare professional. Due to this approach, we do not know how many invitations were distributed. Those wanting to participate contacted the first author using the contact information provided in the invitation. Data collection was continued until data saturation. Ten female leaders from six different municipalities participated in the study. The smallest municipality had less than 1 500 inhabitants, while the largest had about 100 000 inhabitants. Two municipalities had between 4 000 and 6 000 inhabitants, while two municipalities had between 20 000 and 30 000 inhabitants. The leaders had three different job titles: head of department, unit leader, and head of section. They had 1–27 years of practice as leaders and between one and nine tech champions active in their healthcare services. The healthcare services provided ranged from daytime clinical consultations via homecare services on a daily or hourly basis to 24/7 healthcare services in residential settings. The leaders had experience with using different technologies, often in combination, aimed at patients and staff to improve the quality, safety, and efficiency of services. Table 1 presents an overview of the participant characteristics. Table 1 Participant characteristics No. Profession and position Workplace Years as a leader No. of tech champions Acting as a tech champion Technology 1 Nurse, head of department 24/7 healthcare services in institutions 18 9 No Medication management technology, quality and patient safety technology, electronic health records, digital home technology 2 Nurse, head of department Home care services 5 4 Yes Quality and patient safety technology, electronic health records, digital home technology 3 Nurse, unit leader Daytime clinical consultations 4 4 No Electronic health records 4 Nurse, unit leader 24/7 healthcare services in institutions 5 2 No Electronic health records 5 Nurse, unit leader Home care services 1 1 No Digital home technology 6 Disability nurse, head of department 24/7 healthcare services in institutions 13 4 No Electronic health records 7 Nurse, head of department 24/7 healthcare services in institutions 20 3 Yes Portable electronic health records, quality and patient safety technology 8 Nurse, head of section 24/7 healthcare services in institutions 27 5 Yes Portable electronic health platforms, digital home technology 9 Social worker, head of section 24/7 healthcare services in institutions 1 3 No Portable electronic health platforms 10 Nurse, head of section 24/7 healthcare services in institutions 17 3 Yes Portable electronic health platforms Data collection Semi-structured interviews were used for data collection. This type of interview enables the collection of similar types of information from each participant while providing flexibility that allows for openness and the sharing of personal experiences and considerations [ 30 ]. A semi-structured interview guide was developed using insights from previous studies [ 20 , 27 ] on tech champions’ perspectives as well as the authors’ knowledge of municipal healthcare services. The guide was based on three overarching themes: choosing tech champions, experience with the role, and considerations related to having tech champions in healthcare services. Follow-up questions were used to explore the experiences and conditions the participants described. A final open-ended question was included to enable the participants to supplement and summarize their experiences and considerations. The first author conducted the interviews in person between May 2024 and January 2025 at a time and location chosen by the participants. The authors did not have any relationship with the participants prior to the study. Each interview lasted from 36 minutes to 1 hour and 07 minutes, providing 7 hours and 42 minutes of interview data. The first author audiotaped all the interviews and transcribed them verbatim. None of the transcripts were returned to the participants for comment, and none of the participants dropped out of the study. Data analysis Braun and Clarke’s [ 35 ] descriptions of reflexive thematic analysis guided the data analysis. Reflexive thematic analysis is a data-driven approach to interpreting patterns across the data collected while acknowledging knowledge generation as inherently subjective and situated [ 35 ]. Supported by the six phases of reflexive thematic analysis, the authors strived for a reflexive approach to the data analysis by holding several meetings to discuss theme generation and work on shared documents and by presenting the preliminary results at seminars to obtain peer feedback. This iterative process—involving familiarization via coding, theme development, reviewing, and rewriting—went back and forth, with the analytic text revised based on discussions, draft comments, and joint rewriting by the authors. This led to the final analytical narrative presented in the Results section. The participant quotes included were anonymized using reference numbers (e.g., 1–10 for participant number 1, transcript page 10). Methodological rigor Reflexivity involves critical attention to personal, interpersonal, methodological, and contextual factors that influence the study being conducted [ 36 ]. The authors come from different professional health backgrounds and have experience from clinical practice in various services within municipal healthcare. All the authors currently hold academic positions (as a PhD candidate, associate professor, and professor at two Norwegian universities). The study is part of the first author’s project and was motivated by the lack of research on a recommended but understudied measure for successful technology implementation in the context of municipal healthcare services. Maintaining a reflexive approach, the authors strived to benefit from their diverse positions, backgrounds, and expertise by applying strategies such as holding regular meetings to test assumptions, looking for negative cases that challenged the preliminary results, actively using participant quotes, and obtaining peer feedback on article drafts. To ensure rigorous and comprehensive reporting, the consolidated criteria for reporting qualitative research (COREQ) developed by Tong et al. [ 37 ] were applied (additional file 1). Results The analysis of municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation revealed three interrelated themes: 1) leading the technology implementation process, 2) strategically allocating staff resources, and 3) seeking specific qualities in tech champions. An overview of the themes and subthemes is provided in Table 2 . Table 2 Overview of themes and subthemes Themes Subthemes Leading the technology implementation process Overall managerial considerations Reviewing one’s own leadership role Strategically allocating staff resources Technological readiness Willingness to change Utilizing staff resources and capacity building Seeking specific qualities in tech champions Preferred tech champion characteristics Ability to follow tacit work instructions Leading the technology implementation process The municipal healthcare leaders’ strategic considerations regarding tech champions’ role were closely related to their leadership of overall implementation. Two interrelated concerns formed the backdrop of their tech champion considerations: 1) executing their responsibilities as leaders to operate their departments in a professionally sound manner while implementing technology and 2) reviewing their leadership role with a focus on their own capacity and technological competence. Overall managerial considerations The participants’ overall managerial considerations were related to their prior experiences of technology implementation affecting healthcare services and the need to balance the speed of the implementation with the type of healthcare services provided, sound operation of the services, and the type of technology to be included. The decision to apply either a stepwise or a full-scale implementation subsequently affected their need for tech champions, the desired number of champions, and the distribution of them across the department and shifts. As participant 1 explained: As a middle manager, I can’t control everything; even if I know what is going on, I do not have a complete overview. So, we are lucky to have dedicated staff who want to take the role [as tech champions], because it’s a lot of work. (1:1) Several leaders knew from experience that implementing technology is time-consuming for staff and that technology constantly evolves and needs regular updates. As neither they nor the tech champions could be everywhere all the time, they perceived it as necessary to “sell” the perceived benefits to the staff to support their tech champions. Even if the leaders had doubts or concerns about the benefits of implementing a technology, they still promoted the technology and its benefits for staff if the decision to implement it was part of their area of responsibility. Thus, the leaders reported upwards when problems occurred. Several of them admitted that they were skeptical because of prior technological implementations that had failed, although some of these later turned into successes. Based on these experiences, they had realized that successful implementation is not only about technology but also about the context and adoption of technology among staff, including themselves as leaders. In light of these realizations, tech champions as a measure were understood as intertwined with technological, professional, and contextual aspects framing the implementation process. Reviewing one’s own leadership role The municipal healthcare leaders considered their own leadership role, need for control, and capacity when implementing technology, which subsequently affected their perceptions of tech champions’ role. As one participant stated: No matter what technology you use and introduce, it relies on you as the leader. If the leader is not tuned in —holding knowledge of the technology and actively involved in the [implementation] process, then it will fail. It is Alpha and Omega. (8:4). The leaders considered what could be delegated to tech champions and what could not be delegated because the leaders held formal responsibility for the implementation process. The leaders assessed the scope of all technologies and whether it was necessary for them to familiarize themselves with the technologies to be able to lead healthcare services soundly and support technology adoption. Four leaders had chosen to play the role of tech champions themselves and considered it necessary to oversee technology implementation in addition to fulfilling their primary leadership role in ensuring sound services. They argued that playing the tech champion role themselves was important because they had to master the technology to perform their job, such as when preparing shift plans or correcting users’ errors and reviewing system alerts/default reports from the technologies. By fulfilling the role themselves and holding administrator rights, the leaders could oversee the implementation process, monitoring the positive and negative effects on the services provided as well as individual staff members’ use of technology. The other six leaders had assigned the tech champion role (and thereby partial responsibility for successful implementation) to selected staff members and trusted that they had the required expertise and personal qualities to fulfill the role. The leaders who opted out of the role justified this by stating that they lacked technological expertise or the time needed to learn and fulfill the role due to the job specifications of their everyday work. Some healthcare services used a variety of technologies, and the leaders of these services stated that it was not possible for them to follow up on and know all the details of all technologies. Several leaders said that they could not do their job without help from the tech champions, and that it was not possible to control “everything” or function as both a leader and a tech champion. One of the leaders argued that having tech champions was crucial: You must understand the important value of tech champions. It is almost imperative [to have them] for implementation to go well, particularly in major projects. In these situations, it is beneficial to relieve the tech champion of their daily clinical duties for a period [so they can dedicate time to supporting the implementation]. (7:10) Tech champions were perceived as a pivotal measure, especially in large-scale implementations where the healthcare leaders were not able to be hands-on. Furthermore, during major implementations, it was considered prudent to allocate time to the tech champions to fulfill this function if such an allocation was not already included in the department’s implementation strategy. Strategically allocating staff resources The leaders’ approach to utilizing staff in the implementation process was closely linked to strategic considerations regarding the optimal allocation of resources across the entire workforce. These considerations were based on their knowledge of individual staff members’ competencies and capacities, group dynamics among the staff, and the overall resource staff represented. The leaders considered technological readiness, willingness to change, utilization of resources and capacity building. Technological readiness The technological readiness of staff as a group as well as of individual healthcare personnel was perceived as important to consider. The leaders experienced technological readiness as varying across the workforce, with young digital natives perceived to have the best starting point. Temporary workers, persons in part-time positions, those resistant to change, the less technologically skilled, and those who had not mastered the Norwegian language were described as struggling to adopt new technologies. When establishing a new department, one of the leaders had incorporated technological competence in the recruitment process to ensure technological readiness: “ If you are going to work with us, you must be able to use technology, and if you are not interested in it, then you cannot work with us. So, it’s an important topic to discuss ” (8:3). The leaders’ assessments of staff technological readiness influenced their considerations related to using tech champions to facilitate technological adoption, aligned with other proactive and reactive measures to enhance staff technological competencies. Willingness to change The leaders had to consider the entire staff group’s and individual employees’ willingness to get on board with the technology implementation process. Providing overall motivation and accounting for individual differences were perceived as essential for successful implementation. As leaders, they needed to account for staff who were resistant to change and/or had negative attitudes to the adoption of technology. They also needed to support and encourage staff who thought that technologies introduced positive changes and improved services. One leader likened this dual role to that of an air traffic controller who needs to manage the movements of every kind of airplane (support individual employees) while being responsible for sound daily operations (the progress of the technology implementation). Tech champions were perceived as key staff who had a significant impact on their colleagues. Including opinion leaders among tech champions was perceived as beneficial, even when they were not considered to be best suited to or the most qualified for the role. This assessment was related to the leaders’ desire to control any spread of negativity. Utilizing staff resources and capacity building When considering tech champions’ role as a strategic measure, the leaders weighed the utilization of the resource the staff group represented in the present and future. This included an evaluation of staff with designated roles, staff members’ formal and informal qualifications, and capacity building among the staff. In some cases, it was viewed as necessary to appoint an employee with a particular professional role as a tech champion due to the specific technology to be implemented. For example, authorized nurses were appointed as tech champions for medicine cabinets as these nurses were responsible for safe medication procedures. Some leaders also mentioned appointing staff with designated roles, such as “professional development/specialist nurses,” as tech champions since they were already responsible for professional development and peer supervision. As argued by one of the leaders: “ I use a specialist nurse. She must be up to speed on this because she has many teaching responsibilities” (10:5). If the leaders did not perceive a need for tech champions to have specific formal qualifications, they considered staff members’ ability to grow into, and with, the role of acquiring new competencies. As one leader explained: They are given responsibility and build knowledge that they convey to others. They develop cutting-edge expertise in their technologies that allows them to take up space in department meetings, informing others and answering questions. I think they grow in the role.... Their colleagues are very loyal to them and use their expertise, regardless of their formal qualifications. (1:6–9) Another leader explained that the technology suppliers had recommended looking for gamers as potential tech champions and using them as a resource in implementing the technology: “ I think it was a great suggestion from the supplier to choose gamers…. It is a very good competency to hold when you’re a tech champion” (6:15). The leaders perceived that appointing staff members as tech champions could enhance the tech champions’ competence and status among their colleagues and motivate them to engage in further professional training, while exploiting the resources they represented and strengthening the overall robustness of the department’s staff. It was seen as critical for tech champions to be present and available for their colleagues. Some leaders preferred specialist nurses as tech champions based on their frequent contact with other staff members: The specialist nurses only work in the daytime and have no shifts. They are available in the daytime and can attend meetings to catch up on new information and pass it on to the other staff during the reporting between shifts . (4:3) Two of the leaders experienced failure in trying to assign the tech champion role to staff who had just returned from sick leave to facilitate their gradual return without an overly physical workload. This approach was not successful, and they learned to choose tech champions among the staff who were present in the daily work on site. A leader who had recent experience in implementing electronic health records in healthcare services mentioned the number and availability of tech champions as particular concerns. Going live with electronic health records had immediately changed the documentation practices for all staff, necessitating strong support for staff members: “ We had two tech champions on each shift when we went live with the digital platform. Then they were also able to support each other ” (4:10). The leader experienced a need to initially have multiple tech champions available during all shifts to ensure sound implementation. The number of tech champions was gradually reduced over time. In other processes, there were fewer tech champions, and some tech champions remained “on call” at night to assist with technology implementation even if they were not at work. A common challenge was keeping the desired number of tech champions available and distributing them across the shifts. Another key concern was ensuring that tech champions were able to participate in meetings for updates and coordination related to technology implementation efforts. Seeking specific qualities in tech champions The municipal healthcare leaders had clear ideas about the qualities they were looking for in tech champions. They listed many preferred individual characteristics as well as staff members’ ability to follow tacit work instructions. Preferred tech champion characteristics Aside from having technological competencies and know-how, the leaders listed many expectations of tech champions, including an ability to serve as their extension by supporting their peers, helping and engaging staff, and collaborating with stakeholders to ensure full implementation. In line with these expectations, they sought specific personal characteristics in tech champions, preferring to assign the role to staff members who were positive, interested, empathetic, collaborative, communicative, and able to pass on their knowledge to others. One leader stated that “ it is about personal suitability by being someone who is good at communicating and teaching, is preferably structured and organized, and has the necessary overview ” (9:9). The leaders looked for different qualities when choosing tech champions, and the type of technology to be implemented sometimes impacted their choices: “You must find the person who suits what you are going to roll out.... It is preferable to choose someone who is interested, wants the role, and is present at work” (7:9). The leaders wanted to give everybody a chance to fulfill the tech champion role but had experienced that the role did not suit everyone. Personal and interpersonal qualities, interest in technology, and daily presence were prioritized over formal qualifications when choosing tech champions. Ability to follow tacit work instructions The leaders expected tech champions to take responsibility for the tasks they were assigned, although none of them provided formal instructions for the role or any benefits, such as extra compensation or dedicated time to fulfilling the leaders’ expectations. Those assigned as tech champions were expected to play this role on top of their ordinary duties; they were told to prioritize daily tasks and tech tasks at the same time. Therefore, the leaders could not hold them fully and formally responsible for the technology implementation process. As one leader summed up: “ It is a silent instruction, I call it ” (8:6). Despite procedures being in place for implementing each technology, there were no work instructions describing how tech champions should perform their role. The leaders needed champions who took responsibility and expected them to ensure that the technology implementation succeeded in their departments. As summarized by one of the leaders: “ There needs to be someone there [a tech champion] to pull the strings and make things work ” (5:7). “The strings” could be interpreted as referring to the staff, the technology, and the practices in healthcare services. The need to “make things work” could refer to tech champions serving as the link between leaders’ strategic intentions and the reality of staff in terms of the daily work in their departments and between specific technologies and their peers’ adoption of them. Discussion To the best of our knowledge, this is the first dedicated study of healthcare leaders’ strategic perspectives on tech champions’ role in the technology implementation process. Our findings demonstrate that healthcare leaders experienced tech champions as an imperative measure for successful technology implementation. The study found that healthcare leaders’ perspectives on tech champions intertwined with their considerations pertaining to overall strategic implementation, encompassing the implementation phase, type of technology, their knowledge of staff capacity and group dynamics, their own personal capacity and technological competency, and individual tech champion competencies. Due to the importance of tech champions’ role, the healthcare leaders highlighted overall managerial considerations regarding staff allocation and, crucially, their own leadership role in the implementation process. Leaders’ perspectives on tech champions’ role were closely related to their self-perceived role, technological competencies, capacities, and individual needs as leaders to oversee the implementation process. This emerged clearly when they explained their choice to fulfill the tech champion role themselves or delegate the role. By not holding the role themselves, they excluded themselves from insights into specific technologies and administrative access to monitor implementation and foresee and troubleshoot problems. Thus, a potential risk was detaching themselves from the implementation process and having to rely on tech champions’ fulfillment of their self-perceived role [ 27 ], since champions were expected to fulfill tacit job descriptions, with no formal role description, dedicated time, or additional compensation provided for their efforts to enable successful technology implementation among their colleagues. Given that leaders perceived tech champions as their representatives, performing transformative leadership and essential for successful implementation, relying solely on tech champions’ self-perceived responsibility and personal interest may be perceived as an unsecure strategy. The failure rate in technology implementation is still high, ranging from 30% to 90%, and is related to economical, technical, organizational, and social factors [ 38 , 39 ], including a lack of staff support for change [ 40 ]. Given the shortage of personnel, it may be perceived as unrealistic in the short term to expect all staff to have the required technological competencies. Due to the high demand for change management in healthcare today, these findings underline the need for a debate on contemporary healthcare leaders’ role requirements and, subsequently, on the potential pros and cons of formalizing tech champions’ role. The findings on preferred individual characteristics of tech champions align with previous research [ 24 – 25 , 41 – 42 ]. The leaders highlighted qualities such as being positive, interested, empathetic, collaborative, communicative, and able to pass on their knowledge to others. Together with their technological capabilities and organizational know-how, these qualities enabled the tech champions to act as their leaders’ extension in the technology implementation process. These qualities align with transformative leadership qualities [ 15 ], focusing on creating commitment to organizational goals. By being positive, empathetic, and collaborative; engaging their peers; and passing on their knowledge to empower their peers to master technologies, tech champions were expected to facilitate the achievement of the organizational goal of technology implementation. In line with micro-level transformative leadership, the tech champions were supposed to facilitate change at an interpersonal level [ 16 ]. Furthermore, the tech champions were expected to be charismatic, inspirational, and attentive, embodying characteristics of transformational leaders as described by Judge and Piccolo [ 43 ]. The healthcare leaders expected tech champions to perform extra-role behaviors, which are perceived as essential in transformative leadership theories [ 44 ]. An extra-role behavior can be described as one “which benefits the organization and/or is intended to benefit the organization, which is discretionary, and which goes beyond existing role expectations” [ 45 ]. Extra-role behaviors undertaken alongside one’s primary role are also termed organizational citizenship behaviors [ 46 ]. Using volunteer tech champions increased the likelihood of these behaviors. Healthcare leaders valued behaviors linked to tech champions’ mission to facilitate and support the successful implementation of technologies in everyday professional healthcare practice. Implications for future research and practice To avoid detaching themselves from their own transformative leadership role, healthcare leaders considering tech champions as an implementation measure should carefully assess the risks of handing over sole responsibility for monitoring and supporting technology implementation to heath personnel in tech champion roles. Without formal roles and positions, the success of tech champions as an implementation measure seems to depend on leaders’ thorough considerations of organizational, cultural, and contextual factors, including interpersonal relations and tech champions’ personal commitment. Research is needed to clarify how delegating or extending implementation support to tech champions affects leadership–champion dynamics and relates to other implementation strategies. Strengths and limitations The strengths of the study are its focus on healthcare services within both small and large municipalities, its encompassing of various types of services, and its inclusion of both healthcare leaders acting as tech champions and those delegating the role to other healthcare personnel. A weakness is that all participants were recruited through invitations distributed by municipal leaders. Potential participants may have been omitted during this distribution, which could have caused selection bias and prevented excluded participants from sharing critical aspects related to the study aim. Supplementing the interviews with field studies and recruiting more participants could have strengthened the study by enabling thicker descriptions and improving the transferability of the results. Conclusions Healthcare leaders’ perspectives on tech champions intertwine with their overall strategic implementation considerations, encompassing the type of technology, their knowledge of staff capacity and group dynamics, their own personal capacity and technological competency, and individual tech champion competencies. Tech champions are perceived as the leaders’ extensions, performing transformative leadership roles. They are not supported with formal role descriptions, dedicated time, or compensation in their efforts to fulfill the tacit job description of enabling successful technology implementation among their colleagues. Declarations Ethics approval and consent to participate The study was conducted according to the Norwegian Law of Ethics [ 47 ], General Guidelines for Research Ethics [ 48 ] and has followed the Declaration of Helsinki [ 49 ]. Data collection and storage were considered and approved by The Norwegian Agency for Shared Services in Education and Research (Sikt) [ 50 ] (reference number 403183). All participants were given written and oral information about the study and had the opportunity to withdraw. All participants signed a written informed consent form. Consent for publication Not applicable. Funding This study is part of PhD and was financed by Nord University. Author Contribution SP, AB, and HE contributed to the study design. SP was responsible for data collection. SP, AB, and HE conducted the analysis and formulated the discussion and conclusion. SP, AB, and HE helped prepare the manuscript and approved the final version of it. Acknowledgements We would like to thank all the participants who contributed to this study with their expertise and experience. Authors’ information PhD candidate Sissel Pettersen, https://orcid.org/0009-0005-2869-9911 Associate Professor Anita Berg, https://orcid.org/0000-0001-6182-6162 Professor Hilde Eide, https://orcid.org/0000-0003-4428-5047 Data Availability The dataset generated and analyzed during the study is not publicly available because approval for this was not given as part of the participants’ consent. Data cannot be shared openly to protect the privacy of the study participants. On reasonable request, the corresponding author (contact [email protected] ) may consider contacting the participants to request approval for sharing the anonymous dataset. The dataset is in the Norwegian language. 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Bail K, Davey R, Currie M, Gibson J, Merrick E, Redley B. Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study. Aust Health Rev. 2020;44(5):672–6. 10.1071/AH18231 . Bullard KL. Cost effective staffing for an EHR implementation. Nurs Econ. 2016;34(2):72–6. Chung OS, Robinson T, Johnson AM, Dowling NL, Ng CH, Yücel M, et al. Implementation of therapeutic virtual reality into psychiatric care: clinicians’ and service managers’ perspectives. Front Psychiatry. 2022;12:791123. 10.3389/fpsyt.2021.791123 . Dugstad J, Sundling V, Nilsen ER, Eide H. Nursing staff’s evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study. BMC Health Serv Res. 2020;20:163. 10.1186/s12913-020-4998-9 . Kolltveit B-CH, Gjengedal E, Graue M, Iversen MM, Thorne S, Kirkevold M. Conditions for success in introducing telemedicine in diabetes foot care: a qualitative inquiry. BMC Nurs. 2017;16:2. 10.1186/s12912-017-0201-y . Lüchinger R, Audétat M-C, Blondon K, Perron NJ. Implementing collaborative practices in healthcare settings using champions: a scoping review. Implement Sci. 2025;20:48. 10.1186/s13012-025-01463-2 . Pettersen S, Eide H, Berg A. The self-perceived role of tech champions in municipal healthcare services—a descriptive qualitative study. BMC Health Serv Res. 2025;25:856. 10.1186/s12913-025-12994-1 . Nevedal AL, Kowalski CP, Finley EP, Fix GM, Hamilton AB, Koenig CJ. Optimizing qualitative methods in implementation research: a resource for editors, reviewers, authors, and researchers to dispel ten common misperceptions about qualitative research methods. Implement Sci. 2025;21:4. 10.1186/s13012-025-01474-z . Järvinen M, Mik-Meyer N, editors. Qualitative analysis: eight approaches for the social sciences. London: SAGE; 2020. Holloway I, Wheeler S. Qualitative research in nursing and health care. 3rd ed. Iowa: Wiley-Blackwell; 2010. Helse- og omsorgsdepartementet. Lov om kommunale helse- og omsorgstjenester m.m. (helse- og omsorgstjenesteloven) [Act on municipal health and care services etc. (Health and care services act)]. Lovdata. 2011. https://lovdata.no/dokument/NL/lov/2011-06-24-30 . Accessed 5 Feb 2026. Helse- og omsorgsdepartementet. St.meld. nr. 47. (2008–2009). Samhandlingsreformen. Rett behandling – på rett sted – til rett tid [Report to the Storting no. 47 (2008–2009). The coordination reform. Right treatment – in the right place – at the right time]. 2009. https://www.regjeringen.no/contentassets/d4f0e16ad32e4bbd8d8ab5c21445a5dc/no/pdfs/stm200820090047000dddpdfs.pdf . Accessed 5 Feb 2026. Suri H. Purposeful sampling in qualitative research synthesis. Qual Res J. 2011;11(2):63–75. 10.3316/QRJ1102063 . Singh S, Wassenaar D. Contextualising the role of the gatekeeper in social science research. S Afr J Bioeth Law. 2016;9(1):42–42. doi.org/10.7196/SAJBL.2016.v9i1.465 . Braun V, Clarke V. Thematic analysis: a practical guide. London: SAGE; 2022. Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE guide 149. Med Teach. 2023;45(3):241–51. 10.1080/0142159X.2022.2057287 . Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. 10.1093/intqhc/mzm042 . Pakulska T, Religioni U. Implementation of technology in healthcare entities – barriers and success factors. J Med Econ. 2023;26(1):821–3. 10.1080/13696998.2023.2226537 . Schweidenback JS, Rangachari P, D’Amato-Palumbo S, Gladstone JS. Integrating the consolidated framework for implementation research (CFIR) and tensions into a novel conceptual model for telehealth advancement in healthcare organizations. J Healthc Leadersh. 2024;16:501–10. 10.2147/JHL.S497875 . Oreg S, Vakola M, Armenakis A. Change recipients’ reactions to organizational change: a 60-year review of quantitative studies. J Appl Behav Sci. 2011;47(4):461–524. 10.1177/0021886310396550 . Yuan CT, Bradley EH, Nembhard IM. A mixed methods study of how clinician ‘super users’ influence others during the implementation of electronic health records. BMC Med Inf Decis Mak. 2015;15:26. 10.1186/s12911-015-0154-6 . Yusof MM. A case study evaluation of a critical care information system adoption using the socio-technical and fit approach. Int J Med Inf. 2015;84(7):486–99. 10.1016/j.ijmedinf.2015.03.001 . Judge TA, Piccolo RF. Transformational and transactional leadership: a meta-analytic test of their relative validity. J Appl Psychol. 2004;89(5):755–68. 10.1037/0021-9010.89.5.755 . Matthiesen SB. Transformasjonsledelse, ekstrarolleatferd og innovasjon [Transformational leadership, extra-role behavior and innovation]. Magma forskning og viten. 2014;17(5). https://magmaforskning.econa.no/index.php/magma/article/view/880/880 . Accessed 5 Feb 2026. Van Dyne L, Cummings LL, McLean PJ. Extra-role behaviors: in pursuit of construct and definitional clarity (a bridge over muddied waters). In: Cummings LL, Staw BM, editors. Research in organizational behavior. Greenwich: JAI; 1995. pp. 215–85. Hermanto YB, Srimulyani VA. The effects of organizational justice on employee performance using dimension of organizational citizenship behavior as mediation. Sustainability. 2022;14(20):13322. 10.3390/su142013322 . Kunnskapsdepartementet. Lov om organisering av forskningsetisk arbeid (forskningsetikkloven) [Act on the organization of research ethics work (Research ethics act)]. Lovdata. 2017. https://lovdata.no/dokument/NL/lov/2017-04-28-23 . Accessed 5 Feb 2026. The Norwegian National Research Ethics Committees. General guidelines for research ethics. 2019. https://www.forskningsetikk.no/globalassets/dokumenter/4-publikasjoner-som-pdf/general-guidelines.pdf . Accessed 5 Feb 2026. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. 2025. Available: https://www.wma.net/policies-post/wma-declaration-of-helsinki/ . Accessed 13 Mar 2026. Sikt. - Norwegian Agency for Shared Services in Education and Research. https:// sikt.no/en/home . Accessed 10 Feb 2026. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9095841","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608336372,"identity":"dda01379-ada2-4294-a7ed-8aed6215c2bc","order_by":0,"name":"Sissel Pettersen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYBAC+WYQWcBQDxfhBxE8eLQYHAaTDIkNbMwQEckGQloY0LUYHCCkhZ398YcPQC398v0HH1f8sckzvt187MMbhjtyuP3CYyY5w4ChXrKNmdnwbFtasdmdY8kz5zA8M8ZpzWEeNmYeA4YEg2PMbJKNDYcTt93IMWbmYTic2IBTC/vjz3+AWuyPMbP/bPjzP3HzDIJaGAykGUC2sDGzMTawHUjcIEFAi8FhoF96DCQSJI4lG0s2tiUnzriRlsw4x+AwTr/I9x9//OFHhU0Cf/PBhx8b/tgl9s9IPszwpuIwzhCDAgkM2wloGAWjYBSMglGAFwAAbl1TU2XcBS0AAAAASUVORK5CYII=","orcid":"","institution":"Nord University","correspondingAuthor":true,"prefix":"","firstName":"Sissel","middleName":"","lastName":"Pettersen","suffix":""},{"id":608336373,"identity":"f0422940-327d-4792-848f-b0ea6ae63c01","order_by":1,"name":"Hilde Eide","email":"","orcid":"","institution":"University of South-Eastern Norway","correspondingAuthor":false,"prefix":"","firstName":"Hilde","middleName":"","lastName":"Eide","suffix":""},{"id":608336374,"identity":"248991c9-cafb-4ce4-85e3-11632d9bf299","order_by":2,"name":"Anita Berg","email":"","orcid":"","institution":"Nord University","correspondingAuthor":false,"prefix":"","firstName":"Anita","middleName":"","lastName":"Berg","suffix":""}],"badges":[],"createdAt":"2026-03-11 14:53:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9095841/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9095841/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105034969,"identity":"d94ef6f1-2006-4f49-95c7-420778a42735","added_by":"auto","created_at":"2026-03-20 07:25:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":582485,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9095841/v1/1948d2b3-86be-424d-a982-3aaf1a895ec3.pdf"},{"id":104960036,"identity":"3a262a03-006c-4285-bc52-861055caa456","added_by":"auto","created_at":"2026-03-19 08:50:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":268537,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1COREQ110326.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9095841/v1/2351a5dec1b4144bd5ebab25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA qualitative study of Municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eHealthcare systems globally are under increasing pressure to improve their performance, including their productivity, quality of care, and efficiency in service delivery [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. This has led to high expectations of exploiting technology to enhance quality and capacity in healthcare services worldwide. Successful technology implementation is heavily dependent on staff and management’s willingness and capabilities to apply technologies in their practice and service provision. Generating knowledge of the human factors in successful technology implementation outcomes is imperative to ensure optimized use of technology and staff resources for sustainable healthcare services [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealthcare systems are generally acknowledged as complex social systems [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thus, successful implementation of technologies in healthcare depends on both the implementation approach [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] and the leadership provided [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] According to van Gemert-Pijnen [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] implementation can be defined as a process of several planned and guided activities to launch, introduce, and maintain technologies in a certain context to innovate or improve healthcare. Successful technology implementation, also referred to as digital transformation [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e] requires healthcare professionals to be digitally ready and capable [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. Healthcare leaders play a vital role in ensuring success when technology and staff meet. They serve in a middle position between staff and top management [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e] and hold crucial nexus/hub positions in implementation processes. Navigating complex webs of actors (e.g., healthcare personnel, IT personnel, patients, and administrators), healthcare leaders strive to balance priorities, collaborations, and strategic direction to prioritize high-quality care provision, including by governing new technologies. This manifests in leaders playing highly contextual roles (depending on assigned responsibilities and the demands of healthcare environments) in which they serve as catalysts for change among healthcare personnel [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeading technology implementation in healthcare\u003c/p\u003e \u003cp\u003eHealthcare leadership refers to the practice of influencing and guiding individuals and teams within the healthcare sector toward achieving the collective goals of improving patient care, operational efficiency, and healthcare delivery [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Due to technological advancements, there is a need to focus on leading digital transformations in healthcare [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Healthcare leaders must support and encourage staff and act as cheerleaders in technology implementation [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. According to Burgess and Honey [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e], healthcare leaders’ mission is to connect the digital and clinical worlds by facilitating and empowering healthcare personnel to use technology in their practice. In terms of empowerment, giving other staff authority and responsibility and delegating tasks are elements of effective healthcare leadership [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Healthcare leaders play several interrelated roles, serving as supporters, change managers, advocates, project managers, decision-makers, facilitators, and champions [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese leadership roles in implementation processes exemplify the concept of transformational leadership [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. Transformational leadership is the process of creating commitment to organizational goals and empowering people to fulfill those goals [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. According to Crawford et al. [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e] transformational leaders take charge of their organizations at the macro level and facilitate interpersonal changes at the micro level. Transformational leaders motivate staff to accomplish more than they planned to [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e] and more than what is required according to their employment contracts [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTech champions as an implementation measure\u003c/p\u003e \u003cp\u003eSupport from staff is essential for successful technology adoption in healthcare [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. A recent review of Laukka et al. [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e] found that healthcare leaders identifying and appointing champions is one of seven leadership behaviors associated with successful technology adoption. Champions are often referred to as key people in technology implementation [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, champions’ role in technology implementation in healthcare services is still unclear [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although tech champions are described as a beneficial measure in facilitating technology adoption (e.g., [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], studies have found that tech champions play an undefined role in terms of content and task descriptions, and that this role is highly context dependent [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. Tech champions perceive their own mission to be to promote, adopt, and assist technology by playing different roles to help their colleagues implement technology in their practice, most often as a task on top of their ordinary duties [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on this backdrop, this study draws on healthcare leaders’ critical role in technology implementation, tech champions as a recommended measure, and the need to add knowledge from the frontline of contemporary healthcare services where humans and technologies meet. The aim of this study is to explore municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAccording to Nevedal et al. [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], qualitative research provides rich contextual insight into the lived experiences of healthcare systems and complex implementation processes. This study employed a qualitative interview design [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e] with semi-structured interviews [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e] to explore municipal healthcare leaders’ considerations of tech champions’ role as a measure in technology implementation processes in Norwegian healthcare.\u003c/p\u003e\u003cp\u003eStudy setting\u003c/p\u003e\u003cp\u003eIn Norway, municipal healthcare services are provided free of charge and are publicly funded by the tax system. The right to these services is regulated by the Health and Care Services Act [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]. Since 2012, the Norwegian government’s policy has been that, as far as possible, inhabitants who need general healthcare services should be offered them through public municipal healthcare services, preferably in their own homes or alternatively in municipal healthcare institutions [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. Norwegian municipalities are free to organize service provision in line with local conditions, such as geography, demography, number of inhabitants, and resources allocated to municipal healthcare services. The 357 Norwegian municipalities vary in size, although they are mostly rural, with a low number of inhabitants widespread geographically, and are home to ageing populations. An administrative leader usually assumes overall responsibility for municipal healthcare services. Depending on the size of the municipality, this leader is often supported by several sectors responsible for healthcare leaders working on site at primary healthcare service departments/units and overseeing staff and service quality and development. These healthcare leaders, who lead the healthcare personnel serving as tech champions, are the ones included in this study. Healthcare leaders may lead departments providing several types of healthcare organized in various ways, with differing numbers of staff, tech champions, and service users.\u003c/p\u003e\u003cp\u003eRecruitment and participants\u003c/p\u003e\u003cp\u003eWe used purposeful sampling [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e] to recruit leaders experienced with tech champions within municipal healthcare services. Drawing on the authors’ professional networks and information provided on municipalities’ webpages, the first author contacted municipalities known to use tech champions. The first author contacted municipal directors or employees responsible for digitalization in healthcare services to provide information about the study and ask them to invite healthcare leaders to participate in the study. These staff members acted as gatekeepers [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e], distributing digital invitations to the study to potential participants based on the inclusion criteria provided. The inclusion criteria for the participants were as follows: 1) have at least one year of experience as a leader, 2) have one or more tech champions in their service, and 3) hold a minimum of a bachelor’s degree as a healthcare professional. Due to this approach, we do not know how many invitations were distributed. Those wanting to participate contacted the first author using the contact information provided in the invitation. Data collection was continued until data saturation.\u003c/p\u003e\u003cp\u003eTen female leaders from six different municipalities participated in the study. The smallest municipality had less than 1 500 inhabitants, while the largest had about 100 000 inhabitants. Two municipalities had between 4 000 and 6 000 inhabitants, while two municipalities had between 20 000 and 30 000 inhabitants. The leaders had three different job titles: head of department, unit leader, and head of section. They had 1–27 years of practice as leaders and between one and nine tech champions active in their healthcare services. The healthcare services provided ranged from daytime clinical consultations via homecare services on a daily or hourly basis to 24/7 healthcare services in residential settings. The leaders had experience with using different technologies, often in combination, aimed at patients and staff to improve the quality, safety, and efficiency of services. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents an overview of the participant characteristics.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eProfession and position\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eWorkplace\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eYears as a leader\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eNo. of tech champions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eActing as a tech champion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eTechnology\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, head of department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMedication management technology, quality and patient safety technology, electronic health records, digital home technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, head of department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHome care services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eQuality and patient safety technology, electronic health records, digital home technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, unit leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDaytime clinical consultations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eElectronic health records\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, unit leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eElectronic health records\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, unit leader\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHome care services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDigital home technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDisability nurse, head of department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eElectronic health records\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, head of department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePortable electronic health records, quality and patient safety technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, head of section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePortable electronic health platforms, digital home technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSocial worker, head of section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePortable electronic health platforms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNurse, head of section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e24/7 healthcare services in institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePortable electronic health platforms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eSemi-structured interviews were used for data collection. This type of interview enables the collection of similar types of information from each participant while providing flexibility that allows for openness and the sharing of personal experiences and considerations [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. A semi-structured interview guide was developed using insights from previous studies [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e] on tech champions’ perspectives as well as the authors’ knowledge of municipal healthcare services. The guide was based on three overarching themes: choosing tech champions, experience with the role, and considerations related to having tech champions in healthcare services. Follow-up questions were used to explore the experiences and conditions the participants described. A final open-ended question was included to enable the participants to supplement and summarize their experiences and considerations.\u003c/p\u003e\u003cp\u003eThe first author conducted the interviews in person between May 2024 and January 2025 at a time and location chosen by the participants. The authors did not have any relationship with the participants prior to the study. Each interview lasted from 36 minutes to 1 hour and 07 minutes, providing 7 hours and 42 minutes of interview data. The first author audiotaped all the interviews and transcribed them verbatim. None of the transcripts were returned to the participants for comment, and none of the participants dropped out of the study.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eBraun and Clarke’s [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e] descriptions of reflexive thematic analysis guided the data analysis. Reflexive thematic analysis is a data-driven approach to interpreting patterns across the data collected while acknowledging knowledge generation as inherently subjective and situated [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. Supported by the six phases of reflexive thematic analysis, the authors strived for a reflexive approach to the data analysis by holding several meetings to discuss theme generation and work on shared documents and by presenting the preliminary results at seminars to obtain peer feedback. This iterative process—involving familiarization via coding, theme development, reviewing, and rewriting—went back and forth, with the analytic text revised based on discussions, draft comments, and joint rewriting by the authors. This led to the final analytical narrative presented in the Results section. The participant quotes included were anonymized using reference numbers (e.g., 1–10 for participant number 1, transcript page 10).\u003c/p\u003e\u003cp\u003eMethodological rigor\u003c/p\u003e\u003cp\u003eReflexivity involves critical attention to personal, interpersonal, methodological, and contextual factors that influence the study being conducted [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e]. The authors come from different professional health backgrounds and have experience from clinical practice in various services within municipal healthcare. All the authors currently hold academic positions (as a PhD candidate, associate professor, and professor at two Norwegian universities). The study is part of the first author’s project and was motivated by the lack of research on a recommended but understudied measure for successful technology implementation in the context of municipal healthcare services. Maintaining a reflexive approach, the authors strived to benefit from their diverse positions, backgrounds, and expertise by applying strategies such as holding regular meetings to test assumptions, looking for negative cases that challenged the preliminary results, actively using participant quotes, and obtaining peer feedback on article drafts. To ensure rigorous and comprehensive reporting, the consolidated criteria for reporting qualitative research (COREQ) developed by Tong et al. [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e] were applied (additional file 1).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis of municipal healthcare leaders\u0026rsquo; strategic perspectives on tech champions\u0026rsquo; role in technology implementation revealed three interrelated themes: 1) leading the technology implementation process, 2) strategically allocating staff resources, and 3) seeking specific qualities in tech champions. An overview of the themes and subthemes is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of themes and subthemes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeading the technology implementation process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall managerial considerations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReviewing one\u0026rsquo;s own leadership role\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStrategically allocating staff resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnological readiness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWillingness to change\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUtilizing staff resources and capacity building\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSeeking specific qualities in tech champions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreferred tech champion characteristics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbility to follow tacit work instructions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eLeading the technology implementation process\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe municipal healthcare leaders\u0026rsquo; strategic considerations regarding tech champions\u0026rsquo; role were closely related to their leadership of overall implementation. Two interrelated concerns formed the backdrop of their tech champion considerations: 1) executing their responsibilities as leaders to operate their departments in a professionally sound manner while implementing technology and 2) reviewing their leadership role with a focus on their own capacity and technological competence.\u003c/p\u003e \u003cp\u003eOverall managerial considerations\u003c/p\u003e \u003cp\u003eThe participants\u0026rsquo; overall managerial considerations were related to their prior experiences of technology implementation affecting healthcare services and the need to balance the speed of the implementation with the type of healthcare services provided, sound operation of the services, and the type of technology to be included. The decision to apply either a stepwise or a full-scale implementation subsequently affected their need for tech champions, the desired number of champions, and the distribution of them across the department and shifts. As participant 1 explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs a middle manager, I can\u0026rsquo;t control everything; even if I know what is going on, I do not have a complete overview. So, we are lucky to have dedicated staff who want to take the role [as tech champions], because it\u0026rsquo;s a lot of work. (1:1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeveral leaders knew from experience that implementing technology is time-consuming for staff and that technology constantly evolves and needs regular updates. As neither they nor the tech champions could be everywhere all the time, they perceived it as necessary to \u0026ldquo;sell\u0026rdquo; the perceived benefits to the staff to support their tech champions. Even if the leaders had doubts or concerns about the benefits of implementing a technology, they still promoted the technology and its benefits for staff if the decision to implement it was part of their area of responsibility. Thus, the leaders reported upwards when problems occurred. Several of them admitted that they were skeptical because of prior technological implementations that had failed, although some of these later turned into successes. Based on these experiences, they had realized that successful implementation is not only about technology but also about the context and adoption of technology among staff, including themselves as leaders. In light of these realizations, tech champions as a measure were understood as intertwined with technological, professional, and contextual aspects framing the implementation process.\u003c/p\u003e \u003cp\u003eReviewing one\u0026rsquo;s own leadership role\u003c/p\u003e \u003cp\u003eThe municipal healthcare leaders considered their own leadership role, need for control, and capacity when implementing technology, which subsequently affected their perceptions of tech champions\u0026rsquo; role. As one participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNo matter what technology you use and introduce, it relies on you as the leader. If the leader is not tuned in \u0026mdash;holding knowledge of the technology and actively involved in the [implementation] process, then it will fail. It is Alpha and Omega. (8:4).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe leaders considered what could be delegated to tech champions and what could not be delegated because the leaders held formal responsibility for the implementation process. The leaders assessed the scope of all technologies and whether it was necessary for them to familiarize themselves with the technologies to be able to lead healthcare services soundly and support technology adoption.\u003c/p\u003e \u003cp\u003eFour leaders had chosen to play the role of tech champions themselves and considered it necessary to oversee technology implementation in addition to fulfilling their primary leadership role in ensuring sound services. They argued that playing the tech champion role themselves was important because they had to master the technology to perform their job, such as when preparing shift plans or correcting users\u0026rsquo; errors and reviewing system alerts/default reports from the technologies. By fulfilling the role themselves and holding administrator rights, the leaders could oversee the implementation process, monitoring the positive and negative effects on the services provided as well as individual staff members\u0026rsquo; use of technology.\u003c/p\u003e \u003cp\u003eThe other six leaders had assigned the tech champion role (and thereby partial responsibility for successful implementation) to selected staff members and trusted that they had the required expertise and personal qualities to fulfill the role. The leaders who opted out of the role justified this by stating that they lacked technological expertise or the time needed to learn and fulfill the role due to the job specifications of their everyday work. Some healthcare services used a variety of technologies, and the leaders of these services stated that it was not possible for them to follow up on and know all the details of all technologies. Several leaders said that they could not do their job without help from the tech champions, and that it was not possible to control \u0026ldquo;everything\u0026rdquo; or function as both a leader and a tech champion.\u003c/p\u003e \u003cp\u003eOne of the leaders argued that having tech champions was crucial:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYou must understand the important value of tech champions. It is almost imperative [to have them] for implementation to go well, particularly in major projects. In these situations, it is beneficial to relieve the tech champion of their daily clinical duties for a period [so they can dedicate time to supporting the implementation]. (7:10)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTech champions were perceived as a pivotal measure, especially in large-scale implementations where the healthcare leaders were not able to be hands-on. Furthermore, during major implementations, it was considered prudent to allocate time to the tech champions to fulfill this function if such an allocation was not already included in the department\u0026rsquo;s implementation strategy.\u003c/p\u003e \u003cp\u003eStrategically allocating staff resources\u003c/p\u003e \u003cp\u003eThe leaders\u0026rsquo; approach to utilizing staff in the implementation process was closely linked to strategic considerations regarding the optimal allocation of resources across the entire workforce. These considerations were based on their knowledge of individual staff members\u0026rsquo; competencies and capacities, group dynamics among the staff, and the overall resource staff represented. The leaders considered technological readiness, willingness to change, utilization of resources and capacity building.\u003c/p\u003e \u003cp\u003eTechnological readiness\u003c/p\u003e \u003cp\u003eThe technological readiness of staff as a group as well as of individual healthcare personnel was perceived as important to consider. The leaders experienced technological readiness as varying across the workforce, with young digital natives perceived to have the best starting point. Temporary workers, persons in part-time positions, those resistant to change, the less technologically skilled, and those who had not mastered the Norwegian language were described as struggling to adopt new technologies. When establishing a new department, one of the leaders had incorporated technological competence in the recruitment process to ensure technological readiness: \u0026ldquo;\u003cem\u003eIf you are going to work with us, you must be able to use technology, and if you are not interested in it, then you cannot work with us. So, it\u0026rsquo;s an important topic to discuss\u003c/em\u003e\u0026rdquo; (8:3). The leaders\u0026rsquo; assessments of staff technological readiness influenced their considerations related to using tech champions to facilitate technological adoption, aligned with other proactive and reactive measures to enhance staff technological competencies.\u003c/p\u003e \u003cp\u003eWillingness to change\u003c/p\u003e \u003cp\u003eThe leaders had to consider the entire staff group\u0026rsquo;s and individual employees\u0026rsquo; willingness to get on board with the technology implementation process. Providing overall motivation and accounting for individual differences were perceived as essential for successful implementation. As leaders, they needed to account for staff who were resistant to change and/or had negative attitudes to the adoption of technology. They also needed to support and encourage staff who thought that technologies introduced positive changes and improved services. One leader likened this dual role to that of an air traffic controller who needs to manage the movements of every kind of airplane (support individual employees) while being responsible for sound daily operations (the progress of the technology implementation).\u003c/p\u003e \u003cp\u003eTech champions were perceived as key staff who had a significant impact on their colleagues. Including opinion leaders among tech champions was perceived as beneficial, even when they were not considered to be best suited to or the most qualified for the role. This assessment was related to the leaders\u0026rsquo; desire to control any spread of negativity.\u003c/p\u003e \u003cp\u003eUtilizing staff resources and capacity building\u003c/p\u003e \u003cp\u003eWhen considering tech champions\u0026rsquo; role as a strategic measure, the leaders weighed the utilization of the resource the staff group represented in the present and future. This included an evaluation of staff with designated roles, staff members\u0026rsquo; formal and informal qualifications, and capacity building among the staff.\u003c/p\u003e \u003cp\u003eIn some cases, it was viewed as necessary to appoint an employee with a particular professional role as a tech champion due to the specific technology to be implemented. For example, authorized nurses were appointed as tech champions for medicine cabinets as these nurses were responsible for safe medication procedures. Some leaders also mentioned appointing staff with designated roles, such as \u0026ldquo;professional development/specialist nurses,\u0026rdquo; as tech champions since they were already responsible for professional development and peer supervision. As argued by one of the leaders: \u0026ldquo;\u003cem\u003eI use a specialist nurse. She must be up to speed on this because she has many teaching responsibilities\u0026rdquo;\u003c/em\u003e (10:5).\u003c/p\u003e \u003cp\u003eIf the leaders did not perceive a need for tech champions to have specific formal qualifications, they considered staff members\u0026rsquo; ability to grow into, and with, the role of acquiring new competencies. As one leader explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThey are given responsibility and build knowledge that they convey to others. They develop cutting-edge expertise in their technologies that allows them to take up space in department meetings, informing others and answering questions. I think they grow in the role.... Their colleagues are very loyal to them and use their expertise, regardless of their formal qualifications. (1:6\u0026ndash;9)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother leader explained that the technology suppliers had recommended looking for gamers as potential tech champions and using them as a resource in implementing the technology: \u0026ldquo;\u003cem\u003eI think it was a great suggestion from the supplier to choose gamers\u0026hellip;. It is a very good competency to hold when you\u0026rsquo;re a tech champion\u0026rdquo;\u003c/em\u003e (6:15).\u003c/p\u003e \u003cp\u003eThe leaders perceived that appointing staff members as tech champions could enhance the tech champions\u0026rsquo; competence and status among their colleagues and motivate them to engage in further professional training, while exploiting the resources they represented and strengthening the overall robustness of the department\u0026rsquo;s staff.\u003c/p\u003e \u003cp\u003eIt was seen as critical for tech champions to be present and available for their colleagues. Some leaders preferred specialist nurses as tech champions based on their frequent contact with other staff members:\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe specialist nurses only work in the daytime and have no shifts. They are available in the daytime and can attend meetings to catch up on new information and pass it on to the other staff during the reporting between shifts\u003c/em\u003e. (4:3)\u003c/p\u003e \u003cp\u003eTwo of the leaders experienced failure in trying to assign the tech champion role to staff who had just returned from sick leave to facilitate their gradual return without an overly physical workload. This approach was not successful, and they learned to choose tech champions among the staff who were present in the daily work on site.\u003c/p\u003e \u003cp\u003eA leader who had recent experience in implementing electronic health records in healthcare services mentioned the number and availability of tech champions as particular concerns. Going live with electronic health records had immediately changed the documentation practices for all staff, necessitating strong support for staff members: \u0026ldquo;\u003cem\u003eWe had two tech champions on each shift when we went live with the digital platform. Then they were also able to support each other\u003c/em\u003e\u0026rdquo; (4:10). The leader experienced a need to initially have multiple tech champions available during all shifts to ensure sound implementation. The number of tech champions was gradually reduced over time. In other processes, there were fewer tech champions, and some tech champions remained \u0026ldquo;on call\u0026rdquo; at night to assist with technology implementation even if they were not at work. A common challenge was keeping the desired number of tech champions available and distributing them across the shifts. Another key concern was ensuring that tech champions were able to participate in meetings for updates and coordination related to technology implementation efforts.\u003c/p\u003e \u003cp\u003eSeeking specific qualities in tech champions\u003c/p\u003e \u003cp\u003eThe municipal healthcare leaders had clear ideas about the qualities they were looking for in tech champions. They listed many preferred individual characteristics as well as staff members\u0026rsquo; ability to follow tacit work instructions.\u003c/p\u003e \u003cp\u003ePreferred tech champion characteristics\u003c/p\u003e \u003cp\u003eAside from having technological competencies and know-how, the leaders listed many expectations of tech champions, including an ability to serve as their extension by supporting their peers, helping and engaging staff, and collaborating with stakeholders to ensure full implementation. In line with these expectations, they sought specific personal characteristics in tech champions, preferring to assign the role to staff members who were positive, interested, empathetic, collaborative, communicative, and able to pass on their knowledge to others. One leader stated that \u0026ldquo;\u003cem\u003eit is about personal suitability by being someone who is good at communicating and teaching, is preferably structured and organized, and has the necessary overview\u003c/em\u003e\u0026rdquo; (9:9).\u003c/p\u003e \u003cp\u003eThe leaders looked for different qualities when choosing tech champions, and the type of technology to be implemented sometimes impacted their choices: \u003cem\u003e\u0026ldquo;You must find the person who suits what you are going to roll out.... It is preferable to choose someone who is interested, wants the role, and is present at work\u0026rdquo;\u003c/em\u003e (7:9). The leaders wanted to give everybody a chance to fulfill the tech champion role but had experienced that the role did not suit everyone. Personal and interpersonal qualities, interest in technology, and daily presence were prioritized over formal qualifications when choosing tech champions.\u003c/p\u003e \u003cp\u003eAbility to follow tacit work instructions\u003c/p\u003e \u003cp\u003eThe leaders expected tech champions to take responsibility for the tasks they were assigned, although none of them provided formal instructions for the role or any benefits, such as extra compensation or dedicated time to fulfilling the leaders\u0026rsquo; expectations. Those assigned as tech champions were expected to play this role on top of their ordinary duties; they were told to prioritize daily tasks and tech tasks at the same time. Therefore, the leaders could not hold them fully and formally responsible for the technology implementation process. As one leader summed up: \u0026ldquo;\u003cem\u003eIt is a silent instruction, I call it\u003c/em\u003e\u0026rdquo; (8:6).\u003c/p\u003e \u003cp\u003eDespite procedures being in place for implementing each technology, there were no work instructions describing how tech champions should perform their role. The leaders needed champions who took responsibility and expected them to ensure that the technology implementation succeeded in their departments. As summarized by one of the leaders: \u0026ldquo;\u003cem\u003eThere needs to be someone there [a tech champion] to pull the strings and make things work\u003c/em\u003e\u0026rdquo; (5:7). \u0026ldquo;The strings\u0026rdquo; could be interpreted as referring to the staff, the technology, and the practices in healthcare services. The need to \u0026ldquo;make things work\u0026rdquo; could refer to tech champions serving as the link between leaders\u0026rsquo; strategic intentions and the reality of staff in terms of the daily work in their departments and between specific technologies and their peers\u0026rsquo; adoption of them.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first dedicated study of healthcare leaders\u0026rsquo; strategic perspectives on tech champions\u0026rsquo; role in the technology implementation process. Our findings demonstrate that healthcare leaders experienced tech champions as an imperative measure for successful technology implementation. The study found that healthcare leaders\u0026rsquo; perspectives on tech champions intertwined with their considerations pertaining to overall strategic implementation, encompassing the implementation phase, type of technology, their knowledge of staff capacity and group dynamics, their own personal capacity and technological competency, and individual tech champion competencies.\u003c/p\u003e \u003cp\u003eDue to the importance of tech champions\u0026rsquo; role, the healthcare leaders highlighted overall managerial considerations regarding staff allocation and, crucially, their own leadership role in the implementation process. Leaders\u0026rsquo; perspectives on tech champions\u0026rsquo; role were closely related to their self-perceived role, technological competencies, capacities, and individual needs as leaders to oversee the implementation process. This emerged clearly when they explained their choice to fulfill the tech champion role themselves or delegate the role. By not holding the role themselves, they excluded themselves from insights into specific technologies and administrative access to monitor implementation and foresee and troubleshoot problems. Thus, a potential risk was detaching themselves from the implementation process and having to rely on tech champions\u0026rsquo; fulfillment of their self-perceived role [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], since champions were expected to fulfill tacit job descriptions, with no formal role description, dedicated time, or additional compensation provided for their efforts to enable successful technology implementation among their colleagues. Given that leaders perceived tech champions as their representatives, performing transformative leadership and essential for successful implementation, relying solely on tech champions\u0026rsquo; self-perceived responsibility and personal interest may be perceived as an unsecure strategy. The failure rate in technology implementation is still high, ranging from 30% to 90%, and is related to economical, technical, organizational, and social factors [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], including a lack of staff support for change [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Given the shortage of personnel, it may be perceived as unrealistic in the short term to expect all staff to have the required technological competencies. Due to the high demand for change management in healthcare today, these findings underline the need for a debate on contemporary healthcare leaders\u0026rsquo; role requirements and, subsequently, on the potential pros and cons of formalizing tech champions\u0026rsquo; role.\u003c/p\u003e \u003cp\u003eThe findings on preferred individual characteristics of tech champions align with previous research [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The leaders highlighted qualities such as being positive, interested, empathetic, collaborative, communicative, and able to pass on their knowledge to others. Together with their technological capabilities and organizational know-how, these qualities enabled the tech champions to act as their leaders\u0026rsquo; extension in the technology implementation process. These qualities align with transformative leadership qualities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], focusing on creating commitment to organizational goals. By being positive, empathetic, and collaborative; engaging their peers; and passing on their knowledge to empower their peers to master technologies, tech champions were expected to facilitate the achievement of the organizational goal of technology implementation. In line with micro-level transformative leadership, the tech champions were supposed to facilitate change at an interpersonal level [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Furthermore, the tech champions were expected to be charismatic, inspirational, and attentive, embodying characteristics of transformational leaders as described by Judge and Piccolo [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe healthcare leaders expected tech champions to perform extra-role behaviors, which are perceived as essential in transformative leadership theories [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. An extra-role behavior can be described as one \u0026ldquo;which benefits the organization and/or is intended to benefit the organization, which is discretionary, and which goes beyond existing role expectations\u0026rdquo; [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Extra-role behaviors undertaken alongside one\u0026rsquo;s primary role are also termed organizational citizenship behaviors [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Using volunteer tech champions increased the likelihood of these behaviors. Healthcare leaders valued behaviors linked to tech champions\u0026rsquo; mission to facilitate and support the successful implementation of technologies in everyday professional healthcare practice.\u003c/p\u003e \u003cp\u003eImplications for future research and practice\u003c/p\u003e \u003cp\u003eTo avoid detaching themselves from their own transformative leadership role, healthcare leaders considering tech champions as an implementation measure should carefully assess the risks of handing over sole responsibility for monitoring and supporting technology implementation to heath personnel in tech champion roles. Without formal roles and positions, the success of tech champions as an implementation measure seems to depend on leaders\u0026rsquo; thorough considerations of organizational, cultural, and contextual factors, including interpersonal relations and tech champions\u0026rsquo; personal commitment. Research is needed to clarify how delegating or extending implementation support to tech champions affects leadership\u0026ndash;champion dynamics and relates to other implementation strategies.\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eThe strengths of the study are its focus on healthcare services within both small and large municipalities, its encompassing of various types of services, and its inclusion of both healthcare leaders acting as tech champions and those delegating the role to other healthcare personnel. A weakness is that all participants were recruited through invitations distributed by municipal leaders. Potential participants may have been omitted during this distribution, which could have caused selection bias and prevented excluded participants from sharing critical aspects related to the study aim. Supplementing the interviews with field studies and recruiting more participants could have strengthened the study by enabling thicker descriptions and improving the transferability of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHealthcare leaders\u0026rsquo; perspectives on tech champions intertwine with their overall strategic implementation considerations, encompassing the type of technology, their knowledge of staff capacity and group dynamics, their own personal capacity and technological competency, and individual tech champion competencies. Tech champions are perceived as the leaders\u0026rsquo; extensions, performing transformative leadership roles. They are not supported with formal role descriptions, dedicated time, or compensation in their efforts to fulfill the tacit job description of enabling successful technology implementation among their colleagues.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was conducted according to the Norwegian Law of Ethics [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], General Guidelines for Research Ethics [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] and has followed the Declaration of Helsinki [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Data collection and storage were considered and approved by The Norwegian Agency for Shared Services in Education and Research (Sikt) [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] (reference number 403183). All participants were given written and oral information about the study and had the opportunity to withdraw. All participants signed a written informed consent form.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study is part of PhD and was financed by Nord University.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSP, AB, and HE contributed to the study design. SP was responsible for data collection. SP, AB, and HE conducted the analysis and formulated the discussion and conclusion. SP, AB, and HE helped prepare the manuscript and approved the final version of it.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe would like to thank all the participants who contributed to this study with their expertise and experience.\u003c/p\u003e \u003cp\u003eAuthors\u0026rsquo; information\u003c/p\u003e \u003cp\u003ePhD candidate Sissel Pettersen, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://orcid.org/0009-0005-2869-9911\u003c/span\u003e\u003cspan address=\"https://orcid.org/0009-0005-2869-9911\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eAssociate Professor Anita Berg, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://orcid.org/0000-0001-6182-6162\u003c/span\u003e\u003cspan address=\"https://orcid.org/0000-0001-6182-6162\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eProfessor Hilde Eide, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://orcid.org/0000-0003-4428-5047\u003c/span\u003e\u003cspan address=\"https://orcid.org/0000-0003-4428-5047\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset generated and analyzed during the study is not publicly available because approval for this was not given as part of the participants\u0026rsquo; consent. Data cannot be shared openly to protect the privacy of the study participants. On reasonable request, the corresponding author (contact [email protected]) may consider contacting the participants to request approval for sharing the anonymous dataset. The dataset is in the Norwegian language.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoutcher F, Berta W, Urquhart R, Gagliardi AR. The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis. BMC Health Serv Res. 2022;22(1):11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-021-07387-z\u003c/span\u003e\u003cspan address=\"10.1186/s12913-021-07387-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Accessed 10 Feb 2026.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tech champions, healthcare leaders, municipal healthcare services, technology, implementation, transformative leadership","lastPublishedDoi":"10.21203/rs.3.rs-9095841/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9095841/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eStrategic leadership\u0026mdash;including guiding, supporting, and directing staff\u0026mdash;is a critical determinant of successful technology implementation. Having tech champions is a recommended measure for leaders to support staff adoption of technology in their everyday practice. However, there is limited research on leaders\u0026rsquo; perspectives on tech champions\u0026rsquo; role as a strategic measure in technology implementation processes. This study aimed to explore healthcare leaders\u0026rsquo; strategic perspectives on tech champions\u0026rsquo; role in technology implementation processes in municipal healthcare.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSemi-structured interviews were conducted with ten healthcare leaders in municipal healthcare, representing six Norwegian municipalities. The data were analyzed using reflexive thematic analysis based on Braun and Clarke\u0026rsquo;s (2022) descriptions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analysis of municipal healthcare leaders\u0026rsquo; strategic perspectives on tech champions\u0026rsquo; role in technology implementation revealed three interrelated themes: 1) leading the technology implementation process, 2) strategically allocating staff resources, and 3) seeking specific qualities in tech champions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHealthcare leaders\u0026rsquo; perspectives on tech champions are based on considerations regarding the type of technology, leaders\u0026rsquo; own capacity and competences and those of their staff, and individual champion competencies. Tech champions are perceived as healthcare leaders\u0026rsquo; representatives, performing transformative leadership roles without dedicated time, compensation, or job descriptions.\u003c/p\u003e","manuscriptTitle":"A qualitative study of Municipal healthcare leaders’ strategic perspectives on tech champions’ role in technology implementation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 08:50:34","doi":"10.21203/rs.3.rs-9095841/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"233147823563305464823545519448266775432","date":"2026-05-04T21:04:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265581353424624630538219602634888703213","date":"2026-03-16T12:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T08:50:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T08:46:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-16T06:31:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T19:14:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-13T10:30:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"990b0a65-85f0-42fb-b5b6-497228f9b796","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"233147823563305464823545519448266775432","date":"2026-05-04T21:04:57+00:00","index":52,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T08:50:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 08:50:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9095841","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9095841","identity":"rs-9095841","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}