Using Institutional Theory with Sensemaking Theory: A Case Study of Information System Implementation in Healthcare

TLDR

Institutional theory is a key lens for studying IS implementation, yet it does not explicitly capture how organizational actors make sense of and enact technologies in their local context. This study combines institutional theory and sensemaking theory to provide a richer, macro‑to‑micro interpretation of IS implementation. An empirical case of an Electronic Patient Record system in a hospital was examined using constructs from both theories across organisational field, group, and individual levels. The study demonstrates that a myth of an efficient EPR spreads from the organisational field to wards and doctors, while doctors exercise agency to shape its use, highlighting the need to consider both macro structures and individual interpretations in IS adoption.

Abstract

Institutional theory has proven to be a central analytical perspective for investigating the role of social and historical structures of information systems (IS) implementation. However, it does not explicitly account for how organisational actors make sense of and enact technologies in their local context. We address this limitation by exploring the potential of using institutional theory with sensemaking theory to study IS implementation in organisations. We argue that each theoretical perspective has its own explanatory power and that a combination of the two facilitates a much richer interpretation of IS implementation by linking macro- and micro-levels of analysis. To illustrate this, we report from an empirical study of the implementation of an Electronic Patient Record (EPR) system in a clinical setting. Using key constructs from the two theories, our findings address the phenomenon of implementing EPRs at three levels: the organisational field, the organisational/group, and the individual/socio-cognitive level. The study shows how a rationalised myth of an efficient EPR system has travelled from the organisational field to the hospital ward and on to individual doctors. The findings also provide evidence of a strong human agency by showing how doctors enact their work practices and shape the use of the EPR system. The study contributes to IS research by showing the need to address macro-level structures, as well as individual interpretations and practical use situations, in order to identify how and why information systems are adopted by users.