Access and triage in contemporary general practice: A novel theory of digital candidacy

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways.

Configurations of human-centered AI at work: seven actor-structure engagements in organizations

Purpose

The discourse on the human-centricity of AI at work needs contextualization. The aim of this study is to distinguish prevalent criteria of human-centricity for AI applications in the scientific discourse and to relate them to the work contexts for which they are specifically intended. This leads to configurations of actor-structure engagements that foster human-centricity in the workplace.

Theoretical foundation

The study applies configurational theory to sociotechnical systems' analysis of work settings. The assumption is that different approaches to promote human-centricity coexist, depending on the stakeholders responsible for their application.

Method

The exploration of criteria indicating human-centricity and their synthesis into configurations is based on a cross-disciplinary literature review following a systematic search strategy and a deductive-inductive qualitative content analysis of 101 research articles.

Results

The article outlines eight criteria of human-centricity, two of which face challenges of human-centered technology development (trustworthiness and explainability), three challenges of human-centered employee development (prevention of job loss, health, and human agency and augmentation), and three challenges of human-centered organizational development (compensation of systems' weaknesses, integration of user-domain knowledge, accountability, and safety culture). The configurational theory allows contextualization of these criteria from a higher-order perspective and leads to seven configurations of actor-structure engagements in terms of engagement for (1) data and technostructure, (2) operational process optimization, (3) operators' employment, (4) employees' wellbeing, (5) proficiency, (6) accountability, and (7) interactive cross-domain design. Each has one criterion of human-centricity in the foreground. Trustworthiness does not build its own configuration but is proposed to be a necessary condition in all seven configurations.

Discussion

The article contextualizes the overall debate on human-centricity and allows us to specify stakeholder-related engagements and how these complement each other. This is of high value for practitioners bringing human-centricity to the workplace and allows them to compare which criteria are considered in transnational declarations, international norms and standards, or company guidelines.

Challenges in reaching patients with severe mental illness for trials in general practice-a convergent mixed methods study based on the SOFIA pilot trial

BACKGROUND

Patients with severe mental illness (SMI) die prematurely due to undetected and inadequate treatment of somatic illnesses. The SOFIA pilot study was initiated to mend this gap in health inequity. However, reaching patients with SMI for intervention research has previously proven difficult. This study aimed to investigate the recruitment of patients with SMI for the SOFIA pilot study in 2021.

METHODS

We used a mixed-method convergent design. The qualitative material comprised 20 interviews with general practitioners (GPs) and staff, during patient recruitment. The quantitative data consisted of process data on baseline characteristics, GPs reported reasons for excluding a patient, reported reasons for patients declining participation, and registered data from a Danish population of patients with SMI. We used thematic analysis in the qualitative analysis and descriptive statistics for the quantitative analysis. Pillar integration was used for integrating the material.

RESULTS

Our findings show that selection bias occurred in the pilot study. We describe four main themes based on the integrated analysis that highlights selection issues: (1) poor data quality and inconsistency in defining severity definitions troubled identification and verification, (2) protecting the patient and maintaining practice efficiency, (3) being familiar with the patient was important for a successful recruitment, and (4) in hindsight, the GPs questioned whether the target population was reached.

CONCLUSIONS

In the light of theories of professions and street-level bureaucracy, we find that the main drivers of the patient selection bias occurring in the SOFIA pilot study were that 1) GPs and staff mended eligibility criteria to protect certain patients and/or to minimize workload and maintain efficiency in the practice 2) the data from the GP record systems and the digital assessment tool to assist recruitment was not optimal. Interventions targeting this patient group should carefully consider the recruitment strategy with a particular focus on professionals' discretionary practices and information technology pitfalls.

TRIAL REGISTRATION

The pilot trial protocol was registered on the 5th of November 2020. The registration number is NCT04618250 .

Internet-based parenting intervention: A systematic review

Digital technology has become an essential part of people's lives, and the Internet's innovation made it easier for humans to carry out activities. This systematic review aims to examine parenting with a specific internet-based intervention designed to help them gain information about child-rearing. Specifically, it analyses: 1) how the internet-based parenting intervention is studied, 2) how was the study of an internet-based parenting intervention done, and 3) what themes emerged from the systematic review. The finding suggests that most internet-based parenting interventions use transmitting information techniques visually, as the content is displayed through exciting and informative content. Four themes emerged from the thematic analysis: technology-assisted parenting programs, parenting interventions as support for mothers, professional support online, and improved parenting skills. Positive responses from parents as users show that this online parenting intervention can meet their needs and has the potential to continue to be developed. The literature is quite limited regarding assessing internet-based parenting intervention in early childhood education and developmental psychology. Because of that, further research to develop internet-based parenting interventions becomes essential to give parenting professional support.

Digital Disparities in Patient Adoption of Telemedicine

Telemedicine's growth during the COVID-19 pandemic exposed digital and health disparities in U.S. communities. Public health advocates suggest disparities in healthcare access may be mitigated through free or low-cost broadband. However, prior research shows that many factors influence patient adoption of information technologies; therefore, increasing access to broadband alone is insufficient. This paper advances a patient-centered model of telemedicine (TM) adoption supported by qualitative interview data. The model illustrates that patient adoption of TM is driven by a complex sociotechnical system comprised of technology factors, structural factors underlying the provider's provision of TM, and individual patient factors. Findings highlight the importance of the physical place of the TM visit, the need for experienced TM healthcare workers and technology support for patients, the impact of provider-mandated technology on task-technology fit (TTF), and the strength of the patient-provider relationship. These factors affect patient perceptions of TTF and ultimately TM adoption.

“Collaborating” with AI: Taking a System View to Explore the Future of Work

In the wake of media hype about artificial intelligence (AI)/human collaboration, organizations are investing considerable resources into developing and using AI. In this paper, we draw on theories of technology in organizations to frame new directions for the study of what it means to work “with” AI. Drawing on prior literature, we consider how interactions between users and AI might unfold through theoretical lenses which cast technology as a tool and as a medium. Reflecting on how AI technologies diverge from technologies studied in the past, we propose a new perspective, which considers technology as a counterpart in a system of work that includes its design, implementation, and use. This perspective encourages developing a grounded understanding of how AI intersects with work, and therefore ethnography, building on thick descriptions, is an apt approach. We argue that relational ethnographic approaches can assist organization theorists in navigating the methodological challenges of taking a counterpart perspective and propose several strategies for future research.

Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation

Objective

Since the 1990s, almost all healthcare organisations have had electronic health records (EHR) to organise and manage treatment, care and work routines. This article aims to understand how healthcare professionals (HCPs) make sense of digital documentation practice.

Methods

Based on a case study design, field observations and semi-structured interviews were conducted in a Danish municipality. A systematic analysis based on Karl Weick's sensemaking theory was applied to investigate what cues HCPs extract from timetables in the EHR and how institutional logics frame the enactment of documentation practice.

Results

The analysis uncovered three themes: making sense of planning, making sense of tasks and making sense of documentation. The themes illustrate that HCPs make sense of the digital documentation practice as a dominant managerial tool designed to control resources and work routines. This sensemaking leads to a task-oriented practice which centres on delivering fragmented tasks according to a timetable.

Conclusion

HCPs mitigate fragmentation by responding to a care professional logic, where they document to share information and carry out invisible work outside of timetables and scheduled tasks. However, HCPs are focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user's care and treatment disappear. In conclusion, the EHR system eliminates a holistic view of care trajectories, leaving it up to HCPs to collaborate in an effort to obtain continuity for the service user.

The effects of digital nativity on nonvolitional routine and innovative usage

Purpose

This study explores the differences between digital immigrants (DIs) and digital natives (DNs) in the continuance of routine and innovative information system use.

Design/methodology/approach

A quantitative survey was conducted with two different samples comprising 100 DIs and 152 DNs in mandatory information system use contexts. Data were analyzed with structural equation modeling to examine the hypothesized relationships in the research model.

Findings

Results revealed differences among digital nativity groups. The effect of confirmation of expectations about system use on satisfaction is stronger for DNs whereas the effect on task–technology fit (TTF) is similar in both digital groups. Interestingly, significant differences between digital nativity groups occur in routine use. For DIs, TTF and habit are significant while for DNs, satisfaction significantly affects routine use. The results show no difference between digital native groups regarding innovative use.

Originality/value

This study extends the concept of digital nativity to routine and innovative system use, contributing to an enhanced understanding about the differences in information systems continuance (ISC) based on digital nativity. It also provides a fine-grained discussion of how to classify digital nativity and its impact in working contexts and extends the IS continuance model by considering two types of IS usage.

“The old order Changeth!” Building sustainable knowledge management post COVID-19 pandemic

Purpose

The global pandemic and the resulting rapid and large-scale digitization changed the way firms recognized and understood knowledge curation and management. The changing nature of work and work systems necessitated changes in knowledge management (KM), some of which are likely to have a long-term impact. Using the lens of technology in practice, the purpose of this study is to examine the impact of technology agency on KM structures and practices that evolved across five knowledge-intensive global organizations. This study then argues that sustainable knowledge management (SKM) systems evolve in specific contexts.

Design/methodology/approach

This study adopts a qualitative case study design to examine five multinational knowledge-intensive global organizations’ KM systems and practices across diverse industry sectors.

Findings

Based on the findings, the authors develop SKM systems and practices model relevant to a post-pandemic organizational context. The authors argue that KM digitization and adoption support socialization in knowledge sharing. Further formalization through organizational enabling systems aids the externalization of knowledge sharing. Deliberate practices promoted with leadership support are likely to sustain in the post-COVID era. Further, organizations that evolved ad-hoc or idiosyncratic approaches to managing hybrid working are more likely to revert to legacy KM systems. The authors eventually theorize about the socialization of human-to-human and technology-mediated human interactions and develop the three emerging SKM structures.

Originality/value

This study contributed to practitioners and researchers by developing the various tenets of SKM.

Conceptualizing Information Systems Development as an Organizational Routine

Research acknowledges that information systems development (ISD) teams experiment with, overlook, or adapt the methods that they purportedly use. Given this, one stream of research adopts a perspective focused on prescriptions based on the idea of a method. Another stream of research adopts a perspective anchored in the view that human agency plays a critical role in the unfolding of ISD projects. We suggest that our understanding of ISD can be enriched by mobilizing both perspectives. Specifically, we propose a conceptualization of ISD as an organizational routine based on the ontology developed by Feldman and Pentland. We build on the elements of this ontology- (1) the idea of a routine (the ostensive aspect) and (2) its enactment (the performative aspect) as the two mutually constitutive aspects of organizational routines; and (3) the role of artifacts as mediators of the relationship between actors and the ostensive and performative aspects of organizational routines - to develop theoretical arguments explaining the benefits of applying this ontology to the ISD phenomenon. Extending the contextual boundaries of Feldman and Pentland's ontology, we propose research avenues that have the potential to contribute to our understanding of this core phenomenon of the IS discipline.

Smart Justice in Italy: Cases of Apps Created by Lawyers for Lawyers and Beyond

The smart city literature states that three levels of institutional layers (regulatory, normative, and cognitive) and four typologies of actors (government, universities, citizens, and the private sector) support private initiative for developing smart technologies. Focusing on the emergent phenomenon of smart apps ideated by lawyers’ private initiatives, this paper acknowledges that other factors, including the ubiquity of mobile technologies and the absence of effective public services provided by public institutions, contribute to the institutional and organizational humus necessary for the creation of intelligent technological proposals. In the light of the organizational theory framework, and based on the analysis of the literature on smart cities and e-justice and on the empirical investigation of two Italian lawyers’ apps (Collega and Anthea), this paper identifies the institutional, organizational, and technological conditions under which smart technologies are being developed in high-regulated public institutions’ contexts as justice systems. The findings of the study described in this paper help integrate the contribution of the literature on the topic.

Putting head-worn displays to use for order picking: a most-similar comparative case study

Purpose

This paper aims to identify why warehouses do or do not succeed in putting to use digital technologies for order picking.

Design/methodology/approach

Building on structuration theory, the authors investigate the situated use of one such a digital technology, more particularly the head-worn display (HWD). Based on a most-similar comparative case study of two Belgian warehouses pioneering HWDs, the authors focus on whether and how order pickers and their manager interact to modify the properties, functionalities, and the context in which the HWD is used.

Findings

In one warehouse, using the HWD was discontinued after implementation. In the other, order pickers and the order pickers' manager succeeded in implementing the HWD into their work. The authors find that the prime explanation for these opposite findings lies in the extent to which order pickers were given room to improve the properties and functionalities of the HWD as well as the conditions that unfold in the HWD's use context. In the latter warehouse, pressing issues were overcome and improvement suggestions were implemented, both regarding the HWD itself as well as regarding the job-related and person-related conditions.

Originality/value

Theoretically, the authors contribute to the situated use of technology stating that (1) giving room to alter the use of digital technologies, and (2) fostering continuous employee participation regarding conditions stemming from the use context are necessary to realize the promising and unexploited potential of digital technology in practice. Empirically, this paper exposes distinct types of interactions that explain whether and how digital technologies, in particular HWDs, are put to use for order picking practices.

'Bringing the Covert into the Open': A Case Study on Technology Appropriation and Continuous Improvement

As end-users, employees appropriate technologies. Technology appropriation is generally conceived as a covert phenomenon. In particular, alternative ways and new purposes for which employees deploy technologies tend to remain hidden. Therefore, the potential of technologies as a source of organizational improvements may remain undisclosed. Continuous improvement (CI) programs, in contrast, are explicitly oriented at disclosing organizational improvements. In essence, CI programs encourage employees to openly discuss how to improve their work practices. Such continuous movements towards novel, often better, ways of working may be perfectly suited to bring the covert nature of technology appropriation into the open. Based on a case study on a personal digital assistant (PDA) in a Belgian nursing home with such a CI program in place, we document and analyze to what extent and why functionalities of the PDA were discussed and further developed. We distinguish between the functionalities that, upon implementation, intended to improve particular work practices, and those that surfaced after the technology had been introduced. To conclude, we point at employees’ perceived usefulness of their work practices and their willingness to improve these, rather than only the technology itself, to further the debate on technology appropriation.

Individual's Perceptions as a Substitute for Guidelines and Evidence: A Qualitative Study on How Clinicians Choose Between In-person and Remote Consultation

Background

Video consultation (VC) is increasingly seen as a cost-effective way of providing outpatient care in the face of dwindling resources and growing demand for health care worldwide. Therefore, the sustainable implementation of VC is a phenomenon of interest to medical practitioners, researchers, and citizens alike. Studies are often criticized for not being sufficiently robust because the research settings are mostly small-scale pilot projects and are unable to reflect long-term implementation. The COVID-19 pandemic has compelled clinicians worldwide to conduct remote consultation, creating a favorable context to study large-scale remote consultation implementation.

Objective

The aim of this study was to thoroughly investigate how clinicians reason their choice of different consultation modes in the routine of consultation and what the underlying reasons are for their choices. We posited that a deeper understanding of clinicians’ perceptions of remote consultation is essential to deduce whether and how remote consultation will be adopted on a large scale and sustained as a regular service.

Methods

A qualitative approach was taken, in which the unit of analysis was clinicians in one of the largest university hospitals in Norway. In total, 29 interviews were conducted and transcribed, which were used as the primary data source. Using the performative model of routine as the theoretical framework, data were analyzed using deductive content analysis.

Results

Clinicians have mixed opinions on the merits and demerits of VC and its position between in-person and telephone consultation. Totally, 6 different planning criteria were identified, and individual clinicians used different combinations of these criteria when choosing a mode of consultation. The ideals that clinicians hold for conducting consultation can be divided into three aspects: clinical, interpersonal, and managerial. VC engenders a new ideal and endangers the existing ideals. VC causes minor changes in the tasks the clinicians perform during a consultation; thus, these changes do not play a significant role in their choice of consultation. Clinicians could not identify any changes in the outcome of consultation as a result of incorporating a remote mode of consultation.

Conclusions

Clinicians feel that there is a lack of scientific evidence on the long-term effect of remote consultation on clinical efficacy and interpersonal and managerial aspects, which are crucial for consultation service. The absence of sufficient scientific evidence and a clear understanding of the merits and demerits of VC and standard practices and shared norms among clinicians regarding the use of video for consultation both create a void in the consultation practice. This void leads clinicians to use their personal judgments and preferences to justify their choices regarding the consultation mode. Thus, diverse opinions emerge, including some paradoxical ones, resulting in an uncertain future for sustainable large-scale implementation, which can reduce the quality of consultation service.

Healthcare workers' communicative constitution of health information technology (HIT) resilience

Purpose

Although resilience is heavily studied in both the healthcare and organizational change literatures, it has received less attention in healthcare information technology (HIT) implementation research. Healthcare organizations are consistently in the process of implementing and updating several complex technologies. Implementations and updates are challenged because healthcare workers often struggle to perceive the benefits of HITs and experience deficiencies in system design, yet bear the brunt of the blame for implementation failures. This combination implores healthcare workers to exercise HIT resilience; however, how they talk about this construct has been left unexplored. Subsequently, this study explores healthcare workers' communicative constitution of HIT resilience.

Design/methodology/approach

Twenty-three physicians (N = 23), specializing in oncology, pediatrics or anesthesiology, were recruited from one healthcare organization to participate in comprehensive interviews during and after the implementation of an updated HIT system DIPS.

Findings

Thematic analysis findings reveal physicians communicatively constituted HIT resilience as their (1) convictions in the continued, positive developments of newer HIT iterations, which marked their current adaptive HIT behaviors as temporary, and (2) contributions to inter-organizational HIT brainstorming projects in which HIT designers, IT staff and clinicians jointly problem-solved current HIT inadequacies and created new HIT features.

Originality/value

Offering both practical for healthcare leaders and managers and theoretical implications for HIT and resilience scholars, this study's results suggest that (1) healthcare leaders must work diligently to create a culture of collaborative HIT design in their organization to help facilitate the success of new HIT use, and (2) information technology scholars reevaluate the theoretical meaningfulness a technology's spirit and reconsider the causal nature of a technology's embedded structures.

Exploring technologies to better link physical evidence and digital information for disaster victim identification

Disaster victim identification (DVI) entails a protracted process of evidence collection and data matching to reconcile physical remains with victim identity. Technology is critical to DVI by enabling the linkage of physical evidence to information. However, labelling physical remains and collecting data at the scene are dominated by low-technology paper-based practices. We ask, how can technology help us tag and track the victims of disaster? Our response to this question has two parts. First, we conducted a human–computer interaction led investigation into the systematic factors impacting DVI tagging and tracking processes. Through interviews with Australian DVI practitioners, we explored how technologies to improve linkage might fit with prevailing work practices and preferences; practical and social considerations; and existing systems and processes. We focused on tagging and tracking activities throughout the DVI process. Using insights from these interviews and relevant literature, we identified four critical themes: protocols and training; stress and stressors; the plurality of information capture and management systems; and practicalities and constraints. Second, these findings were iteratively discussed by the authors, who have combined expertise across electronics, data science, cybersecurity, human–computer interaction and forensic pathology. We applied the themes identified in the first part of the investigation to critically review technologies that could support DVI practitioners by enhancing DVI processes that link physical evidence to information. This resulted in an overview of candidate technologies matched with consideration of their key attributes. This study recognises the importance of considering human factors that can affect technology adoption into existing practices. Consequently, we provide a searchable table (as Supplementary information) that relates technologies to the key considerations and attributes relevant to DVI practice, for readers to apply to their own context. While this research directly contributes to DVI, it also has applications to other domains in which a physical/digital linkage is required, and particularly within high stress environments with little room for error.

Local Adaptation Without Work Intensification: Experimentalist Governance of Digital Technology for Mutually Beneficial Role Reconfiguration in Organizations

This 1.5-year ethnographic study of a U.S. medical center shows that avoiding loss of autonomy and work intensification for less powerful actors during digital technology introduction and integration presents a multisited collective action challenge. I found that technology-related participation problems, threshold problems, and free rider problems may arise during digital technology introduction and integration that enable loss of autonomy and work intensification for less powerful actors. However, the emergence of new triangles of power allows for novel coalitions between less powerful actors and newly powerful third-party actors that can help mitigate this problem. I extend the political science perspective of experimentalist governance to examine how a digital technology-focused, iterative collective action process of local experimentation followed by central revision can facilitate mutually beneficial role reconfiguration during digital technology introduction and integration. In experimentalist governance of digital technology, local units are given discretion to adapt digital technologies to their specific contexts. A central unit composed of diverse actors then reviews progress across local units integrating similar digital technology to negotiate a new shared understanding of mutually beneficial technology-related tasks for each group of actors. The central unit modifies both local routines and the technology itself in response to problems and possibilities revealed by the central revision process, and the cycle repeats. Here, accomplishing mutually beneficial role reconfiguration occurs through an experimentalist, collective action process rather than through a labor-management bargaining process or a professional-led tuning process.

The Digital Undertow: How the Corollary Effects of Digital Transformation Affect Industry Standards

Digital transformation research shows how waves of digitalization produce strategic changes within and across firms, enabling new forms of value creation. We argue that different but no less important processes of digital transformation are generated by the undertow produced by these waves. Digital undertow, a corollary effect of waves of digitalization, profoundly influences how firms operate by transforming the industry standards that coordinate and regulate their core business activities. This is producing what we refer to as digital displacement, a process that is significantly challenging the capacity of standards to effectively manage industry operations in the digital age.

Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study

Background

Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input.

Objective

This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice.

Methods

HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis.

Results

The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures.

Conclusions

Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.

Digital Technologies in Built Environment Projects: Review and Future Directions

Through a systematic literature review we explore how digital technologies reshape and catalyze digital innovations in the built environment—a highly project-based setting. We analyzed circa 3,000 titles, further narrowed down to 87 articles. We synthesized an original framework for data analysis. The article presents implications for the deployment of digital technologies on three levels: individuals, organizations, and projects. Whereas most of these studies examined the impact of digital innovation in projects, recommendations focused on organizations, suggesting future directions for performance measurement, developing capabilities of firms to manage changes in dynamic environments and interorganizational settings.

The Ethics of Blockchain in Organizations

Blockchain is an open digital ledger technology that has the capability of significantly altering the way that people operations (i.e. human resource management) operate in organizations. This research takes a first step in proposing several ways in which the blockchain technology can be used to improve current organizational practices, while also considering the ethical implications. Specifically, the paper examines the role that blockchain technology plays in three primary areas of people operations: (1) entry to the organization (via recruitment and selection), (2) intraorganizational processes (including compensation via smart contracts, retention and motivation via shared leadership and conflict management via network-based dispute resolution, and performance management), and (3) exit (offboarding). In each section, the paper reviews the ethical implications from the lenses of virtue ethics, utilitarianism, deontology and contractarianism. The paper concludes that in whole the implementation of blockchain technology in people operations processes can create a more ethical work environment. However, careful implementation is necessary and requires extensive examination of ethical implications in advance.

Exploring factors of uneven use of telehealth among outpatient pharmacy clinics during COVID-19: A multi-method study

Background

To enable services to be provided at a distance during the COVID-19 pandemic, outpatient pharmacy services in Australia underwent near-immediate reform by moving to telehealth, including telephone and video consults.

Objective

To investigate how telehealth was used in a metropolitan outpatient pharmacy setting before and after the start of the COVID-19 restrictions and the various influences on the uptake of phone and video modalities.

Methods

A multi-methods approach was used including: (1) quantifying administrative activity data between July 2019 to December 2020 and, (2) semi-structured interviews with key stakeholders (n = 34).

Results

Activity data: Between July 2019 to December 2020 16,377 outpatient pharmacy consults were provided. Of these, 13,543 (83%) were provided in-person, 2,608 (16%) by telephone and 226 (1.4%) by video consult. COVID-19 impacted how these services were provided with telephone activity more than four-times higher in April 2020 than March 2020 and slight increases in video consults. Pharmacists have heavily favoured using the telephone despite the recommendation that video consults be used as the primary mode of contact and that telephone only be used when a video consult was not possible. As soon as COVID-19 restrictions eased, clinicians gradually returned to in-person appointments, maintaining some use of telephone and very limited use of video consult. Semi-structured interviews: Whilst clinicians recognised the potential benefits of video consults, challenges to routine use included the additional administrative and planning work required pre-consult, perceptions that patients were unable to use the technology, and the belief that in-person care was ‘better’ and that the telephone was easier.

Conclusion

Organisational strategies that encouraged the use of video over telephone (e.g. through financial incentives) did not appear to influence clinicians’ choice of care modality. Implementation studies are required to co-develop solutions to embed telehealth options into outpatient pharmacy settings that provide the best experience for both patients and clinicians.

Worlds apart: a socio-material exploration of mHealth in rural areas of developing countries

Purpose

The implementation of mobile health (mHealth) in developing countries seems to be stuck in a pattern of successive pilot studies that struggle for mainstream implementation. This study addresses the research question: what existing health-related structures, properties and practices are presented by rural areas of developing countries that might inhibit the implementation of mHealth initiatives?

Design/methodology/approach

This study was conducted using a socio-material approach, based on an exploratory case study in West Africa. Interviews and participant observation were used to gather data. A thematic analysis identified important social and material agencies, practices and imbrications which may limit the effectiveness of mHealth apps in the region.

Findings

Findings show that, while urban healthcare is highly structured, best practice-led, rural healthcare relies on peer-based knowledge sharing, and community support. This has implications for the enacted materiality of mobile technologies. While urban actors see mHealth as a tool for automation and the enforcement of responsible healthcare best practice, rural actors see mHealth as a tool for greater interconnectivity and independent, decentralised care.

Research limitations/implications

This study has two significant limitations. First, the study focussed on a region where technology-enabled guideline-driven treatment is the main mHealth concern. Second, consistent with the exploratory nature of this study, the qualitative methodology and the single-case design, the study makes no claim to statistical generalisability.

Originality/value

To the authors' knowledge, this is the first study to adopt a socio-material view that considers existing structures and practices that may influence the widespread adoption and assimilation of a new mHealth app. This helps identify contextual challenges that are limiting the potential of mHealth to improve outcomes in rural areas of developing countries.

To Engage or Not to Engage with AI for Critical Judgments: How Professionals Deal with Opacity When Using AI for Medical Diagnosis

Artificial intelligence (AI) technologies promise to transform how professionals conduct knowledge work by augmenting their capabilities for making professional judgments. We know little, however, about how human-AI augmentation takes place in practice. Yet, gaining this understanding is particularly important when professionals use AI tools to form judgments on critical decisions. We conducted an in-depth field study in a major U.S. hospital where AI tools were used in three departments by diagnostic radiologists making breast cancer, lung cancer, and bone age determinations. The study illustrates the hindering effects of opacity that professionals experienced when using AI tools and explores how these professionals grappled with it in practice. In all three departments, this opacity resulted in professionals experiencing increased uncertainty because AI tool results often diverged from their initial judgment without providing underlying reasoning. Only in one department (of the three) did professionals consistently incorporate AI results into their final judgments, achieving what we call engaged augmentation. These professionals invested in AI interrogation practices—practices enacted by human experts to relate their own knowledge claims to AI knowledge claims. Professionals in the other two departments did not enact such practices and did not incorporate AI inputs into their final decisions, which we call unengaged “augmentation.” Our study unpacks the challenges involved in augmenting professional judgment with powerful, yet opaque, technologies and contributes to literature on AI adoption in knowledge work.

Teaching Novice Teachers to Enhance Learning in the Hybrid University

Hybrid learning spaces are often associated with ‘blended’ education and defined by the presence of a mediating technology. In this paper, we shift the focus from technology to practice in the search for a relationist perspective that understands hybrid space as emerging from a sociomaterial assemblage. In this perspective, learning and teaching involve blurred boundaries and spatiotemporal configurations in a context of radical uncertainty. The paper presents a qualitative study of an ongoing project called Teknosofikum, a course/concept for the professional development of novice higher-education teachers in Denmark. The project addresses the complexity of distributed learning in (post-)pandemic hybrid spaces and times. It aims at generating imaginative pedagogies through the use of technology while also nurturing ontological aspects of the teaching profession. The paper presents and discusses data from the first iteration, which included co-designed processes of prototype content development and a mini-trial with seven course participants. Two key findings about teacher professional development emerge from the study. The first is the need to focus on multiple and situated teaching activities, providing a bridge between learning theories and educational practices. The second is the importance of knowing-in-practice, rather than acquiring knowledge, to create space for imagination in teaching with technologies and face up to the dynamic evolution of higher education.

We Are All Theorists of Technology Now: A Relational Perspective on Emerging Technology and Organizing

Technologies are changing at a rapid pace and in unpredictable ways. The scale of their impact is also far-reaching. Technologies such as artificial intelligence, data analytics, robotics, digital platforms, social media, blockchain, and 3-D printing affect many parts of the organization simultaneously, enabling new interdependencies within and between units and with actors that many organizations have typically considered to be outside their boundaries. Consequently, today’s emerging technologies have the potential to fundamentally shape all aspects of organizing. This article introduces the special issue “Emerging Technologies and Organizing.” We treat these new technologies as “emerging” because their uses and effects are still varied and have yet to stabilize around a recognizable set of patterns and because the technologies themselves are, by design, always changing and adapting. To theorize the relationship between emerging technologies and organizing, we draw on relational thinking in philosophy and sociology to develop a relational perspective on emerging technologies. Our goal in doing so is to create a new way for organizational scholars to incorporate the ever-increasing role of technology in their theorizing of key organizational processes and phenomena. By developing a relational perspective that treats emerging technologies not as stable entities, but as a set of evolving relations, we provide a novel way for organizational scholars to account for the role of technology in their topics of interest. We sketch the outlines of this relational perspective on emerging technologies and discuss the implications it has for what organizational scholars study and how we study it.