There is strong pressure to achieve greater uniformity, standardisation and application of best practices in the service professions, a sector which is growing in presence and importance. At the same time, there is a conflicting demand for the delivery of high-quality (or highly priced or 'knowledge intensive') specialised or localised services. Our paper analyses information systems' embedded efforts of standardising service work through an in-depth interpretative study of an ongoing standardisation initiative within the field of nursing. Nursing provides a graphic illustration of the dilemmas involved in the standardisation of service work. In nursing, standardisation is commonly a feature of projects to improve both efficiency and quality in health care. In contrast to the dominant conception of standardisation as a largely top-down, imposed process, we offer a view of standardisation as incomplete, co-constructed with users and with significant unintended consequences. The paper contributes by i) developing a theoretical perspective for the standardisation of information-system-embedded 2 service work and ii) operational and practical implications for system design and health care management.

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Purpose: The paper contributes to the conceptualisation of ''integrated care'' in heterogeneous work practices. A dynamic perspective is developed, emphasising how integrated care is malleable, open, and achieved in practice. Furthermore, we explore the role of nursing plans in integrated care practices, underscoring the inherent difficulties of building one common infrastructural system for integrated care.Methods: Empirically, we studied the implementation of an electronic nursing plan in a psychiatric ward at the University Hospital of North Norway. We conducted 80 hours of participant observation and 15 interviews.Results: While the nursing plan was successful as a formal tool among the nurses, it was of limited use in practice where integrated care was carried out. In some instances, the use of the nursing plan even undermined integrated care. Conclusion:Integrated care is not a constant entity, but is much more situated and temporal in character. A new infrastructural system for integrated care should not be envisioned as replacing most of the existing information sources, but rather seen as an extension to the heterogeneous ensemble of existing ones.

For organisations, the tension between integration and specialisation has become a key issue as the knowledge of work is becoming increasingly fragmented through specialisation (Becker, 2002; Grant, 1996; Kogut & Zander, 1992). Specialisation, as knowing more about less, distributes the overall accomplishment of work on several entities (Aanestad, Mørk, Grisot, Hanseth, & Syvertsen, 2003; Becker; Berg, 1997; Hutchins, 1995) with the consequent need for the integration of different competencies and types of expertise. Becker (p. 3) provides the following definition of knowledge integration:

Drawing on a critical perspective stemming from socially informed studies of medicine, we analyze an ongoing effort to establish electronic nursing plans at the university hospital of central Norway (St. Olav's hospital). We argue for an alternative interpretation of the relative lack of success to date of making the nurses use the nursing plans. Rather than a preoccupation with the singular artifact -the plan -we emphasize the process of planning as a collective, ongoing and heterogeneous achievement. Our perspective on plans implies that they should be recognized as more of a network and less a singular artifact.