Disrupted Routines: Team Learning and New Technology Implementation in Hospitals

• Published in: Administrative science quarterly Vol. 46; no. 4; pp. 685 - 716
• Main Authors: Edmondson, Amy C., Bohmer, Richard M., Pisano, Gary P.
• Format: Journal Article
• Language: English
• Published: Thousand Oaks Cornell University Samuel Curtis Johnson Graduate School of Management 01.12.2001; SAGE Publications; SAGE PUBLICATIONS, INC
• Subjects: Administrative science; Adoption of innovations; Biomedical technology; Business innovation; Business studies; Cardiac surgery; Case studies; Clinical outcomes; Emerging technology; Enrollments; Field hospitals; Heart surgery; Hospitals; Implementation; Innovation; Innovation adoption; Learning; Meaning; New technology; Nurses; Operating rooms; Organizational research; Patients; Psychological safety; Safety; Safety behaviour; State hospitals; Surgeons; Surgery; Teamwork; Technological change; Technological innovation; Technology; Technology adoption
• ISSN: 0001-8392; 1930-3815
• DOI: 10.2307/3094828

This paper reports on a qualitative field study of 16 hospitals implementing an innovative technology for cardiac surgery. We examine how new routines are developed in organizations in which existing routines are reinforced by the technological and organizational context. All hospitals studied had top-tier cardiac surgery departments with excellent reputations and patient outcomes yet exhibited striking differences in the extent to which they were able to implement a new technology that required substantial changes in the operating-room-team work routine. Successful implementers underwent a qualitatively different team learning process than those who were unsuccessful. Analysis of qualitative data suggests that implementation involved four process steps: enrollment, preparation, trials, and reflection. Successful implementers used enrollment to motivate the team, designed preparatory practice sessions and early trials to create psychological safety and encourage new behaviors, and promoted shared meaning and process improvement through reflective practices. By illuminating the collective learning process among those directly responsible for technology implementation, we contribute to organizational research on routines and technology adoption.