An Organizational Culture-Based Theory of Clinical Information Systems Implementation in Hospitals

We propose an organizational culture-based explanation of the level of difficulty of clinical information system (CIS) implementation and of the practices that can contribute to reduce the level of difficulty of this process. Adopting an analytic induction approach, we developed initial theoretical propositions based on a three-perspective conceptualization of organizational culture: integration, differentiation, and fragmentation. Using data from three cases of CIS implementation, we first performed a deductive analysis to test our propositions on the relationships between culture, CIS characteristics, implementation practices, and the level of implementation difficulty. Then, applying an inductive analysis strategy, we re-analyzed the data and developed new propositions. Our analysis shows that four values play a central role in CIS implementation. Two values, quality of care and efficiency of clinical practices, are key from an integration perspective; two others, professional status/autonomy and medical dominance, are paramount from a differentiation perspective. A fragmentation perspective analysis reveals that hospital users sometimes have ambiguous interpretations of some CIS characteristics and/or implementation practices in terms of their consistency with these four values. Overall, the proposed theory provides a rich explanation of the relationships between CIS characteristics, implementation practices, user values, and the level of difficulty of the implementation process.