Co-Creators of Scope of Action : An exploration of the dynamic relationship between people, IT, and work in a nursing context

Abstract: Information Technology (IT) is today widespread in our work places, in our spare time and in our society overall. Implementations of IT in organizations come with high expectations on effectiveness, revenue, smoother work processes and so on. However, this simplified view on IT ignores the fact that it is the IT usage rather than the IT artifact per se that in the end decides the effect of an implementation of IT. Although the IT artifact certainly has been designed to support certain tasks and processes, the success or failure of the Information System (IS) in the end depends on the individuals' actions, which ultimately depend on their perceptions and interpretations of the IS. Thus, when technology is being implemented and becomes an IS in use, it becomes a part of work, and as such more of a social system than a technological one. The actual result of a design process does not solely consist of things or artifacts, but above all changed action patterns for the users. From this follows that we must consider design of artifacts as something more than merely the constructing of actual objects with functions and properties that are easily measured. Rather, a large part of all design activities has to do with design of conceivable social milieus, not artifacts. Thus, design may be defined as the suggesting and establishing of scope of action. The concept scope of action aims at describing the fact that the design of, and consequently the implementation of, a specific IT artifact always aims at creating a certain scope of action; some actions are made easier, others are made more difficult or even impossible. This scope of action has to some extent been deliberately designed, but these changes may on the other hand also be undesired and not predicted in advance. The complexity of this phenomenon is great and hard to grasp in advance. However, this does not mean that we can allow ourselves to ignore exploring this phenomenon more deeply. On the contrary, with a usage perspective on IS success or failure, scope of action becomes very important. Although the term scope of action may seem a rather intuitive concept, we need more concrete knowledge about its character in order to be able to understand IT usage, both when designing a new IT artifact and when studying or evaluating IT. Thus, our intuitive understanding of the concept needs to be complemented with theory on the ‘constituents’ and effects of this phenomenon. For this purpose, in this thesis nurses’ use of the Electronic Patient record (EPR) is being explored in order to gain an empirically derived understanding of the character of scope of action. The research findings highlight the emergent character of scope of action. It is obvious that an individual’s scope of action is not being created on one occasion, and above all not only by the IT artifact. Various co- creators such as the IT artifact, the usage and the social context create and re-create scope of action. Also, how the individual interprets and understands the IT artifact in IT usage will influence her scope of action. This since sensemaking and learning processes on both a personal and organizational level take place that are co-creators of the individual’s scope of action, at the same time as the individual’s knowledge and previous sensemaking and learning influences her use of the IT artifact. Thus, reasoning, thinking, learning, and the IT artifact co-evolve over time in adaptation and appropriation processes. This means that IT as a mediational means constitutes an important co-creator of scope of action. From this also follows that work integrated learning is an important co- creator of scope of action when using IT in a work setting, at the same time as work integrated learning is being influenced by the individual’s scope of action. Finally, in order to understand how scope of action emerges in use, merely focusing on structures is insufficient. Scope of action emerges as a product of interplay between complex processes involving artifacts, usage and context. This means that the user’s scope of action is co-created by both static structures as well as dynamic processes relating to the IT artifact, the organization, and the work practice. Thus, the IT artifact, and subsequently scope of action, must be must be understood in relation to the multi-aspectual context of which it is a part instead of merely in relation to the properties of the IT artifact per se