The implementation of new technologies in healthcare organizations: Cultural-historical activity theory
DOI:
https://doi.org/10.15291/oec.4406Keywords:
new technology implementation, technological change, healthcare organizations, interdisciplinary work, cultural-historical activity theory, practice-based studiesAbstract
The implementation of new technologies in healthcare leads to the emergence of new practices that diverge from traditional medical procedures. Existing scientific literature observes that new technologies often contradict conventional treatment methods, thereby posing a threat to existing divisions of labor and responsibilities among healthcare professionals and their medical domains. It is expected that tensions and conflicts arising from these contradictions hinder the implementation of new technologies and procedures in healthcare organizations. However, this article challenges such assumptions, arguing that conflicts between old and new practices or among practices of different medical domains are actually one of the main drivers of innovation. Cultural-historical activity theory (Engeström, 1987; 2001; Blackler, 2009) promotes a dialectical approach to researching the implementation of new technologies in organizations. It contends that consensus between old and new, or between domain-specific practices is not necessary for new technologies to be successfully implemented, provided there is a shared goal of activity. On the contrary, contradictions and tensions between different ways of working are considered regular characteristics of activity systems during the introduction of new technologies in organizations. This article presents the results of a long-term case study on a hospital’s implementation of a new technology called Transcatheter Aortic Valve Implantation (TAVI) which is a minimally invasive cardiac procedure. The newly introduced procedure enables the treatment of previously inoperable patients suffering from aortic valve stenosis. During the five-year ethnographic study of its implementation, numerous contradictions and difficulties in the progress of this innovation were documented. By applying cultural-historical activity theory to the case, various contradictions initially thought to impede its progress were identified. However, it turns out that the expansion of doctors' activities and the transformation of aortic stenosis treatment arose precisely from these contradictions. Although generalizations cannot be drawn from case studies, this example demonstrates the utility of using cultural-historical activity theory in researching the modernization of healthcare organizations. Therefore, this article contributes to the development of new theoretical approaches and methods, urging researchers and theorists of technology implementation to re-examine the current understandings of these processes.
References
Aanestad, M. (2003) The camera as an actor design-in-use of telemedicine infrastructure in surgery, Computer Supported Cooperative Work (CSCW), 12 (1), pp. 1 - 20.
Abbott, A. (1988) The System of Professions: An Essay on the Division of Expert Labour, Chicago: University of Chicago Press.
Allen, D. K., Brown, A., Karanasios, S., Norman, A. (2013) How should technology-mediated organizational change be explained? A comparison of the contributions of critical realism and activity theory, MIS Quarterly, pp. 835 – 854.
Bailey, D. E., Faraj, S., Hinds, P. J., Leonardi, P. M., von Krogh, G. (2022) We are all theorists of technology now: A relational perspective on emerging technology and organizing, Organization Science, 33(1), pp. 1 - 18.
Barley, S. R. (1986) Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments, Administrative Science Quarterly, pp. 78 - 108.
Barrett, M., Oborn, E., Orlikowski, W. J., Yates, J. (2012) Reconfiguring boundary relations: Robotic innovations in pharmacy work, Organization Science, 23 (5), pp. 1448 - 1466.
Beane, M., Orlikowski, W. J. (2015) What difference does a robot make? The material enactment of distributed coordination, Organization Science, 26 (6), pp. 1553 - 1573.
Beane, M. (2019) Shadow learning: Building robotic surgical skill when approved means fail, Administrative Science Quarterly, 64 (1), pp. 87 - 123.
Blackler, F. (2009) Cultural-historical activity theory and organization studies, Learning and expanding with activity theory, pp. 19 - 39.
Blackler, F., Regan, S. (2009) Intentionality, agency, change: Practice theory and management, Management Learning, 40 (2), pp. 161 - 176.
Blume, S. S. (1992) Insight and industry: on the dynamics of technological change in medicine, Cambridge: MIT Press.
Bryman, A. (2016) Social research methods, Oxford: Oxford University Press.
Burri, R. V. (2008) Doing Distinctions: Boundary Work and Symbolic Capital in Radiology, Social Studies of Science, 38 (1), pp. 35 - 62.
Currie, W. (2009) Contextualising the IT artefact: Towards a wider research agenda for IS using institutional theory, Information Technology and People, 22 (1), pp. 63 - 77.
Currie, G., White, L. (2012) Inter-professional barriers and knowledge brokering in an organizational context: the case of healthcare, Organization Studies, 33 (10), pp. 1333 - 1361.
Currie, G., Lockett, A., Finn, R., Martin, G., Waring, J. (2012) Institutional Work to Maintain Professional Power: Recreating the Model of Medical Professionalism, Organization Studies, 33, pp. 937 - 962.
Corradi, G., Gherardi, S., Verzelloni, L. (2010) Through the practice lens: Where is the bandwagon of practice-based studies heading?, Management Learning, 41 (3), pp. 265 - 283.
Eisenhardt, K. M. (1989) Building theories from case study research, Academy of Management Review, 14 (4), pp. 532 - 550.
Engeström, Y. (1987) An activity-theoretical approach to developmental research, Helsinki: Orienta-Konsultit.
Engeström, Y. (2001) Expansive learning at work: Toward an activity theoretical reconceptualization, Journal of Education and Work, 14 (1), pp. 133 – 156.
Engeström, Y., Blackler, F. (2005) On the life of the object, Organization, 12 (3), pp. 307 - 330.
Feldman, M. S. (1994) Strategies for interpreting qualitative data, London: SAGE Publications.
Feldman, M. S., Orlikowski, W. J. (2011) Theorizing practice and practicing theory, Organization Science, 22 (5), pp. 1240 - 1253.
Ferlie, E., Fitzgerald, L., Wood, M., Hawkins, C. (2005) The nonspread of innovations: the mediating role of professionals, Academy of Management Journal, 48 (1), pp. 117 - 134.
Fleuren, M., Wiefferink, K., Paulussen, T. (2004) Determinants of innovation within health care organizations: literature review and Delphi study, International Journal for Quality in Health Care, 16 (2), pp. 107 - 123.
Freidson, E. (1970) Professional Dominance: The Social Structure of Medical Care, New York: Atherton.
Geertz, C. (1973) Thick description: Toward an interpretive theory of culture, u Geertz, C. ed., The interpretation of cultures: Selected essays, New York, NY: Basic Books, pp. 3 - 30.
Gherardi, S. (2010) Telemedicine: A practice-based approach to technology, Human relations, 63 (4), pp. 501 - 524.
Gherardi, S. (2019) How to conduct a practice-based study: Problems and methods, Edward Elgar Publishing.
Golden-Biddle, K., Locke, K. (1993) Appealing work: An investigation of how ethnographic texts convince, Organization Science, 4 (4), pp. 595 – 616.
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., Hinder, S., Shaw, S. (2017) Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of medical Internet research, 19 (11), p. e8775.
Greig, G., Entwistle, V. A., Beech, N. (2012) Addressing complex healthcare problems in diverse settings: insights from activity theory, Social Science and Medicine, 74 (3), pp. 305 - 312.
Greig, G., Nicolini, D. (2015) Managing artistic work in the real world, Beech, N. & Gilmore, C. eds., Organising music: Theory, practice, performance, Cambridge, UK: Cambridge University Press, pp. 188 - 201.
Hargrave, T. J., Van de Ven, A. H. (2017) Integrating dialectical and paradox perspectives on managing contradictions in organizations, Organization Studies, 38 (3-4), pp. 319 - 339.
Jones, M. (2014) A matter of life and death, MIS Quarterly, 38 (3), pp. 895 - A6.
Karanasios, S. (2018) Toward a unified view of technology and activity: The contribution of activity theory to information systems research, Information Technology and People, 31 (1), pp. 134 - 155.
Kellogg, K. C., Breen, E., Ferzoco, S. J., Zinner, M. J., Ashley, S. W. (2006) Resistance to change in surgical residency: an ethnographic study of work hours reform, Journal of the American College of Surgeons, 202 (4), pp. 630 - 636.
Kirk, J., Andersen, O., Petersen, J. (2019) Organizational transformation in health care: an activity theoretical analysis, Journal of Health Organization and Management, 33 (5), pp. 547 - 562.
Latour, B. (2007) Reassembling the social: An introduction to actor-network-theory, Oxford: Oxford University Press.
Lincoln, Y. S., Guba, E. G. (1985) Naturalistic inquiry, Newbury Park, CA: SAGE Publications.
Lindberg, K., Walter, L., Raviola, E. (2017) Performing boundary work: The emergence of a new practice in a hybrid operating room, Social Science and Medicine, 182, pp. 81 - 88.
Lindwall, O., Lymer, G. (2005). Vulgar competence, ethnomethodological indifference and curricular design, u Koschmann, T., Suthers, D. D. & Chan, T. W. eds., Proceedings of the International Conference on Computer Supported Collaborative Learning 2005, Taipei, Taiwan, May 30 - June 4, 2005., pp. 388 - 397.
Martin, G.P., Currie, G., Finn, R. (2009) Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’of the medical workforce, Social Science and Medicine, 68 (7), pp. 1191 - 1198.
May, C., Gask, L., Atkinson, T., Ellis, N., Mair, F., Esmail, A. (2001) Resisting and promoting new technologies in clinical practice: the case of telepsychiatry, Social Science and Medicine, 52 (12), pp. 1889 - 1901.
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., Murray, E. (2009) Development of a theory of implementation and integration: Normalization Process Theory, Implementation Science, 4 (1), pp. 1 - 9.
Miettinen, R., Virkkunen, J. (2005) Epistemic objects, artefacts and organizational change, Organization, 12 (3), pp. 437 - 456.
Mikhailova, O. (2022) Interactions in innovation processes of medical devices: systemic and network perspectives, u Callegari, B., Misganaw, A. & S. Sardo eds., Rethinking the Social in Innovation and Entrepreneurship, Edward Elgar Publishing, pp. 234 - 256.
Mol, A. (2002) The body multiple: Ontology in medical practice, Duke University Press.
Mørk, B.E., Aanestad, M., Hanseth, O., Grisot, M. (2008) Conflicting epistemic cultures and obstacles for learning across communities of practice, Knowledge and Process Management, 15 (1), pp. 12 - 23.
Mørk, B.E., Hoholm, T., Ellingsen, G., Edwin, B., Aanestad, M. (2010) Challenging expertise: On power relations within and across communities of practice in medical innovation, Management learning, 41 (5), pp. 575 - 592.
Nancarrow, S. A., Borthwick, A. M. (2005) Dynamic professional boundaries in the healthcare workforce, Sociology of Health and Illness, 27 (7), pp. 897 - 919.
Nicolini, D. (2006) The work to make telemedicine work: A social and articulative view, Social Science and Medicine, 62 (11), pp. 2754 - 2767.
Nicolini, D. (2007) Stretching out and expanding work practices in time and space: The case of telemedicine, Human Relations, 60 (6), pp. 889 - 920.
Nicolini, D. (2010) Medical innovation as a process of translation: a case from the field of telemedicine, British Journal of Management, 21 (4), pp. 1011 - 1026.
Nicolini, D. (2012) Practice theory, work, and organization: An introduction, Oxford: Oxford University Press.
Nicolini, D., Monteiro, P. (2017) The practice approach: For a praxeology of organisational and management studies, The Sage Handbook of Process Organization Studies, pp. 110 - 126.
Oborn, E., Barrett, M., Davidson, E. (2011) Unity in diversity: Electronic patient record use in multidisciplinary practice, Information Systems Research, 22 (3), pp. 547 - 564.
Omachonu, V. K., Einspruch, N. G. (2010) Innovation in healthcare delivery systems: a conceptual framework, The Innovation Journal: The Public Sector Innovation Journal, 15 (1), pp. 1 - 20.
Orlikowski, W. J., Scott, S. V. (2008) Sociomateriality: challenging the separation of technology, work and organization, Academy of Management Annals, 2 (1), pp. 433 - 474.
Putnam, L. L., Fairhurst, G. T., Banghart, S. (2016) Contradictions, dialectics, and paradoxes in organizations: A constitutive approach, Academy of Management Annals, 10 (1), pp. 65 - 171.
Rystedt, H., Ivarsson, J., Asplund, S., Johnsson, Å. A., Båth, M. (2011) Rediscovering radiology: New technologies and remedial action at the worksite, Social Studies of Science, 41 (6), pp. 867 - 891.
Sannino, A., Engeström, Y., Lemos, M. (2016) Formative interventions for expansive learning and transformative agency, Journal of the Learning Sciences, 25 (4), pp. 599 - 633.
Schatzki, T. R. (2001) Introduction: Practice Theory, u T. R. Schatzki, K. Knorr Cetina & E. von Savigny eds. The Practice Turn in Contemporary Theory, New York: Routledge, pp. 1 - 14.
Schultze, U. (2001) Reflexive Ethnography in Information Systems Research, u E. M. Trauth ed. Qualitative Research in IS: Issues and Trends, Idea Group Publishing, pp. 78 - 103.
Schwandt, T. A., Lincoln, Y. S., Guba, E. G. (2007) Judging interpretations: But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation, New Directions for Evaluation, 2007 (114), pp. 11 - 25.
Sergeeva, A.V., Faraj, S., Huysman, M. (2020) Losing touch: An embodiment perspective on coordination in robotic surgery, Organization Science, 31 (5), pp. 1248 - 1271.
Silverman, D. (2006) Interpreting Qualitative Research: A practical Handbook, London: SAGE Publications.
Spradley, J. P. (1979) The Ethnographic Interview, New York: Holt, Rinehart and Winston.
Stahl, N. A., King, J. R. (2020) Expanding approaches for research: Understanding and using trustworthiness in qualitative research, Journal of Developmental Education, 44 (1), pp. 26 - 28.
Swanborn, P. (2010) Case Study Research: What, Why and How?, London: Sage Publications.
Tobin, G. A., Begley, C. M. (2004) Methodological rigour within a qualitative framework. Journal of Advanced Nursing, 48 (4), pp. 388 - 396.
Verrier, E. D., Mack, M. J. (2014) Viewpoint: transitions in cardiac surgery and interventional cardiology… team mates or rivals?, Heart 2014, 0, pp. 1 - 3.
Vygotsky, L. S. (1978) Mind in Society: The Development of Higher Psychological Processes, Cambridge, MA: Harvard University Press.
Yanow, D., Schwartz-Shea, P. (2006) Interpretation and Method, Armonk: M.E. Sharpe.
Yazan, B. (2015) Three approaches to case study methods in education: Yin, Merriam, and Stake, The Qualitative Report, 20 (2), pp. 134 - 152.
Zetka Jr, J. R. (2001) Occupational divisions of labor and their technology politics: The case of surgical scopes and gastrointestinal medicine, Social Forces, 79 (4), pp. 1495 - 1520.
