From ICT to Integrated Care: the Performative Cohesion of Organizing Visions

Abstract

We link the concept of an ‘organizing vision’ to the idea of ‘performativity’ in order to better understand the challenges associated with implementing integrated care, i.e. the usage of ICT in order to coordinate medical treatments of the same patient by multiple medical professionals. More specifically, we focus on how medical autonomy affects the performativity of an organizing vision. Through an inductive case study of one German integrated care provider, we indicate that medical autonomy seems to be positively related to adoption decisions of ICT by medical professionals if an ICT-based business model embraces medical autonomy. However, through looking at the first four years of the implementation process, we also find that medical autonomy seems to be negatively related to important ICT-related outcomes of integrated care. Our study implies that a focus only on how actors translate organizing visions may run the risk of underemphasizing context factors that affect the adoption of integrated care on the organizational level. To depict how such contexts influence the degree at which an organizing vision is performative, we introduce the concept of ‘performative cohesion’.