Margunn Aanestad

Guest editors’ introduction: Actor‐network theory and information systems. What's so special?

In this editorial introduction Allen Lees definition of the information systems (IS) field is taken as the starting point: “Research in the information systems field examines more than just the technological system, or just the social system, or even the two systems side by side; in addition, it investigates the phenomena that emerge when the two interact” (Lee, A. “Editorial”, MISQ, Vol. 25, No. 1, 2001, p. iii). By emphasizing the last part of this, it is argued that actor‐network theory (ANT) can provide IS research with unique and very powerful tools to help us overcome the current poor understanding of the information technology (IT) artifact (Orlikowski, W. and Iacono, S., “Research commentary: desperately seeking the ‘IT’ in IT research – a call for theorizing the IT artifact”, Information Systems Research, Vol. 10 No. 2, 2001, pp. 121‐34). These tools include a broad range of concepts describing the interwoven relationships between the social.

Building nation-wide information infrastructures in healthcare through modular implementation strategies

Initiatives that seek to realize the vision of nation-wide information infrastructures (II) in healthcare have often failed to achieve their goals. In this paper, we focus on approaches used to plan, conduct, and manage the realization of such visions. Our empirical material describes two Danish initiatives, where a national project failed to deliver interoperable Electronic Patient Record (EPR) systems while a small, local solution grew and now offers a nation-wide solution for sharing patient record information. We apply II theory, specifically the five design principles proposed by Hanseth and Lyytinen, to contrast the organization and implementation strategies of the two projects. Our findings highlight how implementation strategies differ with respect to how stakeholders are mobilized. We argue that the realization of nation-wide IIs for healthcare not only requires a gradual transition of the installed base, which current II theory advocates. Here we articulate and exemplify a modular implementation strategy as an approach that also addresses the challenges related to mobilization and organization of multiple stakeholders.

Hospitality and hostility in hospitals: a case study of an EPR adoption among surgeons

The purpose of this paper is to discuss the adoption of healthcare information systems (HIS) from a user perspective. Our case study concerns how a group of orthopaedic surgeons experienced and reacted to the adoption and mandatory use of an Electronic Patient Record system in a Danish hospital. We propose to use the concepts of hospitality and hostility to turn our attention to the interaction between the host (the surgeons) and the guest (the information system) and consider how the boundaries between them evolved in the everyday work practices. As an alternative to previous studies on technology adoption, these concepts help us appreciate and put special emphasis on particular aspects of the adoption process: the mutual and co-constitutive relationship between the users and the technology and the continued co-existence of both positive and negative attitudes among the users. The findings suggest an alternative way of thinking about an adoption process that is considered relevant to managers who strive to ensure successful adoption of HIS.

Challenging expertise: On power relations within and across communities of practice in medical innovation

This article addresses the question of how practices perform power effects within and across communities of practice. It does so by drawing on a study of two medical innovation projects leading to radical changes of practice. Situated learning theory has to some degree acknowledged the asymmetry in power between masters and apprentices. Meanwhile, this study suggests that the novelty of new practices may lead to a contestation of the established master-apprentice relationship and even challenge the basis of the community of practice itself. We therefore argue that innovation processes may highlight the political processes and negotiations already at play in communities of practice. Hence, we investigate how communities of practice tried to control the new practices through mobilizing arguments, marginalizing opponents and building alliances. Consequently, the article argues that changing practices may be highly political.

Negotiating Multiple Rationalities in the Process of Integrating the Information Systems of Disease Specific Health Programmes

The topic of this paper is the integration of different information systems, and in our case study we analyse information systems in the Mozambican health care sector. The context is a health care sector reform that involves the integration of separate, stand‐alone, or so‐called vertical health programmes. These programmes are usually disease‐specific, i.e. targeted towards malaria, HIV/AIDS, or other major diseases. The reporting and monitoring systems for the activities within these programmes are organised differently, in terms of which data elements are collected, to whom and how frequently they are reported etc., but in general they are all paper‐based, at least at the peripheral level. The multitude of different systems places an unnecessary high workload on the health care personnel who do the initial data collection. However, the practical challenges related to the integration of the diverse information systems have not yet been the focus for the decision makers. Our aim with this paper is to describe some of the differences between the systems. Our claim is that these differences are not arbitrary. On the contrary, they may be significant indicators of different realities and different interests. Integration of these systems will thus not be a purely technical or practical issue, but will entail a political negotiation of interests. We employ the notions of multiple rationalities as a theoretical tool to discuss this issue. In particular we find tensions between rationalities ‘on the ground’, i.e. in the health care facilities, and ‘on the top’, among the policy makers, the government and the donor organisations.

Changing practice through boundary organizing: A case from medical R&D

This article contributes to our understanding of practices in innovating organizations. Previous studies have demonstrated how breakthroughs in knowledge may fail to be translated into practices if they are not aligned with existing practices, or if they cut across established boundaries and power structures. By drawing upon an ethnographic study of a medical R&D department that has been highly successful in developing new medical practices, this article investigates how such challenges can be overcome. To date, much of the literature has focused on coordination across single, well-defined boundaries. We here extend this focus and introduce the notion of ‘boundary organizing’ to analyse highly political and contingent processes of innovation and change within and across different practices. We add to existing literature by highlighting how the handling of multiple boundaries, the indirect effects of boundary work, the negotiation of mutual benefits and interests, and mutual adaptation are key aspects of boundary organizing.

Constructing, enacting and packaging innovations

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 usa...

Control Devolution as Information Infrastructure Design Strategy: A case study of a content service platform for mobile phones in Norway

This paper depicts the results of an empirical case study on how two Norwegian telecommunications operators developed a business sector information infrastructure for the provision of mobile content services. Focusing on the context of this technologys development, and the strategic issues behind its design, implementation and operation, control devolution as a design strategy is explored. This analysis draws on insights presented by Claudio Ciborras in his study of the change from alignment to loose coupling in the Swiss multinational Hoffmann-La Roche. This paper illustrates how control is played out on different levels, and balanced against autonomy. The theoretical implications of this paper highlight how the differences and transformations between information systems and information infrastructures are conceptualised, with the development of the latter better understood in light of a balance between control and autonomy. Consequently, it is suggested that control devolution as a design approach should be based on a deep understanding of the existing control/autonomy balance as well as the distribution of resources, risks and the ability and willingness to innovate.

Information infrastructures and public goods: analytical and practical implications for SDI

Spatial Data Infrastructures (SDIs) are envisioned to increase efficiency, transparency and equity, but realising this potential has proven problematic. We argue that insights from studies of large-scale, integrated but distributed information systems, dubbed “information infrastructures” are applicable. This perspective may help address an important dimension of SDIs: their character of being public goods rather than private assets. We identify and illustrate four key aspects of information infrastructures that underpin such a public goods focus. First, we advocate the necessity of deploying a socio-technical rather than a limited technical perspective. We further argue that the notion of installed base is central, that it is important to be aware of the “politics of representation” and to accept the unavoidable “messines” of reality. We illustrate these concepts through examples from health care in developing countries, an area particularly concerned with the potential to increase equity.

Living with Contradictions: Complementing Activity Theory with the Notion of “Installed Base” to Address the Historical Dimension of Transformation

This article addresses the historical dimension of the relation between information systems innovation and organizational transformation. We analyse findings from a study of ongoing transformations in the healthcare sector in Zanzibar, Tanzania. The process is described with a particular focus on instances where some contradictions in the old activity system were not resolved but inherited by the new activity system. To address this we complement the activity theory framework with the notion of “installed base” from studies of information infrastructures. This helps to illuminate the theme of unresolved and continuing contradictions, and thus contribute to the concept of historicity in CHAT-informed studies.