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Disrupted routines: Team learning and new technology implementation in hospitals

Administrative Science Quarterly, Dec, 2001 by Amy C. Edmondson, Richard M. Bohmer, Gary P. Pisano

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Adopting new technologies is essential to sustained competitiveness for many organizations. In both manufacturing and service industries, new technology can lead to product and process improvements that produce tangible market advantages--but these advantages can be elusive. Failure to adopt innovations, even those with demonstrable benefits, is commonplace (Kimberly and Evanisko, 1981; Tushman and Anderson, 1986; Henderson and clark, 1990). Organizations have been depicted as blind to the existence or advantage of external innovations (March and Simon, 1958), trapped by current competencies (Levitt and March, 1988) or business models (Christensen, 1997), paralyzed by core rigidities (Leonard-Barton, 1992), and handicapped by a lack of relevant expertise (cohen and Levinthal, 1990)--all leading to a failure to adopt external innovations. Further contributing to the challenge of new technology adoption, organizational routines, which characterize much of an organization's ongoing activity, reinforce the status quo (Nelson and Winter, 1982; Levitt and March, 1988). Organizations develop routines around the use of existing technologies, giving rise to a self-reinforcing cycle of stability (Orlikowski, 2000). Similarly, routines in task-performing groups tend to persist, even in the face of external stimuli that explicitly require a new course of action (Gersick and Hackman, 1990; McGrath, Kelly, and Machatka, 1984). Routines are thus thought to provide a source of resistance to organizational change, and the process through which organizations and managers alter routines remains underexplained in the technology and organization literatures.

Technology researchers point to both organizational and technological features that thwart adoption of innovations. The timing of adoption decisions thus tends to vary within an industry (Rogers, 1980; Baldridge and Burnham, 1975). An organization's history of innovation and the sophistication of its own research activities build absorptive capacity (Cohen and Levinthal, 1990) and the ability to recognize the significance of external innovations (lansiti and Clark, 1994), leading to a greater proclivity to adopt new technologies. Organizational size and resources promote adoption of new technology (Kimberly and Evanisko, 1981), as does senior management support (Yin, 1977). Finally, certain technologies themselves present barriers to adoption; for example, architectural innovations--those with familiar components but new configurations--are often initially misunderstood (Henderson and Clark, 1990).

Following an organization's decision to adopt a technology, users' perceptions and managers' attitudes affect their willingness to use it, which affects implementation success (Leonard-Barton and Deschamps, 1988). Successful implementation has been defined as the incorporation or routine use of a technology on an ongoing basis in an organization (Yin, 1977; Szulanski, 2000). Many studies emphasize the need for organizations to adapt for a new technology to be effectively used (Barley, 1986; Attewell, 1992; Orlikowski, 1993, 2000; Szulanski, 2000). Leonard-Barton (1988) described a need for mutual adaptation by both organizations and technologies. For many technologies, new knowledge must be transferred to enable use--not just technical knowledge but social knowledge about who knows what (Attewell, 1992; Moreland, 1999). Also, technology adoption occurs in stages, presenting different hurdles to adoption over time (Szulanski, 2000). Evidence from a range of studies thus suggests that adopting new technologies in organizations is difficult. Less attention has been paid to understanding the process through which new behaviors and organizational routines are developed when technologies are implemented, a gap this study seeks to address by examining the collective learning process that takes place among interdependent users of a new technology during implementation.

We take the perspective that when a new technology disrupts existing work routines, the adopting organization must go through a learning process, making cognitive, interpersonal, and organizational adjustments that allow new routines to become ongoing practice. In contrast to previous research that emphasizes organizational characteristics, we focus on those directly responsible for implementation--the teams that initially use, communicate beliefs about, and transfer practices related to a new technology. A qualitative study of 16 hospitals that made the decision to adopt an innovative technology for cardiac surgery is used to explore the implementation process and to propose a process model for establishing new routines.

CHANGING ORGANIZATIONAL ROUTINES FOR NEW TECHNOLOGIES

Organizational routines refer to the repeated patterns of behavior bound by rules and customs that characterize much of an organization's ongoing activity (Cyert and March, 1963; Nelson and Winter, 1982). Gersick and Hackman (1990: 69) defined a habitual routine as "a functionally similar pattern of behavior [used] in a given stimulus situation without explicitly selecting it over alternative ways of behaving." The design of a technology often reinforces a habitual routine; for example, the design of a commercial aircraft's cockpit is conducive to certain standard operating procedures for takeoff and landing. The strength of this correspondence can lull teams into executing well-known routines even when external stimuli vary. For example, accustomed to uniformly warm weather, an Air Florida pilot automatically responded in the affirmative to his team member's routine question, "Anti-ice off?" despite the heavy snowfall at Washington, D.C.'s National Airport during the January 1982 takeoff. Tragically, this in appropriate adherence to routine led to the flight's crashing into a bridge over the Potomac River, killing all 74 crew members and passengers (Gersick and Hackman, 1990). The tendency to invoke familiar, routine sequences of behavior in situations in which they are no longer appropriate is well established in the psychology literature (Weick, 1979; Gersick and Hackman, 1990) and has been implicated as a cause of medical and other error (Reason, 1984).

Business Services Industry

Disrupted routines: Team learning and new technology implementation in hospitals

Administrative Science Quarterly, Dec, 2001 by Amy C. Edmondson, Richard M. Bohmer, Gary P. Pisano

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