Conflicting Institutional Logics: A National Programme for IT in the Organisational Field of Healthcare

Abstract

This paper reports the findings from a 4-year study on the UK National Health Service on the introduction of a national programme for information technology. 1 This is the largest civil IT programme worldwide at an estimated technical cost of d6.2 billion over a 10-year period. An institutional analysis of our historical and empirical data from six NHS organisations identifies growing fragmentation in the organisational field of healthcare, as past and present institutional logics both fuel and inhibit changes in the governance systems and working practices of healthcare practitioners. This is further complicated by new institutional logics that place the citizen at centre stage of the NPfIT, in a move to promote patient choice and public value.

When innovation fails: An institutional perspective of the (non)adoption of boundary spanning IT innovation

“…In particular, research has considered the tensions between (i) institutional arrangements in one organizational field within which innovation happens; and (ii) the institutional logic embodied within the IT innovation itself. For example, misalignments between institutional arrangements on one hand and a medical innovation (Cho and Mathiassen, 2007;Jensen et al, 2009), or a nationwide IT programme (Currie and Guah, 2007) on the other, were found to explain the lack of adoption within healthcare settings. Similarly, it has been suggested that mismatches between the institutional logic embodied within a new information system and the dominant institutional logic within the adopting organization create resistance to the implementation of IT innovations at an organizational level (Gosain, 2004).…”

“…There is, however, mounting evidence that organizations are subject to competing institutional demands within their organizational fields (Reay and Hinings, 2009;Scherer et al, 2013), and that these conflicting demands influence IT innovation adoption (Butler, 2003) and diffusion (Currie and Guah, 2007). However, existing information systems research has primarily examined one category of conflictsmisalignments between the organizational field and the institutional demands embodied within the IT artefact (see Gosian, 2004;Jensen et al, 2009) (STREAM 2).…”

“…For example, institutional misalignments within UK healthcare were identified by Currie and Guah (2007) and were found to both fuel and inhibit the diffusion of a nationwide IT innovation. The conflicts within the healthcare field were explained largely based on the fragmentation of the organizational field, which was characterised by the conflict between public and private sector ethoses (see also Reay and Hinings, 2009).…”

“…However, as environments become more complex and contested, organizations increasingly experience conflicting institutional demands (Pache and Santos, 2010). Conflicting institutional demands are important as they call into question the ability of innovator actors to align an innovation successfully with the range of diverse and inconsistent institutional logics that characterise adopting organizational fields (Currie and Guah, 2007). Misalignments between conflicting demands become an even bigger challenge when adoption cuts across different organizational fields characterised by diverse institutional logics.…”

“…Nevertheless, the extent of misalignments between different institutional logics within the environment in which innovations are introduced plays a critical role in shaping their adoption (see Currie and Guah, 2007). The goal of this paper is to develop an understanding of the nature of these misalignments and how they influence the adoption of IT innovations.…”