Kjersti Wendt, Bjørn Erik Mørk, Ole Trond Berg and Erik Fosse
The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands…
Abstract
Purpose
The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.
Design/methodology/approach
The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.
Findings
Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.
Practical implications
Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.
Originality/value
This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.
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Keywords
Bjørn Erik Mørk, Thomas Hoholm and Margunn Aanestad
The purpose of this paper is to describe the knowledge generation in a cross‐disciplinary group in Norway that developed a new medical device. The aim is to shed light on how…
Abstract
Purpose
The purpose of this paper is to describe the knowledge generation in a cross‐disciplinary group in Norway that developed a new medical device. The aim is to shed light on how knowledge was generated and how the relationships between different communities of practice were mediated. In particular, the paper seeks to examine how material objects and contextual conditions influenced the innovation process.
Design/methodology/approach
In this longitudinal case study an innovation process was followed for five years, and the research material was constructed through extensive observations, interviews and document analysis.
Findings
The innovation process exhibited different themes in varying degrees of blend throughout the process. First, the practices of constructing the device and ascertaining technical feasibility are described. Then the enacted nature of the work is outlined; how it was significantly dependent on circumstantial factors, but also strongly shaped by the need to ensure clinical usability of the device. Finally, the work to package the innovation and turn it into a commercial product is explored.
Originality/value
In contrast with many previous studies, this study follows large parts of the innovation process, and it emphasises how knowing and practice are a result of networked, and changing, relations between both human and non‐human actors. Rather than one community of practice emerging around the innovation work, what can be called an object‐centred assemblage of communities of practice was seen, which grew and changed according to the changing nature of knowledge needs for the project to continue and succeed. This has interesting implications for the understanding of cross‐disciplinary innovation processes.
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– The purpose of this paper is to develop the case for studying non-interaction in networks, particularly instances of intentional avoidance of interaction.
Abstract
Purpose
The purpose of this paper is to develop the case for studying non-interaction in networks, particularly instances of intentional avoidance of interaction.
Design/methodology/approach
The paper is based on the analysis of instances of interaction avoidance across four case studies in medical technology development, food product development, food distribution network change, and regional innovation in construction.
Findings
Some answers are provided to the questions of why and how actors may seek to avoid interaction. Five modes of interaction avoidance are identified and outlined. Within these modes, interaction avoidance took place in order to protect knowledge, enforce progress, economise in business networks, avoid wasting resources, and maintain opportunities respectively. This list is not seen to be exhaustive of the theme, and further studies are encouraged.
Originality/value
Few inter-organisational network studies have dealt explicitly with interaction avoidance or non-interaction.
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Nima Herman Shidende, Margunn Aanestad and Faraja Igira
This paper presents a work-centred study of how information systems practices and tools become shaped by their context. The purpose of this paper is to increase the understanding…
Abstract
Purpose
This paper presents a work-centred study of how information systems practices and tools become shaped by their context. The purpose of this paper is to increase the understanding of how practices and tools co-evolve, with a specific focus on the role of context, and based on this to offer relevant design implications. The empirical motivation comes from attempts to utilize information and communication technologies (ICT) in resource-constrained settings.
Design/methodology/approach
Empirical work was conducted in primary healthcare facilities in Tanzania that offer Prevention of Mother-To-Child Transmission services. Four health facilities with different organizational and socio-economic characteristics were studied using ethnographic methods (participant observation, interviews and document analysis). The authors have employed activity theory as the theoretical framework, since it explicitly places human activity within a cultural, social and temporal (developmental) context. Specifically, the concept of mediation breakdown was used for data analysis at activity, action and operation levels.
Findings
By focussing analytically on situations of mediation breakdown in the situation of use, at both an activity, action and operation level, the authors have achieved an understanding of how information tools are being adapted to both their contextual conditions and the information needs of the community of users.
Research limitations/implications
The study illustrates the decisive role that context may play in shaping the actual usage of information technology. While the detailed findings were specific to the concrete domain, time and place, in general, an increased awareness of the role of context may lead to more robust approaches to the introduction of ICT solutions.
Originality/value
While activity theory literature offers insight on how to analyse context, the discussion is limited to the understanding of how context can be modelled into artefacts. The paper suggests that the contradiction concept is useful for studying the role of context and its impact in co-evolution of work and information tools. The study also contributes to the discourse in health information systems in developing countries by emphasizing the crucial role of the front line health workers’ own problem solving, invention and adaptation of information tools.