The notion that the design of technology is only fully completed when in use [23] is shared by many who now investigate user participation in design and the domestication of new technologies. Taking this idea as our starting point, we developed a research to action project with a major Canadian hospital. Our goals were to address technology implementation issues that arose as most units in the hospital moved to a new building, in which most technology (ranging from wired beds to drug dispensing

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... machines) was new. This paper reports our findings from this project. Emphasis is placed on how institutional arrangements influenced the range of socio-technical possibilities that could be pursued [7] . Work practice problems are discussed in relation to the meso or organizational contexts, including organizational, vendor and staff actor networks.