Understanding variation in subunit adoption of electronic health records: facilitating and constraining configurations of critical dependencies

Marjolein van Offenbeek, Janita Vos, Albert Boonstra*

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

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This interpretative case study demonstrates how the work system properties and roles of clinical departments are perceived to shape their adoption of an organisation-wide electronic health record. In hospitals, with their heterogeneous and powerful clinical departments, partial or non-adoption by some departments may jeopardise effective overall use. Viewing a hospital’s EHR adoption from a sociotechnical fit perspective, we unravel how clinical departments’ adoption of this organisation-wide system was primarily shaped by their critical work system dependencies rather than their role during its implementation. From the interviewees’ accounts, three orientations emerge: (1) organisation-oriented resulting in unconditional adoption; (2) department-oriented resulting in problematic or delayed adoption with high compromise costs; (3) environment-oriented resulting in at least partial non-adoption or extra design costs. Our subsequent analysis leads to the identification of four types of subunit-level characteristics influencing adoption. Their interplay informs departments in balancing between accepting compromise costs and negotiating design costs. We develop a diagnostic system model of subunit-level adoption that takes the embeddedness of the subunit into account and thereby complements individual- and organisation-level adoption theories. An accompanying heuristic may enable hospital managers to better anticipate the heterogeneity in departments’ adoption.
Originele taal-2English
Pagina's (van-tot)221-243
Aantal pagina's23
TijdschriftEuropean Journal of Information Systems
Volume33
Nummer van het tijdschrift2
Vroegere onlinedatum25-jun.-2023
DOI's
StatusPublished - 2024

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