Aprendizaje cooperativo y experiencias de responsabilidad

While the proposed framework offers a rich, yet parsimonious basis for developing a Polycentricity Theory of information management, it also has clear limitations that call for further research. In this research, the limitations relate to the generalizability of the research and the choice of theoretical foundations. Accordingly, I present directions for future research, in which I discuss the status of the suggested framework and present ideas on how to develop it further.

12.4.1 Generalizability

The research draws on a single longitudinal field study (Miles and Huberman 1994; Pettigrew 1990), limiting our ability to conduct comparisons or generalize findings to other contexts. However, the limited generalizability of a single study should be balanced against the advantages of its attention to context, dynamics, and multiple stakeholder perspectives (Mason 2002). To document such effects, I have provided a rich description of the situation at EMC and of the interventions involved. These will help other researchers assess our findings and their transferability to other contexts (Lincoln and Guba 1985). To ensure rigor, we designed this research by applying established principles of canonical action research (Davison et al. 2004; McKay and Marshall 2001). Further, to gain an unbiased understanding of the problem situation, especially “sensitive” issues such as the resistance of nurses to adopt EMR-facilitated clinical documentation, we asked multiple interviewees to reflect on the same issue. We further sought to minimize this effect by triangulating between different data sources, checking against public data, Government reports and internal communications, using multiple methods and investigators to interpret the data, and by iteratively seeking feedback on our interpretations from key stakeholders at EMC (Miles and Huberman 1994, p267; Yin 2003).

Although our empirical descriptions are limited to the EMC context, this does not rule out the possibility of generalizing from description to theory (Lee and Baskerville 2003; Yin 2003). Following Mason (2002, p196), our argument for generalizability draws on the quality of our analyses: “Whatever else you do, you should make some claims for the wider resonance or generalizability of your explanations which are based on the rigor of your analysis.” Still, the theoretical generalization from our engagement at EMC and the components of IPF should be

Singh | Dissertation | CONTRIBUTIONS AND LIMITATIONS 183 limited to conditions similar to those of EMC—using IT to transform information management in complex organizations.

12.4.2 Theoretical Framing

Following Poggi’s (1965) dictum that “a way of seeing is a way of not seeing,” we accept a second limitation of the research that relates to the choice of underlying theory. This choice can limit our empirical explanations and our attempts to develop IPF as a new theoretical framework. In all likelihood, other theories exist that can serve as foundations for examining and explaining the situation at EMC. However, after a systematic review of the problem situation, we realized that EMC’s major challenge lay in managing information in its revenue cycle. Therefore, it seemed appropriate to explore existing information management theories to help understand the challenges of information management in EMC’s revenue cycle. After extensive review of the literature, we decided to select theories of information management that proffer a subjective view of information and focus on information processing in organizational decision making (Daft and Lengel 1986; Galbraith 1974; 1977; Mathiassen and Sørensen 2008; Mintzberg 1979; 1980; Ramaprasad and Rai 1996).

As we gained further understanding of the context of EMC’s health delivery, it became apparent that a healthcare organization represents a very complex organizational setting. Several studies have discussed the complexity of healthcare service delivery (Plsek 2001; Rouse 2008; Tan et al. 2005; Wim Van Lerberghe et al. 2008). They draw on Complexity Theory, which defines a complex system as having large number of interdependent parts, which together work as a whole and are interdependent with larger organizational structures or external environments (Simon 1981; Thompson 1967). Taking this view allowed us to appreciate the considerable challenges of decision making and information management in hospitals. Thus, a combination of existing theories of information management and a complex system view of a hospital provided our primary theoretical lens as we began preparations for interventions to improve EMC’s revenue cycle performance.

During the two-year period of action research engagement at EMC, we explored the workflows and exchanges of clinical, financial, and administrative information within the hospital and with external partners. Many of these exchanges involved multiple centers of decision making within

Singh | Dissertation | CONTRIBUTIONS AND LIMITATIONS 184 EMC and its external partners. We observed centers of decision making existing side-by-side (such as EMC and its external partners) and centers of decision making existing within centers of decision-making (such as the various functional units within EMC, represented by clinicians, nurses, registration clerks, and billing staff). Our review of the current literature on information management did not provide sufficient theoretical anchoring for such multiple nested centers of decision making, as most of the existing literature assumes a hierarchical decision-making authority in organizations (Arrow 1974; Simon 1981; Wiseman 1988). But, as we noticed in the context of EMC, organizations exist not only as large pyramidal structures that are managed as a bureaucracy (which may justify a hierarchical decision-making structure), but also as networks of firms, functional departments, work groups, teams, and informal peer groups (Piore and Sabel 1984) with multiple centers of decision making. The current literature on information management fails to account for these distributed, multiple levels of decision making in complex organizational settings. We initially considered Hypercomplexity Theory (Qvortrup 2003)— which deals with complexity inscribed within complexity—as a framing choice. Qvortrup’s theory explains the complexity of current post-industrial information society. However, his framing does not concern itself with multiple decision-making levels. In contrast, Polycentricity Theory (Ostrom 1972; Ostrom et al. 1961; Polanyi 1951) applies well to fragmented, multi-level decision making in complex human action situations as demonstrated by the work of Vincent Ostrom (1962; 1972; 1961), Elinor Ostrom (2009), and others (Sproule-Jones et al. 2008). Although we found very few applications of Polycentricity Theory in the IS, healthcare, or organizational literature—with the notable exception of Perlmutter (1969)—we selected the theory as it offers a promising framework for understanding information management in complex organizations.

The choice of Transaction Cost Theory, developed by Coase (1937), Williamson (1975; 1981), Ouchi (1980) and others, was a consequence of selecting Polycentricity Theory as our theoretical lens. From a transaction cost perspective, workflows (and related information exchanges) in complex organizational contexts can be better understood as transactions (as compared to tasks) across functional and organizational boundaries. This conceptualization allows IPF to consider multiple nested human transactions as the basic context for theorizing information management in complex organizational settings, such as hospitals. In particular, we followed Ciborra (1981; 1993), who emphasized the potential of the transaction cost approach to build IS theory. Another

Singh | Dissertation | CONTRIBUTIONS AND LIMITATIONS 185 advantage of taking this approach is that it allows for the three-fold governance mechanisms— relating to transactions, information processing for the transactions, and the supporting technological configurations—that form a key component of IPF.