Disrupted Routines: Team Learning and New Technology Implementation in Hospitals

This research was supported by the Division of Research at Harvard Business School and would not have been possible without the superb research assistance of Ann Winslow, Sakina Berman, Shoshanna Dobrow, and Naomi Atkins. We are grateful to Teresa Amabile, Robin Ely, David Garvin, Richard Hackman, Jody Hoffer Gittell, and Linda Johanson for feedback on earlier versions of this paper. The comments and suggestions of Joe Porac and three anonymous reviewers greatly improved the paper. This paper reports on a qualitative field study of 16 hospitals implementing an innovative technology for cardiac surgery. We examine how new routines are developed in organizations in which existing routines are reinforced by the technological and organizational context. All hospitals studied had top-tier cardiac surgery departments with excellent reputations and patient outcomes yet exhibited striking differences in the extent to which they were able to implement a new technology that required substantial changes in the operating-room-team work routine. Successful implementers underwent a qualitatively different team learning process than those who were unsuccessful. Analysis of qualitative data suggests that implementation involved four process steps: enrollment, preparation, trials, and reflection. Successful implementers used enrollment to motivate the team, designed preparatory practice sessions and early trials to create psychological safety and encourage new behaviors, and promoted shared meaning and process improvement through reflective practices. By illuminating the collective learning process among those directly responsible for technology implementation, we contribute to organizational research on routines and technology adoption.0