Liette Lapointe

A Triple Take on Information System Implementation

While researchers have used a variety of models to explain information system (IS) implementation outcomes, few have analyzed the same project or set of projects with different models looking for complementary explanations. Recognizing the multilevel nature of IS implementation, our study rises to this challenge by conducting an alternate template analysis of three cases of IS implementation in hospitals. First, we explain individual use, group resistance, and organizational adoption with models situated at the same level of analysis as each outcome. At the individual level, we use a model of cognitive absorption to explain individual system usage. At the group level, the political variant of interaction theory is used to explain group resistance to IS implementation. At the organizational level, we use organizational configurations to explain IS adoption in terms of emergence and routinization. We identify each models limits and prediction failures, and we show that using alternate models helps to remedy a models prediction failures and overcome its limits. Finally, we propose an alternate-template theory of IS implementation outcomes that takes into account all three levels of analysis, their respective outcomes, and the time dimension. This multilevel, longitudinal theory provides a better understanding of IS implementation and further elucidates what may initially have seemed to be contradictory results.

The dynamics of IT adoption in a major change process in healthcare delivery

The main objective of the study is to comprehend the dynamics of interactions between partners (caregivers, promoters, consultants, patients and managers) involved in the implementation process of an integrated delivery system designed to support the treatment of women with breast cancer. Preliminary findings permit to identify adoption/resistance factors at individual, professional and organizational levels in addition to technological factors. They give insights on the challenges to be faced when redesigning work processes in an interorganizational setting. Significant adoption factors include individual participation to the project and positive assessment of benefits of the system by individuals as well as by professional groups. On the other hand, the absence of a multidisciplinary committee and the complexity of the environment, the tasks and the technology are among the factors identified as troublesome. In terms of the dynamics of the process, our observation reveals that promoters have adopted a contingent and political approach. While this strategy is usually considered appropriate in healthcare organizations, information generated by this study has allowed for a better understanding of important factors and mechanisms to consider and address in the subsequent phases of implementation.

The ongoing quest for the IT artifact: Looking back, moving forward

More than 10 years ago, Orlikowski and Iacono (2001) examined the conceptualization of Information Technology (IT) in Information Systems Research (ISR) articles published in the 1990s. Their main conclusion was that the majority of these articles did not properly conceptualize the IT artifact. They recommended that IS researchers start to theorize about the IT artifact and employ rich conceptualizations of IT. The Orlikowski and Iacono paper provides a strong anchor point from which to analyze the evolution of the IS discipline. In order to obtain an up-to-date image of contemporary IS research, and to assess how the IS field has evolved since the 1990s, we carried out a similar analysis on a more recent and broader set of articles, that is, the full set (N=644) of papers published between 2006 and 2009 by six top North American (ISR, MISQ, JAIS) and European (JIT, ISJ, EJIS) journals. The statistics in our results reveal no drastic advance in terms of deeper engagement with the IT artifact; more than 39% of the articles in our set are virtually mute about the artifact, and less than 16% employ an ensemble view of IT. Moreover, we note differences among the North American and European journals. Implications of the findings for two perspectives central to the IS research legitimacy debate are discussed.

A novel model of integrated care for the elderly: COPA, Coordination of Professional Care for the Elderly

Despite strong evidence for the efficacy of integrated systems, securing the participation of health professionals, particularly primary care physicians (PCPs), has proven difficult. Novel approaches are needed to resolve these problems. We developed a model — COPA — that is based on scientific evidence and an original design process in which health professionals, including PCPs, and managers participated actively. COPA targets very frail community-dwelling elders recruited through their PCP. It was designed to provide a better fit between the services provided and the needs of the elderly in order to reduce excess healthcare use, including unnecessary emergency room (ER) visits and hospitalizations, and prevent inappropriate long-term nursing home placements. The model’s originality lies in: 1) having reinforced the role played by the PCP, which includes patient recruitment and care plan development; 2) having integrated health professionals into a multidisciplinary primary care team that includes case managers who collaborate closely with the PCP to perform a geriatric assessment (InterRAI MDS-HC) and implement care management programs; and 3) having integrated primary medical care and specialized care by introducing geriatricians into the community to see patients in their homes and organize direct hospitalizations while maintaining the PCP responsibility for medical decisions. Since COPA is currently the subject of both a quasi-experimental study and a qualitative study, we are also providing preliminary findings. These findings suggest that the model is feasible and well accepted by PCPs and patients. Moreover, our results indicate that the level of service utilization in COPA was less than what is reported at the national level, without any compromises in quality of care.

Patients’, family caregivers’, and professionals’ perspectives on quality of palliative care: A qualitative study

Background: The quality of palliative care is the foremost preoccupation of clinicians, decision-makers, and managers as well as patients and families. Major input from healthcare professionals is required to develop indicators for the quality of palliative care, but the involvement of patients and families is also recognized as essential, even though this is rarely achieved in practice. Aim: The objectives of this study were to identify (1) convergences and divergences in the points of view of different stakeholders (patients, families, healthcare professionals) relative to key elements of the quality of palliative care and (2) avenues for refining existing indicators of quality of palliative care. Design: Cross-sectional qualitative study. Setting/participants: There were six settings: two hospital-based palliative care units, one hospice, and three other medical units where a mobile palliative care team intervene. Semi-structured interviews were conducted among 61 patients, families, healthcare professionals, and managers. Results: Four major dimensions of quality of care are deemed critical by patients, their families, and professionals: comprehensive support for the patients themselves, clinical management, involvement of families, and care for the imminently dying person and death. Differences exist between various stakeholders regarding perceptions of some dimensions of quality of care. Avenues for improving current quality of care indicators are identified. Conclusion: Our study results can be used to refine or develop quality indicators that truly mirror the points of view of patients and their families and of healthcare professionals.

Impact on hospital admissions of an integrated primary care model for very frail elderly patients

Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.

Fostering participation of general practitioners in integrated health services networks: incentives, barriers, and guidelines

BackgroundWhile the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation.MethodsData were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN.ResultsThe key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice.ConclusionThroughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our study provides guiding principles for establishing future integrated models of care. It suggests practical guidelines to support the active participation of GPs in these networks such as physicians with collaborative practices, recruitment of significant number of patients per physicians, the information provided and the accompaniment by geriatricians.

Collaborating through Social Media to Create Health Awareness

This paper examines the role that individuals and organizations can play in creating awareness through the use of social media. In the healthcare context, creating cancer awareness is key in early detection of cancer as well as cancer prevention altogether. Using a multiple case study analysis, we are able to understand how collaboration through social media is used to promote such awareness. We find that social media is used to create an online community that drives the creation of cancer awareness in many different ways. This research has implications for organizations looking to use social media to promote awareness as it explains the building process and role of social media grassroots communities.

Social media affordances for connective action - an examination of microblogging use during the Gulf of Mexico oil spill

This research questions how social media use affords new forms of organizing and collective engagement. The concept of connective action has been introduced to characterize such new forms of collective engagement in which actors coproduce and circulate content based upon an issue of mutual interest. Yet, how the use of social media actually affords connective action still needed to be investigated. Mixed methods analyses of microblogging use during the Gulf of Mexico oil spill bring insights onto this question and reveal in particular how multiple actors enacted emerging and interdependent roles with their distinct patterns of feature use. The findings allow us to elaborate upon the concept of connective affordances as collective level affordances actualized by actors in team interdependent roles. Connective affordances extend research on affordances as a relational concept by considering not only the relationships between technology and users but also the interdependence type among users and the effects of this interdependence onto what users can do with the technology. This study contributes to research on social media use by paying close attention to how distinct patterns of feature use enact emerging roles. Adding to IS scholarship on the collective use of technology, it considers how the patterns of feature use for emerging groups of actors are intricately and mutually related to each other.

A typology of user liability to IT addiction

To date, information systems (IS) research mainly has provided a monolithic view of information technology (IT) use, considering it to be a desired behaviour with positive outcomes. However, given the dramatic increase in the use of technology during the last few years, susceptibility to IT addiction is increasingly becoming an important issue for technology users and IS researchers. In this paper, we report the results of a study that focuses on identifying variations in user liability to IT addiction, which reflects the susceptibility of individual users to develop IT addiction. First, a review of the literature in different disciplines (e.g. health, psychology and IS) allows us to better understand the concepts of IT addiction and liability to addiction. The literature review also provides an overview of the antecedents and consequences associated with IT addiction. Then, building on the analysis of 15 in‐depth interviews and 182 exploratory open‐ended surveys collected from smartphone users, we apply the concept of liability to addiction in the IT use context and propose a typological theory of user liability to IT addiction. Our typology reveals five ideal types; each can be associated to a user profile (addict, fanatic, highly engaged, regular and thoughtful). Building upon both the extant literature and our results, we put forth propositions to extend the theoretical contributions of the study. We finally discuss the contributions and implications of our paper for research and practice.