Disrupted Routines: Team Learning and New Technology Implementation in Hospitals

Citation: Edmondson, A. C, Bohmer, Richard M., Pisano, Gary P. (2001/12) Disrupted Routines: Team Learning and New Technology Implementation in Hospitals. Administrative Science Quarterly (Volume 46) (RSS)
Internet Archive Scholar (search for fulltext): Disrupted Routines: Team Learning and New Technology Implementation in Hospitals
Download: http://www.jstor.org/stable/3094828
Tagged: Business (RSS) routines (RSS), Organizational Change (RSS), surgery (RSS), matched case (RSS), technology implementation (RSS)

Summary

To begin their piece about successful change in routines, Edmondson and her colleagues offer an unsurprising opener: most change fails in organizations. The literature is overwhelming in its support of this point (e.g. March & Simon 1958 through Orlikowski 2000).

Why, then, in their interviews at 16 well-matched hospitals, did six out of sixteen hospitals succeed in implementing a new technology that had radical implications for current cardiac surgical practice? This is Edmondson et. al.'s central question.

Their next move in the paper is to indicate the apparent strong link between change in organizational routines and successful implementation of new technologies: you can't have one without the other. In particular, they claim, technologies that most threaten the status quo in this way are those with interdependent users. They cite the teams-focused literature, which indicates that coordination and learning are central to successful implementation, and these, in turn, rely upon (at least) three organizational factors: authority structures, psychological safety (popularized by Edmondson in her 1999 paper) and team stability.

Edmondson and her colleagues' data concerns the implementation of minimally-invasive cardiac surgery (MICS). Where previous technologies and procedures associated with cardiac surgery required the breaking of the breastbone, this new procedure allowed for surgeons to operate through small incisions between the ribs, thus greatly improving patient outcomes.

In the "old" procedure, the surgeon could essentially "run the show"; they saw the heart at all times, and called on specialists for help in very circumscribed ways and at more-or-less predetermined times. The MICS procedure all but required the surgeon to cede this control, and for the team to communicate much more frequently.

Given the strictures associated with MICS (as compared to current practice), Edmondson et. al.'s main finding is perhaps unsurprising: successful implementations involved greater intentionality in MICS team formation, greater intentionality and psychological safety in team preparation, greater team openness and flexibility during trial implementation, and regular, sincere team-based reflection after each MICS procedure (at least initially). The authors focus primarily on the team leader's role in these processes.

Towards the end of their piece, the authors also raise the importance of technological frames (c.f. Orlikowski & Gash, 1994) for successful implementations: successful teams saw MICS as implying a fundamental shift in the nature of the cardiac surgery practice, while unsuccessful teams saw MICS as a "plug and play" technology/procedure.