Microprocesses of healthcare technology implementation under competing institutional logics

The healthcare sector is one where two co-existing and competing institutional logics – professional and market logics – occur. Following extant research on institutional logics and institutional work, we propose to understand “what microprocesses and institutional practices do institutional actors enact during the implementation of healthcare IT system? What are the impacts of these practices on project outcomes?” In our study, we were interested to understand how actors within organizations were constrained and enabled by the co-existing and competing institutional logics as they implemented a new integrated health IT project. Health IT implementation projects are especially revelatory episodes since different stakeholders with different logics need to collaborate closely and build integrated solutions to make such projects successful. Furthermore such projects typically aim to support significant organizational and even institutional change occur. It is our goal to understand the interplay between actors and their competing logics within such a context

Web Technology Diffusion - Initial Adoption, Assimilation and Network Prominence

This study conceptualizes a staged model of web technology diffusion across enterprises and considers initial adoption, assimilation and the emergence of network prominence as progressive phases that build upon earlier outcomes. Based on the resource-based view of the firm and organization learning theories, we suggest that success at each innovation stage is based on overcoming the knowledge barriers that arise in the utilization of complex technologies. Factors related to the financial resource base, the prominence of the IT function, expertise in the IT domain and a visionary growth orientation are proposed to be important. We test three models corresponding to different phases of the technology diffusion process based on secondary data for a large sample of enterprises. Dedicated financial resources allocated to IT and Internet-related initiatives are found to be associated with reduced time to initial adoption. The level of IT budget as well as prominent leadership of IT function are found to be associated with website sophistication. Companies in the information technology industry and information-intensive services industry had more sophisticated websites but were not associated with higher network prominence. As expected, early initial adoption of technology led to higher network prominence judged through the number of web links from other sites. Our results suggest the need to take a multi-dimensional and staged perspective of complex technology diffusion

Marrying Work and the Technical Artifact Within the Healthcare Organization: A Narrative Network Perspective on IT Innovation-Mediated Organizational Change

Despite the implicit belief that IT innovations brings beneficial change, medical practitioners and healthcare professionals constantly struggle to realize the innovation potential of electronic medical records (EMR) system in revolutionizing clinical practices. To understand this conundrum, this paper uses an in-depth case study of an EMR implementation to develop a grounded theory of why, when, and how IT-innovation mediated change occur. We propose the Narrative Network Perspective that combines the analysis of the processes of configuration, implementation and use of the system. This combined view allows researchers to understand how “production narrative network”, infrastructure and the macrostructure in healthcare environment co-evolve with the idealized production narrative network inscribed in the EMR system within and across the three phases. By tracing and taking into account all these elements time, this perspective provides plausible answers to when and why organizational innovation occur with the introduction of IT innovations. (147

THE ROLE OF WORKAROUNDS DURING AN OPENSOURCE ELECTRONIC MEDICAL RECORD SYSTEM IMPLEMENTATION

A significant degree of customization of medical information technology is required to effectively integrate the promise of IT with the diversity and complexity of medical work. In the absence of such customizations, dissatisfaction and resistance toward the system arise. Indeed, the complexity of the medical work and the inability of software to tailor to the diverse medical practices may explain the limited diffusion of health information systems especially in North America. We study the role of workarounds during an open-source Electronic Medical Record System (EMR) implementation at a medium-size urgent care clinic in a major Canadian city. We found that the technology appropriation process involved the evolving of number of non-trivial workarounds in order to match the EMR to medical work. The emergence of workarounds is conceptualized as a knowledge creation and integration process. This perspective allows us to look at the antecedents and the change dynamics of workarounds in the clinic. Furthermore diverging from the negative view toward workarounds, we discuss the importance of incorporating workarounds during and following system development. The workaround perspective shed the light on how users’ behavior can be channeled into a constructive development effort. This paper contributes by examining the workaround of medical practitioners using an open-source electronic medical record system as well as offering a knowledge perspective for the study of EMR appropriation

IT in Healthcare: an Integrative Study of Organizational Change

Research on Healthcare IT is a highly multidisciplinary field. Each stream of research brings a certain focus and contributionsto our understanding of the role of technology in healthcare. However, this high multidisciplinary can be confusing as theresults and implications of the different streams may look incommensurable. This paper looks at various streams of researchon health IT and presents an integrative framework that utilizes organizational change to understand how different researchstreams on health IT interrelate and contradict in terms of their focus, contributions and implications. We argue that such anintegrative understanding is the key to capture the complexity of health IT projects and ensure their success

Technology Affordances: The Case of Wikipedia

The affordance perspective to technology research aims to offer a definition of technology that bridges between previous positivist and constructivist perspectives. To study technology from an affordance angle, it needs to be defined and extracted. This study aims to develop a better understanding of technology by conceptualizing and dimensionalizing technology affordances. To demonstrate the practical value of our conceptualization, we empirically identify and define six affordances of Wikipedia as a case

Knowledge Collaboration in Distributed Practice Communities

Information Technology is now making distributed collaboration possible on a very large-scale and across many different kinds of boundaries, thereby transforming professional work. Yet, our understanding of how such work is accomplished in large, distributed environments is limited. Professional work tends to be complex, uses established procedures, and is rooted in specific historically and materially situated practices. Approaches that take the social and situated nature of knowledge and learning into account, such as the literature on communities of practice, have been developed largely in relation to small, collocated groups. The practices that enable knowledge collaboration in large, distributed environments, mediated by a variety of information technology and other artefacts, have not received attention. Therefore, we undertook an empirical investigation of the practices through which work is accomplished in a professional legal association, whose more than ten thousand members are scattered around North America and play an essential role in shaping how the laws related to their practice areas are developed and implemented. Our investigation revealed two sets of practices that allow this organization to balance demands of stability and change. These practices shed light on how larger communities of practice overcome diversity, dispersion, and a complex set of boundaries to achieve a deeper and more dynamic level of collaboration

Strategic Action Repertoires and Performance of Firms in the Internet Industry

Researchers have called for new theoretical frameworks and empirical analyses to understand variations in organizational strategies and management practices in the Internet industry, where existing paradigms may have limited applicability. Studies to date have neither articulated the repertoire of key firm actions in this context nor developed theory to relate firm actions to performance. This paper seeks to identify a key set of firm moves in the Internet industry and develop a theoretical model to relate firm actions to two important firm outcomes: sales performance and firm survival. We draw on the construct of dynamic resourcefulness to the firm level and develop a research model linking the actions of firms in the Internet industry underlying dynamic resourcefulness to firm-level outcomes. We test our hypotheses using the action repertoire-year mode of analysis on the actions of 106 leading firms in the Internet industry over a period of 6 years from 1994 to 1999. Our results suggest that firm actions to manage and direct their intellectual, relational, and financial capital resources are associated with higher levels of performance and survival