Understanding variation in subunit adoption of electronic health records: facilitating and constraining configurations of critical dependencies

This interpretative case study demonstrates how the work system properties and roles of clinical departments are perceived to shape their adoption an organisation-wide electronic health record. In hospitals, with heterogeneous powerful departments, partial or non-adoption by some may jeopardise effective overall use. Viewing a hospital’s EHR from sociotechnical fit perspective, we unravel departments’ this was primarily shaped critical dependencies rather than role during its implementation. From interviewees’ accounts, three orientations emerge: (1) organisation-oriented resulting in unconditional adoption; (2) department-oriented problematic delayed high compromise costs; (3) environment-oriented at least extra design costs. Our subsequent analysis leads identification four types subunit-level characteristics influencing adoption. Their interplay informs balancing between accepting costs negotiating We develop diagnostic model that takes embeddedness subunit into account thereby complements individual- organisation-level theories. An accompanying heuristic enable hospital managers better anticipate heterogeneity