Bridging the socio-technical gap

As can be seen in recent articles (for example at ictzorg.com), hospitals increasingly take an agile and iterative approach to EHR development.
As appears, the EHR implementation trajectory is a very bumpy journey where planning beforehand seems nearly impossible, inducing these kind of approaches. Continuously, there seems to be a socio-technical gap during and after design and implementation leading to delays, high extra costs and partly failure due to a lack of acceptance. Involving the end-users in premature stages seems the only way to overcome this gap.

Where does this gap come from? Partly this has to do with a lack of system and software flexibility, including the existing often fragmented IT architecture and infrastructure of hospital organizations at the time of EHR implementation. EHR software often does not contain the amount of flexibility needed to match the individual professional communities within a hospital. However, at the same time we see so-called 'over-functionality' of EHR systems in other areas. Hospitals want to get the most functionality when engaging in EHR implementation and purchase. Of course; when you know you need the system for the next ten years you want to but top-off the bill now. A frequent error however is that hospitals overestimate the absorptive capacity of their organization in achieving their often high-set ambitions; 'we want workflow functionality implemented in year 2" and still working on paper and stick-its at year 0....

In other words, in able to effectively being able to close the socio-technical gap, hospitals need to establish realistic goals, ambitions and estimation of their organization's absorptive capacity. Setting these goals in an agile, iterative and participative way is the first step to minimize the gap.
This first alignment at least makes sure the metaphoric innovation journey is started from the same starting point...
Now, we can effectively engage in monitoring the environment and engaging them to ensure 'controlled agile implementation'. How? To be continued....

Research model (simple version)

The understandable version of my research model ;)

Management summary proposal

Hierbij de management summary van het onderzoeksvoorstel, de basis voor mijn promotie onderzoek!

Stakeholder dynamics in innovation adoption

The introduction of new information technology in organizations seems to lead to mixed success results in practice (Aydin and Rice 1991). In recent news articles these findings are found to be reality in hospitals as well; many EHR[1] implementations fail, delay or cost more than budgeted, not leading to expected results like quality or efficiency improvement. We define a successful innovation when there´s uniformity (same usage of innovation among users) and fidelity (usage conform intended design) of the innovation after implementation (Lewis and Seibold 1993).

The required absorption of the innovation in work processes requires the commitment of the, in literature often mentioned, potential adopter population for the continued usage of the innovation over time (Bhattacherjee 1998).  We extend this term potential adopter population by introducing the term decision making unit, hypothesizing that not only the potential adopter population has influence or requires commitment on innovation adoption outcomes during innovation adoption processes. This decision making unit thus comprises a variety of stakeholders, with different stakes, capacities and intentions.

For this reason, much can be gained in insights in the role of stakeholders during innovation adoption processes and their intentions over the innovation process. In our research we describe the innovation process as the process through which an individual or other decision making unit passes from the initiation phase, to the development phase, to the implementation phase and finally to the maintenance phase. This process is also known as the innovation journey.(Rogers 1995; Van de Ven, Polley et al. 1999)

We introduce the term stakeholder dynamics by which we refer to (a) the changing nature of stakeholder salience and changing role involvements of stakeholders during innovation adoptions on the one hand, and (b) the changing nature of stakeholder-innovation interaction during the adoption processes on the other. (Lewis and Seibold 1993; Mitchell, Agle et al. 1997)

In other words, to be able to define the decision making unit and its effects on innovation adoption outcomes, both the who matters- question (salience or capacity of the stakeholders) as well as the subsequent question how do they matter (intentions of stakeholders and the effect on innovation adoption predictors) are relevant. The intentions of a stakeholder are correlated with a stakeholders’ (formal and emergent) role and its coping tactics. The intentions of dominant stakeholders may potentially affect innovation adoption predictors, like perceived usefulness or perceived relative advantage of an innovation (Jeyaraj, Rottman et al. 2006).

The above leads to the following problem statement as subject for research;

What is the role of stakeholder dynamics in individual and organizational IT innovation adoption in hospitals?

In the described research framework, in order to evaluate these dynamics, we aim to investigate the effect of structured implementation activities (eg. Training, education) during different phases of the innovation journey on the decision making unit (Lewis and Seibold 1993).  The changing composition of the decision making unit as a possible result of these kind of activities may in turn have an effect on innovation adoption predictors.  This makes it possible to both investigate the effect of certain implementation activities on the evolvement of the decision making unit during an innovation adoption process as well as the effect on innovation adoption outcome predictors.

This approach may lead to insights in when to involve what stakeholders when introducing innovations in hospital contexts, in what way, and how to effectively intervene if necessary. These insights may contribute to relevant issues in daily practice, for example;

•           When to address what stakeholder groups in the innovation deployment process?
•           What does my decision making unit look like at different points of time during the implementation process?
•           What effects do changes in stakeholder salience have on individual and organizational innovation adoption?
•           How to manage outcomes on significant innovation adoption predictors during the IT deployment process, considering stakeholder salience?
• What structured implementation activities support favorable innovation adoption outcomes?

In a theoretical sense, this research may contribute to the sparse body of literature concerning stakeholder identification, classification and dynamics during innovation processes (Vos and Achterkamp 2006).

---

[1] EHR: Electronic Health Record