Why is it difficult to design innovative IT? : An agential realist study of designing IT for healthcare innovation

Sammanfattning: It may seem strange to claim that it is difficult to design innovative information technology (IT) in a time when the technological progress leaps forward like never before. However, despite the numerous opportunities that this rapid progress provides, we often design IT that is similar to existing artifacts, making IT design incremental rather than radical. At the same time, IT innovations are pointed out as crucial to meet the societal challenges we are facing, not least in the public sector, including a growing and older population, increasing demands from citizens and reduced tax revenues. This calls for us to better understand why it is difficult to design innovative IT. Previous research on this topic have mainly focused on human and social aspects, not paying close attention to IT. In this thesis, it is suggested that the sociomaterial theory agential realism can help shed light on the role of IT in innovative IT design, acknowledging the sociomateriality of IT. Thus, the overarching aim of this thesis is to apply agential realism on an empirical case in order to explore and explain why it is difficult to design innovative IT. To fulfill the aim, a qualitative case study was conducted in publicly funded healthcare. The empirical case is an example of an attempt to design innovative IT in a healthcare context. The empirical material was generated through participant observations, including video recordings, and semi-structured interviews. The material was analyzed in several rounds, with and without a theoretical lens. In the agential realist analysis, IT has been viewed as entangled with the world. The analysis focused on what boundaries IT produced and how these boundaries were consequential for what was possible and impossible to design. The thesis illustrates how IT is produced and productive in terms of both matter and meaning, and thus, is agential – IT makes differences in the world. What is possible to design is not only constrained by social structures but by the materiality of IT, what boundaries IT helps produce and the material-discursive practices that enact IT. Innovative IT design means to design material configurations that produce boundaries that are different from what have been enacted before and, thus, deviate from existing material-discursive practices. However, it is difficult to deviate from these since material-discursive practices are agential and define what boundaries are meaningful and legitimate. Hence, it is difficult to design innovative IT since innovative IT design has to both enact boundaries that deviate from agential material-discursive practices and also gain legitimacy. Through this explanation, the thesis makes an explanatory knowledge contribution which differs from and adds to earlier explanations. It also makes a contribution to conceptualizing the IT artifact by emphasizing IT as sociomaterial and providing examples of how IT can be understood as produced, productive, agential and entangled. Finally, the thesis also makes an empirical and methodological contribution in the sense that it demonstrates how an agential realist case study can be conducted in the field of Information Systems.