Marjolein van Offenbeek

Towards Integrating Acceptance and Resistance Research: Evidence from a Telecare Case Study

There is wide agreement that acceptance and resistance are crucial factors in information system (IS) adoption. Research has yielded many theories that have focused on either acceptance or resistance, often implicitly assuming that these are opposites. This paper proposes a two-factor view on acceptance and resistance, and shows how this idea may advance our knowledge of IS adoption. In developing a user reactions framework, we take a first step towards integrating the IS literature on acceptance and on resistance. This framework distinguishes between two behavioural dimensions, namely, acceptance, ranging from high use to non-use, and a dimension that ranges from enthusiastic support to aggressive resistance. Combining the two dimensions leads to four categories of user reactions. We show the frameworks usefulness by analysing data from a telecare implementation project. The findings identify ambivalent reactions. Many clients are identified as supporting but non-using, while we also find telenurses and care coordinators that show themselves to be resisting but using. These findings support the view that non-acceptance and resistance are conceptually non-equivalent. Our data suggest voluntariness as one determinant of the variation in behavioural reactions encountered. We argue that the concepts are also functionally different: IS implementers will have to adapt their strategies to the different reactions described.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

Managing IS adoption in ambivalent groups

Insightful implementers refocus user ambivalence and resistance toward trust and acceptance of new systems.

Service decomposition: a conceptual analysis of modularizing services

Purpose – Applying “modularity” principles in services is gaining in popularity. The purpose of this paper is to enrich existing service modularity theory and practice by exploring how services are being decomposed and how the modularization aim and the routineness of the service(s) involved may link to different decomposition logics. The authors argue that these are fundamental questions that have barely been addressed. Design/methodology/approach – The authors first built a theoretical framework of decomposition steps and the design choices involved that distinguished six decomposition logics. The authors conducted a systematic literature search that generated 18 empirical articles describing 16 service modularity cases. The authors analysed these cases in terms of decomposition logic and two main contingencies: modularization aim and service routineness. Findings – Only three of the 18 articles explicitly addressed the service decomposition by reflecting on the underlying design choices. By unravelling...

The compatibility of future doctors' career intentions with changing health care demands

Background  In the Netherlands the medical education system is in the process of being transformed to establish a more demand‐oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of future doctors are also changing.

Is Telecare Feasible? Lessons from an In-depth Case Study

This paper describes the empirical findings of a large-scale telecare pilot implementation, called KOALA. The pilot is based on video interaction of clients with a medical service centre of a home care provider. The purpose of the project was to gain experience with telecare and to measure the effects in terms of costs and perceived well-being. The expected effects were that clients’ well-being would be increased and overall costs of health care would be reduced. The results of this study are:• the positioning of the medical service centre in the care provider’s network and the organization of the centre are crucial for attaining acceptance and cost effectiveness;• introduction of a telecare program needs careful preparation with clients and employees, and alignment with existing care;• there is substantial difference in the use of telecare and its advantages for different groups of clients; this is especially relevant when using proprietary technology.

Enacting Fit in Work Organization and Occupational Structure Design: The Case of Intermediary Occupations in a Dutch Hospital

We report and interpret findings from an investigation of work redesign and the introduction of a new occupational position, nurse practitioner (NP), in four different subunits in a large Dutch university hospital. Full development of the new position and its contribution to performance crucially depend on the delegation of medical tasks to NPs. The motive for introducing the new occupation and redesigning the work processes was to improve treatment quality and patient-centredness, to reduce throughput times and to assure operating efficiency. However, the degree and modality of reaching such objectives depends on the local politics of management and medical practitioners, resting on interpretations of appropriate roles and task divisions. Thus, task environmental influences affect work structure redesign as the former were perceived and enacted by local practitioners. The overall process of redesign and the way it differed between departments is best explained by combining a modified contingency theory with an interactionist and organizational politics approach.

The dual impact of online communication on older adults’ social connectivity

Purpose – In today’s aging world online communication is often viewed as a means to enhance social connectivity, and therefore well-being, of older adults. However, previous research on the influence of online communication on social connectivity largely disregards older adults, yields conflicting results and fails to assess the – debatable − causal direction of relationship. The purpose of this paper is to overcome these issues by developing four hypotheses related to who uses what, how, with whom. Design/methodology/approach – The authors use a panel data study to test the hypotheses, including 302 older adults. Response rates are between 62 and 75 percent. Findings – The authors find, first, that older adults differentiate between social connectivity with other village members, i.e., village connectivity, and connectivity with friends. Second, the impact of online communication varies among these two types of social connectivity. Where e-mail use has a negative impact on village connectivity, it does n...

What professionals consider when designing a modular service architecture

Purpose The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture. Design/methodology/approach Action design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them. Findings A wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept’s functionality with their professional norms, values and established practices. Originality/value The study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.

Shaping a buyer’s software selection process through tendering legislation

Tendering legislation aims to enhance competitiveness by promoting equality, proportionality, transparency, and non‐discrimination. Such legislation applies to the procurement of software packages by public institutions in many countries. This study explores how tendering legislation shapes a buyers software selection process through the lens of competing decision‐making rationalities. From the literature, 3 rationalities enacted in software selection are deduced that we relate to the software selection literature regarding tendering legislation. Through this lens, we subsequently examine how a large health care provider selected a supplier for an electronic health record system after an extensive tendering process. Many health care professionals within this organization were in favour of a particular software package. Yet, the organization purchased a different package from a relatively unknown supplier, the implementation of which failed. The actors involved experienced shaping on 5 decision‐making themes, the implications of which are evaluated against the functional, economic, and political rationality norms derived from the literature. The findings suggest that compliance with tendering legislation over the public procurement of software results in increased legal complexity, greater linearity and objectivity, more extensive formalization, and less relational communication. Functional norms of rationality are stressed, seemingly to balance the enforced economic norms of rationality and to compensate for the decreased room for political rationality. Even so, the shaping by the tendering legislation threatens functional rationality. Ultimately functional and economic norms of rationality win over political rationality, yet the latter still dribbles through, albeit in a different guise than reported for software selection in general.