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Unsettling Settled Knowing: Reconciling Differences in Expert Practice

Organization Science 

Occupational subgroups with similar training often develop differing work practices within their local settings. These differences may create inconsistencies when organizational change brings subgroups together to work alongside each other. Based on a two-year qualitative study of a hospital merger combining two neonatal intensive care units, we consider how differing expert practices may be challenged, preserved, or reconciled when subgroups are brought together. We find that reconciliation processes are unexpectedly triggered by novice newcomers who struggle to socialize into a consistent way of working. Comparing five expert practices over time, we also find that when groups are able to converge around the type of knowledge that should apply to expert practices (abstract versus experiential knowledge), a form of reconciliation is possible, but when there is divergence around the type of knowledge that is relevant to the situation, reconciliation fails. Converging on experiential knowledge implies a simplified process of reconciliation that preserves expert autonomy while masking residual differences. Converging on abstract knowledge involves a complex, multilayered process in which expert subgroups need to revert in part to mechanisms resembling those that underpinned their initial socialization into the discipline. These mechanisms include mobilizing evidence to update abstract knowledge, situated mentoring with respected experts, and authoritative reinforcing via interventions from high-status professionals. Our study highlights the challenges of changing expert practices that are rooted in ingrained experiential knowledge. It reveals that abstract knowledge alone is insufficient and that reconciliation invariably involves settlements and agreements on what form of knowledge matters.

The governance of open science: A comparative analysis of two open science consortia

Research Policy 

Recent open science efforts recognize that the efficient, credible, and transparent development of scientific knowledge relies on the capacity to verify and reuse the “intermediate resources” employed throughout the research process, including data, computer code, and other research material. Prior research has shown that the disclosure of such resources is often hindered by the incentives and disincentives perceived by individual scientists. Beyond the level of individual incentives, however, the sharing of intermediate resources is obstructed by the governance norms that inform these incentives in the first place, such as the norms of authorship and evaluation. Thus, our central research question asks how the limitations of the established norms of authorship and evaluation are addressed at the organizational level within open science consortia that are premised on the sharing of intermediate resources. Drawing on qualitative methods, we present an in-depth comparative analysis of two open science consortia–the Canadian Open Neuroscience Platform (CONP) and The Cancer Genome Atlas (TCGA)–that illustrates how the limitations of the established norms of authorship and evaluation are navigated in brain and cancer research, respectively. Our findings show that the governance mechanisms designed and implemented in CONP and TCGA reflect two distinct forms of governance, one distributed and the other layered, which are characterized by different understandings of scientific authorship and evaluation. Our study thus contributes to ongoing debates on open science and the governance of scientific collaboration by shedding light on the relationship between governance forms and variable conceptions of authorship and evaluation.

Coordinating Frontline Expertise in a Multi-Front Crisis

Academy of Management Proceedings 2025

Healthcare organizations face significant challenges in coordinating cohesive responses to large-scale unexpected disruptions. Previous studies have emphasized the need for protocols and planning in response to crises. However, for crises that are extended, novel, and ambiguous, the coordination of responses to the unfolding crisis becomes more important. In order to understand how coordination unfolded over time, we conducted a two-year qualitative field study in a frontline hospital during the 2020–2022 COVID-19 pandemic. Our findings reveal that such wide-spread crises unfold as multiple concurrent episodes, disrupting work across units and requiring flexible and evolving coordination practices. These practices enable the hospital to manage novel interdependencies, establish shared frameworks to navigate disruptions, and strategically foreground and background relevant expertise across the organization. Our study highlights how hospitals can leverage localized knowledge and resources to produce cohesive, organization-wide responses. This approach enhances efficiency, fosters innovation, and ensures coherence in addressing both routine and extraordinary challenges.

Digital infrastructure development through digital infrastructuring work: an institutional work perspective

Journal of the Association for Information Systems

Being able to understand and characterize the digital infrastructure development (DID) process has become even more pressing today due to the rapid advent and implementation of new digital infrastructure (DI) in organizations as well as since the COVID-19 crisis. While information systems (IS) research has begun to recognize the institutional nature of such digital infrastructures, there remains a gap in our understanding of how such developments unfold from an institutional perspective. Through our field study of a digital infrastructure development project involving the implementation of an enterprise-wide electronic medical record system at a large US medical facility, we show how the tensions in the DID process were linked to the institutional work these organizational actors performed when they attempted to disrupt and protect the hospital’s institutional arrangement. We introduce the “digital infrastructuring work” concept to describe the combinations of digital object work, DI relational, and DI symbolic work enacted during DID. Specifically, digital object work reveals how material institutional work is directed at multiple DI elements. Our findings also highlight how organizational actors combine DI relational work and DI symbolic work with digital object work to shape the overall DI. As such, our study shows how organizational actors go beyond symbolic and discursive forms of institutional work, and digital object work in particular, to achieve DID outcomes. Future research could explore digital infrastructuring work in different organizational and technological settings.

Leading from the Frontline: Autonomy and Improvisation in a Hospital During Times of Crisis

Academy of Management Proceedings 2024

How organizations coordinate a unified response under system-wide disruption impacting multiple units in different ways is a crucial question for healthcare organizations today. To address this question, we report on a qualitative field study of a frontline hospital over the course of the 2020-2022 COVID-19 pandemic. Our findings reveal that such crises require multiple extended coordinated response processes where central coordinators assign new work, prioritize resources, and modulate the autonomy and improvisational ability of multiple organizational sub-units to mount organization-wide responses. We contribute to healthcare management and coordination research by offering a process model for coordinating responses to broad-scale disruption that leverages local knowledge and resourcefulness of experienced hospital personnel under conditions of disruption, and allows for standardization and refinement as disruptions are resolved or normalized.

Strategic organization in the digital age: Rethinking the concept of technology

Strategic Organization

Digital technologies, enabled by data, algorithms, and artificial intelligence, are creating new competitive opportunities. But how does one strategize when the technologies core to organizational action is constantly changing? We suggest that for strategy scholars to answer this question, they will need to rethink the concept of technology. We begin by discussing the conceptual treatment of technology in studies of strategy and strategizing, and, in so doing, we highlight the ways in which current conceptualizations of technology are problematic for theorizing about the role of technology in the digital age. We then advance a relational perspective on technology that overcomes many of these problems. We illustrate the potential utility of this perspective for theories of strategic organization by using it to reconceptualize the boundaries of the firm, the process of innovation, and the process of organizational knowing.

Relationships and Resilience in the COVID-19 Pandemic

Academy of Management Proceedings 2022

Society, organizations, and individuals inevitably face crises that threaten their functioning and even survival. As a result, crisis management scholars have sought to explain both the nature and impact of crises and how organizations effectively prepare for, respond to, and overcome various forms and degrees of challenges (Williams, Gruber, Sutcliffe, Shepherd, & Zhao, 2017). In response to a rise of grand challenges (e.g., Covid-19 pandemic), there have been a number of calls for management research to further explore the crisis-organization interaction, including how to develop resilience not only to respond to adversity but also to use it as an opportunity for future growth (van der Vegt, Essens, Wahlström, & George, 2015; Williams & Shepherd, 2016). Following this, our symposium aims to provide a unique and critical perspective that focuses on relational practices as the approach to address grand challenges as well as the relational capability to respond to and recover from adversity. In the context of crisis management, relational practice has been considered an important approach to shape immediate response to disturbances and ultimately enhance reliability to challenging events (Williams et al., 2017). For example, Gittell (2008) found that relational coordination—communicating and relating for the purpose of task integration—is critical in overcoming challenges. The coordinated collective response across multiple functions or roles create a relational system that enables and strengthens resilient responses to external pressures. Similarly, Shepherd and Williams (2014) and Colquitt et al. (2011) found that trust is an elemental capability to enable a more effective response to a disaster.

Unto the breach: What the COVID-19 pandemic exposes about digitalization

Information and Organization 

Much recent scholarly investigation has been focused on the promise of digitalization and the new ways of working and organizing it makes possible. In this paper, we analyze how the COVID-19 pandemic has acted as a natural breaching experiment that has challenged taken-for-granted expectations about digitalization and revealed four important issues: uneven access to digital infrastructures, the persistence of the analog in digitalization, the brittleness of unchecked digitalization, and panoptical surveillance. The sudden shift to digital work has exposed taken-for-granted assumptions about the universality of digital access. The crisis has also revealed that many highly digitalized processes still rely on analog elements. The pandemic has also exposed that many algorithms used in digitalized inter-organizational processes are brittle due to overreliance on historic patterns. Finally, the pandemic has breached fundamental expectations of privacy when organizational surveillance was extended into private and public spaces. Thus, the pandemic has laid bare fundamental challenges in digitalization and has exposed the limits of rose‑tinted thinking about the relation between technology and organizing.

Shaping the buildings that shape us: Restoring coordination following a disruption

Academy of Management Proceedings 2021

The move to a new, state-of-the-art building is a momentous occasion in the life of an organization as it offers the rare opportunity to establish novel ways of working and organizing. However, when long established coordination practices can no longer be carried out in the new space, costly breakdowns may occur, necessitating effortful repair work to re-establish coordination. Through a two-year ethnographic study, we examine how coordination was disrupted and restored following the relocation of a leading hospital into a newly built and equipped state-of-the-art building. We show how established care coordination practices could no longer be sustained in the new setting and how the urgency of addressing situations of breakdown forced a reconstitution of coordination arrangements to better align with the new space. Our findings highlight the importance of the situation, rather than external environments, in guiding shared action and the importance of organizing boundaries and scripts in reassembling a novel coordination ordering. Thus, we suggest a move away from the notion of “coordination as social structure” toward a performative view of coordination that foregrounds the situation, the joint effects of material arrangements and boundaries and scripts.

Losing Touch: An Embodiment Perspective on Coordination in Robotic Surgery

Organization Science 

Because new technologies allow new performances, mediations, representations, and information flows, they are often associated with changes in how coordination is achieved. Current coordination research emphasizes its situated and emergent nature, but seldom accounts for the role of embodied action. Building on a 25-month field study of the da Vinci robot, an endoscopic system for minimally invasive surgery, we bring to the fore the role of the body in how coordination was reconfigured in response to a change in technological mediation. Using the robot, surgeons experienced both an augmentation and a reduction of what they can do with their bodies in terms of haptic, visual, and auditory perception and manipulative dexterity. These bodily augmentations and reductions affected joint task performance and led to coordinative adaptations (e.g., spatial relocating, redistributing tasks, accommodating novel perceptual dependencies, and mounting novel responses) that, over time, resulted in reconfiguration of roles, including expanded occupational knowledge, emergence of new specializations, and shifts in status and boundaries. By emphasizing the importance of the body in coordination, this paper suggests that an embodiment perspective is important for explaining how and why coordination evolves following the introduction of a new technology.

Designing Healthcare Ecosystems with Relational Coordination Principles: Leveraging Technology

Academy of Management Proceedings 2019

The greatest challenge in healthcare is no longer creating inclusive organizations, but creating inclusive ecosystems of organizations that can tackle the complexity of diagnosing, treating and caring for patients with complex health issues. It is critical to understand and leverage technology as the healthcare industry is undergoing a transformation to value-based care and more coordination among healthcare organizations is necessary. In this presenter symposium, we apply a relational lens on coordination to the influence of technology on knowledge work that must carried out as collaboration among different organizations. We examine how health information technology influences relational coordination – and vice versa – in the particularly complex healthcare space. We discuss the good, the bad, and the ugly of health information technology as healthcare ecosystems begin to emerge.

Shaping the Buildings that Shape Us: The Entanglement of Space and Care Coordination

Academy of Management Proceedings 2018

In the rare event that a hospital confronts radical change, care activities must remain performant despite disruptions and unanticipated influences, otherwise patients may lose their lives. The reliable coordination of care work is central to this challenge because critically ill patients must get the appropriate treatment at the right time by the right specialists in the most cost-effective manner possible. Recent organizational research has shown that care coordination practices are emergent and socially situated but has paid less attention to the spatial context in which care work unfolds. Yet, the latter has direct implications for what is possible in the delivery of patient care. In this paper, we examine what happens to the work of neonatal intensive care when a leading Canadian hospital relocates to a newly built and equipped CAN$ 3 billion super hospital with a vastly different spatial layout and equipment arrangements. Through a two-year ethnographic field study of neonatal intensive care work before, during and after ‘the move’, we examine how space and coordination practices are transformed so that care activities can “travel” reliably. We show how and why care activities initially broke down as they were transported to a new socio-spatial setting and elaborate the process by which they were reconstituted to re- establish performance. In so doing, we explore the material- spatial basis of coordinating and deliver a material rather than a cultural or institutional account of radical change.

The Role of Anchoring in Actualizing IT Affordances in EMR Implementations

Proceedings of the 51st Hawaii International Conference on System Sciences  2018

Affordances are useful theoretical tools to study IT mediated organizational change. Affordance actualization process provides a temporal structure to build a model that lays out a non-deterministic sequence to understand the changes that happen in organizations on the introduction of new IS. Affordances and affordance actualization have been studied in many contexts with the focus on material agency of the new IS or human agency of the user groups. Using the case of an EMR implementation in a family and urgent care clinic in Canada observed over 5 years, we discovered that anchoring on legacy systems in place before the EMR implementation has a significant influence in the actualization of affordances of the new IS. We present an affordance actualization process model including the anchoring influence observed, to provide a richer explanation of affordance actualization in EMR implementations.

The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis

The Reconstitution of Work Practices Following a Radical Hospital Restructuring

Academy of Management Proceedings 2017

Through this two-year ethnographic study we report on the merger and integration of two neonatal intensive care units belonging to separate hospitals into a newly built super hospital. Our field study of this transformation process offers analysis regarding the organizing challenges surfaced by the move, the adaptation to a new space with novel material arrangements, and the melding of units previously located in different hospitals. We trace how and why, as a result of sweeping changes in social and material configurations, work practices became less resilient and less performant. From this radical hospital restructuring, we offer insight on how the organizing mechanisms of existing work practices are constituted and how they are reconstituted given novel material, technological and social foundations. We find that practices have to be reconstituted when the sociality and materiality of a site of practice are dramatically altered. We develop how three essential organizing mechanisms (practice orientations, skillful performance and instrumentation configurations) provide coherence and resilience to a practice.

Open-source health information technology: A case study of electronic medical records

Health Policy and Technology

Open-source software (OSS) has achieved widespread adoption in many domains such as , tools, and databases. We review the status of open-source in healthcare and discuss the potential of open-source to resolve some of the challenges surrounding the wide adoption of Health IT in North America. Specifically, we address aspects that are unique to using open-source in ambulatory care. We present the case of a Canadian open-source system (EMR) named OSCAR that is widely adopted by primary care units and family physicians in Canada. A based on semi-structured interviews with various stakeholders of the EMR including users (medical and staff), developers, and service providers. In addition, we assess arguments presented in the literature for and against open-source software in healthcare in light of the OSCAR EMR. Open-source development provides a unique platform that enlists contributions from various stakeholders toward creating a common good. As evident from the OSCAR case, the dynamics of are potential solutions for the low adoption of technology in healthcare. In particular the low cost of acquisition and maintenance, the high degree of customizability, and the community of users are important advantages of OSS EMR. On the other hand, the lack of understanding of OSS model and the unavailability of trusty support providers are unique challenges facing OSS EMR.