Academic Detailing as a Health Information Technology Implementation Method: Supporting the Design and Implementation of an Emergency Department-Based Clinical Decision Support Tool to Prevent Future Falls

BACKGROUND

Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians' expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing-personal visits to clinicians by an expert in a specific health IT tool-as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool's implementation.

OBJECTIVE

This study aimed to assess academic detailing as a method for simultaneously ensuring the correct understanding of an emergency department-based CDS tool to prevent future falls and identifying factors impacting clinicians' use of the tool through an analysis of the resultant qualitative data.

METHODS

Previously, our team designed a CDS tool to identify patients aged 65 years and older who are at the highest risk of future falls and prompt an interruptive alert to clinicians, suggesting the patient be referred to a mobility and falls clinic for an evidence-based preventative intervention. We conducted 10-minute academic detailing interviews (n=16) with resident emergency medicine physicians and advanced practice providers who had encountered our CDS tool in practice. We conducted an inductive, team-based content analysis to identify factors that influenced clinicians' use of the CDS tool.

RESULTS

The following categories of factors that impacted clinicians' use of the CDS were identified: (1) aspects of the CDS tool's design (2) clinicians' understanding (or misunderstanding) of the CDS or referral process, (3) the busy nature of the emergency department environment, (4) clinicians' perceptions of the patient and their associated fall risk, and (5) the opacity of the referral process. Additionally, clinician education was done to address any misconceptions about the CDS tool or referral process, for example, demonstrating how simple it is to place a referral via the CDS and clarifying which clinic the referral goes to.

CONCLUSIONS

Our study demonstrates the use of academic detailing for supporting the implementation of health information technologies, allowing us to identify factors that impacted clinicians' use of the CDS while concurrently educating clinicians to ensure the correct understanding of the CDS tool and intervention. Thus, academic detailing can inform both real-time adjustments of a tool's implementation, for example, refinement of the language used to introduce the tool, and larger scale redesign of the CDS tool to better fit the dynamic work environment of clinicians.

Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation

OBJECTIVE

To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED).

BACKGROUND

Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED. We demonstrated high usability of the CDS during scenario-based usability testing. We implemented the HF-based CDS in one ED in December 2018.

METHOD

We conducted a survey of ED physicians to evaluate the usability and use of the HF-based CDS. We distributed the survey via Qualtrics, a web-based survey platform. We compared the computer system usability questionnaire scores of the CDS between those collected in the usability testing to use of the CDS in the real environment. We asked physicians about their acceptance and use of the CDS, barriers to using the CDS, and areas for improvement.

RESULTS

Forty-seven physicians (56%) completed the survey. Physicians agreed that diagnosing PE is a major problem and risk scores can support the PE diagnostic process. Usability of the CDS was reported as high, both in the experimental setting and the real clinical setting. However, use of the CDS was low. We identified several barriers to the CDS use in the clinical environment, in particular a lack of workflow integration.

CONCLUSION

Design of CDS should be a continuous process and focus on the technology's usability in the context of the broad work system and clinician workflow.

Interpreting technology: Use and non-use of doctor-patient video consultations in Danish general practice

This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice.

Defining re-implementation

BACKGROUND

The first attempt to implement a new tool or practice does not always lead to the desired outcome. Re-implementation, which we define as the systematic process of reintroducing an intervention in the same environment, often with some degree of modification, offers another chance at implementation with the opportunity to address failures, modify, and ultimately achieve the desired outcomes. This article proposes a definition and taxonomy for re-implementation informed by case examples in the literature.

MAIN BODY

We conducted a scoping review of the literature for cases that describe re-implementation in concept or practice. We used an iterative process to identify our search terms, pilot testing synonyms or phrases related to re-implementation. We searched PubMed and CINAHL, including articles that described implementing an intervention in the same environment where it had already been implemented. We excluded articles that were policy-focused or described incremental changes as part of a rapid learning cycle, efforts to spread, or a stalled implementation. We assessed for commonalities among cases and conducted a thematic analysis on the circumstance in which re-implementation occurred. A total of 15 articles representing 11 distinct cases met our inclusion criteria. We identified three types of circumstances where re-implementation occurs: (1) failed implementation, where the intervention is appropriate, but the implementation process is ineffective, failing to result in the intended changes; (2) flawed intervention, where modifications to the intervention itself are required either because the tool or process is ineffective or requires tailoring to the needs and/or context of the setting where it is used; and (3) unsustained intervention, where the initially successful implementation of an intervention fails to be sustained. These three circumstances often co-exist; however, there are unique considerations and strategies for each type that can be applied to re-implementation.

CONCLUSIONS

Re-implementation occurs in implementation practice but has not been consistently labeled or described in the literature. Defining and describing re-implementation offers a framework for implementation practitioners embarking on a re-implementation effort and a starting point for further research to bridge the gap between practice and science into this unexplored part of implementation.

Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

“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.

Temporal contexts and actors vis-a-vis I-deals' timing and creation: Evidence from Nigeria

I-deals (that is, personalised, non-standard employment arrangements negotiated between employees and their employers) arise at different stages of the employment lifecycle. I-deals can vary by timing, such as those created before hire (ex-ante) versus after hire (ex-post). However, scholars have not fully considered the impact of the temporal context (environmental, social, economic, individual) on I-deals or how a range of organisational actors may respond to enabling/constraining conditions when creating I-deals. Our paper focuses on the under-explored issue of I-deals’ timing by applying the theoretical lens of institutional entrepreneurship (IE). Key IE concepts enable a more critical understanding of broader temporal context impacts and the role of various actors (I-dealers, organisational agents) in creating I-deals. Drawing on a multicase study of 3 Nigerian organisations (62 semi-structured interviews, including fieldnotes and organisation-specific documents), our data revealed that field-level conditions and actors’ social positions interact to highlight (i) several distinctive temporal contexts, (ii) with differential impacts on I-deals’ timing and subsequently (iii) organisational actors adopting a range of tactics in response to enabling/constraining conditions. Based on these findings, we offer a theoretical model that reconceptualises I-deals’ timing by specifically focusing on the invisible concept of time. Finally, we discuss our study’s implications for I-deal research and offer future research directions and recommendations for practice.

Being ethically resilient during COVID-19: a cross-sectional study of Indian supply chain companies

Purpose

The present study aims to examine the relationship between techno-ethical orientation and ethical decision-making (EDM) in Indian supply chain companies during the COVID-19 pandemic. It also aims to explore the moderating role of technological frames (TF) in the relationship between techno-ethical orientation and EDM.

Design/methodology/approach

The relationship between techno-ethical orientation and EDM is examined using correlation and regression analysis. The moderating effect of five dimensions of TFs (personal attitude, application value, organisational influence, supervisor influence and industry influence) is analysed using structural equation modelling.

Findings

The correlation coefficient between techno-ethical orientation and EDM is 0.513. Also, the regression coefficient (β = 0.213) is significant at 0.05, establishing a positive linkage between the two. R-square values showed a 45.2% variation in EDM is explained by techno-ethical orientation. Similarly, all variables of TFs have a positive and significant moderating effect on the relationship between techno-ethical orientation and EDM.

Originality/value

This is one of the pioneer studies exploring techno-ethical orientation’s impact on EDM in supply chain companies.

Time is of the essence: a systematic literature review of temporality in information systems development research

Purpose

The purpose of this paper is to identify, classify and analyse temporality in information systems development (ISD) literature.

Design/methodology/approach

The authors address the temporality and ISD research gap by using a framework – which classifies time into three categories: conceptions of time, mapping activities to time and actors relating to time. The authors conduct a systematic literature review which investigates time in ISD within the Senior Scholars' Basket, Information Technology & People (IT&P), and top two information systems conferences over the past 20 years. The search strategy resulted in 9,850 studies of which 47 were identified as primary papers.

Findings

The results reveal that ISD research is ill equipped for contemporary thinking around time. This systematic literature review (SLR) contributes to ISD by finding the following gaps in the literature: (1) clock time is dominant and all other types of time are under-researched; (2) contributions to mapping activities to time is lacking and existing studies focus on single ISD projects rather multiple complex ISD projects; (3) research on actors relating to time is lacking; (4) existing ISD studies which contribute to temporal characteristics are fragmented and lack integration with other categories of time and (5) ISD methodology papers lack contributions to temporal characteristics and fail to acknowledge and contribute to time as a multifaceted interrelated concept.

Originality/value

This work has developed the first SLR on temporality in ISD. This study provides a starting point for ISD researchers and ISD practitioners to test commonly held temporal assumptions of ISD researchers and practitioners.

What are patients' first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19

OBJECTIVE

To explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19.

DESIGN

A qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis.

SETTING

Capital and Southern Regions of Denmark.

PARTICIPANTS

27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power.

RESULTS

Three overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being 'better than nothing' given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology 'would work' and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to 'knowing the GP' and 'feeling seen and heard'. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19.

CONCLUSIONS

Our findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice.

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.

Not everything is as it seems: Digital technology affordance, pandemic control, and the mediating role of sociomaterial arrangements

An overly favorable narrative has developed around the role played by digital technologies in containing Covid-19, which oversimplifies the complexity of technology adoption. This narrative takes sociomaterial arrangements for granted and conceptualizes technology affordance - the problem-solving capability of a technology - as a standard built-in feature that automatically activates during technology deployment, leading to undiversified and predetermined collective benefits. This paper demonstrates that not everything is as it seems; implementing a technology is a necessary but insufficient condition for triggering its potential problem-solving capability. The potential affordance and effects of a technology are mediated by the sociomaterial arrangements that users assemble to connect their goals to the materiality of technological artifacts and socio-organizational context in which technology deployment takes place. To substantiate this argument and illustrate the mediating role of sociomaterial arrangements, we build on sociomateriality and technology affordance theory, and we present the results of a systematic review of Covid-19 literature in which 2187 documents are examined. The review combines text data mining, co-occurrence pattern recognition, and inductive coding, and it focuses on four digital technologies that public authorities have deployed as virus containment measures: infrared temperature-sensing devices; ICT-based surveillance and contact-tracing systems; bioinformatic tools and applications for laboratory testing; and electronic mass communications media. Reporting on our findings, we add nuances to the academic debate on sociomateriality, technology affordance, and the governance of technology in public health crises. In addition, we provide public authorities with practical recommendations on how to strengthen their approach to digital technology deployment for pandemic control.

Sustaining Effectiveness in Global Teams: The Coevolution of Knowledge Management Activities and Technology Affordances

Despite the dynamic nature of knowledge-related activities and the availability of a variety of communication technologies, many global teams habitually use technology in the same way across activities. However, as teams move through cycles of accumulating, integrating, and implementing knowledge, the purposes for communication technologies change. Current theorizing and empirical work on team knowledge management has yet to develop a dynamic theory that incorporates these changes. By conducting a multiwave, mixed method analysis of 48 global teams, we develop a theory of how global teams sustain effectiveness through technology affordance processes. We found that effective teams are those that recognize cues indicating change is necessary and coevolve a symbiosis between new activities, new purposes for interaction, and new uses of communication technologies. This coevolution of purpose with technology use forms new affordances, which enable the team to move on to new knowledge management activities and sustain effectiveness. Our theory more realistically models the dynamics of staying connected while sharing, combining, and implementing knowledge across the globe.

Understanding change in circulating constructs: collective learning, translation and adaptation

Purpose

This paper compares the research traditions of organizational translation studies and adaptation studies. The purpose of this paper is to identify differences and similarities in how these traditions approach the study of change in adopted constructs, and by doing so, provide a better understanding of each and how they can inform research into the connection between collective learning and the continuous transformation of circulating constructs.

Design/methodology/approach

The paper is conceptual in that it discusses, critiques and compares other authors’ work and thinking. It also has similarities with a literature review in that it draws out the main tendencies of many scholarly contributions from translation and adaptation literatures, respectively.

Findings

Although the paper identifies differences between translation and adaptation literatures concerning their basic assumptions, it also calls for better integration of the insights provided by them. It argues that both are needed to better understand the learning aspects involved in the transformation of circulating constructs.

Originality/value

This paper is the first to compare translation studies with adaptation studies and to call for better integration of these literatures to better understand the change in circulating constructs.

Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

Background

Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings.

Methods

A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches.

Results

This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed.

Conclusions

This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed.

Trial Registration

This review was registered on the PROSPERO database CRD 42016040081 in June 2016.

Reconciling temporal conflicts in innovation ambidexterity: the role of TMT temporal leadership

Purpose

This study aims to extend the temporal perspective on ambidexterity by investigating how and under what conditions top management team (TMT) temporal leadership improves innovation ambidexterity.

Design/methodology/approach

Using a questionnaire survey, data were collected from 165 small- and medium-sized enterprises in China. Ordinary least squares regression models were applied to test the hypotheses.

Findings

The findings show that TMT temporal leadership has a positive effect on innovation ambidexterity and temporal conflict mediates this relationship. Market dynamism and institutional support moderate the indirect effect of TMT temporal leadership on innovation ambidexterity.

Practical implications

Managers wishing to promote exploration and exploitation simultaneously should pay attention to the temporal aspects of their innovation strategy and improve their temporal leadership activities.

Originality/value

This study highlights the temporal conflicts in ambidexterity and clarifies the enabling role of TMT temporal leadership. It contributes new insights to the research on organizational ambidexterity and strategic leadership.

Organizational learning and bureaucracy: an alternative view

Purpose

This paper aims to reconceptualize the relationship between organizational learning and bureaucracy. Although the two are generally considered to be antithetical, this paper shows that, in some organizations, bureaucracy can be functional for organizational learning.

Design/methodology/approach

The central argument is theoretical and builds on two main ideas: firstly, the nature of knowledge creation and organizational learning is conditioned by the organization’s main technological characteristics; and secondly, bureaucracy has a dual nature as an instrument of managerial control and as a vehicle of large-scale collaboration. This study uses examples from process industries as empirical illustrations.

Findings

As products and production systems come to embody deeper and more diverse knowledge, their development takes on an increasingly collaborative character. The need to integrate differentiated knowledge and material artefacts calls for specialization, formalization, centralization and staff roles. Hence, technological complexity drives a bureaucratization of organizational learning.

Research limitations/implications

The core argument is developed with reference to industries where organizational learning involves the accumulation of knowledge, not its periodic replacement associated with technological shifts. Its relevance outside these industries remains to be assessed.

Practical implications

Organizations, whose knowledge creation fits the pattern of creative accumulation, should learn to harness formal structures for large-scale collaboration.

Originality/value

The main thesis runs counter to mainstream perspectives on organizational learning. This paper explores organizational learning in sectors that have received little attention in debates about organizational learning.

Individual adaptive performance in computer-mediated work: a migration perspective

Purpose

In dynamic environments, employees should respond to changing demands carrying out actions to achieve proper knowledge of the information systems (IS) that they use (individual adaptation). However, few studies have investigated the determinants of this behaviour. This study proposes and empirically evaluates a cognitive-attitudinal model grounded in migration theory, which considers push, pull and mooring factors.

Design/methodology/approach

Data collected from ERP users were analysed using partial least squares.

Findings

Coherent with migration theory, the results show that the individual adapts influenced by push factors (dissatisfaction with their current command of the IS), pull factors (expected benefits from improving their command) and mooring factors (attitude to the adaptation process). Also, inertia and cost of adaption impact on attitude.

Research limitations/implications

This study introduces migration theory to the IS literature as a basis for comprehensively explaining adaptation in organisational settings.

Practical implications

The results suggest that management should: exhibit the instrumental benefits of a solid command of the IS; show the current gap in employee knowledge to revert it and, introduce changes to move employees out of their comfort zone to encourage ongoing learning and reduce resistance.

Originality/value

While previous studies have focused on the implementation stage and the emotional factors to explain adaptation, this study intends to bridge this gap by investigating cognitive-attitudinal factors that trigger the intention to adapt in the post-adoption stage. The findings of this study are useful to researchers in adaptation behaviour, and to managers to promote IS learning for their staff.

Technology barriers and strategies in coordinating care for chronically ill patients

Care managers who coordinate care for chronically ill patients in hospitals and outpatient settings use multiple health information technologies for accessing, processing, documenting, and communicating patient-related information. Using a combination of 41 interviews and observations of 15 care managers, we identified a range of technology-related barriers experienced by care managers (total of 163 occurrences). The barriers are related to (lack of) access to information, inadequate information, limited usefulness and usability of the technologies, challenges associated with using multiple health IT, and technical problems. In 43% of the occurrences, care managers describe strategies to deal with the technology barriers; these fit in three categories: nothing/delay (9 occurrences), work-arounds (32 occurrences), and direct action at the individual, team, and organization levels (29 occurrences). Our data show the adaptive capacity of care managers who develop various strategies to deal with technology barriers and are, therefore, able to care for chronically ill patients. This information can be used as input to work system redesigns.

Consumer safety complaints and organizational learning: evidence from the automotive industry

Purpose

The purpose of this paper is to investigate the value of information in consumer safety complaints for organizational learning.

Design/methodology/approach

Empirical analysis of this study uses a novel secondary data set, which is formed by combining complaints data filed with the National Highway Traffic Safety Administration (NHTSA) for potential safety defects, and design change information from 2003 to 2011 model-year vehicles in the USA.

Findings

First, the paper demonstrates the value of information embedded in complaints. Second, in the case of radical product redesigns, owing to the lack of direct applicability of consumer feedback based learning, the impact of learning on product safety is found to be muted, third, the results suggest that the safety complaint rates vary by vehicle classes/categories and, fourth, the findings differ from prior research conclusions on vehicle quality. Prior research finds the debuting car models have the lowest repair rates among all car models produced in a given year, but the current study finds the debuting models to have the highest rates of safety complaints.

Originality/value

Quality management literature rarely examines the safety complaints data (which, unlike other consumer feedbacks, focuses exclusively on the safety hazards due to flaws that result in accidents). This paper fills the gap in literature by linking safety complaints with future product quality and organizational learning.

E-leadership: an empirical study of organizational leaders’ virtual communication adoption

Purpose

Even though e-leadership was broadly defined in 2001 (Avolio et al.), there has been surprisingly little progress (Avolio et al., 2014). In order to make a better progress, the authors recommend dividing the field into four quadrants to facilitate the research focus. It can be divided by e-leadership phases (the adoption of technology phase vs the quality of use of technology phase), as well as the purposes (e-leadership as virtual communication vs e-leadership as management of organizational structures). The paper aims to discuss these issues.

Design/methodology/approach

This study provides a model of e-leadership as communication adoption at the individual level (ECAMi). Structural equation modeling was used to test a previously published model by Van Wart et al. (2017a). The model included select traits and skills (as antecedent conditions), awareness of ICTs, evaluation of ICTs, willingness to expend effort in learning about ICTs, intention to use ICTs, and facilitating conditions.

Findings

The overall model demonstrates a good fit. It can be concluded that the ECAMi represents a valid model for understanding e-leaders’ technological adoption. It is also found that while all select skills and traits are significant – energy, responsibility and analytical skills stand above the others.

Originality/value

To the best of the authors’ knowledge, this represents the first effort to operationalize e-leadership.

Group Resilience: The Place and Meaning of Relational Pauses

Recent scholarship on resilience has shed light on the processes by which organizations absorb strain and maintain functioning in the face of adversity. These theories, however, often focus on the operational impacts of adversity without accounting for the strain it puts on organizational members and their abilities to work effectively together. We apply a relational lens to better understand how adversity, and the anxiety it triggers in people, affects processes of organizational resilience. This conceptual frame enables us to begin uncovering the relational micro-dynamics underlying the absorption of strain. Drawing on group relations theory, we describe two trajectories of intragroup behavior in which strain, in the form of adversity-triggered anxiety, is either acted out or defused. In the brittle trajectory, group members react to anxiety with defensive patterns that leave them vulnerable to effects of adversity. In the resilience trajectory, groups defuse and mitigate adversity-triggered anxiety through a reflective process we call “a relational pause,” ultimately leaving them strengthened and resilient. We elaborate the model by exploring the potential fragility of relational pauses and likely factors that influence groups’ ability and tendency to enact resilience.

NOT SO SIMILAR AFTER ALL: EXPLORING THE DIVERSITY OF STRATEGIC ORIENTATIONS FOR INNOVATION

Innovation has gained growing attention in the strategic management field, and — as a strategic orientation — it has been predominantly considered as a homogenous class of differentiated strategic mindsets. This contribution aims at distinguishing different sub-typologies of innovation strategies and validating their profiles and consistency. It explores approaches discussed in the mainstream literature as well as the possibility that other orientations could exist. A cluster analysis outlines four strategic orientations showing differences in terms of competitive drivers, value creation architectures, outsourcing and alliance policies, and managerial processes. Findings offer scholars and practitioners a better understanding of strategic alternatives in pursuing innovation through the identification of systems of consistency among managerial variables — e.g., configuration of the supply chain — thus fostering uniqueness and sustainability of the competitive advantage, and driving managers’ decision. In particular, what really characterised the different innovation strategies here shown is the way they deal with the value chain structure, meaning a key part of the business model.

Initiating, challenging and improving knowledge in organizational contexts

Purpose

The purpose of this study is to investigate how organizational knowledge interacts with artifacts and what determinants, driving processes and outcomes govern these interactions in organizational contexts.

Design/methodology/approach

A case study is used and data collected is from a US engineering and consulting company.

Findings

Findings suggested three major driving processes specifically initiating, challenging and improving and several related determinants and outcomes that governed the interaction between organizational knowledge and artifacts over time.

Research limitations/implications

This study has limitations related to the nature and dimension of the case selected.

Practical implications

This study provides a means to explain how organizations hold existing knowledge and what determinants, driving processes and outcomes govern the interactions between knowledge and artifacts to assist managerial practices and improve performance.

Originality/value

This paper contributes to the current debate on organizational knowledge and provides some empirical evidence of how knowledge interacts with artifacts in organizational contexts.

Examining information and communication technology (ICT) adoption in SMEs

Purpose

Since the 1980s, a substantial number of theories have contributed extensively to information and communication technology (ICT) adoption. Much of such theories regarded ICT adoption as a one-off action as they specifically focus on factors affecting decision making at one decision point. They tend to play down on the fact that as adoption decision progresses through stages, they are supposedly influenced by the same or different factors. Therefore, the purpose of this paper is to examine the dynamic process of ICT adoption using the concepts of dynamic capabilities.

Design/methodology/approach

This study used qualitative approach to gain in-depth insight into the dynamic and evolutionary process of emerging information and communication technology (EICT) adoption in UK small service SMEs. Unstructured and semi-structured interviews were conducted in two separate rounds with 26 participants drawn from Crunch Online Data Base and Luton Business Directory. The participants were selected from a sample of 65 drawn from extended classification of professional service businesses proposed by Ramsey et al. (2008). They include managers, government agencies, SMEs consultants and IT vendors; and then purposeful random sampling and snowball sampling were used.

Findings

The study developed a framework from the concept of dynamic capabilities and found that using the concept of dynamic capabilities to examine the process of EICT adoption helps to unveil the recursive nature of the process and how the factors vary at both single and multiple stages of adoption.

Research limitations/implications

This study is limited by its focus and other factors. Studying the opinions of small service UK SMEs limits the power of generalizing the identified causal relationships; therefore, extended measures are required on accounts of environmental, cultural, geographical and sectoral differences. While some errors seemed unavoidable when measures appear subjective and prone to common error biases, the study advised on recognizing the over-riding influence of the factor(s) at each stage of the adoption process in order to be proactive in committing resources.

Originality/value

This work focuses on emerging ICT adoption in SMEs from the dynamic and evolutionary process perspective using the concept of dynamic capability. It advances ICT adoption research by developing a framework to depict that ICT is not a one-off event, rather it is dynamic and interactive in nature and factors influencing adoption vary from one stage or the other.

Executive team consensus-based perspective of organization evolution

Purpose

Executive leadership plays a crucial role in initiating, shaping and directing strategic reorientations. But it must somehow mediate between forces of inertia and fundamental changes. This paper aims to address the unresolved paradox: how do executives address these conflicting demands?

Design/methodology/approach

This paper aims to interweave two streams of seminal research in organizational evolution and organizational culture to develop a typology of strategic reorientations. The four types of strategic reorientations are illustrated with the help of published cases and biographies of CEOs, mostly of high visibility international companies such as Heineken, Burger King and Starbucks.

Findings

Combinations of high and low levels of executive team consensus on its external adaptation tasks and on its internal integration tasks provoke four different types of strategic reorientations: chaotic, negotiated, muted and promising.

Research limitations/implications

Until appropriate methods of empirical research can be found to test this framework, one has to rely on some anecdotal support as preliminary and cursory evidence. This study can inform a wide body of research which incorrectly suggested that consensus among executives during strategic reorientation has a unidirectional, positive impact on organizational performance. Directions to explore how top executives may develop ambidextrous leadership are suggested.

Practical implications

Seeking high growth, executive teams must have a good mix of managerial and entrepreneurial cognitions. Therefore, executives having dissimilar skills and backgrounds should be inducted in the team periodically, instead of hiring hurriedly at the eleventh hour. Otherwise, the new executives may contribute too high or too low levels of consensus of each type needed for optimal strategic reorientation.

Social implications

The paper has not attempted this aspect.

Originality/value

This paper contributes a novel framework that combines two streams of seminal research, which, each by itself, would not sufficiently address the unresolved executive paradox.

Grappling with the future: The messiness of pilot implementation in information systems design

Pilot implementation is a method for avoiding unintended consequences of healthcare information systems. This study investigates how learning from pilot implementations is situated, messy, and therefore difficult. We analyze two pilot implementations by means of observation and interviews. In the first pilot implementation, the involved porters saw their improved overview of pending patient transports as an opportunity for more self-organization, but this opportunity hinged on the unclear prospects of extending the system with functionality for the porters to reply to transport requests. In the second pilot implementation, the involved paramedics had to print the data they had entered into the system because it had not yet been integrated with the electronic patient record. This extra work prolonged every dispatch and influenced the paramedics' experience of the entire system. We discuss how pilot implementations, in spite of their realism, leave room for uncertainty about the implications of the new system.

Fits and misfits of supply chain flexibility to environmental uncertainty

Purpose

The purpose of this paper is to compare the effects on performance of two types of misfits (overfit vs underfit) as well as two types of fits (high-high fit vs low-low fit) between environmental uncertainty and supply chain flexibility.

Design/methodology/approach

The two asymmetry hypotheses have been tested with survey data from 212 Chinese manufacturing firms.

Findings

The results in general provided empirical evidences for the asymmetric effects in the fits and misfits between environmental uncertainty and supply chain flexibility. For the same degree of misfit, underfit deteriorates performance more than overfit. In addition, high supply chain flexibility fitting high environmental uncertainty (i.e. high-high fit) results in a higher performance than low supply chain flexibility fitting low environmental uncertainty (i.e. low-low fit).

Practical implications

It suggests that managers should strive to avoid the underfit of supply chain flexibility rather than the overfit, if the perfect fit is impossible to achieve. In addition, as it is beneficial to realize the fit of supply chain flexibility to high levels of environmental uncertainty, managers should probably embrace the highly uncertain environment and enhance the supply chain flexibility of their organizations to meet the increasing uncertainty of environment.

Originality/value

Fit and misfit are the core concepts to understand the relationships among environmental uncertainty, supply chain flexibility strategy, and performance. While the existing literature highlights the differential performance consequences of fit vs misfit between environmental uncertainty and supply chain flexibility strategy, the effects on performance are assumed to be the same for the two types of misfits, and two types of fits. The authors challenge these symmetry assumptions by arguing that overfit has a less negative effect on performance than underfit, and high-high fit has a stronger positive effect than low-low fit. The authors found empirical evidence in a large sample of Chinese manufacturing firms.

The Future, Disposable Organizations and the Rigidities of Imagination

Predictions of the future of organizations are variations on a theme of fantasy: reliably incorrect and usefully seductive. To illustrate a few general points about the role of imagination in human existence, some predictions about the future of organizations are developed from an interpretation of the environments that will shape organizational survival. The predictions emphasize the adaptiveness of populations of rigid, disposable organizations as well as some of the problems of sustaining rigidity. Imaginations of the future are portrayed as instruments of the organizational obstinacy required by such an adaptive system. Mention is made of one or two of the consequences of robbing fantasy of its innocence in this way.