Justifying health IT investments: A process model of framing practices and reputational value

https://doi.org/10.1016/j.infoandorg.2018.10.003Get rights and content

Highlights

  • We study how practitioners at two hospital organizations facing different reputational circumstances justified IT investments.

  • We develop a performative framing framework to unpack how temporal practices enact reputational value possibilities.

  • We demonstrate how reputational value is performed differently, through the ongoing process of justifying HIT investments.

  • We contribute a process model of framing practices and reputational value oriented towards the past, present and future.

Abstract

Despite important research contributions on the financial and operational dimensions of information technology (IT) value, justifying health IT (HIT) investments remains a difficult and enduring issue for IT managers. Recent work has expanded our understanding of HIT value, by focusing on the initial resource allocation stage, and through conceptualizations of value across multiple dimensions. Building on these developments, we adopt a performative perspective to examine the research question of how practitioners justify early stage HIT investments, with a focus on reputational value. We explored this question through a comparative field study of two hospital organizations in the English National Health Service (NHS). We found that practitioners' temporally orientated framing practices matter in justifying HIT investments, enacting different possibilities for reputational value. We develop a process model to explain these dynamics and highlight the mutability of reputational value, which can lead to different possibilities for restoring, enhancing, or maintaining reputation. We conclude by discussing the implications for justifying HIT investments.

Introduction

For more than two decades, information technology (IT) value research has made important contributions to a fundamental topic in our field, namely how organizations justify and create value from IT investments (Kohli & Grover, 2008). The dominant and enduring stream of literature in this domain has focused primarily on justifying value through a one-off and largely static outcome, by explicating and measuring operational and financial value dimensions of IT (Melville, Kraemer, & Gurbaxani, 2004). Further, the approach taken has been predominantly to assess the value of IT investments post hoc - in other words, after the investments have been made. In healthcare this is problematic as practitioners have historically faced great pressures in justifying health IT (HIT) investments, where institutional pressures are at work. For example, research in the UK's National Health Service (NHS) has highlighted institutional pressures associated with the introduction of a national program for IT between 2002 and 2012 in the UK's NHS (Currie, 2012; Currie & Guah, 2007; Mark, 2007). While there are indications that HIT investments pay off (Ayabakan, Bardhan, & Zheng, 2017; Lin, Chen, Brown, Li, & Yang, 2017) this is neither certain (Chiasson & Davidson, 2004) nor short-term (Schryen, 2013), thus making HIT investments hard to justify and to appropriately assess.

Recent work has emphasized the need to expand our understanding of the HIT investment process by focusing on the initial resource allocation stage (Salge, Kohli, & Barrett, 2015) and by exploring and the multidimensional nature of IT value (Barrett, Oborn, & Orlikowski, 2016; Tempini, 2017) as an important complement to the dominant view of value. In particular, relating economic and operational notions of value to other dimensions has formed a stronger basis for understanding the importance of value as a concept (Stark, 2009). We know, for example, that HIT investments can provide multiple forms of value for different stakeholders, such as reputational, epistemic and platform value among others (Barrett et al., 2016) and that these develop in a nonlinear and contingent trajectory (Tempini, 2017). Yet, while these studies have provided important contributions, by examining how HIT investments provide opportunities for value creation along multiple dimensions, our understanding of how investments are justified in practice during the allocation stage is largely an incomplete task. The purpose of this paper is therefore to respond to a call for a broader HIT research agenda that moves beyond examining operational and financial performance post-hoc, towards exploring how HIT investments can enhance social goals, such as reputation – an intangible asset reflecting multidimensional evaluations held among stakeholders (Ravasi, Rindova, Etter, & Cornelissen, 2018), at the allocation stage (Salge et al., 2015). Healthcare practitioners are justifying HIT investments for reputational value that arises from the general social approval of various stakeholder groups (Rindova, Williamson, Petkova, & Sever, 2005), which in turn can influence operating autonomy, access to financial resources, and help in securing future patient referrals (Scott, Ruef, Mendel, & Caronna, 2000). For these reasons, we shift to a proactive approach to examine how healthcare practitioners are framing and evaluating HIT investments with a broader social focus on reputational value. We therefore examine the research question how do practitioners justify HIT investments, and how are these justifications consequential for enacting reputational value?

To address our research question, we present findings of two case studies at hospital organizations facing different reputational circumstances. The first hospital provided the opportunity of studying how practitioners were restoring reputation with HIT, following a regulatory inspection failure. In contrast, the second hospital enjoys a leading reputation both nationally and internationally for high quality patient care, which practitioners were aiming to reproduce and enhance going forward. Our paper makes two key contributions. First, we develop a process model that unpacks how practitioners justify HIT investments through framing practices. Responding to Davidson's (2006) call, we develop a performative perspective on framing practices, by which justification of HIT investments is accomplished. We find that temporally oriented framing practices in terms of time horizon (short or long term) and value seeking approach (reactive or proactive), enact different possibilities for reputational value. We conceptualize framing practices as performative in that they involve both the creation and emergence of different aspects of value, informed by the past, but also oriented towards the future and the present. Second, we highlight how the justifying of HIT investments is an ongoing process which enacts reputational value that is nevertheless mutable over time, with implications for how reputation is restored, enhanced, or maintained. In the following section, we review different perspectives on justifying IT investments, such as the initial IT allocation stage, and motivate our theoretical and empirical focus on reputational value. This is followed by our theoretical basis which develops a performative HIT value perspective.

Section snippets

Examining the initial IT allocation stage

There is considerable literature in general IT and HIT (Grover & Kohli, 2012; Kohli & Devaraj, 2003; Melville et al., 2004) that focuses on the importance of examining the process of investing in IT. Scholars have examined, for example, IT adoption (Agarwal, Gao, DesRoches, & Jha, 2010; Jha et al., 2009), IT usage (Devaraj & Kohli, 2003; Melville et al., 2004), and IT value appropriation (Davidson & Chismar, 2007; Oborn, Barrett, & Davidson, 2011), thereby justifying the value of IT

Theoretical framework: towards a performative perspective of framing HIT investments

We devise a theoretical framework that conceptualizes HIT value as performed through framing practices. As such, in examining how HIT investments are justified, we pay attention to the way in which justifications are accomplished, and how HIT value is constituted through framing practices. We identify the practices that are constitutive of, and implicated in, performing shared understandings of justifying HIT investments. In so doing, we conceptualize the phenomenon of value as fluid and

Methods and data sources

We followed an inductive research design and adopted an interpretive approach (Golden-Biddle & Locke, 2007; Walsham, 2006), starting from an interest in how organizational participants engaged in framing practices when justifying HIT reputational value. Informed by a process approach (Langley, 1999), we collected data at two different hospitals, which are both members of a common health group we call Alpha Health Partners (AHP).

Findings and analysis

We present our findings for each case separately. We begin by describing the circumstances facing each of our hospital organizations, which are consequential for the temporally oriented framing practices performed by the senior managers and practitioners. We then show how framing practices at AHP1 and AHP2 were used in performing different justifications of HIT reputational value. Finally, drawing on these empirical findings across our cases, we conclude our empirical analysis by synthesizing

Discussion

In this paper, we have addressed the question of how healthcare practitioners enacted framing practices for justifying HIT value, with a focus on reputational value. Through a cross-comparative case study, our study elaborates theory on the role of temporally oriented framing practices which perform multiple justifications of HIT reputational value, leading to different possibilities by which reputation is restored, enhanced or maintained. Our analysis suggests a re-orientation of value, from

Conclusion

In this paper, we studied how practitioners justified HIT investment at two UK hospitals, with a focus on reputational value. We have developed a process model of framing practices and reputational value, which provides an understanding of the dynamic way in which reputational value is performed through the ongoing process of justifying HIT investments, which is influenced by the temporal orientation of individuals' framing practices. Further, our study provides an enhanced appreciation of

Funding

Stavros was supported by a scholarship from the Economic and Social Research Council (Grant Number: 1491536). Eivor Oborn was supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands. This paper presents independent research and the views expressed are those of the authors and not necessarily those of the funders the NIHR.

Acknowledgments

The paper has benefited from the constructive feedback of audiences at the Cambridge Judge Business School Paper Development Sessions and the Workshop on Organizing for Digital Innovation at KIN, Vrije University in Amsterdam. A previous version of the paper was included in the best paper proceedings of the AOM in 2016 at the 76th Academy of Management Annual Meeting. We want to especially thank Karla Sayegh for her insightful comments and support. We would also like to thank the editorial team

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