Utilising resistance feedback for software implementation in healthcare

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Utilising resistance feedback for software implementation in healthcare

Danielle Gervacio Graf,

Marymount University (the USA)

Darrell Norman Burrell,

Marymount University (the USA)



Abstract

The COVID-19 pandemic has caused a rapid transformation in the healthcare industry. Telemedicine, mHealth, and artificial intelligence technologies have become integral components of healthcare delivery, enabling remote consultations, symptom tracking, medication reminders, diagnosis, and treatment. However, the adoption of these technologies in healthcare organisations is often met with resistance from shareholders. The most frequent reasons are fear of technology, uncertainty about the impact of technology solutions on patient care, ethical and regulatory concerns, skepticism about the effectiveness of remote medical consultations, concerns about data privacy and security, reluctance to change workflows, risk ofjob losses due to automation of certain processes, and possible conflicts of interest. This article explores the complex landscape of shareholder resistance during software implementation projects, the origins of this problem, its manifestations, advantages, disadvantages, and consequences. The article also examines this issue through the prism of the Lewin's Change Model and the Transtheoretical Model of Change, and demonstrates it on the examples of Information Technology Company and Microsoft. The article offers strategic recommendations for healthcare organisations to effectively manage and mitigate these challenges, facilitating a successful transition to the healthcare technology landscape. Among the main problems, the article discusses the following things: creating open and transparent communication channels for shareholders; joint problem-solving sessions with all stakeholders; an iterative approach to implementing IT projects in healthcare facilities, which allows reviewing, adjusting, and agreeing on solutions at each iteration; involving shareholders in decision-making at the early stages of the software implementation process; comprehensive programs to improve shareholder competencies; targeting opinion leaders who are supporters of changes in the organisation; maintaining continuous feedback, etc. resistance feedback software healthcare

Keywords: resistance, resistance feedback, software, healthcare, telemedicine, public health, mHealth, shareholders.



INTRODUCTION

The COVID-19 pandemic reshaped healthcare delivery worldwide, compelling healthcare systems to rapidly adopt telehealth technologies to provide safe and effective care. Software development and artificial intelligence (AI) have played pivotal roles in revolutionising telehealth, enabling remote consultations, diagnostics, and treatment (Amjad et al., 2023; Kuziemsky et al., 2019).

The global healthcare landscape witnessed a seismic shift during the COVID -19 pandemic. To adapt to the challenges posed by the pandemic, healthcare organisations rapidly embraced telehealth and AI technologies (Amjad et al., 2023; Kuziemsky et al., 2019). However, implementing these technologies was challenging, one of the most significant being shareholder resistance feedback.

Software implementation is critical for healthcare organisations striving to remain competitive in today's digital age (Kokol, 2022). However, it is often accompanied by resistance from shareholders, which can introduce complexities and challenges that impact project success (Desjardine & Shi, 2022).

Resistance feedback from shareholders in healthcare organisations refers to the opposition or reluctance expressed by individuals or groups toward implementing telehealth and AI technologies. This resistance can take various forms, including skepticism, reluctance to change workflows, concerns about data security, and fear of job displacement (Desjardine & Shi, 2022).

The origins of resistance to feedback in healthcare organisations are rooted in fear of technology, uncertainty about the impact on patient care, and concerns regarding data privacy and security. Understanding the underlying reasons for resistance is crucial for devising effective strategies to address it (Samhan & Joshi, 2015).

The software an organisation selects can help improve or impede processes (Larusdottir et al., 2016). However, the selected software or its change is only one of many factors that can impede or improve processes. Resistance is another factor that an organisation experiences when changing its software. Instead of addressing the change, organisations often proceed with the software change without understanding the resistance, which can be detrimental to the implementation and lead to failure (Hashemzadeh et al., 2019).

Before resistance feedback is understood, the organisation must understand what resistance is and why it occurs. Resistance occurs when change is negatively perceived by the employee (Joshi, 1991, as cited in Meissonier & Houze, 2010). Employees may experience resistance for many reasons, such as poor communication, lack of training, lack of agility, lack of processes, and time management (Chohan, 2022). Cost is another reason resistance is experienced. Cost can increase resistance by reducing the value of switching (Kim, 2011). Shareholders with buying powers, such as management, may look at the cost of implementing a new system and compare it against the cost of keeping the current system. They would then decide if the value was there. These types of resistances can be easily overcome. However, when left unaddressed, it can prevent the implementation from succeeding. Therefore, understanding and addressing resistance is vital to successful organisational changes and implementations (Hashemzadeh et al., 2019).

Resistance is displayed in four ways: apathy, passive, aggressive, and active (Meissonier & Houze, 2010). Apathetic resistance is reflected in the disinterest or inaction of an employee toward the change. In comparison, passive resistance occurs when an employee tries to slow down the change to keep the previous system (Meissonier & Houze, 2010). The feedback from apathetic and passive resistance is easy to overcome. Aggressive resistance is the most challenging type to overcome, resulting in behaviours considered malicious, such as blackmail and boycotts. The last type of resistance is active resistance. Active resistance is a constructive form of resistance. With active resistance, an employee aims to improve the change (Meissonier & Houze, 2010). Active resistance is the most helpful type of resistance and can provide organisations with insights to help implement new software.



Statement of the Problem

Despite an accumulation of the best practices research identifying success factors, IT implementation projects often fail to succeed. Corporations in the United States spend over $275 billion yearly on software development projects, many of which are doomed to fail, and 83.9% of IT projects fail (Standish Group, 2023). By ignoring resistance, an organisation can experience a failed software implementation, resulting in high and long-lasting costs (Rivard & Lapointe, 2012). These types of costs come in many forms. This paper explores the nature of those dynamics through the perspective of shareholder feedback.

Research Objective

To understand the complex dynamics resistance feedback during software implementation in healthcare organisations through a review of current and emerging literature.

ANALYTICS, THEORY AND CONCEPTUAL FRAMEWORK

The proliferation of mHealth and healthcare diagnostics software applications has expanded access to telehealth services. These applications offer features such as symptom tracking, medication reminders, and remote consultations (Kuziemsky et al., 2019).

Telehealth technology has witnessed remarkable growth, driven by the need for remote healthcare services, especially during the COVID-19 pandemic (Kuziemsky et al., 2019). As healthcare organisations invest in innovative software development for telehealth technologies, they often encounter resistance feedback within their software development decision-making processes.



What is Resistance Feedback?

Whenever a change occurs in an organisation, resistance will occur. Resistance is natural and a part of the change management process. Instead of ignoring resistance, an organisation should discuss and understand resistance (Anderson, 2020). Understanding the resistance to change is essential because it can determine whether a project is a success or failure (Mathews and Linski, 2016, as cited in Okumus et al., 2017).

The literature around IT change systems identifies resistance as the primary reason for organisational change. However, this is a complex topic since everyone handles change differently. The lack of consistency in resistance makes new software implementation challenging (Davis & Songer, 2008, as cited in Okumus et al., 2017). Therefore, it is essential to gather feedback regarding the resistance. Gathering feedback through interviews or surveys can help organisations identify a pattern of resistance to understand the issue's root. By understanding the root of the resistance, the organisation can strategically address the concerns and objections to get shareholders to gain buy-in (Rivard & Lapointe, 2012).

The Complexities of Resistance Feedback

Resistance feedback often stems from a combination of factors, including fear of change, uncertainty about the software's impact, and perceived threats to job security. It is essential to recognise that resistance is a natural response to significant organisational changes and should be addressed empathetically (Landaeta et al., 2008).

Ethical and Regulatory Concerns

Telehealth and AI technologies in healthcare raise ethical and regulatory challenges, contributing to resistance feedback. Issues related to patient consent, data protection, and compliance with healthcare regulations add layers of complexity to the implementation process (Safi et al., 2018).

Interdisciplinary Collaboration

Healthcare delivery involves many stakeholders, including clinicians, IT professionals, administrators, and patients. Resistance feedback often arises from conflicts between these stakeholders, challenging interdisciplinary collaboration and alignment (Safi et al., 2018).

Emotional Dimensions

One complexity of resistance feedback lies in the emotional dimensions associated with it. Shareholders may have strong emotional attachments to existing processes or systems, making it challenging to accept change. Managing these emotions requires a nuanced approach considering individual and group dynamics processes (Safi et al., 2018).

Cognitive Biases

Cognitive biases, such as confirmation bias and status quo bias, play a significant role in the resistance feedback process (Safi et al., 2018). Shareholders may seek evidence to confirm their negative perceptions of the new software or prefer to maintain the status quo. Recognising and addressing these biases is essential for effective communication and change management.

Organisational Culture

The organisational culture of healthcare institutions plays a pivotal role in shaping resistance feedback. Hierarchical structures, traditions, and resistance to change can hinder the successful implementation of new technologies. Managing these cultural factors is a significant challenge. The existing organisational culture can foster or hinder resistance feedback (Rider et al., 2018). Cultures that promote openness to change and collaboration are more likely to handle resistance effectively. Conversely, cultures emphasising hierarchy and rigid structures may need help constructively addressing resistance (Rider et al., 2018).

Challenges of Managing Resistance Feedback

Communication Challenges

Effective communication is crucial in managing resistance feedback. Organisations often need help conveying the new software's benefits, addressing concerns, and fostering a sense of ownership among shareholders. The challenge lies in finding the proper communication channels, timing, and messaging when there is resistance (Gjellebsk et al., 2020).

Leadership and Change

Management Leadership is pivotal in managing resistance (Gjellebsk et al., 2020). Leaders must exhibit a clear vision for the software implementation, provide support, and lead by example. Change management strategies, such as stakeholder engagement and training, are essential tools for mitigating resistance challenges (Rivard & Lapointe, 2012).

Balancing Stakeholder Interests

Stakeholder opposition is a critical phenomenon in contemporary organisational settings. Here, stakeholders express resistance, skepticism, or objection to specific organisational decisions or initiatives (Desjardine & Shi, 2022). Different shareholders may have conflicting interests and priorities, further complicating the management of resistance feedback. Balancing these interests while aligning them with the organisation's objectives is a delicate task that requires strategic decision-making (Rivard & Lapointe, 2012).

Resistance can be a helpful tool, but often, managers see it as a challenge to their leadership. Leadership sees it as employees questioning their reasoning, which can threaten leadership. However, resistance feedback can help make a complex project run sm oothly and be more successful. When using resistance as a tool, managers should ask themselves two questions. These questions are, “Why am I seeing this behaviour as resistance?” and If I viewed the resistance as feedback, “What could I learn about how to refine the change effort?” (Ford & Ford, 2009, para. 4). These two questions can help drive the success of understanding and resolving resistance. If resistance is resolved and understood correctly, it can help boost morale, target the project's purpose, encourage change, and build participation and engagement among team members (Ford & Ford, 2009).

One study addressed resistance through clear communication, identifying champions, emphasising the new system's benefits, and facilitating collaboration (Okumus et al., 2017). Other ways to address resistance are having a solid leadership team, addressing workflow concerns, and leveraging the younger employees. A strong leadership team and project champions can en courage other shareholders to support and utilise a new system. They can also remind them of the end goal (Okumus et al., 2017). Hiccups occurring during the implementation of new software can discourage the team members from utilising the software. During these frustrating times, leaders and champions should continue emphasising the need for change (Okumus et al., 2017).

Workflow concerns should also be addressed to help with resistance to change (Okumus et al., 2017). Part of the hiccups that occur during new software implementation is workflow concerns. Learning a new system can be challenging and may seem more difficult to use initially. However, once the initial training period ends and employees get more comfortable with the system, they often see the new system's benefits (Okumus et al., 2017). Younger employees can also serve as information technology champions. Younger employees often have an easier time implementing new software than older employees. Younger employees can help older employees see the new system's benefits by discussing the outcomes and allowing them to see how the new system will help them (Okumus et al., 2017).

The same study gathered resistance feedback from owners, executives, employees, and customers (Okumus et al., 2017). The feedback was broken down into sections and was addressed. For example, cost of investment, return on investment, and resistance from owners and executives were grouped as preimplementation phase barriers. To address the issues in this category, the organisation explained the longterm benefits of the new system, identified the realistic return on investments estimates, and increased owner and executive engagement by involving them in the process (Okumus et al., 2017). This study showed that overcoming employee resistance is critical to implementing new software systems for an organisation (Rivard & Lapointe, 2012). Part of this is utilising resistance feedback as a component of a participative design approach. It assumes the implementation success is dependent on the support and commitment of those shareholders who will be using the software system (Purser and Cabana, 1998, as cited in Okumus et al., 2017).

Another study utilised the psychological contract theory to understand user resistance, drawing attention to problems that can slow the implementation process and address unresolved issues (Fiorelli and Margolis, 1993, as cited in Klaus & Blanton, 2010). An organisation's software implementation plan can continue when these concerns go unaddressed. Klaus and Blanton (2010) recognise four types of resistance. The resistance types can be classified as individual, system, organisational, and process issues. Each of these classifications focuses on how psychological determinants interfere with processes. For individual issues, Klaus and Blanton use the example of different ways employees may feel. One employee may feel safe if their job is secure; another may need more. They may need additional, unscheduled tasks added to their role to feel valued (Klaus & Blanton, 2010).

With system issues, implementations may frustrate employees due to technical problems or the system's complexity. The determinants around system issues would be technical problems and complexity. This can make employees not want to utilise the system, leading to the implementation failing. Organisational issues focus on the organisation's inability to meet employees' needs (Klaus & Blanton, 2010). Organisational issues present problems since employees may need to be more secure in their roles to support implementing a new system (Rivard & Lapointe, 2012). This is also like process issues. Process issues address the psychological determinants that prevent users from accepting a new system. Klaus and Blanton (2010) state that when users feel an issue with processes, they can psychologically consider this process changes a contract breach.

Organisations can develop new psychological contracts by understanding the type of psychological determinants before implementing the software (Klaus & Blanton, 2010). Organisations will aim to understand the current psychological determinants and address resistance feedback to develop a new psychological contract. Assessment is critical because resistance is the root of many software implementation failures (Hill, 2003, as cited in Klaus & Blanton, 2010).

Immediate Consequences of Resistance Feedback

Project Delays

One of the most immediate consequences of resistance feedback is project delays. Stakeholder objections or disagreements can lead to prolonged decision-making processes, causing project timelines to slip (Yip et al., 2014).

Cost Overruns

Resistance feedback can result in cost overruns due to extended project timelines, additional resource allocation, and the need for additional communication and negotiation efforts (Yip et al., 2014).

Diminished Stakeholder Relationships

Persistent resistance to feedback can strain relationships between project stakeholders, leading to a breakdown in trust and collaboration. Pervasive resistance can have long-lasting effects on future projects and organisational dynamics (Yip et al., 2014).

Software Quality Compromises

Resistance feedback can lead to compromises in software quality. Rushed development to meet delayed deadlines or inadequate resource allocation can result in subpar software products (Yip et al., 2014).

Impact on Innovation

Resistance to feedback may stifle innovation and creativity within the software development process, as stakeholders may be hesitant to explore new ideas or technologies due to resistance from others (Yip et al., 2014).

Employee Morale and Turnover

Prolonged resistance feedback can adversely affect employee morale and job satisfaction. Team members working on contentious projects may experience burnout or consider leaving the organisation.

The Lewin's Change Model

The Lewin's Change Model is a foundational theory that describes change as a three-step process: unfreezing, changing, and refreezing (Manchester et al., 2014).

Unfreezing: In this phase, the existing equilibrium is disrupted, challenging the status quo and making stakeholders aware of the need for change.

Changing: Once unfrozen, change is implemented. New behaviours, processes, or technologies are introduced and adopted.

Refreezing: In this stage, the change is stabilised and integrated into the organisational culture, establishing a new equilibrium.

In the unfreezing stage, healthcare organisations must first create awareness among shareholders regarding the need for software development changes and the associated benefits. Effective communication plays a crucial role here, as it helps to break down resistance barriers by providing stakeholder s with a clear understanding of the necessity for change (Manchester et al., 2014). During this stage, organisations can engage shareholders in open dialogues, addressing their concerns and clarifying misconceptions, thus preparing them for the upcoming change (Manchester et al., 2014).

The changing stage involves the actual implementation of software development changes. Healthcare organisations can apply the Lewin's model by involving shareholders in decision-making and soliciting their input, leading to a more collaborative and inclusive approach. Additionally, it is vital to provide shareholders with the knowledge and skills necessary to adapt to the changes succe ssfully. Training programs and resources that empower stakeholders to embrace and navigate the software development process can mitigate resistance and promote a smoother transition.

The refreezing stage represents the consolidation of the change and its integration into the organisational culture (Manchester et al., 2014). Healthcare organisations can utilise this stage to reinforce the benefits of software development, highlight early successes, and anchor the new approaches in the organisation's values and practices. Recognising and rewarding stakeholders who embrace the change can help solidify the new software development processes as the norm, reducing the likelihood of future resistance (Manchester et al., 2014).

In summary, the Lewin's Change Model provides a structured framework for healthcare organisations to address shareholder resistance during software development effectively. By focusing on the unfreezing stage to create awareness, the changing stage to involve and equip shareholders, and the refreezing stage to consolidate and institutionalise change, organisations can foster a more receptive and adaptive environment for software development initiatives, ultimately leading to improvement and embracing new developments.

The Transtheoretical Model of Change (TTM)

The Transtheoretical Model of Change (TTM) identifies stages individuals go through when making behavioural changes and offers insights into overcoming resistance (Hashemzadeh et al., 2019).

Precontemplation

In the pre-contemplation stage, shareholders may not recognise the need for change. They may resist the implementation of new software because they need to perceive its relevance or benefits.

Contemplation

In the contemplation stage, shareholders know the need for change but may be ambivalent. They may resist because they are still determining how the new software will affect their roles or are comfortable with existing practices.

Preparation

During the preparation stage, shareholders are ready to embrace change but may still need more confidence in using the new software.

Action

In the action stage, shareholders actively engage in the change process. Resistance may still arise if they encounter difficulties or obstacles during software implementation.

Maintenance

The maintenance stage involves sustaining the change. Shareholders may only accept if they perceive that the promised benefits of the new software are materialising or if they experience setbacks.

The Transtheoretical Model of Change (TTM) offers valuable insights into understanding and addressing shareholder resistance to change in the context of software development for healthcare organisations (Hashemzadeh et al., 2019). The TTM posits that individuals progress through distinct stages when adopting new behaviours or changes (Hashemzadeh et al., 2019). These stages include pre-contemplation, contemplation, preparation, action, and maintenance. Each stage represents a unique mindset and set of actions, and stakeholders may find themselves at different stages of readiness when confronted with software development changes in healthcare.

In the pre-contemplation stage, shareholders may need to be made aware of the need for software development changes or underestimate their importance. Healthcare organisations can address this by providing clear information about the benefits of the change, emphasising how it aligns with its mission, and illustrating the potential positive impact on patient care and operational efficiency.

The contemplation stage signifies that shareholders are beginning to recogn ise the need for change but may still have reservations or concerns. Healthcare organisations can communicate openly and transparently during this stage, encouraging stakeholders to voice their doubts and questions. Providing evidence-based data on the advantages of software development in healthcare and sharing success stories from other organisations can help sway shareholders toward a more favourable view of the change.

As stakeholders move into the preparation stage, they seek information and solutions to facilitate the software development change. Healthcare organisations can support this stage by offering training, resources, and guidance on navigating the transition effectively. By aligning the organisation's goals with the shareholders' aspirations and needs, healthcare organisations can encourage a smoother transition to the action stage, where shareholders actively participate in and support the software development process.

By recognising the stages of change outlined by the Transtheoretical Model, healthcare organisations can effectively tailor their approaches to address shareholder resistance. Recognising the stages of change includes providing the necessary information, resources, and support at each stage to facilitate a smoother transition to the adoption of software development initiatives, ultimately benefiting both the organisation and its stakeholders.



CONCLUSIONS

Companies Who Have Utilised Resistance Feedback

In the 1990s, the Information Technology Company or ITC utilised resistance feedback to lead a software process improvement project or SPI (Ngwenyama & Nielsen, 2014). The organisation was snowballing and needed to improve its software and processes. However, the group faced resistance from the beginning. The organisation faced resistance in three ways. The first was the structure of the hierarchy. At the time, product managers did not have authority over other project managers who were not their software project managers. These barriers meant that other project managers were able to block the implementation.

The next area ITC faced resistance in was management buy -in. First, ITC needed more top management support for the implementation. Top management believed that the business case needed to be more robust due to competing business goals and needing a high-priority commitment to the project. Lastly, the company had faced past implementation failures, which led employees to believe that this implementation would fail (Markus & Benjamin, 1996, as cited in Ngwenyama & Nielsen, 2014).

The organisation began the implementation by conducting the Capability Maturity Model assessment. The Capability Maturity Model assessment is utilised in continuous process improvement to understand where an organisation lands on a process evolutionary level. The Capability Maturity Model has five levels of maturity. ITC was at level 1 of the Capability Maturity Model. At this initial level of maturity, the organisation had much work to do, such as establishing key performance indicators, improving and formalising quality assurance practices around crucial project decisions, establishing test environments and processes, improving existing methods, techniques, and tools, and improving project management practices. In addition, ITC focuses on improving project management practices since the project managers would lead the implementation (Ngwenyama & Nielsen, 2014).

ITC then enacted a coordination organisational influence strategy (Ngwenyama & Nielsen, 2014). Although the strategy as a whole contributed to the implementation success, the project manager selfassessment was a tool that ITC used to understand where changes were needed. Project managers would selfassess the weaknesses they must overcome for ITC to mature to level two. This self-assessment tool was also utilised as a resistance indicator, and project managers needed to address this resistance to mature to level two. The implementation took 23 months but was successful, unlike ITC's other failed implementations (Ngwenyama & Nielsen, 2014).

More recently, Microsoft also utilised resistance feedback in its change management process. For example, in 2020, Microsoft needed a new tool to analyse data to track sales and operational activities across the organisation (Delaini, 2023). The team's implementation plan was vigorous, which included weekly and biweekly meetings that prioritised needs and triaged problems. The team understood they would need to address potential blockers and resolve the issues to implement them successfully. Some potential blockers included planning for training and obtaining executive buy-in. The Microsoft team understood two of the most significant resistances towards new systems: lack of training and executive support (Delaini, 2023).

The team addressed this by engaging with the team closely (Delaini, 2023). The team would contact employees and executives to form champions within the organisation. Senior Director Andrew Osten knew that users had different needs. Osten (as cited in Delaini, 2023) asked, “What do they need to see, and what behaviour are we trying to drive?” (para. 8). Osten's team would also ask about the challenges they faced with metrics and provide solutions to help meet their needs. The team closely listed these shareholders ' priorities and built a business case around the provided information to gain buy -in. This method proved to be a success. There are now more than 30,000 users of the business intelligence platform in 95 countries (Delaini, 2023).

These types of methods can also be used in other ways. Microsoft has also utilised champions on the external front. Microsoft trains employees for organisations to be Microsoft Champions to help guide and encourage users to utilise Microsoft 365. Microsoft 365 Champions are individuals who will be early adopters of the system (Granada, 2021). These individuals receive training to become proficient with Microsoft 365 apps. In addition, they are trained to understand Microsoft 365 policies, procedures, and the best practices (Granada, 2021).

The Champions will also test new processes. During these tests, the Champions can discuss what is working and what is not, training tips, and suggestions for a better workflow (Granada, 2021). Champions can also help address resistance. Since they are testing the processes early, Champions can predict what technological resistance they can expect before implementation.

Advantages of Utilising Resistance Feedback

Utilising resistance feedback to help overcome resistance has both advantages and disadvantages. One of the advantages is improved communication. When an organisation encourages feedback, employees are more willing to participate. Embracing feedback opens the lines of communication and makes employees feel they are a part of the process. Participatory decision-making and feedback also allow employees to feel that the organisation is being transparent, which builds trust with employees.

Another advantage ties in with improved communication. This advantage is increased engagement. Employees are likelier to engage if they feel a part of the decision-making process. The more employees engage in the resistance feedback process, the better the outcomes will be. Participatory decision -making and feedback will allow the organisation to address multiple resistances that the new software implementation will experience. The most significant advantage is understanding the resistance. Understanding the resistance is the goal because it helps organisations overcome obstacles that may lead to a failed software implementation.

Resistance feedback is a tool to build trust and transparency in addressing resistance feedback . It creates trust between developers and shareholders. This trust is essential for effective communication, knowledge sharing, and establishing strong working relationships (Leyland et al., 2009; Palmer, 2004; Larusdottir et al., 2016).

Resistance feedback often presents challenges that require innovative solutions. Encouraging stakeholders to contribute ideas for overcoming obstacles can lead to novel approaches, creative problem-solving, and breakthrough innovations (Leyland et al., 2009; Palmer, 2004; Larusdottir et al., 2016).

Resistance feedback acts as a magnifying glass, pinpointing weaknesses, vulnerabilities, and blind spots in software development projects. Stakeholders may uncover usability, functionality, security, or compatibility issues developers might have overlooked (Leyland et al., 2009; Palmer, 2004; Larusdottir et al., 2016).

Shareholder resistance feedback serves as an early warning system, highlighting potential issues and concerns that might go unnoticed. By actively seeking and embracing this feedback, healthcare organisations

can identify and address challenges in the software development process before they escalate (Leyland et al., 2009; Palmer, 2004; Larusdottir et al., 2016).

Engaging shareholders in constructive dialogues about their concerns fosters a sense of ownership and involvement. This engagement can lead to more meaningful collaboration between developers, clinicians, administrators, and patients, ensuring that software solutions are tailored to meet the diverse needs of all stakeholders. Effective resistance feedback can lead to software refinements and improvements. Shareholders ' insights can enhance telehealth and AI solutions' usability, functionality, and overall quality, resulting in better patient care and clinician experiences. Seeking resistance feedback fosters an inclusive decision-making process that values stakeholder input. Engaged stakeholders are likelier to feel a sense of ownership over the project, leading to more significant commitment and collaboration (Leyland et al., 2009; Palmer, 2004; Larusdottir et al., 2016).

Strategies for Effective Resistance Management

Establishing Open Channels of Communication

Healthcare organisations should create open and transparent channels for shareholders to voice their concerns and suggestions. Regular feedback sessions, surveys, and focus groups can facilitate productive discussions and information sharing (Rivard & Lapointe, 2012).

Collaborative Problem-Solving

Shareholders should be viewed as partners in the software development process. Collaborative problemsolving sessions that bring together stakeholders, developers, and healthcare professionals can yield innovative solutions and overcome resistance barriers (Rivard & Lapointe, 2012).

Iterative Development

An iterative development approach, which involves continuous refinement and feedback incorporation, aligns well with leveraging resistance feedback. This approach allows for ongoing adjustments based on real - world experiences and stakeholder input (Rivard & Lapointe, 2012).

Early Engagement and Involvement

Engaging shareholders early in the software implementation process can reduce resistance. Involving them in decision-making, soliciting their input, and addressing concerns proactively fosters a sense of ownership and commitment to the project (Rivard & Lapointe, 2012).

Education and Training

Comprehensive education and training programs can alleviate concerns related to software adoption. Shareholders who feel adequately prepared are more likely to embrace the change and provide constructive feedback (Rivard & Lapointe, 2012).

Change Champions

Identifying and empowering change champions within the organisation can be a powerful strategy (Rivard & Lapointe, 2012). These individuals can advocate for the software implementation, addressing concerns and promoting its benefits among their peers.

Continuous Feedback Mechanisms

Establishing mechanisms for ongoing feedback is essential (Rivard & Lapointe, 2012). Regular feedback loops allow organisations to identify issues promptly and make necessary adjustments, creating a culture of responsiveness and adaptability.

Resistance feedback from shareholders in software implementation projects is a complex and multifaceted phenomenon that organisations must address effectively to ensure project success. Shareholder resistance feedback is a valuable resource that can significantly enhance the software development process for healthcare organisations implementing telehealth technologies and AI. By actively seeking and utilising resistance feedback, healthcare organisations can address issues early, enhance stakeholder engagem ent, and ultimately deliver higher-quality software solutions. Embracing resistance as a constructive force improves software and fosters a culture of collaboration and innovation that can positively impact healthcare delivery. Recognising the importance of shareholder input in software development is essential as healthcare continues to evolve in 114 the digital age.



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