Loose Coupling and Healthcare Organizations: Deployment Strategies for Groupware

Healthcare organizations are often organized in a modular, loosely coupled fashion where separate and semi-autonomous work units specialize in different areas of care delivery. This partitioning allows each unit to adapt to emerging practice standards in its area of expertise and to adjust to its local work environment. However, organizational loose coupling can limit the flow of information within organizations and can make it difficult to coordinate services when patients’ care is dependent on professionals from more than one unit. Groupware systems have the potential to improve coordination and information access in healthcare organizations. However, modularity and loose coupling make it difficult to introduce new systems when they span more than one unit, since authority is not always centralized and since perceptions and frames of reference on new deployments differ across units. In this paper, we define a groupware deployment framework for loosely coupled healthcare organizations that has two parts: a set of deployment challenges and a set of deployment strategies. The deployment challenges include: difficulties centralizing deployments, perceptions of inequity, role conflicts, and problems achieving critical mass. The deployment strategies outline a preliminary set of approaches for addressing the difficulties of deploying CSCW systems in loosely coupled healthcare organizations. We illustrate the framework by presenting a case study of a groupware deployment in a home care setting.

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