Disrupted Routines: Team Learning and New Technology Implementation in Hospitals

Amy C. Edmondson, Richard M. Bohmer, Gary P. Pisano
2001 Administrative Science Quarterly  
for feedback on earlier versions of this paper. The comments and suggestions of Joe Porac and three anonymous reviewers greatly improved the paper. 685/Administrative Science Quarterly, 46 (2001): 685-716 6861ASQ, December 2001 Diupted Routines a technology often reinforces a habitual routine; for example, the design of a commercial aircraft's cockpit is conducive to certain standard operating procedures for takeoff and landing. The strength of this correspondence can lull teams into executing
more » ... ell-known routines even when external stimuli vary. For example, accustomed to uniformly warm weather, an Air Florida pilot automatically responded in the affirmative to his team member's routine question, "Anti-ice off?" despite the heavy snowfall at Washington, D.C.'s National Airport during the January 1982 takeoff. Tragically, this inappropriate adherence to routine led to the flight's crashing into a bridge over the Potomac River, killing all 74 crew members and passengers (Gersick and Hackman, 1990). The tendency to invoke familiar, routine sequences of behavior in situations in which they are no longer appropriate is well established in the psychology literature (Weick, 1979; Gersick and Hackman, 1990) and has been implicated as a cause of medical and other error (Reason, 1984). Despite its emphasis on the stability of routines, the organizational literature acknowledges that routines can change. Classic models of organizational routines suggest that they change slowly, through evolutionary processes (Cyert and March, 1963; Nelson and Winter, 1982). According to organizational learning theory, experience with known routines inhibits active seeking of alternatives, but exceptional mismatches between current routines and environmental conditions can provoke change (Levitt and March, 1988). Recent research showed that routines can change when groups spend time reflecting on outcomes of previous iterations of the routines. In a detailed case study of a university housing office, Feldman (2000) found that an annually executed routine for allocating housing assignments was altered after a series of intensive meetings among stakeholders. Gersick and Hackman (1990) proposed several conditions under which habitual routines in task groups are likely to change, including encountering novelty and experiencing failure. It is widely acknowledged that new technology is a trigger for changing organizational routines (e.g., Barley, 1986; Tyre and Orlikowski, 1994; von Hippel, 1994; Szulanski, 2000) . Ethnographic studies provide rich descriptions of routines being disrupted during technology implementation, showing both cognitive and interpersonal changes. Orlikowski (1993) found that cognitive changes in "technological frames," which describe how people think about a technology, facilitated appropriate use of new information technology. Barley (1986) studied two hospitals implementing CT scanners and found that interpersonal "scripts" governing the interaction between physicians and technicians were altered in one but not in the other. In both studies, new technologies led to changes in established routines, but not without a struggle. In contrast to this micro lens on how technology disrupts existing ways of thinking and acting in organizations, stage models of technology transfer (Szulanski, 2000)-which recognize that organizational routines are disrupted by technologies-employ a macro lens that conceptualizes the technology adoption process broadly into encompassing temporal stages. Between these two approaches to studying technolo-687/ASQ, Decemnber 2001 When you're on bypass for the standard CABG, there's no need for communication at all. In MICS there's a lot more. The pressures have to be monitored on the balloon constantly. For putting in the balloon and the primary line, the communication with perfusion is 691/ASQ,
doi:10.2307/3094828 fatcat:uhacv7tsrjea5kwqiu6xuroqwm