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In Proceedings of the 26th Information Systems Research Seminar in Scandinavia (IRIS
2003), August 9 - 12 2003, Haikko, Finland.
VIEWS OF COMPUTERIZATION: THE TALE OF CARESYS
Karin Hedström
Emma Eliason
Abstract
This paper deals with how divers different groups of people can view the effects of
computerization. The introduction of an IT system in home help, CareSys, is used as an
example. The main objective is to analyse the effects of computerization from the per-
spective of different social groups where the actors are seen as carriers of the computeri-
zation process. The results illustrates that depending on the organisational position, the
effects of computerization are viewed differently.
Keywords: Effects of Computerization, Evaluation, ANT, Intended and Experienced Effects,
Computerization, Home help
2
1. INTRODUCTION
Whether the introduction of installing and using an IT system is a success or not depends on whom
you ask. A study by Vidgen & McMaster (1995) show that the effects different stakeholders attribute a
system depends on their perception, and Robey and Boudreau propose that we should concentrate on
the “[…] interplay of opposing forces” (1999:179) when we want to understand the effects of com-
puterization.
The purpose of this paper is to analyse which effects of computerization different actors attri-
bute to the process of computerization. The effects are viewed in a time-perspective – that is how the
effects change during the course of computerization. An IT system for administrating elderly care is
used as an example. This approach builds on two elements: firstly, to understand the computerization
process and its effects from the view of its actors, and secondly to focus the actions in the computer-
ization process from a time-perspective. Another objective is to compare how these views differ bet-
ween different groups’ of actors.
The paper starts with a short introduction on the notion of actors as carriers of the computer-
ization process, section three describes the case study. Section four describes the analysis the results
and the paper ends with a summing up in section five.
2. ACTORS AS CARRIERS OF THE COMPUTERIZATION PROCESS
This work rests heavily on a social constructivist perspective in relation to technology (Bijker 1995;
Latour 1987; Law 1992; Monteiro et al. 1995). The research objective for the technological con-
structivist is to describe technological development, not to be normative, offer value judgment, or de-
termine whether a certain technology supports the interests of a specific group (Winner 1993). We feel
that it is important, however, to acknowledge the consequences of IT systems, and analyse whether the
introduction of a new technology supports the interests and values of certain groups on the expense of
others. And to offer insights and explanations that may help us understand how IT can be developed
and used to support, not only the strong, but also the weaker actor groups. Design and development of
IT systems always involve moral value judgments (Klein et al. 2001:81).
A fundamental question within ANT (Actor Network Theory) is how different actors reach
agreement on e.g. an artefact (Latour, 1987; Monteiro & Hanseth, 1995). Technology has no inertia,
no power to move or change without the application of external forces. It is only through the actions of
the actors that technology is spread. It is the actors who design, adapt and use the technology; they
take the decisions and make the choices that create the process of computerization. An IT system is, by
this definition, a result of the people and artefacts that have taken part in its creation (Law, 1992). That
an artefact survives is thus not only a consequence of its intrinsic physical qualities, but also of its
cultural, social, political and economical adaptation – its history of negotiations (see e.g. Winner 1980;
MacKenzie & Wajcman 1999). The negotiations are carried out by different social groups (e.g. Kline
& Pinch 1996) who are “[…] identifiable social groups that play a role in the development of a tec-
hnological artefact.” (Pinch 1996:23-24) Walsham (1993) means that stakeholder assessments are
vital when trying to make sense of the social context of evaluation, and in order to understand a social
process as computerization we must see it through the eyes of the people who created it.
2.1 The Effects of Computerization
2.1.1 From Idea to IT system
As the IT system is built, it changes from a project to an object (Latour 1996). The process of com-
puterization is a process of negotiation, and the IT system is a product of compromises and adaptations
(Law 1992). Computerization is illustrated as a network consisting of actors, IT systems, texts, other
types of artefacts, work methods, and system development methods etc. (see Figure 1). The degree of
materialization creates the shift from an idea (illustrated by a question mark) to an IT system (illus-
trated by a computer). In the beginning the new system is highly abstract, consisting of thoughts,
sketchy ideas on paper, plans etc. During the computerization these ideas are put into a more concrete
form as high-fi and low-fi prototypes, system presentations, etc., and the various actors’ different
views of the IT system will become more and more shared.
?
Figure 1: The Computerization Process as a network
2.1.2 Intended and Experienced Effects
Computerization is a social, economical and political process where the technology plays an important
part (see e.g. Kling 1987; Iacono & Kling 1996). In order to analytically discuss the computerization
process we suggest that we divide the computerization process in four overlapping phases: the plan-
ning phase, the design/adaptation phase, the implementation phase and use/maintenance phase (see
figure 2) (Walsham 1993).
The planning phase refers to the initial discussions when the reasons to computerize are first
raised. It is also here the change analysis and the work with the requirements specification takes place.
In the second phase, design/adaptation, the system is implemented, tested and adapted. In the last
phase, use/maintenance, the IT system is taken into use and maintained. With the help of this model of
computerization it is possible to discuss the way intended effects differs from experienced effects (see
also Davern & Kauffman, 2000). Intended effects are the effects different social groups believe the IT
system will contribute to (phase 1 – 2), while experienced effects are effects of using IT
(use/maintenance phase). The actors’ different views of the computerization process are manifested in
the effects they attribute to the use of the IT system. The intended effects show the intended and
planned effects of using an IT system, and thus they mirror the role the actors attribute the use of com-
puters within the organization. The same is true for the experienced effects. Depending on the interests
and values the actors attribute different experienced effects to the use of computers.
T
INTENDED
EFFECTS
EXPERIENCED
EFFECTS
Planning Design/Adaptation Implementation Use/Maintenance
?
Figure 2: Reconstructed Computerization Process
The reasons for computerization are transformed into intended effects (see figure 2), which usu-
ally are associated with the use of IT as it is the desired future effects of computer use that is the rea-
son for wanting to introduce a new IT system. The intended effects can be planned in the beginning of
the project or emerge during the process of computerization, due to experiences of working with the
project, as well as due to changes in the organization and the environment. Experienced effects are the
organisational effects that actors experience from the computerization process. There are intended
effects that are not experienced and experienced effects that were not intended. Of course, there are
also effects that are both intended and experienced.
3
4
3. CASE STUDY
3.1 Research Method
Considering the nature of the research questions this study is classified as interpretive (Walsham,
1993; Walsham, 1995; Klein & Myers, 1999). The starting point is different social groups’ views of
the computerization process. This is also a critical study as the objective is to disclose what have been
hidden and taken for granted. This is in line with Kling et. al. (2000) who argue that the critical comes
into play when artefacts as IT systems are analysed from multiple perspectives, and when the goals
and beliefs of different groups are examined and critically analysed.
This case is a reconstruction of a computerization process of a standardized IT system (Car-
eSys)
1
. We have been able to study the consequences of implementing and using the IT system as
CareSys was implemented in 1998. One problem with doing a retrospective study is that we in some
cases had problems making comparisons between the initial phase of the computerization with today
due to lack of data.
The empirical data has been collected through interviews, document analysis and observations.
The case centred on the work in one home help unit. The following social groups were interviewed:
users (home help assistants and home help mangers), project leader for the IT/Change-project, system
owner, contractor and system administrator. The interviews focused questions such as reasons for
computerization, the process of computerization, effects of computerization and the actors’ roles in the
process. Statements related to intended effects of computerization have in the analysis solely origi-
nated from documents, protocols dated from that time, since we wanted to minimize the time effect.
The second type of empirical data is historical records such as protocols from different political
board meetings (1996-2001), documents directly linked to CareSys: contracts, system documentation,
requirements specification, offers, etc and reports from the IT/Change-project.
2
The work of the home help assistants has been observed as well as on one meeting where differ-
ent stakeholders together with one of the authors and other researchers discussed the computerization
of home help. CareSys has also been tested in order to gain an understanding of the system (for an
evaluation of CareSys see Hedström & Cronholm, 2000).
3.2 The Social Groups of CareSys in 2001
The social groups included in the analysis of CareSys are the executive committee, section managers
(users), home help assistants (users), system administrator, contractor, system owner/community care
committee, and the IT/Change project (see figure 3).
The system owner – which is also the community care committee – is closely connected to the
IT/Change project, as the IT/Change project acted on the behalf of the system owner. The executive
committee are ultimately responsible for providing high quality home help for the citizens, and they
decide on the available resources as well as the high-level goals for home help.
1
The IT system will henceforward be called CareSys, which is a pseudonym.
2
For reasons of confidentiality the documental records will not be referred to in their real name, and will not be
listed in the reference list. But is available on request.
System owner/
community care
committee
Executive
Committee
CareSys
Home help as-
sistants
(
users
)
IT/Change-
Project
System
administrator
Section manag-
ers (users)
Contractor
Figure 3. The social groups influencing CareSys in the use-phase
4. THE ACTIVITIES OF THE SOCIAL GROUPS
The activities in table 1 are actions by different social groups that in some way change the status of the
computerization process, often official decisions that can be found in protocols or reports issued by
social groups within the local government. These activities are sometimes an effect of a breakdown, as
for instance when the executive committee repeatedly requested the social welfare department to inte-
grate their system with CareSys, or when the service provider orders an evaluation of CareSys.
The story of CareSys started in 1994 when the board of local government decided to “Inspect
certain fundamental issues within the jurisdiction of the community care committee” (Protocol meet-
ing executive committee, 1994) They already had an IT system for debiting, but there was a need to
purchase a system that could support more actors and processes and was cheaper to maintain and tech-
nically capable to deal with the shift to the year 2000. One of the important issues the community care
committee wanted to inspect was development of simple and efficient administrative routines and sys-
tems for evaluating and follow-up the care with the elderly as well as the organisation (Commission
document, 1994). Nothing is mentioned about IT-support, but from the formulation it is easy to see
that they had the purchase of an IT system in mind. The project leader who in an interview said that
they saw the need for an IT system long before the start of the official IT project supports this. An IT
system is first mentioned in a report from 1995, when the project leader of the IT/Change-project
states: “The need for appropriate technology for time-registration that automatically will provide ba-
sis for debiting and invoicing is acute […] technology for registering time will probably increase the
productivity through knowledge about the actual circumstances.” (Report, IT/Change-project, 1995)
The executive committee issued money to purchase an IT system in 1996. The same year the
IT/Change-project creates a separate IT-project. An offer is sent out later the same year, and in 1997 a
contract is signed with the contractor carrying CareSys. CareSys is put into use in 1998, and in 1999
an external consultant is commissioned to carry out an evaluation of the system. The same consultant
also gets the assignment to try to increase the uses of CareSys. “[The external consult] is doing a pro-
ject in [a home help unit]. Is [CareSys] something we can use? Or not? Can we improve [CareSys]?“
(Interview, system administrator, 2001)
The politicians repeatedly demanded, without success, that the social welfare department
should integrate their system with CareSys. In September 2001 the executive committee gives the
community care committee’s secretariat the assignment to “[…] return with a plan for purchasing a
5
6
complete IT-support system for the local government.” (Protocol, meeting the executive committee,
2001)
Table 1. Events concerning the computerization process involving CareSys from a time-
and social group perspective
Contractor Executive
Care Com-
mittee
System
Owner/Community
Care Committee
IT/Change-
project
Users (Home
help assis-
tants, Section
managers) &
System Ad-
ministrator
2001
Decides to
create a plan
for purchasing
a new IT sys-
tem
2000
Request to
social welfare
department to
connect to
CareSys
1999
Request to
social welfare
department to
establish
connection
with CareSys
Publishes
final report
from IT/-
Change-
project
1998
CareSys starts
to be utilized
and adminis-
tered
1997
Signs con-
tract
Signs contract
1996
Grants money
for purchasing
a new IT sys-
tem
Starts IT-
Project and
sends out
offer
1995
Mentions
technology
1994
Starts
change
project
The computerization process can be said to begin in 1994 (see Figure 4) when the Social De-
mocrats presented a private motion where they among other things suggested that ‘[…] elderly care in
our local government should be analysed in a thorough and scientific manner, thus resulting in ideas
and action plans for care until the beginning of the 21
st
century’ (Private motion for the development
of elderly care, 1994). A project plan for purchasing a new IT system for elderly care was presented in
1996 (Project plan for implementing a new IT system for elderly care, 1996). In November 1996 it
was decided that CareSys was going to be the new IT support for elderly care (Purchase of CareSys,
1997). A contract was entered between the system owner (also the community care committee) and the
contractor. CareSys was finally implemented during 1998.
Presentation of p
vate motion from
the Social Democ-
rats
ri-
ACTIONS
CareSys im-
plemented
CareSys
chosen
Presentation
of project
plan
1998
TIME
1994
1996
1997
Figure 4: The Purchase of CareSys
4.1 Different Views of CareSys
The different social groups’ intended and experienced are sketched in table 2 together with the initial
reasons to computerize. In some cases social groups have evolved over time. Some actors started out
as part of the same social group (the system owner and the system administrator was members of the
IT/Change project), but in the last phase of computerization, the use phase, they have changed into
several groups with different norms, values and interest.
System Owner/Community Care Committee
In the first phase of computerization, the community care committee view the installation of a system
as way to increase efficiency and improve administration, which is more clearly defined in the second
phase: “The community care committee’s primary interest in CareSys is to secure satisfying routines
for debiting of fees, bases for compensation for service providers and following-up of achievements,
etc.” (Protocol, community care committee, 1997) In phase three one can see that some of the in-
tended effects have failed to be met as the politicians repeatedly demand the social welfare department
to integrate their system with CareSys in order to fulfil expected savings in administrative efficiency.
A representative of the system owner says that the effects are not as positive as expected even though
the costs for administration probably has increased. He states that the main purpose of purchasing
CareSys ”[…] was to ensure that the elderly obtained correct fees, but also to support organizational-
and staff planning.” (Notes meeting, 2001) He says that the administrative routines concerning billing
have improved. The system owner also states that CareSys is not used to its full potential.
Home help Assistants (users)
There is unfortunately no data related to intended effects of installing a computer system for the home
help assistants. But the interviews disclosed that the effects they experience from using CareSys are
contradictory. At one hand they experienced a lot of problems with CareSys, problems leading to dis-
rupted work routines, which decreased the efficiency. These problems made them experience a di-
lemma between their nursing and administrative role.
The positive effects of using CareSys has to do with a better understanding of administrative
routines and the home help assistants mentioned that they now better than before could answer the
elderly and their relative’s questions about their invoices. They enjoyed using CareSys; it had made
them experts in this specific field. Using CareSys has changed their work routines and assigned them
special areas of responsibility.
Section Managers (users)
We do not have any data on the home help managers before CareSys was installed. The home help
managers mostly see the effects of using CareSys in terms of providing more accurate information.
7
8
Before the installation of CareSys they suffered from problems of updating many information sources,
and there were problems keeping information consistent in the different locations. They say it is much
better now.
System Administrator
The system administrator was also part of the project group responsible for the purchase of CareSys,
and can thus be seen as standing for the same view as IT/Change-project, and as in earlier cases there
is a lack of data from the initial phases of computerization.
She says the reason for purchasing CareSys mainly was to make the administrative routines for
billing work, and that to purchase a system that supported the rest of the organization was less impor-
tant: “The process of billing was the most important reason to computerize. And if we also got a sys-
tem that was appropriate for the organization was it of course a bonus. But it was most of all the deb-
iting. It was what we worked hardest with and something that just had to work.” (Interview system
administrator, 2001)
She sees several different types of experienced effects. They now have a system that is techni-
cally working, has changed the home help assistants’ work routines as well as increased the home help
assistants’ awareness about the importance of register accurate data. She states as well that using Ca-
reSys has increased the home help assistants’ knowledge about the organizational and administrative
routines. Another effect she sees is that the installation of CareSys has forced the high-level manage-
ment to raise questions about IT-management.
Contractor
When the contractors tried to promote CareSys they stated that the intended effects were improved
strategic planning, increased efficiency and better administration. “CareSys will provide improved
management, simplified routines, improved access to information, improved legal rights for the indi-
vidual.” (Offer CareSys, 1996) They also meant that CareSys would support political decisions, in-
crease the competency and organizational knowledge as well as increase service quality.
The experienced effects have not met the intended effects. The contractor was very disappointed
with the limited use of functionality. The local government has, according to him, bought parts they do
not use.
IT/Change-project
The initiating reasons to computerize were that they had an old and costly IT system that did not sup-
port the current organizational structure. They also felt they needed support for following up as well as
providing an IT system for the whole organization.
The reports issued from the IT/Change-project in phase one states that CareSys’ intended effects
were to reduce costs and increase productivity. The project sees IT as a tool for increased efficiency
and improved administration. “Technology for decentralised decision support and time registration
increases the productivity by providing knowledge about the actual situation.” (Report IT/Change
project, 1996) They also wanted the future system to be an IT-support for everyone working with eld-
erly care. The intended effects in phase two matches these effects.
The project leader states that using CareSys has made data more accurate, which produces bet-
ter information for planning and managerial support. He says that using CareSys probably does not
save any money, but that computerization has increased the IT-maturity in the organization and
changed the users’ standpoints about computers. “CareSys has provided the necessary basis for devel-
oping a more modern system, which might make it possible to spread the usage.” (Interview project
leader, 2001) He says that CareSys is not used to the extent it was expected.
He means that the reason they purchased CareSys was that the old system was going to be shut
down and that they need a more modern system that was easier and cheaper to maintain and change.
He also said that they saw the need for a mutual IT system for the whole organization.
9
Table 2. The Groups’ intended and experienced effects of computerization
SOCIAL GROUPS Initiating rea-
sons to comput-
erize
(1995-1997)
Intended effects
phase 1 (1994-
1996)
Intended ef-
fects phase 2-3
(1997)
Experienced ef-
fects (phase 4,
1998 Æ)
Community Care
Committee
New systems are
needed for time-
registration,
debiting and
documentation.
Increased effi-
ciency and better
administration.
Improved organ-
izational evalua-
tion.
Secure satis-
fying routines
for debiting of
fees, bases for
compensation
and following--
up achieve-
ments.
Lack of integration
between different
systems. Difficult
to obtain inform-
ation that provides
a good overview.
Home Help
Assistants
Not part of the
process
Not part of the
process
Not part of the
process
Disrupted work and
time consuming.
Increased organiza-
tional knowledge.
Increased service
quality, more re-
sponsibility and
different work
routines. More
enjoyable work.
Section Managers
Not part of the
process
Not part of the
process
Not part of the
process
More accurate
information.
System
Owner/Community
Care Committee
New systems are
needed for time-
registration,
debiting and
documentation
Increased effi-
ciency and better
administration.
Improved organ-
izational evalua-
tion.
Secure satis-
fying routines
for debiting of
fees, bases for
compensation
and following--
up achieve-
ments.
Better administra-
tion. There is a
potential that is not
used. Lack of inte-
gration between
different systems.
Difficult to obtain
information that
provides a good
overview.
System Adminis-
trator
Not part of the
process
See IT/Change-
project
See IT/Change-
project
A technically work-
ing system. More
responsibility and
different work
routines. Increased
organizational
knowledge. Has
forced the manage-
ment to analyse the
IT-organization.
Contractor
Not part of the
process
Improved strate-
gic planning.
Increased effi-
ciency and better
administration.
Support for po-
litical decisions
in the system.
Increased compe-
tency and organ-
izational knowl-
edge. Increased
service quality.
N/A Lack of spread of
usage. Use a very
small part of the
system.
IT/Chan
g
e- Pro-
Lack of in
t
e- Reduced costs Com
p
osed in- Did
p
robabl
y
not
10
ject
grated IT-
support. The
current IT sys-
tem is designed
for a different
organizational
structure. High
costs for mainte-
nance and de-
velopment.
Problems with
organizational
and economical
assessment. A
great part of the
home help or-
ganization lacks
IT-support.
and increased
productivity.
Increased effi-
ciency and better
administration.
Improved qual-
ity. IT-support
for home help
managers.
formation about
the elderly.
Simplify the
administrative
routines for
debiting, regis-
tration, invoic-
ing and statis-
tics. A modern
and appropriate
IT-support for
home help man-
agement. Will
simplify their
work considera-
bly.
reduce costs as
planned. Lack of
spread of use. In-
creases organ-
izational know-
ledge. More accu-
rate data. Increased
organizational IT-
maturity. Increased
planning and mana-
gerial support.
4.2 CareSys as a tool for Efficiency and Organizational Ability
Efficiency and organizational ability are two categories that illustrate the different types of effects that
can be found in table 2. Using IT as a tool for efficiency means to view the use of an IT system as a
way to “[…] reduce the cost of performing a particular process or task.” (Fitzgerald, 1998:17-18)
With organizational ability we refer to the organizational actors’ capability to carry out their work and
“[…] create value by action for its clients/customers.” (Goldkuhl & Braf 2002)
The story of CareSys illustrates how the IT/Change project’s view of the effects of CareSys
changes from mainly viewing CareSys as a tool for efficiency to seeing CareSys as tool that in particu-
lar increased the users’ ability to act within the organization. The representative of the IT/Change pro-
ject (project leader) also saw the computerization process as contributing to an overall increased or-
ganizational ability to make decisions about IT-related organizational changes.
The story also shows that the executive committee as well as the system owner were true to
their initial views of CareSys as a tool for efficiency while the home help assistants valued how well
CareSys supported their work as home help assistants. That is whether CareSys increased or decreased
their organizational ability. The system administrator who views CareSys as an instrument for chang-
ing the home help assistants’ work and roles gives voice to the same perspective.
We believe that the role of home help assistants is changing from a primarily nursing role to a
nursing and administrating role. The installation of CareSys is one instrument to change the home help
assistants’ view of administration and computer use. The project leader means that the computeriza-
tion process of CareSys has changed “[…] beliefs and attitudes” concerning computer use and if
“[…] we said that it is time to go back to the old ways and register on paper, people would think we
were crazy.” (Interview, project leader of IT/Change-project, 2001) Organizational ability means dif-
ferent things for different groups.
4.3 CareSys – A Success or Failure?
CareSys can be seen as a failure as the system probably does not save money as expected, and the
community care committee has had problems getting people using the system even though the system
owner made enrolment inescapable since the use of certain functions is obligatory. That CareSys has
had problems gaining support can be seen by the many activities intended to increase the numbers of
actors using CareSys. The executive committee also seem to view the system as a failure as the only
comment that can be found in recent material is that CareSys failed to live up to its promises and they
now support the purchase of a new system. Also the contractor views CareSys as a failure and is dis-
appointed as there is a negative view towards the system and the effects he hoped for failed to be real-
ised.
From another viewpoint CareSys can be seen as a success, the project leader of the IT/Change-
project argues that they now have the IT-competency to do a better job in purchasing and installing a
11
more modern system. “A system that will be used by more people using more advanced functions.”
(Interview project leader, 2001) He says this even though he acknowledges that CareSys probably
failed to contribute to cost reduction and increased efficiency. CareSys can be seen as a success also
from the point of view of the home help assistants who were more positive than negative towards us-
ing the system. This even though they had experienced many problems and found the system difficult
to use. They felt using CareSys has enriched their work, and increased their organizational knowledge
leading to better service.
5. SUMMING UP
By drawing on examples from a case study within elderly care, we have illustrated how contradictory
different actor groups can view the effects of computerization. There can be as many answers to the
question of success as there are actors, which make it less than straightforward to value the effects of
computerization.
That organizational effects of computerization are contradictory is also shown by Robey &
Bodreau (1999) who propose that we should use research methods that illustrate and take into account
these sometimes contrasting views. Viewing the effects of computerization from the perspective of
different social groups together with following the trajectory of effects makes this possible.
We believe that it is fruitful to analyse the effects of computerization from the viewpoint of so-
cial groups. Dividing the computerization process into different phases has allowed us to explore how
the effects of computerization changes over time, which also allows us to compare how the actors
view effects during the different phases. Due to lack of data we have not always been able to com-
pletely follow the trajectory of effects in different phases of computerization, but the case study shows
however that this will be possible in future research. The fragmented data has also limited the possibil-
ity to draw any definite conclusions on different views. This will also be tested in further research.
ACKNOWLEDGMENTS
This research has been supported by the Knowledge Foundation. We would also like to thank Åke
Grönlund, Göran Goldkuhl and Ewa Braf who have contributed with helpful comments, and last, but
definitely not least, the many actors in the local government who has been so generous with their
thoughts and time.
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