Staff Experiences Transitioning to Digital Dermatopathology in a Tertiary Academic Medical Center: Lessons Learned From Implementation Science

Digital pathology (DP) transforms practice by replacing traditional glass-slide review with digital whole slide images (WSIs) and workflows. Although digitization may improve accuracy and efficiency, transitioning to digital practice requires staff to learn new skills and adopt new ways of working and collaborating. Herein we evaluate the experiences and perceptions of individuals involved in the day-to-day work of implementing DP in a tertiary academic medical center using Normalization Process Theory (NPT), a social theory that explains the processes by which innovations are operationalized and sustained in practice. Between September 2021 and June 2022, dermatopathologists, referring clinicians, and support staff at Mayo Clinic (MN, FL, AZ) participated in interviews (n=22) and completed surveys (n=34) concerning the transition. NPT informed the selection of validated survey items (NoMAD) and guided qualitative analysis. Participants reported high agreement with statements related to shared understanding and potential value of DP for workflow integration and working relationships. Qualitative themes reflecting the way organization and social context enable these processes were mapped onto implementation stages and related key activities. We found that earlier processes of implementation (“understanding” and “working out participation”) were better supported than later stages (“doing it” and “reflecting on it”). Our analysis helps identify targets for further intervention to hasten and help sustain implementation, including additional support in software and technological integration, workflows and work redesign, and regular monitoring and feedback systems. The use of implementation theory, such as NPT, may provide useful pointers to enable other similar digital system transition efforts.