Thinking big whilst making do: Mismatching expectations of a national human resource information system in healthcare.

We adopted a qualitative case study research design and examined a major Information System (IS) innovation project that aimed to develop and implement Human Resource Information System (HRIS) across all health organizations within one European National Health Organization (NHO). Here we set out to contribute to institutional literature by exploring the processes through which institutional pressures shape the intention to adopt, adoption and implementation of an IS innovation within an organizations setting, particularly by examining such influences over time. We also draw on the concepts of the organizing vision and strategic responses, in order to understand how organizational actors interpret the nature and goals of the innovation and respond to the various institutional pressures associated with them. Adopted institutional lens allowed us to explain the unexpected difficulties that NHO encountered during the implementation of this IS innovation that seems to have been strongly supported at the outset. Our results indicate that at the comprehension stage, alignments between all three types of institutional pressures led to cohesive expectations concerning the core business problematic of the innovation and resulted in an initial acquiescence response. As the innovation progressed through adoption and implementation, misalignments between coercive, normative and mimetic pressures begin to manifest more strongly, exposing the inherent conflicting expectations that became part of the organizing vision about the technology itself, the organizational practices that would be changed and how these would be addressed by the innovation. We also found that as changes in institutional demands increase the tensions within the organizing vision, the variety in response strategies also increases reflecting greater uncertainty. Thus whilst previous research indicates a linear move from acquiescence to manipulation as environmental uncertainty increases (e.g. Oliver, 1991), our findings suggest an increase in the variety of responses during the implementation stage ranging from compromise to manipulation.