title: Understanding managerial behaviour during initial steps of a clinical information system adoption.
abstract: BACKGROUND
  While the study of the information technology (IT) implementation process and its outcomes has received considerable attention, the examination of pre-adoption and pre-implementation stages of configurable IT uptake appear largely under-investigated. This paper explores managerial behaviour during the periods prior the effective implementation of a clinical information system (CIS) by two Canadian university multi-hospital centers.
  
  
  METHODS
  Adopting a structurationist theoretical stance and a case study research design, the processes by which CIS managers' patterns of discourse contribute to the configuration of the new technology in their respective organizational contexts were longitudinally examined over 33 months.
  
  
  RESULTS
  Although managers seemed to be aware of the risks and organizational impact of the adoption of a new clinical information system, their decisions and actions over the periods examined appeared rather to be driven by financial constraints and power struggles between different groups involved in the process. Furthermore, they largely emphasized technological aspects of the implementation, with organizational dimensions being put aside. In view of these results, the notion of 'rhetorical ambivalence' is proposed. Results are further discussed in relation to the significance of initial decisions and actions for the subsequent implementation phases of the technology being configured.
  
  
  CONCLUSIONS
  Theoretical and empirically grounded, the paper contributes to the underdeveloped body of literature on information system pre-implementation processes by revealing the crucial role played by managers during the initial phases of a CIS adoption.
authors.affiliation: Area of Health Services and Policy Research, Department of Family Medicine, McGill University, 515-517 Pine Avenue West, Montreal, Quebec, H2W 1S4, Canada. charo.rodriguez@mcgill.ca
authors.forename: Charo
authors.initials: C
authors.lastname: Rodríguez
authors.forename: Marlei
authors.initials: M
authors.lastname: Pozzebon
mesh_terms: D002170:Canada; D006740:Hospital Administrators / Q000523:psychology*; D006801:Humans; D007256:Information Systems / Q000458:organization & administration*