Table 4:

Illustrative Data Excerpts Relating to the Challenging Wider External Environment.

Restructuring of NHS England	Q1 “ … the health services are going through this tremendous upheaval. It’s beyond anything that any of us have experienced. I’ve been in the health service now nearly 40 years. I mean, it has… I think it’s well evidenced that nothing like this has happened since the health service was incepted. So people are trying to deal with the here and now, and understand what’s happening., in their own sphere of work in health service-land. I think the local authority are doing the same, against a background of massive efficiencies and so, they can be very distracting, understandably.… So I think people, in their hearts, understand them and want it promoted and be sponsors for it, but I think because there’s so much going on, they’re just distracted from that … ” (C2(b) Clinicial – NHS).
Fear of role redundancy	Q2 Interviewee “…..but I think there is some negative… negativity among different staff groups thinking technology will be replacing people.” IV “What staff groups are you sensing that among?” Interviewee “Carers.” IV “The social Carers, that they’ll be made redundant by this… these technologies?”Interviewee “Well, yes. I think that’s quite a big initial thought of a lot of different care groups, that they’d be made redundant by the introduction of technology.” (Interview with C2(b) Representative – Charity organization).
	Q3 “I think there’s been, particularly the first year, there was almost no focus, it was very hard to get attention from the NHS, where everybody whom you thought who could have become a Champion was… was worried about what their next job was. You know, the whole thing, you it’s hard to imagine, […], how disruptive that was.” (C3(m) Manager 2 – Business).
Aligning with new organizational structures	Q4 “ … Because the clinical commissioning groups are now bought into dallas and they will drive this forward. I think the only concern is that there is a lot of change going on at the moment, but a lot of the change that is going on with the clinical commissioning groups involved are things that were suggested in dallas… ” (C2(b) Manager, Informatics).
Impact of wider economic environment	Q5 “ … and unfortunately they went bust so that was quite a setback for us. The alternative we came up with which was for online and telephone sales; that hasn’t gone down brilliantly … and what we’ve done since then is we’ve re-grouped and reconsidered; well, should we be selling them?[…]. We’ve just sort of moved into that because we’ve lost our Retail so we’ve regrouped now.We are back where we wanted to be, I think, which is we will vet products, make sure that the products are reliable, etc., before we actually feature them … and so on. But we would look to proper Retailers to actually sell them rather than trying to sell them ourselves. ” (C2(m) Manager 1 – NHS).