Context is king! Considering particularism in research design and reporting

Advancing laboratory medicine in hospitals through health information exchange: a survey of specialist physicians in Canada

BACKGROUND

Laboratory testing occupies a prominent place in health care. Information technology systems have the potential to empower laboratory experts and to enhance the interpretation of test results in order to better support physicians in their quest for better and safer patient care. This study sought to develop a better understanding of which laboratory information exchange (LIE) systems and features specialist physicians are using in hospital settings to consult their patients' laboratory test results, and what benefit they derive from such use.

METHODS

As part of a broader research program on the use of health information exchange systems for laboratory medicine in Quebec, Canada, this study was designed as on online survey. Our sample is composed of 566 specialist physicians working in hospital settings, out of the 1512 physicians who responded to the survey (response rate of 17%). Respondents are representative of the targeted population of specialist physicians in terms of gender, age and hospital location.

RESULTS

We first observed that 80% of the surveyed physicians used the province-wide interoperable electronic health records (iEHR) system and 93% used a laboratory results viewer (LRV) to consult laboratory test results and most (72%) use both systems to retrieve lab results. Next, our findings reveal important differences in the capabilities available in each type of system and in the use of these capabilities. Third, there are differences in the nature of the perceived benefits obtained from the use of each of these two systems. Last, the extent of use of an LRV is strongly influenced by the IT artefact itself (i.e., the hospital's LRV available capabilities) while the use of the provincial iEHR system is influenced by its organizational context (i.e. the hospital's size and location).

CONCLUSIONS

The main contribution of this study lies in its insights into the role played by context in shaping physicians' choices about which laboratory information exchange systems to adopt and which features to use, and the different perceptions they have about benefits arising from such use. One related implication for practice is that success of LIE initiatives should not be solely assessed with basic usage statistics.

Entrepreneurial actions and the legitimation of free/open source software services

Free/open source software users were previously responsible for managing the challenges associated with their software themselves. Recently, a new generation of entrepreneurs seized this emerging market opportunity by positioning themselves as service providers for free/open source software users. Conceptualizing such providers as “institutional entrepreneurs,” we find that due to the nature of the free/open source software context, they exhibit a different set of legitimation actions compared with similar efforts in other contexts. Based on our empirical analysis of free/open source software service providers and drawing on prior theory, we identify two entrepreneurial actions aimed at gaining legitimacy specific to the free/open source software context, namely, product-based theorization actions and evangelization actions. We also demonstrate that institutional entrepreneurship is shaped by the nature of free/open source software products and the openness values at the core of the free/open source software movement. Our work hence underscores the importance of the context of institutional entrepreneurship.

Exploring gender discursive struggles about social inclusion in an online gaming community

Purpose

The purpose of this paper is to adopt a critical relational dialectics framework to identify and explore gender discursive struggles about social inclusion observed in an online gaming community, in South Africa.

Design/methodology/approach

The paper uses a technique called contrapuntal analysis to identify and explore competing discourses in over 200 messages on gender struggles about social inclusion posted in the local community’s gamer discussion board, based on seven threads initiated by women gamer activists.

Findings

The findings show how four interrelated gender discursive struggles about social inclusion and social exclusion animated the meanings of online gamer relations: dominance vs equality, stereotyping vs diversity, competitiveness vs cooperativeness and privilege vs empowerment.

Practical implications

Game designers should reinforce more accurate and positive stereotypes to cater for the rapidly growing female gamer segment joining the online gaming market and to develop a less chauvinistic and more diversely representative online gaming community. Enlightened gamers should exercise greater solidarity in fighting for gender equality in online gaming communities.

Originality/value

The critical relational dialectics analysis adopted in this study offers a promising avenue to understand and critique the discursive struggles that arise when online gamers from the different gender groups relate. The findings highlight the unequal discursive power and privilege of many white male gamers when discussing social inclusion. Advancing our understanding of these discursive struggles creates the possibilities for improving social inclusion in online gaming communities.