Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

A systems approach to describing the process of individual adoption of IT innovations

Research on the adoption of innovations by individuals has been criticized for focusing on various factors that lead to the adoption or rejection of an innovation while ignoring important aspects of the dynamic process that takes place. Theoretical process-based models hypothesize that individuals go through consecutive stages of information gathering and decision making but do not clearly explain the mechanisms that cause an individual to leave one stage and enter the next one. Research on the dynamics of the adoption process have lacked a structurally formal and quantitative description of the process. ^ This dissertation addresses the adoption process of technological innovations from a Systems Theory perspective and assumes that individuals roam through different, not necessarily consecutive, states, determined by the levels of quantifiable state variables. It is proposed that different levels of these state variables determine the state in which potential adopters are. Various events that alter the levels of these variables can cause individuals to migrate into different states. ^ It was believed that Systems Theory could provide the required infrastructure to model the innovation adoption process, particularly applied to information technologies, in a formal, structured fashion. This dissertation assumed that an individual progressing through an adoption process could be considered a system, where the occurrence of different events affect the system's overall behavior and ultimately the adoption outcome. The research effort aimed at identifying the various states of such system and the significant events that could lead the system from one state to another. By mapping these attributes onto an “innovation adoption state space” the adoption process could be fully modeled and used to assess the status, history, and possible outcomes of a specific adoption process. ^ A group of Executive MBA students were observed as they adopted Internet-based technological innovations. The data collected were used to identify clusters in the values of the state variables and consequently define significant system states. Additionally, events were identified across the student sample that systematically moved the system from one state to another. The compilation of identified states and change-related events enabled the definition of an innovation adoption state-space model. ^

Teams leading teams: Examining the role of leadership in multi-team systems

A major challenge of modern teams lies in the coordination of the efforts not just of individuals within a team, but also of teams whose efforts are ultimately entwined with those of other teams. Despite this fact, much of the research on work teams fails to consider the external dependencies that exist in organizational teams and instead focuses on internal or within team processes. Multi-Team Systems Theory is used as a theoretical framework for understanding teams-of-teams organizational forms (Multi-Team Systems; MTS's); and leadership teams are proposed as one remedy that enable MTS members to dedicate needed resources to intra-team activities while ensuring effective synchronization of between-team activities. Two functions of leader teams were identified: strategy development and coordination facilitation; and a model was developed delineating the effects of the two leader roles on multi-team cognitions, processes, and performance.^ Three hundred eighty-four undergraduate psychology and business students participated in a laboratory simulation that modeled an MTS; each MTS was comprised of three, two-member teams each performing distinct but interdependent components of an F-22 battle simulation task. Two roles of leader teams supported in the literature were manipulated through training in a 2 (strategy training vs. control) x 2 (coordination training vs. control) design. Multivariate analysis of variance (MANOVA) and mediated regression analysis were used to test the study's hypotheses. ^ Results indicate that both training manipulations produced differences in the effectiveness of the intended form of leader behavior. The enhanced leader strategy training resulted in more accurate (but not more similar) MTS mental models, better inter-team coordination, and higher levels of multi-team (but not component team) performance. Moreover, mental model accuracy fully mediated the relationship between leader strategy and inter-team coordination; and inter-team coordination fully mediated the effect of leader strategy on multi-team performance. Leader coordination training led to better inter-team coordination, but not to higher levels of either team or multi-team performance. Mediated Input-Process-Output (I-P-O) relationships were not supported with leader coordination; rather, leader coordination facilitation and inter-team coordination uniquely contributed to component team and multi-team level performance. The implications of these findings and future research directions are also discussed. ^

Framework for enterprise systems engineering

This research aimed at developing a research framework for the emerging field of enterprise systems engineering (ESE). The framework consists of an ESE definition, an ESE classification scheme, and an ESE process. This study views an enterprise as a system that creates value for its customers. Thus, developing the framework made use of system theory and IDEF methodologies. This study defined ESE as an engineering discipline that develops and applies systems theory and engineering techniques to specification, analysis, design, and implementation of an enterprise for its life cycle. The proposed ESE classification scheme breaks down an enterprise system into four elements. They are work, resources, decision, and information. Each enterprise element is specified with four system facets: strategy, competency, capacity, and structure. Each element-facet combination is subject to the engineering process of specification, analysis, design, and implementation, to achieve its pre-specified performance with respect to cost, time, quality, and benefit to the enterprise. This framework is intended for identifying research voids in the ESE discipline. It also helps to apply engineering and systems tools to this emerging field. It harnesses the relationships among various enterprise aspects and bridges the gap between engineering and management practices in an enterprise. The proposed ESE process is generic. It consists of a hierarchy of engineering activities presented in an IDEF0 model. Each activity is defined with its input, output, constraints, and mechanisms. The output of an ESE effort can be a partial or whole enterprise system design for its physical, managerial, and/or informational layers. The proposed ESE process is applicable to a new enterprise system design or an engineering change in an existing system. The long-term goal of this study aims at development of a scientific foundation for ESE research and development.

Framework for Enterprise Systems Engineering

This research aimed at developing a research framework for the emerging field of enterprise systems engineering (ESE). The framework consists of an ESE definition, an ESE classification scheme, and an ESE process. This study views an enterprise as a system that creates value for its customers. Thus, developing the framework made use of system theory and IDEF methodologies. This study defined ESE as an engineering discipline that develops and applies systems theory and engineering techniques to specification, analysis, design, and implementation of an enterprise for its life cycle. The proposed ESE classification scheme breaks down an enterprise system into four elements. They are work, resources, decision, and information. Each enterprise element is specified with four system facets: strategy, competency, capacity, and structure. Each element-facet combination is subject to the engineering process of specification, analysis, design, and implementation, to achieve its pre-specified performance with respect to cost, time, quality, and benefit to the enterprise. This framework is intended for identifying research voids in the ESE discipline. It also helps to apply engineering and systems tools to this emerging field. It harnesses the relationships among various enterprise aspects and bridges the gap between engineering and management practices in an enterprise. The proposed ESE process is generic. It consists of a hierarchy of engineering activities presented in an IDEF0 model. Each activity is defined with its input, output, constraints, and mechanisms. The output of an ESE effort can be a partial or whole enterprise system design for its physical, managerial, and/or informational layers. The proposed ESE process is applicable to a new enterprise system design or an engineering change in an existing system. The long-term goal of this study aims at development of a scientific foundation for ESE research and development.

Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

Towards the formation of a sustainable South Florida: An analysis of conflict resolution and consensus building in the South Florida Everglades Ecosystem Restoration Initiative

This dissertation examines the sociological process of conflict resolution and consensus building in South Florida Everglades Ecosystem Restoration through what I define as a Network Management Coordinative Interstitial Group (NetMIG). The process of conflict resolution can be summarized as the participation of interested and affected parties (stakeholders) in a forum of negotiation. I study the case of the Governor's Commission for a Sustainable South Florida (GCSSF) that was established to reduce social conflict. Such conflict originated from environmental disputes about the Everglades and was manifested in the form of gridlock among regulatory (government) agencies, Indian tribes, as well as agricultural, environmental conservationist and urban development interests. The purpose of the participatory forum is to reduce conflicts of interest and to achieve consensus, with the ultimate goal of restoration of the original Everglades ecosystem, while cultivating the economic and cultural bases of the communities in the area. Further, the forum aim to formulate consensus through envisioning a common sustainable community by providing means to achieve a balance between human and natural systems. ^ Data were gathered using participant observation and document analysis techniques to conduct a theoretically based analysis of the role of the Network Management Coordinative Interstitial Group (NetMIG). I use conflict resolution theory, environmental conflict theory, stakeholder analysis, systems theory, differentiation and social change theory, and strategic management and planning theory. ^ The purpose of this study is to substantiate the role of the Governor's Commission for a Sustainable South Florida (GCSSF) as a consortium of organizations in an effort to resolve conflict rather than an ethnographic study of this organization. Environmental restoration of the Everglades is a vehicle for recognizing the significance of a Network Management Coordinative Interstitial Group (NetMIG), namely the Governor's Commission for a Sustainable South Florida (GCSSF), as a structural mechanism for stakeholder participation in the process of social conflict resolution through the creation of new cultural paradigms for a sustainable community. ^

The Ghana National Service Scheme: Perceptions of former educational personnel, students and guardians

The purpose of this inquiry was to investigate the perceptions of former service personnel, students and their parents about the organizational effectiveness of the Ghana National Service Scheme (GNSS). The inquiry addressed the following questions: How do the participants perceive the effectiveness of the national service program on the Ghanaian society? What are the perceptions of school administrators who worked with service personnel, parents and students vis-à-vis the over all impact of the GNSS on the educational system? What are the perceptions of former service personnel, students and their parents in regard to the impact of the GNSS on them? ^ The GNSS is a part within the ministry of education, which is also part in the Ghanaian social structure. Hence, a systems theory approach which asks, “How and why a system as a whole functions as it does” (Patton, 1990), was utilized in the study. Methodologies included purposive sampling; interviews; participant observation, and follow-up interviews. The study was conducted over a six-moth period. ^ A cross-sectional survey design was used to generate data. The survey was followed up with an ethnographic study where in-depth, face-to-face interviews were conducted together with observations. The results were described and interpreted. ^ The summary of findings concludes that perceptional determinants of the effectiveness of the GNSS were biased by the age and zone of origin but not gender. This partially agrees with Marenin's (1990) except for gender. A significant difference was detected between the responses of those who were officials of the National service Secretariat and of former service personnel. The administrators defended the status quo and demonstrated their deeper knowledge about the scheme. The former personnel and parents freely criticized the program when necessary and did not seem to know much about the GNSS. Respondents mostly stressed the need for the secretariat to focus on the following areas: (1) involvement in the agricultural sector of the economy, (2) involvement in rural mass, civic and health education, (3) adequacy of remuneration and personnel welfare, and (4) ensuring posting of personnel to areas of their expertise. Recommendation for further research concluded the study. ^

A Case Study of the Ellison Model's Use of Mentoring as an Approach Toward Inclusive Community Building

The Ellison Executive Mentoring Inclusive Community Building (ICB) Model is a paradigm for initiating and implementing projects utilizing executives and professionals from a variety of fields and industries, university students, and pre-college students. The model emphasizes adherence to ethical values and promotes inclusiveness in community development. It is a hierarchical model in which actors in each succeeding level of operation serve as mentors to the next. Through a three-step process--content, process, and product--participants must be trained with this mentoring and apprenticeship paradigm in conflict resolution, and they receive sensitivitiy and diversity training, through an interactive and dramatic exposition. The content phase introduces participants to the model's philosophy, ethics, values and methods of operation. The process used to teach and reinforce its precepts is the mentoring and apprenticeship activities and projects in which the participants engage and whose end product demontrates their knowledge and understanding of the model's concepts. This study sought to ascertain from the participants' perspectives whether the model's mentoring approach is an effective means of fostering inclusiveness, based upon their own experiences in using it. The research utilized a qualitative approach and included data from field observations, individual and group interviews, and written accounts of participants' attitudes. Participants complete ICB projects utilizing the Ellison Model as a method of development and implementation. They generally perceive that the model is a viable tool for dealing with diversity issues whether at work, at school, or at home. The projects are also instructional in that whether participants are mentored or seve as apprentices, they gain useful skills and knowledge about their careers. Since the model is relatively new, there is ample room for research in a variety of areas including organizational studies to dertmine its effectiveness in combating problems related to various kinds of discrimination.