A Contextualist Approach to Telehealth Innovations By Sunyoung Cho Abstract Healthcare is considered one of the most important social issues in the U.S. as well as in other societies with ever-increasing costs of medical service provision. The information-intensive nature of the healthcare industry and the perception of information technology (IT) as a way to ease up healthcare costs and improve quality have lead to increased use of and experiments with IT-based innovations. These activities present interesting research opportunities for IS researchers and they have led to an increasing body of knowledge on healthcare information systems. This research aims at contributing to this line of research by adopting a contextualist approach to examine the adoption, use, and further diffusion of telehealth innovations. A contextualist approach provides a particularly interesting and relevant perspective to study adoption and diffusion processes of healthcare innovations. The adopted contextualist approach is process-oriented, it applies multiple levels of analysis, and it accommodates different theoretical lenses to make sense of the two telehealth innovations under investigation. A key assumption is that innovations should be understood as ongoing processes of change, not just technologies, or isolated change events with clear boundaries. Healthcare innovations have in this view much broader connotations, including development of IT-based applications, their adoption and diffusion over time, and the interactions between many stakeholders and organizations that shape the innovation in a specific context. The contextualist approach suggested by Pettigrew is adopted as an overarching framework for multiple studies based on empirical investigation of two telehealth innovations; the main focus is on a telestroke innovation in the U.S. while a radiology innovation in Sweden serves as a complementary case. Each study is documented as an independent research publication with its own theoretical perspective and contributions. The overall contextualist approach and the related findings are then summarized across the individual studies. Telehealth innovations are particularly interesting examples of healthcare information systems. They leverage contemporary network infrastructures and interaction devices to allow provision of healthcare services, clinical information, and education over distance, thereby reducing the costs and improving the availability of medical services. The two telehealth innovations are investigated through in-depth case studies. This theses summary presents the theoretical background for the studies; it motivates and details how the qualitative case studies based on critical realist assumptions were designed and conducted; it outlines the resulting research publications; and it discusses the contributions of investigating telehealth innovations from a contextualist approach.

The purpose of this dissertation was to understand how radical organizational change impacts the effectiveness of national-level sport organizations, during the process of change, through the perceptions and experiences of internal and external stakeholders. Four research questions were addressed: (1) What success factors and challenges do national-level sport organizations face while undergoing radical change? (2) How does radical change impact the goals, internal processes, resources, and multiple constituents of the focal organization? (3) How does radical change impact external stakeholders? (4) How does radical change impact the effectiveness of external stakeholders’ own organizations? A single case study was built using 32 semi-structured interviews and 61 documents, and data were thematically analyzed. Results showed an initial decline in overall organizational effectiveness in the early stages of the change process followed by an increase. Findings highlight similarities and differences between internal and external stakeholder perspectives, demonstrating the importance of obtaining both perspectives when studying organizational effectiveness during radical change.

Notre recherche doctorale se propose d’analyser la mise en place de la Gestion Prévisionnelle des Emplois et des Compétences (GPEC) dans le cadre d’un regroupement de cliniques privées appartenant à un même opérateur de santé. Organisée en trois temps, notre thèse vise à se démarquer de l’approche fonctionnaliste qui domine les écrits sur la GPEC en Sciences de Gestion et qui traite principalement du contenu de la démarche. Elle tente, en ce sens, d’ouvrir la « boîte noire » que constitue la GPEC à l’aune de la dimension humaine et du processus de construction. Dans un premier temps, nous mobilisons l’approche contextualiste de Pettigrew (1985, 1987, 1990) qui rend compte des interrelations entre trois grandes dimensions : un contenu de changement, le contexte interne et externe dans lequel il se développe et le processus de son déploiement. Ce cadre d’étude contextualiste initial ne suffit pas à lui-seul pour étudier un phénomène. Dès lors, nous proposons de le faire évoluer par l’introduction de variables explicatives dans ses trois dimensions. Cette modélisation systémique particulière est réalisée dans une logique abductive alternant des allers et retours entre les observations théoriques et les observations réalisées sur le terrain d’étude mobilisé, CAPIO BAYONNE. Dans un second temps, nous mettons à l’épreuve notre modèle contextualiste de recherche sur le terrain d’étude en question. La déclinaison empirique obtenue révèle de nombreux enseignements qui inscrivent la GPEC dans une vision multi-paradigmatique et intégrée combinant l’approche contingente, l’approche incrémentale et l’approche fonctionnaliste. Enfin, dans un troisième et dernier temps, la recherche cherche à établir, à partir de notre modèle contextualiste et de ses enseignements issus du terrain, un mode de gestion « générique » de GPEC pour les managers qui souhaitent se doter d’une telle démarche dans le cadre d’un regroupement de cliniques privées. / This doctoral research work proposes to analyse the implementation of Provisional Management of Employment and Skills practices (“GPEC” in French) within the framework of a regrouping of several private French clinics belonging to a common health care provider. Our thesis is organised in three parts, and aims to distinguish itself from the functionalist approach which currently dominates the literature on “GPEC” in Management Sciences and which limits itself mainly to studying the content of the approach. We thereby try to continue the work of opening up the "black box" of the “GPEC” in terms of the human dimension and the construction process involved. Firstly, we mobilise Pettigrew's contextualist approach (1985, 1987, 1990), which describes the interrelationships between three major dimensions : a content of change, the internal and external context in which this develops, and its deployment process. This initial contextualist framework is not in itself sufficient for studying a phenomenon.We therefore propose to further develop it by introducing explanatory variables into each of its three dimensions. This specific systemic modeling is performed using abductive logic to frequently alternate between the theoretical findings on the one hand and the observations conducted on the study site, CAPIO BAYONNE, on the other. Secondly, we test our contextualist research model on the study site in question. The empirical declination thus obtained teaches many lessons which set the “GPEC” in a multi-paradigm, integrated view of things, combining the contingency approach, the incremental approach and the functionalist approach. Finally, in a third and final part, our research seeks to establish, on the basis of our contextualist model and the lessons learnt from the field, a "generic" GPEC management mode for managers who wish to develop such an approach as part of a regrouping of private clinics.