Digital operating rooms and clinical readiness: Understanding stakeholder expectations and concerns in Ireland’s healthcare transformation

Abstract

This study examined stakeholder expectations, concerns, and readiness for Digital Operating Room (Digital OR) implementation in Irish hospitals. It was found that readiness is not determined by technological capability alone, but by how well systems align with clinical practice, organisational capacity, and the expectations of end-users. Six stakeholders were interviewed across clinical, nursing, technical, and managerial roles, including a Digital OR project manager with experience in European healthcare settings. Semi-structured interviews were conducted and analysed using thematic analysis. To guide this process, a conceptual framework was created, drawing concepts from the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, the Human-Organisation-Technology fit framework, and Normalisation Process Theory. Six themes were identified: perceived clinical and operational value; workflow integration and practical fit; readiness, skills, and support needs; organisational capacity for implementation; trust, safety, and data governance; and future conditions for successful adoption. Patient safety was identified as the primary driver of anticipated value, as participants described how real-time data access and digital decision-support tools could reduce error and improve surgical outcomes. However, value was consistently depicted as being dependent on system reliability, workflow alignment, and organisational support rather than on technology alone. Resistance to adoption was found to be a rational response to concerns about workflow disruption and patient safety rather than opposition to change. Digital literacy was no longer identified as a major barrier, which reflects the increased familiarity with technology in everyday life. However, implementation quality and organisational conditions emerged as key constraints on readiness. Trust was found to emerge gradually through consistent system performance and shown to be influenced by wider healthcare factors, including prior experiences of national cyber incidents. The study concluded that Digital OR implementation requires the development of organisational structures that allow technology to be used safely and effectively at the point of care. Twelve evidence-based recommendations were produced for health service organisations and implementation teams. They cover pre-deployment planning, role-based training, embedded support structures, fallback planning, and governance. Digital OR readiness in Ireland will not be achieved through procurement or policy alone, but through continued investment in human and organisational conditions that support adoption.