Klas Gäre

Designing for complex innovations in health care: design theory and realist evaluation combined

Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design - evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances by combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design - evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design propositions, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design - evaluation cycle is to provide support to implementers and practitioners in designing and implementing complex innovations in health care. As a result, the design - evaluation cycle could provide opportunities of improving dissemination of complex innovations in health care.

SMEs need formative infrastructure for business transformation

Purpose – ICT has considerable importance for increasing productivity and growth. Using ICT requires resources to create value. As resources are more limited in smaller enterprises, and the context ...

Sociomaterial actors in the assimilation gap: a case study of web service, management and IT-assimilation

This paper investigates the conditions for the assimilation of information systems (IS) and information technology (IT) in organizations and the influence of various actors in the organization and eBusiness context. To do so it draws on the literature on assimilation gap, sociomateriality and infrastructure together with a study of implementation and use of information and communication technology in and among organizations in a Swedish region. There were substantial investments in web infrastructure made on a regional level and the focus of this study is how the investments were transformed and assimilated in practices, relations and communication. Based on the empirical data from the case study, the paper extends the assimilation process into interplay among actors in organizations contexts. It describes organizations’ strategies for coping with their needs for information and the actors in these processes. Two categories of actors are identified, sensemaking and sensegiving actors, as most important in assimilation of IS/IT in organizations. A sociomaterial perspective gives guidance and a better understanding of the assimilation process in terms of knowledge and interpretative frames, and how assimilation involves identity construction and negotiations among sensemaking and sensegiving actors. The contribution of this paper is a better understanding of the context of assimilation and adaptation of IT in organizations’ business processes, and steps to be taken to improve readiness.