Marching to different drum beats: a temporal perspective on coordinating occupational work

In this paper, we contribute a temporal perspective on work coordination across collaborating occupations. Drawing on an ethnographic study of medical specialists – surgeons, pathologists, oncologists and radiologists – we examine how their temporal orientations are shaped through the temporal structuring of occupational work. Our findings show that temporal structuring of occupational practices develop in relation to the contingencies and materialities of their work, and that this shapes, and is shaped by, specialists’ temporal orientations. Further, we show that differences in occupations’ temporal orientation have important implications for coordinating work. More specifically, our study reveals how the domination of one temporal orientation can lead to recurrent strain, promoting a competitive trade-off between the different temporal orientations in guiding interaction. This temporal orientation domination is accompanied by a persistent emotional strain and potential conflict. Finally, we suggest that, alternatively, different temporal orientations can be resourced in solving coordination challenges through three inter-related mechanisms, namely juxtaposing, temporal working, and mutual adjusting. In so doing, we show how temporal resourcing can be productive in coordinating work.Eivor Oborn is supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands

Creating value in online communities: the sociomaterial configuring of strategy, platform, and stakeholder engagement

How is value created in an online community (OC) over time? We explored this question through a longitudinal field study of an OC in the healthcare arena. We found that multiple kinds of value were produced and changed over time as different participants engaged with the OC and its evolving technology in various ways. To explain our findings, we theorize OC value as performed through the ongoing sociomaterial configuring of strategies, digital platforms, and stakeholder engagement. We develop a process perspective to explain these dynamics and identify multiple different kinds of value being created by an OC over time: financial, epistemic, ethical, service, reputational, and platform. Our research points to the importance of expanding the notion of OC users to encompass a broader understanding of stakeholders. It further suggests that creating OC value increasingly requires going beyond a dyadic relationship between the OC and the firm to encompassing a more complex relationship involving a wider ecosystem of stakeholders.Eivor Oborn is part-funded/supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands

Trajectory dynamics in innovation: developing and transforming a mobile money service across time and place

This paper examines how and why innovations are reshaped as they become implemented and used in locales that are distant and distinct from those where the innovation was initially developed. Drawing on an in-depth field study of the innovation process that produced a mobile money system for Kenya, we contribute an understanding of the particular dynamics that arise when an innovation trajectory interacts with local trajectories that constitute the local conditions and practices of specific places. We identify four distinct patterns of trajectory dynamics — separation, coordination, diversification, and integration — each of which has different implications for the innovation, its implementation, and consequences on the ground. Developing a model of trajectory dynamics in innovation, we theorize the processes through which innovations are transformed over time as they interact with multiple local trajectories, and the specific innovation outcomes that are generated as a result. Such theorizing reconceptualizes traditional notions of innovation diffusion by explicating how and why innovations change in multiple and unexpected ways as they move to particular places and engage with local conditions and practices

Trajectory dynamics in innovation: developing and transforming a mobile money service across time and place

This paper examines how and why innovations are reshaped as they become implemented and used in locales that are distant and distinct from those where the innovation was initially developed. Drawing on an in-depth field study of the innovation process that produced a mobile money system for Kenya, we contribute an understanding of the particular dynamics that arise when an innovation trajectory interacts with local trajectories that constitute the local conditions and practices of specific places. We identify four distinct patterns of trajectory dynamics — separation, coordination, diversification, and integration — each of which has different implications for the innovation, its implementation, and consequences on the ground. Developing a model of trajectory dynamics in innovation, we theorize the processes through which innovations are transformed over time as they interact with multiple local trajectories, and the specific innovation outcomes that are generated as a result. Such theorizing reconceptualizes traditional notions of innovation diffusion by explicating how and why innovations change in multiple and unexpected ways as they move to particular places and engage with local conditions and practices

Inpatient telemedicine and new models of care during COVID-19: hospital design strategies to enhance patient and staff safety

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research

The emergence of change in unexpected places: resourcing across organizational practices in strategic change

In our longitudinal, in-depth case study of strategic change within the English National Health Service we compare three practices related to contracting healthcare services. Contrary to what we would have believed from the extant literature, we found that the most profound change did not emerge in practices that witnessed the greatest increase in the quantity of resources or in which change agents were given the highest degree of control. Instead, change emerged in a practice that was not treated as a priority and that subsequently attracted interest from a very limited number of individuals. Our findings contribute to the resourcing literature by showing that the ability to use resources is shaped by how they are valued and distributed and that strategic change initiatives can act as triggers for resource revaluations and redistributions. Specifically, we demonstrate that strategic change initiatives may contribute to the emergence of favorable conditions for change in practices that do not become associated with valued resources. This is because a lack of valued resources attracts limited interest from stakeholders, thereby allowing changes to emerge as powerful agents face minimal coordination costs and scrutiny when attempting to align arrangements with their own interests. Our study thereby shows how and why change initiatives can trigger divergent developments across multiple practices and lead to change emergence in unexpected places. It also highlights the role of what we call resourcing space in contributing to emergent change.Eivor Oborn is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands. This paper presents independent research and the views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

Justifying health IT investments: a process model of framing practices and reputational value

Despite important research contributions on the financial and operational dimensions of information technology (IT) value, justifying health IT (HIT) investments remains a difficult and enduring issue for IT managers. Recent work has expanded our understanding of HIT value, by focusing on the initial resource allocation stage, and through conceptualizations of value across multiple dimensions. Building on these developments, we adopt a performative perspective to examine the research question of how practitioners justify early stage HIT investments, with a focus on reputational value. We explored this question through a comparative field study of two hospital organizations in the English National Health Service (NHS). We found that practitioners' temporally orientated framing practices matter in justifying HIT investments, enacting different possibilities for reputational value. We develop a process model to explain these dynamics and highlight the mutability of reputational value, which can lead to different possibilities for restoring, enhancing, or maintaining reputation. We conclude by discussing the implications for justifying HIT investments.Stavros was supported by a scholarship from the Economic and Social Research Council (Grant Number: 1491536). Eivor Oborn was supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands

The Gridded Retarding Ion Drift Sensor for the PetitSat CubeSat Mission

The Gridded Retarding Ion Drift Sensor (GRIDS) is a small sensor that will fly on the 6 U petitSat CubeSat. It is designed to measure the three-dimensional plasma drift velocity vector in the Earth’s ionosphere. The GRIDS also supplies information about the ion temperature, ion density, and the ratio of light to heavy ions present in the ionospheric plasma. It utilizes well-proven techniques that have been successfully validated by similar instruments on larger satellite missions while meeting CubeSat-compatible requirements for low mass, size, and power consumption. GRIDS performs the functions of a Retarding Potential Analyzer (RPA) and an Ion Drift Meter (IDM) by combining the features of both types of instruments in a single package. The sensor alternates RPA and IDM measurements to produce the full set of measurement parameters listed above. On the petitSat mission, GRIDS will help identify and characterize a phenomenon known as plasma blobs (or enhancements)

Implementing pelvic floor muscle training in women's childbearing years: A critical interpretive synthesis of individual, professional, and service issues

Antenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations.MethodsCritical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT.ResultsFifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over?arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers.ConclusionNumerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low?risk, low?cost, and proven strategies as part of women's reproductive health

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

Background: Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME. Methods: The primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally. Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only. All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter. Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol. Discussion: Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere. Trial registration: https://doi.org/10.1186/ISRCTN10833250. Registered 09/03/202