Power and resistance in the implementation of a medical management information system

Abstract

This paper presents an analysis of the implementation of a large information system in a New Zealand hospital. The system was intended to monitor and scrutinize clinical activity, and management hoped to influence clinical behaviour through the increased visibility afforded by the system. However, doctors were not the passive subjects of a computerized control system, and some were able to resist the application of the information produced by challenging its validity or using it to argue for more resources. Nevertheless, the interrelatedness of the information system with the organizational forms and practices within which it was used and which it helped shape reinforced the concepts, norms and values associated with the new management and economic discourse prevalent in the hospital, and helped to produce more defined accountabilities for doctors. With time, the role of the information system was reinterpreted, and in the face of continued resistance by doctors, it was relegated to a less significant role. The potential for engendering self-disciplining behaviour in organizational participants through the pervasive, everyday use of the information the system produced likewise diminished.