Working papers in
Information Systems
BEYOND THE PROJECT? CHALLENGING OUR
CONCEPTUALISATIONS OF ICT-ENABLED CHANGE
PROCESSES
Margunn Aanestad and Miria Grisot
WP 8/2006
Copyright © with the author(s). The content of this material is to be considered preliminary and are not to
be quoted without the author(s)'s permission.
Globally Scalable Information Infrastructures Group
Department of Informatics
University of Oslo
Gaustadalléen 23
P.O.Box 1080 Blindern
N-0316 Oslo
Norway
http://www.ifi.uio.no/forskning/grupper/is/GI
2
Aanestad and Grisot
Copyright © with the author(s). The content of this material is to be considered
preliminary and are not to be quoted without the author(s)'s permission.
Beyond the project? Challenging our conceptualisations of ICT-enabled change
processes
Margunn Aanestad
Miria Grisot
Dept. of informatics
University of Oslo
P.O. Box 1080 Blindern
0316 Oslo
Norway
<margunn@ifi.uio.no>
+47 2285 2410 (phone)
+47 2285 2401 (fax)
Dept. of informatics
University of Oslo
P.O. Box 1080 Blindern
0316 Oslo
Norway
<miriag@ifi.uio.no>
+47 2285 2410 (phone)
+47 2285 2401 (fax)
Abstract:
Information and communication technologies play a crucial role in organisational change
processes, however, the visions and aims are often a far cry from the actual outcomes. We attempt
to contribute to research on the role of IS in organizational change by critically reconsidering our
understandings of such processes. We do this through discussing the notion of the ‘project’,
seeing it as a notion that shapes our understanding in specific and not necessarily adequate ways.
Empirical material drawn from a longitudinal case study at one of Norway’s major hospitals
exemplifies and illustrates the message. We offer examples from a process where the paper-based
information infrastructure was transformed into a digital one, and focus on how this longitudinal
change process ‘overflowed’ the project category. Specifically, we discuss how the real-life
phenomenon differed from a ‘project’ with respect to four dimensions: 1) the time frame of the
change process 2) the scope of the process 3) where agency was located, and 4) how the room for
action was changing. We discuss the ways this process was handled, sustained and steered,
comprising a set of practices and skills not usually in focus within traditional models for project
or change management.
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1.
Introduction
The topic of this paper is the way we conceptualise information and communication technologies
(ICT) and the relations with organisational change. ICT-enabled organizational change initiatives
are often imbued with expectations of improved quality, effectiveness and efficiency of
organisational processes. However, most practitioners also know that actually realising all the
potential benefits is difficult. Failure stories abound, and IS failures has for some time been a
research topic in its own right 1 . Lyytinen and Hirscheim’s survey of the empirical literature
emphasised the complex nature of failures (Lyytinen and Hirscheim 1987). Failures may occur in
different domains: the project may exceed the time or budget constraints, fail to deliver the
requested or required functionality, leading to resistance or non-use from the users, or the
technical performance may be unsatisfactory. However, defining success versus failure is also
related to different stakeholders’ interests. Lyytinen and Robey (1999) describes how
organisations fail to learn and consequently how they learn to fail, and they see the problem to be
that organisations misplace their attention on what and how they should learn. Organisations try
to encapsulate knowledge rather than make sense of their experience. This leads us to ask: Does
the high amount of IS failures point to shortcomings in the ways we understand and handle such
processes?
In this paper we will focus on the notion of the project, which is a widespread and well known
notion since many, if not most software activities are organised as projects. A premise for this
paper is that the notions and concepts we use have an impact on our understanding. We want to
focus on the way the project notion shape how we think complex ICT-related organisational
change projects should be managed. We are particularly interested in technologies that can be
classified as information infrastructures, i.e. large collages of interconnected systems, widely used
for different purposes, either within one organisation (as is the case here) or within an entire
sector or society. Before elaborating on our research aims and theoretical framework, let us
consider the notion of the project more closely.
Most definitions of a project would emphasise its difference to routine work: a project is a unique
and temporary endeavour, it has a life cycle, and it is not a continuous routine activity. Moreover,
it is a complex undertaking, often requiring a team with diverse skills. Project teams are thus
often organised in a temporary matrix structure that cut across the ordinary (routine)
organisational division of labour. Planning is one of the central aspects of project management.
Complex tasks are separated and broken down into manageable subprojects. Subprojects can be
organised as temporally separate phases, or as different parallel subprojects. During the planning
period, goals have to be set, roles and responsibilities must be agreed upon, and schedules must
be defined. Traditionally, project planning was seen as striking the appropriate balance between
the triple constraints of quality (technical performance), time and costs. Recently, other
dimensions have been added to the list of constraints, for instance the project’s scope, the
associated risks, and the cost/benefit ratio. As soon as the project starts, the progress must be
monitored and deviations from the plan must be handled. Both the project’s scope, costs, risks,
schedules, resource use are monitored and controlled. While traditional project management
focused on defining procedures and developing tools to support these control activities, more
recent practices also include an emphasis on issues such as communications, human resources,
and team performance. Increasingly, projects are undertaken in collaborative arrangements
beyond the single organisation, and one stream of project management focus on how to enable
this kind of collaboration to go beyond the often adversarial ways of organising such projects, for
1
There even exists a journal for the study of failures, the International Journal of Failures and
Lessons Learned in Information Technology Management.
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instance through owner-contractor integration (such as the “one team” concept) and models for
sharing gain and loss.
Creating projects is a way to attempt to render the complex reality in understandable and
manageable terms. We question the adequacy of the project approach in handling the real-life
challenges of managing ICT-related processes of organisational change. In the following section
we discuss relevant literature from the IS field on ICT-enabled organisational change and some
resources for critical examination of the project notion. In section three we present details about
the construction of our empirical material. In section four we present descriptions from change
processes in the hospital, followed by a discussion and interpretation of these events and
processes in section five. Finally we conclude by discussing the ways in which the project notion
restricts our perception, and suggest alternative directions for conceptualising such processes.
2.
Information Systems Projects and Control
How we think about the links between technology and organisational change will influence how
we attempt to handle ICT-related organisational change processes. In this section we will review
some central works from within the IS field. While studies of organisational change and learning
are also relevant, we have limited our review to studies that explicitly discusses the role of
information and communication technology in such change processes. Markus and Robey (1988)
discusses three ways of conceptualising the relationship between technology and organisational
change: the technological imperative, the organisational imperative and the emergent perspective.
Within the technological imperative, technology is seen as an exogenous force which has definite
effects and determines changes in organizations, and social actors have little control over its
impact. Consequently, the emphasis within this stream of research is on the selection of
technologies, on identifying which technologies that is expected to give the intended effect in a
certain context. The organizational imperative emphasises human choice and control over
technologies and their consequences. Thus, change take place according to how human actors
design information systems in order to satisfy specific organizational needs. The third perspective
looks at unpredictability as a central factor in organizational change, and states that how change
will evolve can not be predicted a priori, but emerges from the interaction between social actors
and technological features. Consequently, proponents of this view may suggest different
strategies may be used to intervene in the process, such as for instance users’ participation in
system design. Also considering non-anticipation as major assumption in change processes,
Orlikowski (1996) suggest conceptualising organisational change as an ongoing process of
improvisations, played out against a backdrop where there also are plans, rational decisions and
deliberate design. This improvisational model of organisational change is further developed to
encompass different types of changes (anticipated, emergent or opportunity-based) and it is
argued that the management of change should be seen “more as an ongoing improvisation than as
a staged event” (Orlikowski and Hofman, 1997; p.12). Similarly, the concept of drift, introduced
by Ciborra (1996), emphasises the limitations of the top-down, rational control-focused
management techniques. A number of case studies of large-scale, interconnected assemblages of
information systems (called information infrastructures) underscore the impossibility and futility
of applying centralised control in developing and managing these (Ciborra 2000). Information
infrastructures grow slowly from the installed base, from that which is already in place, hence
radical and abrupt changes are rare. Planned change or intervention attempts need to take into
account the inertia of the installed base, and the notion of cultivation is offered as an alternative
way to conceptualise management or governance of such processes.
From different perspectives these studies emphasise how the assumption of control is
problematic. This is exactly where we want to pose a question. If it is the case that the socio-
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technical ensemble escapes our attempts at control and prediction, that it defies our simplistic
causal models, then how may such change processes be governed in an appropriate way? Is the
control-oriented approach of the project appropriate? John Law and Vicky Singleton emphasize
how the accounts we as researchers create are not innocent, but performative; they frame
technology and technological stories in particular ways. They discuss specifically that when using
the notion of project “we tend breath life into a whole set of assumptions which we might think of
as ‘projectness’” (Law and Singleton, 200, p.3). What are these assumptions? Among others Law
and Singleton mention these: projects need centralised control, they move through stages, they
need to be managed, they involve coordinated puzzle-solving, and they should be coordinated and
not fragmented. Their point is that telling and enacting technological stories in this way (or in any
other way) is not just descriptive, it is also an intervention, an action with some effects. This point
is also underscored by Bloomsfield and Vurdubakis, saying that “such representations create a
presence for a particular set of relevant facts, defining their range of possibilities and rendering
them visible to the participants in the organising process (Bloomfield and Vurdubakis, 1997, p.
641) The taken-for-granted representations and practices work as ‘framing devices’ and shapes
the vision. The reason why this is important is the following: Creating presence also creates
absence; parts of the reality is ‘Othered’ (Law, 2004, p.144). It is made silent, irrelevant,
invisible, or uninteresting. We want to examine the ‘project’ notion in this light. What parts of the
complex and messy reality is ‘othered’ and silenced through thinking this way? If organisational
change processes are inherently open-ended and unpredictable, as the ‘emergent’ tradition within
IS research emphasise, is then the project notion’s control-focus sustainable and realistic? When
projects fail, is it the ‘othered’ and neglected parts of reality that ‘strikes back’?
3.
Methodology
Our empirical material has emerged from longitudinal research collaboration between the
Department of Informatics at the University of Oslo and the IT department (currently comprising
around 100 staff) at a major Norwegian hospital2. Students and researchers have documented
various phases during the introduction of information technologies into the clinical work practices
since 1996, when the hospital started to implement an electronic patient record (EPR) system.
Initially the process was aimed at gradual expansion to one department at a time, involving
extensive user training and customisation. In 2001, the basic functionality of the system was
‘rolled out’ and swiftly implemented in all departments. Since it was not a fully developed and
complete version, a double system of electronic plus paper records have existed in parallel. Since
then, gradual expansion of the functionality has increasingly required changes in the existing
paper based arrangements of work practices and coordination mechanisms. This change process
will be the topic of the fourth section.
Our own empirical work started in the autumn of 2002 and is still ongoing. It has consisted of
interviews with clinical, administrative and technical staff, observations, document analysis, and
participation in meetings both in the clinical departments and with the IT department. From 2002
to 2003 we examined the results of the implementation of the EPR system in general across
several departments3. Later we have performed individual in-depth studies of two different cases.
The first author has followed the scanning project, which was initiated by the IT department and
the paper record archive department. The project’s aim was to reduce the amount of paper that
had to be archived through scanning the documents that did not (yet) exist in electronic form.
2
Previously Rikshospitalet University Hospital, currently the Rikshospitalet-Radiumhospitalet
Trust, which is located in Oslo, Norway.
3
This study comprised among other things 18 instances of participant observations and 35 formal
interviews with 23 different employees, and is reported elsewhere (See e.g. Hanseth et al., 2006).
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This study entailed 7 formal interviews with project management staff from the IT and the
archive department over a period of two years. These interviews focused on the project’s progress
and the interviewees’ perceptions of obstacles and opportunities. The interviews lasted for about
45 minutes to 1,5 hour and were usually taped and partly transcribed. The researcher participated
in 6 meetings at one of the pilot departments for the project and in return for access often wrote
the minutes from the meetings. In addition she assisted the personnel in compiling detailed
information about document flows in the department, and documented the actual scanning work
through time studies, documentation of errors and problems etc. These results were fed back to
the department and the project management. In total 17 hours of participant observation were
conducted, and during this work a number of informal conversations were carried out; these
added to the background perception of the process. The second author has studied in detail the
coordination processes around heart transplantation, which involves several departments within
the hospital, as well as external hospitals and organisations. This study comprised interviews with
physicians, patient coordinators, and nurses involved with the heart transplant process, where the
interviews were taped and transcribed. The study aimed at describing the various work practices
involved in the entire process, with a specific focus on how it was coordinated, and what role
tools and artefacts such as paper or digital documents, played in this coordination.
The account we present here has emerged through a long time period. Initially, we compiled the
research material based on a perspective that emphasised the non-predictability and complexity
involved in developing an information infrastructure in the organisation. The collected material
has allowed us to describe how loose coordination allows complex and distributed work practices
to hold together (Grisot, 2004), to examine the impact of regulatory and technological constraints
on the organisational change process (Aanestad and Boulus, 2004), and how the role of
unpredictability and side effects are of crucial significance (Hanseth et al., 2006). As this paper
has taken shape, we have focused our analysis on how the actual trajectory of the project
contrasted with the ‘project’ notion. This focus has guided our selection and presentation of the
empirical material, to which we now turn.
4.
Changing the Organisation
Our case account will start with a general overview over the larger implementation process at the
hospital, followed with more detailed excerpts from events and phases in the process that we
found particularly interesting.
4.1
Implementing the Electronic Patient Record
After the rollout of the Electronic Patient Record system in 2001, all users were expected to use
the system for specified tasks, but not for the whole documentation process, as the system was not
complete. This had the results that the changes of existing work practices were not radical. The
doctors would continue to dictate their notes, reports and letters, and the secretaries would type
them. One difference was that the document would no longer be saved as a Word document in an
ad hoc file structure, but were archived in the EPR system. Subsequently the doctor would view,
correct and sign the document, based on the individual work list of documents to be checked out.
Preferably this should have been done through the EPR system, but not all doctors were willing to
do that and continued their paper-based practices, leaving the secretaries to do the ‘computer
work’. The electronic system was not yet a complete record; it did not include all the relevant
documents that were in use, and in addition several other information systems would contain
other relevant information. Consequently, only the paper record had the possibility to be
complete, and it served as the legally valid record. Thus all notes, discharge letters and reports
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that were entered in the electronic patient record system would subsequently be printed and put in
the paper patient record.
During 2002 and 2003 we studied the impact of the implementation, and we found that only a
small number of doctors used more than minimal functionality, e.g. the possibility for defining
their own prescription templates for standard or often used prescriptions. The average doctor
would not use the digital version of official forms that the system offered (e.g. sick leave forms).
Moreover, in their daily encounter with patients the doctors would usually request and use the
paper record. The doctors would only consult the electronic patient record (EPR) system if the
paper version was not immediately available, e.g. if they received telephonic requests, or if the
record was missing. As new versions of the EPR system were continuously released and
implemented, the functionality was increasingly extended to also cover process support tools.
This implicated the need to proceed ‘deeper’ into work process redesign and organisational
changes. This process of changing of the hospital’s paper-based information infrastructure into a
digital one has been a longer and ‘larger’ process than anyone expected. We now turn to
describing some salient features of this process in more detail.
4.2
The Scanning Project
In the paper archive the ever-increasing amount of patient records soon started to pose a problem.
The new facility, built in 2000, was designed based on the expectation that the hospital would
have an electronic patient record and would not need much storage space for paper records.
However, the volume of paper for archiving actually increased after the introduction of the EPR
system, and soon the crisis was impending. Abolishing the double (paper + digital) record system
seemed wise, and a recent change of the law allowed the record to be in digital format. But until
the national archiving authorities (Riksarkivaren) had accredited the EPR system, the paper
records had to be kept complete. This accreditation concerned the technical solutions for long
time storage of digital data, and it was dependent on the software vendor implementing specific
measures and releasing a new version of the system. While the hospital awaited this, the scanning
project was initiated. While initially perceived as a minor and straightforward project of
technology implementation (the estimates predicted one person in 50 % position for 6 months), it
has grown both in time and scope.
The scanning project started in the spring of 2003 with a bid for tender on scanners and software
that would import the scanned documents into the EPR system. During the summer the chosen
solution was to be tested and finalised, and actual scanning would be started in the early autumn.
By January 2004, no paper documents should be sent to the paper archive. Problems with the
delivery (the software had not previously been customised to run on an NT local area network)
led to some delays in this process. In December 2004, the scanners were installed in four pilot
departments, where secretaries started testing of the scanners and software. Throughout the next
weeks bugs were identified and fixed and the departments were developing routines for how to
arrange the scanning.
The project was divided into phases, and in the first phase a subgroup of documents was targeted:
referral letters. A referral letter arrives with the ordinary mail from general practitioners,
specialists or other hospitals, requesting the transfer of one of their patients to the hospital. The
reasons for addressing these documents were several: after registration, the referral letters were
sent to the archive until the patient arrived. Due to substantial backlog of archiving the letters
very often were not found when the patient arrived. Digitising these letters would thus eliminate a
large work burden for the archive (archiving and retrieving the letters within a short time period)
and a problem for the user departments (missing letters). In addition, the referral letters from
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outside partners would continue to be on paper for the foreseeable future, so scanning would have
become necessary anyhow. It was also seen as important to digitise information as early in the
work process as possible, to be able to realise the potential benefits.
What was not expected was to which degree this seemingly simple change triggered redesign of
work processes. During the first period of pilot site usage (spring 2004), the project management
realised the need for assisting the departments with organisational development, a task they were
not initially prepared for. Several workshops were conducted, in which the practices around
handling incoming mail, distributing it, registration, and evaluation of referrals were collectively
charted. The aim was explicitly to detect overlaps, gaps and potentials for simplification.
However, the outcome of these redesign exercises were not major changes. Some procedures for
improved mail handling were drafted and implemented, but major changes could not be carried
through because the EPR system was not ‘complete’. For example, if the paper letter should have
been removed from the work flow after scanning, a software feature that would notify the
responsible doctor that it existed and was awaiting evaluation was required. This feature was
supposed to be implemented in the next release of the EPR software, which was expected to come
‘soon’.
In addition, technical factors shaped the way in which the processes could be redesigned. Before a
document could be scanned, a digital record had to be created, and before the record could be
created, the patient information had to be entered into the patient administrative system (PAS).
The PAS application was running on the hospital’s Windows NT network, while the scanning
software required Windows 2000. These systems were thus running on different machines in
different work places, and at least two persons had to be involved in the task, rather than one (as
the optimal solution would have been). The work of redesigning work routines continued as the
pilot departments gradually expanded their scanning activities to also encompass other incoming
(external) documents as well as internal documents. Hospital-level general procedures were
drafted, based on these experiences, and each department was required to adapt these procedures
to their own needs. Gradually, the scanning took off, but the paper documents were still used for a
long time. A year beyond the intended deadline, the amount of paper sent to the archive was
finally starting to decrease.
We offer this account not as an example of lax estimation and suboptimal project management.
On the contrary, we do not interpret any of the actions and decisions of the project management
as inappropriate. Rather we believe that this case points to issues that are crucial for the dilemmas
of infrastructural ICTs for organisational change in general. The project meetings we attended in
one of the pilot departments offer a telling example of the nature of this process. The meetings
would seem rather disorderly, without a strict agenda and without much tangible results. Various
pressing issues and proposed changes were discussed, and the participants would ask or comment
on them in an ad hoc, non-systematic way. The actual work performed in the meetings could be
characterised as unravelling. The participants were trying to sort out the pre-conditions for the
planned or wished-for changes, predicting the consequences of them, and devising the appropriate
actions to be taken. Tensions often arose between the new, ‘digital’ workflows that were expected
to emerge, and the existing organisation of work. The work the involved secretaries had to
perform was not just the unravelling of predictions and consequences. The reason for this work
was the need to sustain the ongoing everyday work processes. While changes were intended,
these were not allowed to disrupt today’s work; the existing processes would need to ‘hold
together’ during the change period. Partial and gradual changes of single elements in a work flow,
rather than a ‘clean slate’ approach, required careful consideration.
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4.3
Developing the Portal
Currently several hundred computerised systems exists in the hospital, many of them in
conjunction with specialised medical equipment. Approximately 160 of the systems contain
information that is relevant to include in the patient record, and for about 30 of these, a means of
linking them to the EPR it is considered important. While the initial ambition of the EPR project
around 1996 was to develop modules in the EPR system to cater for the special needs, this turned
out to be infeasible. Subsequently, some of the most important systems4 were integrated with the
EPR system, but also this turned out to be too complex to extend to all systems. In 2003 the IT
department started to develop a portal solution that would integrate the relevant specialised IT
systems in use at the hospital. This portal was also intended to offer more and better process
support functionality than the EPR system could offer. The challenges were not just to build a
technically appropriate solution; there were also the need to sort out how it could be made to
comply with the existing paper-focused laws and regulations. These activities (the portal project)
were not just about the technical solution. It was part of a larger shift in the IT department’s selfunderstanding and approach. From the previous focus on products and solutions they were
increasingly focusing on services and process support. The ‘portal project’ consequently
consisted of a comprehensive framework for how to undertake change projects. User participation
was sought through the establishment of e.g. reference groups of users and mechanisms for
collecting feedback. The IT department succeeded in securing support from the hospital’s
management for this development project. This was crucial for the future trajectory of the project,
but not enough to guarantee plain sailing.
In January 2002 the Norwegian health sector underwent an ownership reform. 19 counties were
divided into five health regions, hospitals were transformed into enterprises, and ownership of the
individual hospitals was transferred from the county levels to a regional enterprise. This spurred a
stronger drive for inter-hospital standardisation of the ICT portfolio. Within its health region, this
hospital was the only one running the Siemens system; all the other hospitals that were using an
EPR system at all, had products from other vendors. Moreover, the regional health enterprise
intended to reorganise and centralise the IT-support for the whole region, meaning a significant
curtailing of the IT department’s room for action. The hospitals management were fighting to
preserve the autonomy over its IT activities, but in addition the threat had another effect: the IT
department speeded up the implementation process and increased the ambitions in order to be
perceived as being too important to be stopped. This ‘escalation’ of the project had significant
effects on the subsequent process of development and implementation. The progress and priorities
of the IT department became explicitly aimed at generating ‘quick wins’, emphasising relatively
simple changes that were expected to give significant impact. Visual integration (presentation
layer integration) of laboratory results with the information from the patient record became the
most used feature of the portal. Functionality for activity planning, to support process and
logistics, were the second prioritised area, as it was expected to offer a large potential for
improving services and reducing costs.
The regional ‘IT politics’ led to a dramatic increase in uncertainty for the IT department. Projects
would be halted or stopped at short notice as funds were withdrawn or did not continue. In this
situation, developing scenarios and conducting economic estimates became important in order to
convince management and support it versus the regional ‘competitors’. The standard budgetary
processes became problematic to adhere to in such a turbulent environment, as detailed forward
4
The Patient Administrative System, which provides demographic data to the EPR system, as well
as uses data to generate statistics for the hospital’s financial reimbursement, was the first system to be
integrated, and the only to achieve a complete integration.
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planning was not feasible. Emphasising the potential of the software itself became an important
element of the ‘survival strategy’. In one instance where funds were being stopped, a deal was
struck with the involved software companies. The possible commercial value of the planned,
future software was seen as so attractive that the company continued the development work for
the hospital without a guarantee for financial reimbursement. The IT department also offered their
solution in international bid for tenders, and succeeded in gaining funding, legitimacy and further
strength in this way. The actual trajectory of the portal solution has been significantly shaped by
the actors that entered the scene and the events and conflicts that ensued.
5.
Beyond the Project
We suggest with Lounsbury and Ventresca (2003) that it is pertinent to explore “the coevolutionary dynamics of logics, actors, practices and governance”. We argue that our empirical
examples point to fundamental characteristics of this co-evolutionary dynamics that emerges
when infrastructural information technologies are deployed for achieving organisational change.
The aim with this paper is to argue that in important ways these characteristics are at odds with
our traditional approaches for handling change processes, and in this section we aim at
explicating this standpoint.
5.1
Beyond the project: time, scope, agency and room for action
In terms of prediction, success was not overwhelming as the time frame for the activities was
continuously exceeded. Setting of deadlines and milestones turned out to be an activity with little
effect. A major reason was the way in which the activities depended on other factors. For
instance, the elimination of scanned, electronically available paper documents could not be done
until the system had been accredited, and it also required the notifying feature to be implemented
in the EPR system. The users and the project management had little influence of these external
processes. In an interview in January 2005 (one year after the initially planned end of the project),
she said:
Project Manager: “I don’t say that we are delayed anymore, because it could never have worked.
January 2005 is early enough. […] Only now have we received the accreditation and the
notifying functionality in the system. We couldn’t have done this earlier.
In a previous interview with the project manager (who was then a different person) we asked:
Interviewer: But isn’t this a problem for you, I mean, you were supposed to be done by
Christmas?
Project Manager: No. Every-one realises that it was unrealistic, and that we just have to go on.”
The scanning project expanded dramatically in scope. Unexpected technical conditions and
consequences generated more work than planned. This expansion of scope happened mainly
because the project triggered a need to change the work routines. From being seen as a problemsolving, temporary activity, the scanning project has in reality taken on a new role of an
organisational development project. The work routines in a hospital make up a complex mesh or
grid of routines, where several personnel groups and departments are linked in multiple and
complex ways. Any local changes in work practices thus need to be negotiated and coordinated
with other actors. The project management saw the need to take on a role that was not expected or
wanted; that of facilitating organisational change in the clinical departments. This kind of change
work is not easy to organise, and the challenges are exacerbated by the fact that overworked
doctors rarely find the time to participate in activities that are perceived as optional and non-
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critical. Similarly, the initial expectations to the portal was that it would solve the ‘myriad
systems’ problem. As the process evolved, it has become a political and commercial actor, in
which the IT department places much of their expectations and hope for the future.
Throughout the process that we have sketched above, agency, or the power to act, was not wholly
and exclusively located within the project team. The project team depended on the rest of the IT
department to realise the conditions for the promised deliveries, which was not always possible.
Agency also resided with the individual user departments over which the IT department had no
formal mandate, and had to rely on management intervention and instruction. In particular we
want to draw the reader’s attention to the ‘external’ agency, residing with for instance the
software vendor, the regional health enterprise, the other hospitals within the region and the
national archiving authorities. We do not claim that these dependencies are unique for this case;
on the contrary, we claim that this distributed nature of agency is a fundamental characteristic of
infrastructural information and communication technologies, because it is interlinked, connected
and dependent. A consequence of this is that change process can not be fully ‘engineered’ and
controlled, but can only be influenced.
Consequently, the room for action varies significantly with the evolving situation. We see that
the progress of the scanning project was constrained by the awaited accreditation of the EPR
system from the archiving authorities. Also the deliveries from the software vendor influenced the
pace with which the project management could proceed. However, this influence was not only
constraining, nor was it one-way; going from the outside towards the inside. The regional IT
politics constituted a situation with an impetus for increasing the pace and ambitions of the IT
department’s development and implementation work. This again influenced the nature and
direction of the political process, in other words it was a two-way process. Awareness, ability to
read the situation and to intervene and engage in this shifting reality has been crucial for the
department, and for the ensuing achievements of the hospital.
5.2
Implications for IS Research
In this empirical material we see dependencies, interconnections, and consequences. We claim
that when large-scale and complex technologies exhibit these traits, it is not accidental. It is part
and parcel of their reason for existence: the possibility to link and connect actors in various
locations, to enable information to be transferred and transformed, as well as the possibility to
integrate more than one system and build information infrastructures. Interconnections and
dependencies are a fundamental trait of the ‘socio-technical ensembles’ of today’s organisations,
and recognising this will have an impact on how we think about and handle change processes.
However, we claim that this fundamental characteristic of links and dependencies is exactly what
is ‘othered’ and excluded within the ‘project’ approach to ICT-related change management.
Managerial conceptualisations of change processes often assume a “straightforward
consequentiality” (Ciborra and Lanzara, 1994). In contrast to this we hold that complexity (in the
sense of irreducibility, connections and ambiguity) can not be ignored. Specifically we want to
challenge the current understanding of information technology, the belief that it should be
possible to subject it to a ‘project logic’. The project logic is a logic of control: in return for
compliance it promises prediction, overview and effect. Compliance to this logic means being
able to shape and reduce change processes into sub-projects, deliveries, and work packages. It
means calculating the path that leads to the chosen compromise between scope, cost and resulting
quality. Project management is about how to stick to that path and how to avoid deviations from
it, or if they occur, how to handle them. The ‘project logic’ may not be optimal if dependencies
and interconnections is what fundamentally characterises the socio-technical ensemble.
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Alternative governing strategies must be developed that take heed of that fact and creatively deals
with it rather than deny or eliminate it (in vain). Isn’t this suggestion rather naïve? After all, what
managers want is control and prediction. How can alternatives be handled practically? In our case
the initial resource allocation was insufficient, both with regard to manpower and funding for
technology. As the process unfolded additional resources were made available. This does not
mean an instant or a complete meeting of needs or demands. On the contrary, often the required
resources did not exist and had to first be generated. For instance, in order to be able to support
the organisational development work in the scanning project, the staff had to lobby the need for
some time to convince the IT and hospital management. The issue was not so much arguing for
the need for organisational development, on which everybody agreed. The actual accomplishment
of the scanning staff during this period was showing that this change process actually was
triggered and had to occur related to the scanning project, rather than as a self-standing
‘organisational change project’.
For prediction and control to work, links to complicating ‘side’ issues must be severed. In the
scanning project there was not a practical possibility of a pre-designed reduction of the problem
into manageable sub-problems. The whole complex matter of change had to be taken on in its
totality, and the work of ‘unravelling’ and ‘weaving’ of these linkages occurred in a slow and
gradual fashion. We are increasingly dealing with large-scale, interconnected, and regulated
technologies, where reduction as a strategy is often not an option. Improvisation, negotiation,
striking alliances may be more appropriate modes of conduct, and we believe that IS research
should encourage and formulate such alternative approaches. Preferably we should go beyond
general terms such as improvisation, cultivation, etc. so as to exemplify and spell out what
exactly these strategies look like.
At this point we want to point to theories which more explicitly address the issue of complexity
and which we believe have potential to contribute to alternative views on organizational change.
First, understanding technology as information infrastructures helps to frame change process in
alternative terms to that of ‘projectness’, with metaphors such as ‘bootstrapping’ and installed
based cultivation. Going beyond the applied nature of this approach and moving towards the more
theoretical, we believe two promising avenues, may be, on the one hand, the Complex Adaptive
System theory and studies on the theme of complexities from the field of Science and
Technology Studies, in particular from the ‘ANT and After move’ such as e.g. (Law and Mol,
2002). Rather than finalised, ‘packaged’ and coherent bodies of work, they are more like a web of
concepts concerned with, among other things, understanding what happens to complexity when
simplifications are made.
6.
Concluding remarks
Our contribution to the research on the role of IS in organizational change, is intended to be a call
and a first attempt to critically reconsider its understandings of such processes. Following Law
and Singleton (2000) we hold that widespread notions such as the ‘project’ are crucial and nonneutral; they do not only describe but also perform technologies’ trajectories. Our case study
shows how the process ‘overflowed’ the ‘project’ notion. Specifically, we discussed how the reallife phenomenon differs from a ‘project’ with respect to four dimensions: 1) the time frame of the
change process has neither been possible to predict nor to define in advance; the setting of
milestones and deadlines has been an activity that had little effect on the actual achievements 2)
the scope of the process was continually changed (expanded and redefined) implying major
changes in the strategy and actual activities, as well as the team makeup, technologies deployed
and alliances made 3) related to the previous characteristic: who would count as relevant actors
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were changing, and agency was distributed far beyond the project management or even the
hospital management 4) the room for action was shaped by a multitude of factors beside and
beyond the project and its host organisations, constraints and dependencies served as major
determinants for the actual trajectory of the change process. The ways this process was handled,
sustained and steered, comprised a set of practices and skills not usually in focus within
traditional models for project or change management. The alternative approaches and strategies
are not codified rules, but vaguely formulated strategies. We believe that the IS field would
benefit from explicating and emphasising such strategies. Otherwise, practices such as the work
of ‘unravelling’ and ‘weaving’ in order to detect and/or create dependencies, or the political
manoeuvring necessary, could easily be perceived as marginal and irrelevant. Relevant strategies
for handling complexity that do not fit within the ‘project’ notion’s universe, could easily go
unnoticed and get lost rather than inform the process of enabling ICT-related organisational
change.
Acknowledgements
We are grateful to the staff at the hospital who generously assisted us during our field work, and
in particular to Arve Kåresen and Ivar Berge at the IT Department for opening doors and keeping
in touch with us. Our colleagues at IFI, as well as the anonymous reviewers have also provided
helpful suggestions.
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