What Teams Need to Be Clear about - an Activity Theoretical Perspective on Shared Understanding in Health IS Implementation

Shared understanding facilitates the implementation of IS and can help to prevent unintended consequences. However, research is hitherto not precise on the kind of knowledge such understanding needs to capture. Taking an activity theory perspective, this paper theorizes that shared understanding needs to cover knowledge, experiences and perspectives on the contested activity systems the HIS is implemented in. Analyzing the data of an in-depth case study, it is found that issues emerging during the rollout can be traced back to a lack of shared understanding about the affected activity systems, particularly to insufficient shared understanding about the instrument-mediated relationships between contradictory motives, rules and the evolved division of labor. These findings are synthesized in a framework on critical aspects of shared understanding. This framework offers a coherent explanation for the rise of unintended consequences and enhances our learning of shared understanding in IS implementation.