Management information systems, knowledge production and legitimacy in health care

This paper investigates the dynamics of legitimacy in relation to IT based production of knowledge within a context of strategic change. Applying a resource-based view on strategy we analyze the development and use of an MIS in a local health care organization in Norway. Although the resource-based view on strategy is highly relevant in analyzing strategic use of IT in health care, it should be complemented with theories that deal with the context more specifically. We argue that due to the contradictory logics, interests and values at work in such an organizational context, the dynamics of legitimacy are of crucial importance for the construction of MIS and the possibility for using it effectively. The case analysis demonstrates that through the process of MIS development its structure and functionality reflects the interests and values legitimately at work in the field. However, the analysis also demonstrates that the MIS is biased towards an administrative logic, which indicates that the extensions of the system and the compromises made are only partial. The paper concludes that strategic use of IT within such a context should face the problem of politics, but this is highly problematic because of the apparently apolitical nature of new public management reforms.

1. Introduction

The interest in strategic use of MIS in the health care sector both as a research topic and in practical information system development has led to an increased understanding of how MIS gets caught up in heterogeneous processes of change [19]. This implies that neither the strategy process nor the enabling role of IT can be understood without investigating how a MIS becomes enabling within a certain context [17]. IT development can fruitfully be viewed as a continuous process of change within a mixture of deliberate strategies and emergent strategies [15]. Moreover, strategic use of IT must face the challenge of legitimacy. The health care sector is characterized by several and partly contradictory logics, values and interests all of which have a legitimate status. For instance, administrative control must compete and potentially be in conflict with claims for professional autonomy. It is well known that deliberate strategies face resistance from stakeholders whose interests are perfectly legitimate.