AbstractsMedical & Health Science

Ph.D. University of Hawaii at Manoa 2014. This dissertation research investigates the interrelationships between information systems affordances and relational coordination in high velocity, high reliability organizations. Based on a qualitative case study of an intensive care unit and a general medical /surgical unit, I identified a set of nine distinct foundational information systems affordances for coordination related to accessibility and integration of information. Four affordances (i.e., Immediacy, Comprehensiveness, Interpretability, Visibility) were particularly essential for effective coordination in the high velocity environment. Enactments of information systems affordances within groups depended on feature fit as defined in the information systems affordance literature, but as importantly also on use of the electronic health record system by others and rules and regulations. Enactment variations of the four essential information systems affordances enabled or constrained relational coordination on a day-to-day practice level, depending on how team members incorporated verbal communication with adaptive or non-adaptive enactments of the meta-level affordances for Facilitation, Supplementation or Substitution of verbal communication in situations with varying time constraints and complexity. This research contributes to the literature on information systems affordances by highlighting the importance of use variations by team members in addition to feature fit, and by proposing a meta level of affordances that contextualizes effects of foundational affordances on relational coordination. It further contributes to the literature on the implications of health IT on practices by showing how enactment variations of information systems affordances reflected collaborative relationships among professional groups and reinforced rather than mitigated challenging relationships among team members. Finally, this study contributes to the literature on Relational Coordination Theory by proposing an additional, distinct communication dimension 'comprehensive communication', which was critical for enabling the relational dimensions in day-to-day practice. The research highlights the importance of the practice level to examine effects of health IT on the relational dimensions of relational coordination.