Justifying health IT investments: A process model of framing practices and reputational value
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
References (78)
- et al.
Pushing the contextual envelope: Developing and diffusing IS theory for health information systems research
Information and Organization
(2004) Media reputation as a strategic resource: An integration of mass communication and resource-based theories
Journal of Management
(2000)- et al.
Materiality and change: Challenges to building better theory about technology and organizing
Information and Organization
(2008) Till data do us part: Understanding data-based value creation in data-intensive infrastructures
Information and Organization
(2017)- et al.
The digital transformation of healthcare: Current status and the road ahead
Information Systems Research
(2010) - et al.
Building Intangible Resources: The Stickiness of Reputation
Corporate Reputation Review
(2009) - et al.
Social contagion and information technology diffusion: The adoption of electronic medical records in U.S. hospitals
Management Science
(2010) - et al.
The impact of health information sharing on duplicate testing
MIS Quarterly
(2017) Editor's introduction
Firm resources and sustained competitive advantage
Journal of Management
(1991)
A rhetorical approach to IT diffusion: reconceptualizing the ideology-framing relationship in computerization movements
MIS Quarterly
Creating value in online communities: The sociomaterial configuring of strategy, platform, and stakeholder engagement
Information Systems Research
Object lessons: Workplace artifacts as representations of occupational jurisdiction
American Journal of Sociology
Framing processes and social movements: An overview and assessment
Annual Review of Sociology
Calculators, lemmings or frame-makers? The intermediary role of securities analysts
The Sociological Review
Toward a theory of social judgments of organizations: The case of legitimacy, reputation, and status
Academy of Management Review
On justification: Economies of worth
Reputational spillovers: Evidence from French architecture
Strategic Organization
Performativity, misfires and politics
Journal of Cultural Economy
A pragmatic view of knowledge and boundaries: Boundary objects in new product development
Organization Science
“Tough talk” and “soothing speech”: Managing reputations for being tough and for being good
Corporate Reputation Review
Constructing grounded theory: A practical guide through qualitative analysis
Institutional isomorphism and change: The national programme for IT–10 years on
Journal of Information Technology
Conflicting institutional logics: A national programme for IT in the organisational field of healthcare
Journal of Information Technology
Technology frames and framing: A socio-cognitive investigation of requirements determination
MIS Quarterly
A technological frames perspective on information technology and organizational change
The Journal of Applied Behavioral Science
The interaction of institutionally triggered and technology-triggered social structure change: An investigation of computerized physician order entry
MIS Quarterly
Electronic health records' limited successes suggest more targeted uses
Health Affairs
Performance impacts of information technology: Is actual usage the missing link?
Management Science
What is agency?
American Journal of Sociology
Theorizing practice and practicing theory
Organization Science
What's in a name? Reputation building and corporate strategy
The Academy of Management Journal
Reputation: Realizing value from the corporate image
Fame & fortune: How successful companies build winning reputations
Performativity as ongoing journeys: Implications for strategy, entrepreneurship, and innovation
Long Range Planning
Composing qualitative research
Cocreating IT value: New capabilities and metrics for multifirm environments
MIS Quarterly
The strategic analysis of intangible resources
Strategic Management Journal
Computerization movements: The rise of the internet and distant forms of work
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