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In this study, we propose a Bilateral Double Motive framework of stakeholder cooperation in complex projects. The framework analyses and explains dyadic promoter-stakeholder relationships at a micro level by acknowledging both transactional and relational motives. We demonstrate the framework’s usefulness by illustrating its explanatory power in two instances of cooperation and two of non-cooperation within two health information technology projects. The study contributes to project management theory through its combined focus on transactional and relational motives. Further, the study contributes to practice by providing a tool for planning and evaluating cooperation in health Information Technology projects and similar complex multi-stakeholder environments.

During the last decades, organizations worldwide have replaced their fragmented and home-grown information systems with standardized Enterprise Systems that span the entire organization. The logics embedded in Enterprise Systems, such as a centralized and integrated view on the firm, standardized organization-wide working processes, and data sharing, may or may not be congruent with the cultural context of the user organization. Especially in case of a limited alignment, the adoption and full use of the Enterprise System will require specific attention from implementers. By developing a theoretical explanation of how responses to Enterprise Systems are influenced by cultural values, we contribute to the development of a cultural alignment theory of Enterprise Systems. Drawing on Hofstede’s cultural values framework, we analysed 85 published cases from firms operating in different cultural contexts, which resulted in the modelling of two contrasting archetypical cultural profiles: one that is more, and one that is less, receptive to the logics embedded in Enterprise Systems. Our model provides implementers with the necessary insights to develop implementation strategies that take the cultural context into account.

Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.

Background One of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics. Methods We conducted an embedded case study at five outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through interviews with representatives of medical specialties, administration, nursing, and management. Documents were analyzed to contextualize these data. We examined the following collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating. Results Our findings demonstrate how an EHR will both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the hospital because: (a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use. (b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital. (c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration. (e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority. Conclusions For the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.

In the change management literature, most studies on recipients' resistance to change include only the views of agents or of recipients, thereby ignoring that these parties may have different perceptions. In this quantitative study, we include the perceptions of both parties in studying the recipients' resistance and the impact of the agent's leadership behavior. In a sample of 117 agent-recipients groupings, covering 110 different change projects in 90 organizations, we found that agents perceive higher levels of recipients' resistance than do the recipients themselves. Additionally, we found that agents who create space to enable recipients to think and act differently (by employing creating behavior) report higher levels of recipients' resistance, whereas recipients perceive their resistance to be lowered when agents facilitate an emotional connection to the change (framing behavior). The depth of the change appeared to moderate the relationship between agent's leadership behavior and recipients' resistance, indicating that agents and recipients differ in which change leadership behaviors they perceive as increasing or decreasing resistance at different levels of change depth. These findings imply to reconsider the relationship between agent and recipients and we propose some promising avenues for future studies in resistance research.

Background: Electronic Health Records (EHR) are integrated software applications used by healthcare providers to create, share, retrieve, and archive patients’ health status information. Especially for large healthcare organizations, implementing Electronic Health Records organization-wide is a complex endeavour. The EHR literature generally suggests that contextual factors play a major role in adoption. We demonstrate how the work context influences adoption at the departmental level in a situation where each department has its own medical specialty or patient stream, clinical authority, and accountability. Here, the achievement of full adoption by all departments is not self-evident. Drawing on EHR implementation in a Dutch hospital, this study explores how the clinical departments’ work context characteristics contribute to their pre-implementation intended adoption and their post-implementation EHR uptake. Methods: This embedded case study allowed us to examine the EHR adoption of eight diverse clinical departments in terms of their work and socio-political context. Data collection entailed semi-structured interviews, observing meetings, document analysis, and feedback sessions to check our interpretations. We examined the context and adoption intentions before implementation and the adoption level approximately half a year after the Go Live. The comparative case analysis iterated between holistic department-level descriptions and structured data displays based on inductive and deductive coding. Results: We identified three departmental types that varied both in adoption intention and post-implementation uptake: (1) departments oriented towards the organization with an enthusiastic or compliant adoption; (2) internal-oriented departments with a selective or conditional adoption; and (3) externally oriented departments with no or low adoption with workarounds. Conclusions: We conclude that work context characteristics contribute to individual departments’ adoption of an EHR. By acknowledging departmental types that will vary in adoption intention, and especially the underlying explanatory mechanisms, we recommend that implementers acknowledge these departmental types and differentiate their strategies towards clinical departments accordingly based on their observable work context characteristics. Based on these findings, we develop propositions that contribute to the development of a department-level EHR adoption theory.

This article analyzes the tensions evolving from project management dilemmas and how they relate to stakeholders in large technology projects. The study addresses an organization-wide electronic health record implementation in a large hospital. It adopts a duality lens in exploring whether and how these tensions materialize through stakeholder voices. In contrast to traditional linear and unitarist thinking in project management, duality thinking may lead to project management practices that acknowledge, appreciate, and accommodate the tensions originating from dilemmas inherent in complex projects. We propose three stakeholder roles that can contribute to project managers’ tension awareness and inform duality management.

This study examines how national culture manifests itself in integrative IS implementations and how it influences user behavior. Adopting a case survey approach, a sample of 70 cases encompassing 18 countries/regions, 18 industries and over 25 different integrative IT systems resulted in 481 instances of national culture dimensions, manifestations and effects. These were analysed through the lens of Hofstede's five national culture dimensions. Three types of national culture manifestations were identified, namely trust and respect, management culture and conflict. Management style and implementation ownership were identified as effects of national culture on user resistance.

The stakeholders and the issues associated with a project are different concepts but closely interconnected. Despite this, the project stakeholder management literature falls short in analyzing the linkages between the stakeholders and the issues they bring. This paper develops a multilayered stakeholder–issue framework that makes the connections between stakeholders and issues explicit with the aim of helping project managers analyze and prioritize the issues that stakeholders confront them with. The framework's usability is preliminary evaluated through a case study of a multi-stakeholder implementation of an electronic health record (EHR) system in an institutionalized hospital environment. The framework enables a coherent assessment of stakeholders' issues. Using the case study, we discuss how such an assessment could improve the management of stakeholders' issues and their influence on a project's progress and outcomes.

Purpose– The purpose of this paper is to present a 2 × 2-perspective of management–stakeholder cooperation in organizational issues. The model encompasses the perspectives of both management and stakeholder and bridges the two dominant views in stakeholder thinking, namely, the transactional and the relational view.Design/methodology/approach– From a state-of-the-art elaboration of the stakeholder literature, this paper combines two separate perspectives on management–stakeholder cooperation.Findings– The bilateral perspective stresses that the ease of this collaboration not only depends on the willingness of management to pursue cooperation, but also on that of the stakeholder. The double-motive perspective signifies that both parties can be dominantly motivated by either individual, issue-based reasons (transactional motives) or by the desire to establish lasting relationships (relational motives).Originality/value– This paper presents a more elaborate picture of management–stakeholder cooperation by combining the transactional concept of stakeholder salience with the concepts “stakeholder reputation” and “management reputation” associated with the relational dimension.

An important responsibility of promoters of enterprise information systems (EIS) is to manage the relations with the system's stakeholders. This is a complex task because of the increasing scope and impact of modern information technologies. In this study we propose and test a model of stakeholder cooperation in a healthcare-EIS context. The model explains effective promoter-stakeholder cooperation by acknowledging transactional as well as relational motives. In the empirical part, this Bilateral, Double Motive (BDM) model is validated by the analysis of three different cases of promoter-stakeholder cooperation. The study contributes to stakeholder theory in EIS contexts by its combined focus on transactional as well as relational motives. Furthermore, the study contributes to practice by providing a systematic way to consider cooperation in EIS projects, especially in healthcare environments.

In project management it is commonly accepted that the interests of stakeholders need to be dealt with to support the success of a project. By doing a meta-analysis of project management literature it is investigated how the stakeholder notion is used in this literature. Forty two publications are assessed against the purpose of this notion, the stakeholder definition and how the identification of stakeholders is addressed. The analysis shows that only a minority of the publications provides a clear definition and addresses the identification of stakeholders. We argue that a role perspective on the stakeholders issue fits the project context and therefore could fill this gap in the project management literature. After comparing the stakeholder approach with project role classifications from the literature, we conclude that a role-based stakeholder identification method is a promising approach for identifying stakeholders in projects.

PurposeIn the literature on complaint management the importance is acknowledged of learning from complaints. Still, the concept of organisational learning has not yet been embedded in the field of complaint management. Therefore, this paper aims to adjust a general model for organisational learning to the concept of complaint management in order to make it operational for this field.Design/methodology/approachThe notion of organisational learning in combination with complaint management is modelled as a system. This system enabled us to analyse the practices of handling and analysing complaints within six Dutch service organisations and to assess the potential of these organisations for organisational learning.FindingsThe results of the paper categorise a variety of complaint management practices along two elements of organisational learning: triggers and modes of learning (i.e. informational learning or interactive learning).Research limitations/implicationsFurther research should include the applicability of the learning model to different sectors or organisations.Practical implicationsThis collection of practices can be used as a managerial guideline for improving the processes of learning from complaints.Originality/valueThis paper contributes to embedding the concept of organisational learning in the field of complaint management.

Although (the relevance of) stakeholder management receives considerable attention in literature, the problem of actual stakeholder identification is yet unresolved. This article analyses the potential contributions of critical systems thinking to solving this problem. Especially Ulrich's notion of boundary critique, by which he focuses on stakeholder roles and particularly the role of 'the affected', seems a fruitful contribution. By adapting the role definitions towards a project context, including project dynamics, and adding operating instructions, a method has been developed that can be used for actual stakeholder identification in organizational projects. This method is demonstrated on two projects. The results show that this adapted version of boundary critique, which in its original form mainly is used in the context of civil society, is also relevant in an organizational profit-based context. Copyright (c) 2007 John Wiley & Sons, Ltd.

Making sustainability operational within organisational practice requires dealing with three interrelated questions: A "what-question", an "attribute-question" and a "who-question". The complexity of these questions needs a tailor-made interpretation of sustainability. This paper provides a framework that can be used for obtaining such a tailor-made interpretation of sustainability. This framework is based on the notion that staff members somehow need to make sense of sustainability. By taking a cognitive mapping approach, a multidimensional space of sustainability can be deduced. The interpretation of the dimensions of this space can then provide a definition of sustainability. We illustrate the framework by obtaining an image of sustainability for a firm of consulting engineers.

As a management problem the identification of stakeholders is not easily solved. It comprises a modelling and a normative issue, which need to be solved in connection with each other. In stakeholder literature knowledge can be found, e.g. on various stakeholder categorizations, that could be useful for the modelling issue. However, the normative issue remains unresolved. Additionally, the modelling of the so-called stakeholder category ‘the affected’ further complicates this issue. Nevertheless, from a normative perspective, this group holds justified interests in aspects of organizational activity and its members are, for that reason, legitimate stakeholders. In this article it is explored to what extent critical systems heuristics can help in resolving the managerial problem of identifying stakeholders. Critical systems heuristics is a modelling methodology in which the normative aspect of modelling is crucial. Using the distinction between ‘the involved’ and ‘the affected’, a variety of boundary judgments are discussed. Special attention is given to the so-called ‘witness’ as a representative of the affected. Copyright © 2003 John Wiley & Sons, Ltd and ERP Environment.

Background: The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and toidentify generally applicable findings and lessons for implementers.Methods: A systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles werealso analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online,(3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying establishedquality criteria.Results: Of the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a frameworkconsisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process.Conclusions: Although EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity andpresents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies forhospitals.

PurposeThe management of stakeholder involvement within innovation projects is a task of growing importance. The purpose of this paper is to present a method for the first challenge in stakeholder management: the identification of those stakeholders to be involved in innovation projects.Design/methodology/approachAnalysis of stakeholder literature leads to the conclusion that stakeholder identification is considered a problem of classification. Although the availability of a classification model is necessary, it is argued that for a classification model to be of use in identifying stakeholders, such a model needs to be supplemented with an identification procedure for identifying real world parties. Furthermore, a classification model should fit the context the stakeholders are identified for, in this case for innovation projects. These insights have led to the development of a classification model fitting the innovation context, and to the embedding of this model, along with a matching identification procedure, in an identification method.FindingsA partial and integral evaluation of the method on four cases showed its efficacy in the managerial practice of identifying stakeholders within innovation projects.Originality/valueThe method as proposed in the paper can be used for identifying stakeholders in innovation projects. The method can be considered a first step in managing stakeholder involvement.

This article presents a framework that can serve as a first step towards managing stakeholder involvement in sustainable innovation projects. This framework is based on the questions of which stakeholders ought to be involved, in which phase of the innovation project, and how. The underlying idea is that stakeholder involvement serves two goals: to clarify the local criteria for sustainable outcomes, and to activate organisational practices according to these criteria. In the framework we combine a new perspective on sustainability, 'the reduction of offload', with the well-known Triple P-perspective, to designate certain types of stakeholders. These stakeholders should be consulted to clarify criteria for sustainable innovation. Active participation of organisational members in stakeholder involvement might lead to the commitment needed for the actual use of these criteria in different phases of the innovation process. In this way stakeholder involvement can also lead to organisational practices consistent with sustainability criteria.