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

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

A paradox theory perspective on HIT’s impact on continuity of care

Regulators of healthcare systems continue to investigate ways to improve continuity of care (COC) for patients given its inherent fragmented nature. Integrated healthcare information technology (HIT) system is touted as one of the ways to improve COC. Yet, studies show that there are still challenges in achieving effective COC even when supported by integrated HIT. These persistent challenges are likely due to deep-seated tensions among the various parts of the healthcare system that are involved in providing care. Drawing on HIT impact literature and paradox theory, we study the implementation of an integrated electronic medical record (EMR) system aimed at improving COC for the specialist referrals process in a hospital cluster. We found that while the system had positive impacts on some aspects of the COC, we uncover two types of paradoxical tensions occurring in this healthcare context that interfered with those positive impacts and contributed to ongoing COC challenges

Healthcare processes and IT: Exploring Productivity Gains through Improved Allocative Efficiency

The benefits of health information technology (HIT) are widely accepted. Nonetheless, how HIT becomes embedded and transforms health-care processes remain an understudied area in the literature. In this study we extend prior research by undertaking a more granular examination of HIT systems’ impact on how non-IT resources are allocated to healthcare tasks and routines. The context of our research is a natural field study whereby an acute-care hospital implemented telemedicine as a tool to consult its geriatric patients. We collected and analyzed resource and patient consultation level data, both pre and post technology use to quantify possible shifts in resource allocations as well as cost efficiencies over time. Our findings suggest that HIT affords changes to non-IT resource allocations in clinical work processes which lead to changes in cost efficiencies. Depending on the nature of these non-IT resource re-allocations, cost efficiencies may not always be improved

Lurking: Legitimate or Illegitimate Peripheral Participation?

By sponsoring, promoting or simply monitoring virtual communities related to their products, work processes, and other topics of interest, organizations leverage the efforts, insights, and abilities of individuals inside and outside their organization. Lurkers are participants who persistently demure from engaging in the core activities that sustain a virtual community. Because virtual communities are perpetuated through voluntary contributions, the persistent peripheral participation of lurkers is sometimes viewed negatively as social loafing or free-riding. Alternatively, an individual may engage in legitimate peripheral participation when their passive monitoring of group activities educates, socializes, and otherwise prepares them for more effective contribution. We reconcile these conflicting views of lurking with individual- and community-level models of peripheral participation that include a parsimonious typology of virtual communities. Through empirical tests based on over 395,000 observations gathered over five months from 548 online discussion forums, we demonstrate how lurking effects growth in site membership and participation. We conclude that lurking as legitimate or illegitimate peripheral participation is context-dependent and a more complex, nuanced activity than previously theorized and measured

Artifacts, Actors, and Interactions in the Cross-Project Coordination Practices of Open-Source Communities

While there has been some research on coordination in FLOSS, such research has focused on coordination within a project or within a group. The area of cross-project coordination, where shared goals are tenuous or non-existent, has been under-researched. This paper explores the question of how multiple projects working on a single piece of existing software in the FLOSS environment can coordinate. Using the Ordering Systems lens, we examine this question via a cross-case analysis of four projects performed on the open source game Jagged Alliance 2 (JA2) in the forum Bear’s Pit. Our main findings are that: (1) Ongoing cross-project ordering systems are influenced by the materiality of development artifacts. (2) The emergent trajectory of cross-project ordering systems is influenced by affordances that emerge from the interaction between the goals and desires of the project team building the development artifact, and the materiality of the development artifact. (3) When two parties need to coordinate in the ordering system, all or almost all coordination effort can be borne by a single party. Furthermore, over time, emergent FLOSS projects bear more coordination effort than stable, mature projects

How Do You Perpetuate IT-Enabled Change When Top Management Participation and Involvement Diminish?

Background: Research has demonstrated that sustained top management participation and involvement are important for IT-enabled change. However, this is not always possible. How IT-enabled change can succeed when top management participation and involvement diminish is an unsolved, but important research question. Method: We perform a 5-year exploratory longitudinal case study. Results: Our data is presented in two parts. We first present the contextual elements (goals, people, structures/processes, and artifacts) during the two years top management was actively participating and involved. For the three-year period where top management participation and involvement diminished, we present the contextual elements, and middle management’s enactment of traditional middle management roles (information broker, mediator, facilitator, change agent) on three kinds of threats to the change (deviations from change vision, emergent issues, involving new stakeholders). Conclusions: We find IT-enabled change can succeed when top management participation and involvement diminish if middle management engages in joint action, i.e., intentional collective activity where members consciously choose to coordinate to achieve a goal. We identify three kinds of joint action: Constraining, where actions of the group limit the ability of individual middle managers to deviate from shared goals, Enabling, whereby a group of middle managers adapt the project to changing circumstances, and Extending, where groups of middle managers engage with others not in their functional areas. Joint action emerges when top management embeds, in the project context, (1) key influential stakeholders who are involved in the change, (2) a common goal, (3) structures and processes that promote collective work, and (4) artifacts inscribed with the common goal and collective work. Available at: https://aisel.aisnet.org/pajais/vol11/iss4/2