Leadership in Evolving Learning Organizations [WLO: 4] [CLOs: 2, 5]
Prior to beginning work on this discussion forum,
- Read Chapter 3 from Organizational Behavior and Theory in Healthcare: Leadership Perspectives and Management Applications.
- Read the following articles:
- How to Be a “Humbitious” Leader (Links to an external site.)
- Bringing Value at Top Organizations, Learning Means Living (Links to an external site.)
- A Learning Organization in The Service of Knowledge Management Among Nurses: A Case Study (Links to an external site.)
- Exploring the Potential of a Multi-Level Approach to Improve Capability for Continuous Organizational Improvement and Learning in a Swedish Healthcare Region (Links to an external site.)
Assess how health care leadership is evolving. Describe the three takeaways found in the required articles for this discussion that you may employ in a learning organization. Support your response with a minimum of two scholarly sources published within the last five years.
Careers
How to Be a “Humbitious” Leader
Empirical evidence connects humility and ambition with high performance.
Humility is making a comeback as one of the most sought-after professional virtues organizations look for in candi- dates. The Wall Street Journal reported that humility is becoming the “flavor du jour” among executives in large companies, as boards are increasingly looking for humble leaders.
When Krispy Kreme Doughnuts was looking for a CEO a few years ago, the main traits it identified as important for the leadership role were that of humility and servant leadership. Similarly, humility is what Google has been looking for in its new hires. “Without humility, you are unable to learn,” Lazlo Bock, senior vice presi- dent, people operations, Google, told Harvard Business Review. A recent arti- cle in the Journal of Business Ethics agreed that, “the humble leader is pre- cisely the person who is best qualified to transform his firm into a profitable, successful and respected organization.”
What does humble leadership actually mean? The book Executive Ethics: Ethical Dilemmas and Challenges for the C-Suite identifies the five foundations of humility related to leaders as authen- ticity, teachability, transparency, humaneness and interdependency.
Humble, authentic leaders confess to their followers that they make mistakes
and ask for their patience in correcting them. They demonstrate their teach- ability by acknowledging openly when they are wrong and asking for forgiveness when mishaps happen. They are transparent and admit when they don’t know something, and they constantly ask their team members for their ideas. They show their humaneness by accepting that they can’t do everything and that they need all their followers’ talents to achieve their goals. And finally, they exhibit interdependency by stressing that they are there for a larger purpose and not for themselves. Humility is not, as some people believe, weak- ness, low self-esteem, lack of assertive- ness or absence of ambition. On the contrary, humble leaders are ambitious, strong, self-confident and fiercely deter- mined. They are also highly effective.
The Case for Humility The introduction of humility into lead- ership studies can be credited to Jim Collins and his management book Good to Great (Harper Collins, 2001). Collins and his team identified compa- nies that made the transition from good to great financial performance over time and concluded that they were all headed by “level 5 leaders” who are humble and fiercely ambitious. Collins and his team were surprised to discover the type of leadership required for
turning a good company into a great one. He notes: “Compared to high- profile leaders with big personalities, who make headlines and become celeb- rities, the good-to-great leaders seem to have come from Mars.”
These findings provided empirical evi- dence to what many had suspected for a long time: humility and ambition, or “humbition,” are related to high per- formance. However, what wasn’t clear from Collins’ analyses is how humility and positive outcomes are actually connected, and recent research is start- ing to clarify that connection.
One way leader humility can affect performance is through employee engagement and satisfaction. A study of a large health services organization asked employees to rate the humility of their immediate supervisors. The employees were also asked to assess their own job engagement and satis- faction. The results were published in 2013 in the journal Organization Science. Participants who viewed their leaders as more humble were more likely to report being happy at work and less likely to voluntarily leave the organization.
“In contrast to ‘rousing’ employees through charismatic, energetic and idealistic leadership approaches […], our study suggests a ‘quieter’ leader- ship approach, with listening, being transparent about limitations, and
Amer Kaissi, PhD
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Healthcare Executive NOV/DEC 2017
54
appreciating follower strengths and con- tributions as effective ways to engage employees,” wrote the authors of the study. In the current labor market, where organizations are struggling to attract and retain talent, humility can be a valuable competitive advantage. Another way leader humility works is by creating a culture of shared unpre- tentiousness that enables the team to grow and reach its full potential. For example, research published in 2016 in the Academy of Management Journal found teams that perceived their lead- ers as willing to learn, able to admit to not knowing something and likely to compliment others on their strengths had higher collective humility, team growth and performance. These find- ings provide empirical evidence to
support the old adage, “leaders should lead by example.” Similarly, humble lead- ers in private companies were found to empower their top and middle managers to collaborate, share information, make joint decisions and develop a shared vision in an Administrative Science Quarterly study, published in 2014.
The results from a study of healthcare organizations published in my book Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders suggest that leaders who are approach- able not only create an environment where employees feel comfortable, but also foster improved outcomes in the organization. My team received sur- vey responses from 577 employees, supervisors, directors and executives working in nine different hospital and
health systems. When asked about the leadership traits that have had a negative influence on their career, 52 percent of the respondents chose arrogance as the top factor, making it the most common negative leader- ship trait chosen. Many respondents indicated that nothing has been more damaging to their career than having an arrogant boss. Similarly, when asked to describe the one leader that has been the least successful in terms of improving outcomes in the organi- zation and getting things done, 44 percent of respondents described this leader as “self-focused” and 42 percent described the leader as “arrogant.”
According to these results, not only do self-focused and arrogant leaders
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Healthcare Executive NOV/DEC 2017
56
frustrate their followers and disen- gage them, they also may drive their organizations into poor performance. Here are some day-to- day techniques and behaviors healthcare leaders can adopt to increase their humility:
How to speak: Use “we” instead of “I”; talk about team accomplish- ments; greet team members and gen- uinely listen, understand and reply to them; and use respectful language.
How to be approachable: Have a true open door policy but protect your time when necessary; talk to employees at all levels; turn off elec- tronic devices while listening; avoid cell phone use in the hallways so you are able to greet others as you pass by; and—much like clinicians—do rounds in your units regularly and purposefully.
How to give credit to others: Give credit frequently but only when it is due; acknowledge employees doing something good; say, “You went above and beyond,” to employees who exceed expectations; and provide prompt, accurate and sincere feed- back to those looking to improve.
How to handle mistakes and failures: Be calm and controlled; identify root causes, not scapegoats; have tough conversations with low- performers; admit mistakes, accept responsibility and move on.
How to respond to success: Brag about and celebrate team and organi- zational accomplishments; share credit; don’t show off with status symbols; build on successes for future improvements.
Effective leaders are admired for their humility and are respected for their ambition. They are humbitious. There is an abundance of empirical evidence that strongly suggests that these types of leaders achieve signifi- cantly more success in the long run for themselves, their teams and their organizations. s
Amer Kaissi, PhD, is an executive coach, speaker and professor, the Department of Health Care Administration, Trinity University, San Antonio. He is also the author of the Health Administration Press book, Intangibles: The Unexpected Traits of High-Performing Healthcare Leaders ([email protected]).
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58 NOVEMBER/DECEMBER n 2017
HEALTH CARE ORGANIZATIONS
BRINGING VALUE
AT TOP ORGANIZATIONS, LEARNING MEANS LIVING n Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, and Jennifer J. Robertson, MD, MSEd, FAAEM
In this article … In a “learning organization,” knowledge is power. Acquiring information and processing it into useful business insight is essential in every industry, including health care. Physician leaders have an important role to play.
THE CONCEPT OF ORGANIZATIONAL LEARNING includes both acquisition and dissemination of knowledge that an organization can use to shape its future. To efficiently man- age the information, learning organizations use knowledge management systems to facilitate sharing and integration.1,2
Using these systems, learning organizations have the ability to think for themselves, communicate effectively internally, and use the knowledge they acquire to create and innovate.
It is important to know the difference between “organiza- tional learning” and a “learning organization.”3
Any institution may participate in ongoing organizational learning, yet only a few can be called learning organizations, especially in health care. That’s because there are environ- mental, organizational and ecosystem constraints on every health care organization that limit their planning, financing and operational functions.4 Accordingly, the scope and prac- tice of a health care organization as a learning organization should be viewed in that framework.
Successful organizations are those that continually evolve, using specific tools and strategies to adapt to the changing marketplace. The best ones take a learning organization ap- proach. While organizations can offer learning activities, they aren’t learning organizations until they undergo key process changes. That includes a transformation in which all primary stakeholders are involved — senior management, the board of directors, the medical staff and, of course, the workforce.4
Specific conditions within an organization are essential to facilitate learning, including the capabilities for continuous im- provement, a willingness to practice the newly acquired skills, taking the necessary risks to learn, providing feedback to the participants, and fostering a climate of rewarding all learning participants.4 Often, that means major cultural change must occur within every aspect of the organization and its related processes.
In addition to the conditions noted above, six additional critical elements5 help define a learning organization:
THE CONCEPT The idea of “learning organizations” took root after the publication of organizational expert Peter M. Senge’s seminal book, The Fifth Discipline (Currency, 1990). It focuses on group problem-solving through “systems thinking” — understanding how a system works by examining the relationships among the unique components.
With that understanding, an organization’s employees can create, acquire and transfer knowledge that allows the organization to adapt to unpredictable market conditions more quickly than competitors.
American Association for Physician Leadership® n Physician Leadership Journal 59
Organizations that are able to acquire knowledge faster than their competitors, and process it into useful insights for business, have a distinct advantage in the marketplace. This isn’t a new concept, but it has taken on contemporary importance in today’s ever-changing business environment.
60 NOVEMBER/DECEMBER n 2017
n A process of continuous knowledge acquisition by the workforce and the integration of this knowledge into routine institutional processes.
n Effective knowledge generation and sharing among participants.
n Critical systems thinking.
n A culture of learning.
n A group spirit of flexibility and experimentation.
n An organizational culture that values its workforce.
These additional critical elements characterize and define the organization’s knowledge management system. An effec- tive system creates the ideal framework for an organization’s workforce to learn and compete.
FIVE ENABLING DRIVERS
In today’s competitive business environment, an organization’s only sustainable advantage is its ability to acquire knowledge at a faster rate than its competitors.2 Understanding this is critical in a modern, ever-changing health care environment.
In addition to the concept of rapid knowledge develop- ment, there are five enabling drivers that, if mastered, will pro- pel any health care organization to higher levels of knowledge acquisition. These drivers began appearing approximately 20 years ago but only now are starting to converge into an or- ganizational learning model. These drivers include:
n Systems thinking: Seeing the big picture and how work processes are linked.
n Personal mastery: Making individual commitment to lifelong learning.
n Mental models: Managing preconceived ideas that could hinder new insights and ideas.
n Shared visions: Building visions that will survive good times and bad times.
n Team learning: Realizing organizations cannot learn and improve if team members cannot learn and improve.
One could argue that these drivers can be organizationally grouped under one common strategic initiative: the ability to innovate faster than your competitors.
Employees must become skilled at acquiring, mastering, and transferring and/or teaching new knowledge. Senior lead- ers must be able to allow their organization to remain flex- ible, take risks and use newly acquired information within the framework of the organization’s strategic plan.
Despite a significant amount of information advising lead- ers how to put a learning organization into operation, there has been significant difficulty in doing so.6 Senior leaders have had problems measuring organizational progress, using important tools of a learning organization successfully, and managing knowledge for innovation.6
To help direct physician leaders, three primary operational pillars are key starting points for organizational learning and adaptability.6 They are:
n Developing a supportive learning environment.
n Building strong learning processes into the culture and work systems of the organization.
n Developing leadership behaviors that reinforce organi- zational learning and knowledge acquisition.
THE ROLE OF PHYSICIAN LEADERS
To help develop a supportive learning environment, physician leaders should consider directing attention to creating psy- chological safety for their employees.6 The idea of removing psychological risk from the workplace first was proposed in the 1950s by Edward Deming in his famous “14 Points for Total Quality Management.“ Workers must feel safe, rather than fearful of their superiors, so that they can work effectively with their leadership team, rather than withdrawing out of fear of retribution.7
Physician leaders also should be open to differences of opinion and opposing ideas. This attitude energizes individuals and tends to spark creativity and innovation. Third, employees should be encouraged to explore new ideas, even if these new ideas entail some risk. Finally, physician leaders should factor in some time during the day for problem-solving and thoughtful reflection among their employees.
Another major task for physician leaders in helping to de- velop a learning organization is to create the subsystems of the learning processes and practices.6 These include the processes of generation, collection, interpretation and dissemination of information.
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Pursuing the Triple Aim through Education and Science
American Association for Physician Leadership® n Physician Leadership Journal 61
Information in any organization resides not only in the formal written arena of protocols and white papers, but also in the minds of the workforce. For physician leaders, the ability to tap into this workforce knowledge for organizational innova- tion is important. Many successful companies are using their employees to advance innovation and learning through team interaction, knowledge sharing across silos, and shared infor- mation data banks. Finally, senior leaders must reinforce the learning environment, which entails human behavior. When the environment is safe and leaders are supportive, employees will be willing to entertain alternative ideas without fear of losing their jobs.
CREATING THE STRUCTURE
Learning organizations neither can be developed nor sustained without understanding the underlying structures that allow organizations to constantly acquire and maintain new knowl- edge.8 Think of these as the foundation, pillars and roof that compose a physical building.
n Foundation: management science, computer science, organizational development and cognitive psychology.
n Pillars: the organization, its people, knowledge and acquired technology.
n Roof: the environment, the economy, society, politics and evolving technology.6
For physician leaders, each of these components has im- portant ramifications for guiding and directing not only the organization, but also in helping facilitate the ongoing devel- opment of the medical staff.
The list of substructures might sound fairly abstract, and it might be unclear how to ensure an organization has a realistic, easy-to-understand and actionable definition of a learning organization that is also acceptable to all levels of the work- force. Many suitable definitions have been proposed over the years, but here’s one of the best: “A learning organization is an organization skilled at creating, acquiring and transfer- ring knowledge, and modifying its behavior to reflect new knowledge and insights.”6
What should be recognized is that learning begins with newly acquired ideas. New ideas sometimes are created in- ternally, but they may also be acquired from the outside. It is not simply the act of generating new ideas but rather the act of generating and incorporating these new ideas into the fabric of the organization.
How many team events generate lots of ideas that are never actually implemented? Learning organizations find ways to translate ideas into action. They know how to positively change the behavior of the workforce. Physician leaders who wish to ensure their organizations are learning organizations should develop an understanding of organizational dynamics and personal interplay among key constituencies.
FIVE ACTION PLANS
Physician leaders should focus on five specific action plans when thinking about how to develop their organization into a learning organization.6
n The first is related to problem-solving. Continuous- improvement organizations use specific tools, such as Deming’s Plan-Do-Check-Act Cycle, to ensure conclu- sions being reached by work teams are scientifically valid. In addition, using statistical methods ensures bias-free decision-making. This analytical approach creates workforce discipline and helps remove non- fact-based decisions. Systematically embedding these tools throughout an organization is critical to get every functional aspect of an organization aligned.
n The second is experimentation. For health care organi- zations, this often is difficult when they’re focused on protocols, pathways and policies. Ongoing experimen- tation requires risk-taking, employee time, educational programs, resource allocation, and a defined process that allows ongoing experimentation.
n The third is to learn from the past. Human nature tends to extoll success while ignoring failure. But learning from failure is powerful — and perhaps the ultimate teacher. Most physicians hate failure and rarely admit to it. Yet they have used trial and error to improve
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62 NOVEMBER/DECEMBER n 2017
their practices for centuries. Using information from others is an important concept, sometimes known as “benchmarking.”9 We can learn from colleagues, other organizations, our own actions and from customers. Organizations that do learn and can incorporate it into cohesive processes to retain learning and knowledge will be more competitive.
n The fourth is to learn how to transfer knowledge. Learning shouldn’t be one person learning a new technique. It must be a widespread effort so it can be effective organizationally. For example, many medical staffs employ “grand rounds” in which all members participate and learn from a presented case study. Many organizations also use site visits, training pro- grams and cross-training to further the acquisition and sharing of knowledge.
n The fifth is to develop yourself as a teacher, a designer and coach. There is no easy process available for that. Learning organizations are not built overnight, but rather are cultivated over time. Same for individuals. Se- nior leaders should ensure appropriate commitments, management and processes are established to allow learning to flourish — not only for physician leaders, but also for medical staffs.
Consider starting with fostering an environment that’s conducive to learning.6 Physician leaders should build in time for reflection, analysis and strategic planning. This should in- volve all members of the workforce, who should be trained in brainstorming techniques and problem-solving. Problem- solving should be done in the context of team activity across the organization. Physician leaders should ensure that there are adequate resources, both in time and money, to support team activities of their organizations, and also should work to eliminate any boundaries or silos in their organizations. Reduc- ing boundaries allows an organization to develop powerful and stimulating learning activities. Creating an environment of openness also allows for effective communication, sharing of ideas and risk-taking.
Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, is professor emeritus at the School of Medicine and co-director of the physician leadership program at the Henry W. Bloch School of Management at the University of Missouri in Kansas City.
Jennifer J. Robertson, MD, MSEd, FAAEM, is an assistant professor in the emergency medicine department at Emory University in Atlanta, Georgia.
REFERENCES
1. Alavi M, Leidner DE. Knowledge management systems: Issues, challenges, and benefits. Communication of the Association for Information Systems. 1(7):1-37, 1999.
2. Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization New Yor, NY: Currency and Doubleday Publishers. 1990.
3. Finger M, Brand SB., The Concept of the Learning Organization Applied to the Transformation of the Public Sector. In Organizational Learning and the Learning Organization, Easterby-Smith M, Araujo L, Burgoyne J, Ed. London: Sage, 1999.
4. DeBurca S. The learning health care organization. International Journal for Quality in Health Care. 12(6):457-8, December 2000.
5. Liebowitz J. Building Organizational Intelligence: A Knowledge Management Primer. New York, London: CRC Press, 1999.
6. Garvin DV, Edmondson AC, Gino F. Is Yours a Learning Organization? Harvard Businsess Review, March 2008.
7. Deming WE. Out of the Crisis. Cambridge, MA: . Massachusetts Institute of Technology. Center for Advanced Engineering Study, 1986, p. 510.
8. Serrat O. Building a Learning Organization. Knowledge Solutions. Asian Development Bank. May 2009.
9. Cox JW, Mann L, Samson D. Benchmarking as a mixed metaphor: Disentangling assumptions of competition and collaboration. Journal of Management Studies. 34(2):285-314, March 1997
Do you have a “learning organization”? How has it helped your
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some of the best practices your organization has developed?
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Aims–amp–Scope-Editorial-Bo_2015_International-Journal-of-Information-Mana.pdf
International Journal of
Information Management The International Journal of Information Management (IJIM) is an international, peer-reviewed journal which aims to bring its readers the very best analysis and discussion in the developing fi eld of information management. The journal: • keeps the reader briefed with major papers, reports and reviews • is topical: Viewpoint articles and other regular features including Research Notes, Case Studies and a Reviews section help keep the reader up to date with current
issues. • focusses on high quality papers that address contemporary issues for all those involved in information management and which make a contribution to advancing
information management theory and practice. Information is critical for the survival and growth of organisations and people. The challenge for Information management is now less about managing activities that collect, store and disseminate information. Rather, there is greater focus on managing activities that make changes in patterns of behaviour of customers, people, and organizations, and information that leads to changes in the way people use information to engage in knowledge focussed activities. Information management covers a wide fi eld and we encourage submissions from diverse areas of practice and settings including business, health, education and govern ment. Topics covered include: Aspects of information management in learning organisations, health care (patients as well health workers and managers), business intelligence, security in organizations, social interactions and community development, knowledge management, information design and delivery, information for health care, Information for knowledge creation, legal and regulatory issues, IS-enabled innovations in information, content and knowledge management, philosophical and methodological approaches to information management research, new and emerging agendas for information research and refl ective accounts of professional practice.
EDITOR
Dr Philip Hills Centre for Research into Human Communication and Learning, The Old School House, Little Fransham, Dereham Norfolk NR19 2JP Email: [email protected]
REGIONAL EDITOR: NORTH AMERICA Dr Paul Solomon Associate Professor School of Library and Information Science University of South Carolina 1501 Greene Street Columbia, SC 29208 803-777-5512 Email: [email protected]
REGIONAL EDITOR: ASIA AND PACIFIC Dr Thompson Teo Department of Decision Sciences NUS School of Business Mochtar Riady Building BIZ 1 #8-75
15 Kent Ridge Drive Singapore, 119245 Email: [email protected]
ASSISTANT EDITOR Robert Wiggins The Cura Consortium Ltd, 1, Theatre Street, Chichester. West Sussex. PO19 1SR Email: [email protected]
REVIEWS EDITOR Dr Stuart Fitz-Gerald Principal Lecturer and Course Director MSc BIT, Kingston Business School, Kingston Hill, Kingston upon Thames, Surrey, KT2 7LB, UK Email: fi [email protected]
CASE STUDIES EDITOR Professor Raymond A. Hackney Chair in Business Systems Brunel University Business School, Uxbridge Middlesex UB8 3PH, UK Email: [email protected]
RESEARCH NOTES EDITOR Professor David Ellis Department of Information Studies Aberystwyth University Aberystwyth Ceredigion SY23 3AS Email: [email protected]
INTERNATIONAL EDITORIAL BOARD
Professor Sherry Y. Chen Graduate Institute of Network Learning Technology National Central University, Taiwan, ROC Email: [email protected]
Dr Chun Wei Choo Associate Professor Faculty of Information Studies University of Toronto 140 St. George St, Toronto, Ontario Canada M5S 3G6 Email: choo@fi s.utoronto.ca
Professor Blaise Cronin School of Library and Information Science Indiana University, Bloomington, IN 47405, USA Email: [email protected]
Professor Paul Beynon-Davies Cardiff Business School Cardiff University Aberconway Building, Colum Drive Cardiff, CF10 3EU Email: [email protected]
Dr Brian Detlor DeGroote School of Business, McMaster University DSB-419, 1280 Main St. W., Hamilton Ontario, Canada, L8S 4M4 Email: [email protected]
Dr Kevin Grant School of Business, Management & Economics, University of Sussex, Brighton. Sussex Email:[email protected]
Professor Josef Herget Head of Center for Knowledge and Information Management Danube University Krems / Donau- Universität Krems, Dr.-Karl-Dorrek-Str.30, A-3500 Krems, Austria, Tel: + 43-2732-893-2332 Fax: + 43-2732-893-4335 www.donau-uni.ac.at/wimjosef. [email protected]
Professor Tommi Laukkanen University of Eastern Finland Business School Joensuu, Finland [email protected]
Professor Feng Li Chaitr of Information Management Cass Business School City University 106, Bunhill Row London EC1Y 8TZ Email: [email protected]
Professor Massimo Magni Department of Management & Technology, Bocconi University, Milano 20136. Italy Email: [email protected]
Dr Linda D. Peters Associate Professor in Marketing Nottingham University Business School Jubilee Campus, Woolaton Road Nottingham, NG8 1BB, UK Email: [email protected]
Professor Yannis Pollalis Business Strategy and Policy University of Piraeus 80, Karaoli & Dimitriou Street GR-185 34 Piraeus, Greece Email: [email protected]
Dr Mark Stansfi eld School of Computing University of the West of Scotland High Street, Paisley, PA1 2BE Scotland, UK Email: Mark.Stansfi [email protected]
Colin Theakston Durham Business School, School of Economics, Finance & Business, Durham University, Mill Hill Lane, Durham DH1 3LB, UK Email: [email protected]
Professor Adam Vrechopoulos Department of Management Science and Technology, Athens University of Economics and Business, 76 Patission Street, Athens 104 34, GREECE e-mail: [email protected]
Professor David Wainwright Head of the Information Management Innovation (IMI) Research Group Professor in Information Systems School of Computing, Engineering and Information Sciences Northumbria University Pandon building Camden Street Newcastle upon Tyne NE2 1XE UK Email: [email protected]
Martin White Managing Director, Intranet Focus Ltd. 12 Allcard Close, Horsham West Sussex, RH12 5AJ Email: [email protected]
Professor Susan P. Williams Institute for Information Systems Research University of Koblenz-Landau Koblenz 56070 Germany Email: [email protected]
How-are-citizens–public-service-choices-s_2015_International-Journal-of-Inf.pdf
International Journal of Information Management 35 (2015) 527–537
Contents lists available at ScienceDirect
International Journal of Information Management
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j i n f o m g t
How are citizens’ public service choices supported in quasi-markets?
Agneta Ranerup a,∗, Lars Norén b,1
a Department of Applied Information Technology, University of Gothenburg SE-412 96 Göteborg, Sweden b Department of Business Administration, University of Gothenburg, PO Box 610, SE-412 96 Göteborg, Sweden
a r t i c l e i n f o
Article history: Received 30 March 2015 Received in revised form 7 May 2015 Accepted 22 May 2015 Available online 2 June 2015
Keywords: Electronic government Quasi-markets Decision support Sociomateriality Citizen
a b s t r a c t
Many countries have introduced quasi-market reforms that enable citizens’ choice in education, health- care, and other public services. The research question in this paper is the following: How can Web-based decision support help citizens to make calculated public service choices in quasi-markets? In Section 3, the paper focuses on how decision support design helps citizens make such choices as they isolate, examine, and rank alternatives. A case study, set in Sweden, explores 14 cases of decision support in education, healthcare, elder care, and the public pension system. Decision support is most evident in the area of education, but decision support is found in the other areas as well. In most cases, the support consists of information on the right of choice and instructions on how to search among alternatives. Many areas permit direct comparisons, but some areas only permit more indirect comparisons. All 14 cases explain how to make a choice, but only a few cases offer a ranking device. The decision support for choice is inconsistent with the theoretical model of calculated choice in all aspects despite the trend toward greater consistency with the model. Our results call for a critical discussion of technology design that aids citizens as consumers or customers in their relationship with public services.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
In many countries, new institutional arrangements, in the form of market reforms, have been introduced that affect the admin- istration and deliverance of public services (Le Grand, 2007). For more than two decades, different types of market reforms have been important features in education systems in many OECD countries (Grubb, 2002). Such reforms are also found in healthcare (Chauvette, 2003) and in other public service areas.
These institutional arrangements, using supply/demand mech- anisms, often strengthen citizens’ ability to make choices about the public services that affect them. Some mechanisms allow citizens to make their choice of services directly while others permit citizens to make their choices more indirectly (e.g., through a mediat- ing, contracting agency). Although the sellers, or service providers, in these markets may not necessarily strive to maximize their profits, they are very aware they exist in an environment where other sellers/providers compete for the same citizens–buyers. The citizen–buyers do not use private capital when they make their public service choices. Instead, they have vouchers that allow them
∗ Corresponding author. Tel.: +46 31 7862766. E-mail addresses: [email protected] (A. Ranerup),
[email protected] (L. Norén). 1 Tel.: +46 31 7861540.
to “shop around” for public services. These arrangements are often described as quasi-markets (Le Grand, 2007).
Clearly, the central figure in such arrangements is the citizen. Yet there is little research on how to support citizens when they make choices in quasi-markets (Greener, 2007; The Swedish Agency for Public Management, 2007; Winblad & Blomqvist, 2013). In the limited research available, the focus is the information needs of citi- zens as they choose schools or doctors, and the design of Web-based support for such choices (Allen & Burgess, 2011; Leckie & Goldstein, 2011; Ranganathan, Hibbard, Rodday, & de Brantes, 2009). It is also important to note that the design of such technological, often Web-based, decision support for citizens influences their relation- ship with the state (Chadwick & May, 2003; Gauld, Goldfinch, & Horsburgh, 2010; Lips, 2007). This relationship can be discussed in terms of citizens, patients, service users as well as customers and consumers.
The focus in this paper is the sociomaterial constellation con- sisting of technology (“web-based decision support”) and people (“citizens with a right to choose”) where the possibility of mak- ing calculated choices in quasi-markets is present. The research question is the following: how can Web-based decision support help citizens to make calculated public service choices in quasi- markets? In Section 3, we focus on the design of technological decision support, especially as it can help citizens make calculated choices (cf. Callon & Muniesa, 2005). Our study, which is set in the
http://dx.doi.org/10.1016/j.ijinfomgt.2015.05.002 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
528 A. Ranerup, L. Norén / International Journal of Information Management 35 (2015) 527–537
context of Swedish public services, contributes to the research on decision support in quasi-markets as well as the research on the materiality of markets (cf. MacKenzie, 2009) with specific reference to the sociomaterial design of Web-based support for choice.
2. Previous research on decision support for citizens’ choice
Coulter (2010) discussed the introduction of, and the need for, well-designed support for patient choice in a healthcare setting. Green, McDowell, and Potts (2008), who studied the Choose & Book system, found that doctors still retain considerable influ- ence on patients’ choices. Ranerup, Norén, and Sparud-Lundin (2012) and Damman (2010) conducted broad surveys of techni- cal support for choice in healthcare in Sweden and in Holland, respectively. Fasolo, Reutskaja, Dixon, and Boyce (2010), Moser, Korstjens, van der Weijden, and Tange (2010), and Ranganathan et al. (2009) emphasized the importance of design as an influence on choice itself. They described the various kinds of infor- mation that designs provide, such as quality information or patient evaluations. Interestingly, Angst, Agarwal, Gao, Kuhntia, McCullough (2014) discussed the voluntary provision of qual- ity information by hospitals in a study of the costs of providing such information. There is far less research on decision sup- port in elder care; furthermore, the research that is available is somewhat contradictory. Meinow, Parker, and Thorslund (2011) described cognitive difficulties that the elderly have in making choices. However, Goodwin (2011) argued that the elderly can make such choices. Winblad and Blomqvist (2013) claimed that both properly designed technologies and more information are needed.
Regarding education, research in UK focuses on how parents used quantitative information (“League Tables”) to choose schools for their children (Allen & Burgess, 2011; Leckie & Goldstein, 2011). More recent studies examine if and how quality information affects parents’ choice of schools in Chile and the Netherlands (Gomez, Chumarcero, & Paredes, 2012; Koning & van der Wiel, 2013), as well as more generally how information should be designed and provided (Allen & Burgess, 2013). A general theme in the research on choice in education is that, despite difficulties, simple perfor- mance tables are useful. More specifically, in a study of the visual and textual designs of support for school choice, Wilkins (2012) claimed these designs express cultural, historical, and pedagogical values.
In one of the few studies on choice related to public pen- sion investing, Ranerup (2007) concluded that support for choice might exist if the intention is to provide information on rather advanced knowledge levels. Sundén (2004) described technolog- ical support for choice as a complement to written information. Hagendorff, Hudson, and Keasy (2006) described the complexity or “Byzantine” logic of designing electronic support for choice and advice for pension annuities that would satisfy the various needs of retirees.
In sum, most of the research on citizen choice, which is rather “non-theoretical”, has been conducted in healthcare settings, prob- ably because of the many different kinds of healthcare choices (e.g., doctor, hospital, treatment, primary care clinic, etc.). However, to our knowledge, as yet, there is no research that examines in com- prehensive fashion, decision support for choice in several different public service areas. To fill this research gap, our intention with this theory-based, comparative case study is to provide a comprehen- sive study of available, Web-based support in four public service areas.
3. Theory
Our study falls within the current sociomaterial tradition with its focus on the joint activities of people and technology (Jones, 2014; Leonardi, 2012). This tradition is concerned with people’s use of technology in general, viewing technology as a socio-technical system that emphasizes the interdependence of social and techni- cal subsystems (Leonardi, 2012). This tradition grew out of an older tradition based on workplace studies conducted in the 1930s and developed, for example, by key figures at the Tavistock Institute, including Fred Emery, Ken Bamforth, Eric Trist, and others).
The sociomaterial tradition is more radical than this older tradi- tion because of its focus on how people and technology act together. In a discussion on the roles of people and technology, McMaster and Wastell (2005, p. 179) concluded: “[T]echnology cannot act without people, any more than people can act without technology. Agency cannot be reduced to either pure humans or pure machines.”
Leonardi (2012, p. 34) took a broader perspective in his discus- sion of sociomateriality:
[T]alking about sociomateriality is to recognize and always keep present to mind that materiality acts as a constitutive element of the social world, and vice versa. Thus, whereas materiality might be a property of a technology, sociomateriality represents that enactment of a particular set of activities that meld materiality with institutions, norms, discourses, and all other phenomena we typically define as ‘social’.
Of course, practical situations exist in which the social and the material act together or, as described by Leonardi (2012), are “constitutively entangled.” For example, several researchers are now engaged in the on-going debate on the theoretical and methodological problems in this tradition. This debate, among other things, occurs in the investigation of “mute” technology and in the investigation of agency and separation among the “hybrid” actors of people and technology (see Cecez-Kecmanovik, Galliers, Henfridsson, Newell, & Vidgen, 2014; Leonardi, 2013; Mutch, 2013; Scott & Orlikowski, 2013). Some, although not all, studies in this tra- dition combine theoretical and empirical research (Jones, 2014). In our study, we contribute to a particular stream in this research with our focus on markets and their constructed nature. This approach allows us examine the sociomaterial design of Web-based support that helps citizens make their calculated public service choices.
We call attention to other important studies that take this approach. Callon (1998), for example, studied how actors use eco- nomic theories to construct markets in which people as well as technologies are involved in choice. MacKenzie (2009) used mostly financial market case studies in his study that deals with how economic agents are constructed, often in a very material sense. In more recent publications, Jeacle and Carter (2011) and Scott and Orlikowski (2012) studied how the spread of technology in the travel sector allows people to evaluate and rank travel ser- vices using technology that displays these evaluations on computer screens. They also looked at how technology creates trust by dis- playing other people’s evaluations. In all of these cases, people’s joint activities with technology are the de facto focus, which makes technology an important component of a hybrid actor.
Taking a somewhat different perspective, Pollock and Dı́Adderio (2012) focused on technologies used in a material sense for rank- ing options via computer screens. In their study of how lists and graphic design aimed at ranking influence the actions of human actors in the market, they created an additional layer between the individual consumer and the market. In line with these perspectives, we find that technology not only provides the traditional (and neutral) decision support for choice, but also mutually influences, or controls, citizens when they make their choices.
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Callon and Muniesa (2005) designed a fundamental model of choice behavior that we use as the theoretical framework of our paper. Their model assigns technology a role that enables people to perform as calculating consumers/customers. Their theoretical framework for the model includes the concept of calculation, which refers to the general idea of how people make thoughtful and cal- culated choices in any situation. In defense of their model, Callon and Muniesa (2005) state that economists view reality as “pure” calculation. Other social scientists, they argue, try to show that real practices are more complex and leave little room for calculation practices. In contrast to that perspective, Callon and Muniesa (2005) looked at processes in which calculated choices were made in an examination of the sources of economic calculation. As followers of the sociomaterial tradition, they argue that material devices (e.g., weighing scales or supermarket shelves) as well as more abstract tools (e.g., Web portals such as those described in this article) are of critical importance in helping individuals act as calculating con- sumers (see also Callon, 1998).
More specifically, Callon and Muniesa (2005) argue that design- ers should follow certain basic principles when they construct technological devices such that choice and ranking are supported through the joint activities of technology and people. First, to enable choice, options must be detached or isolated from their context and grouped into a common framework such as on a computer screen. In public services, this means, for example, that all schools or pri- mary care clinics in a municipality are listed or shown on a screen. In this format, consumers may easily obtain a general overview of unknown or scattered options that otherwise would be unavailable. Second, once the options have been isolated in this manner, con- sumers require the means to examine and compare them. Advanced devices, some more complex than others, as well as data about the public services, support consumers in this step. For example, detailed computer screen data for all options or selected options, as well as various devices for use in comparisons of a few options, may be available. Third, designers must create a method by which consumers can use the comparisons to produce a new entity (e.g., a sum, an ordered list, or a holistic evaluation). In this manner, rank- ing/choice are enabled. The use of this method may produce a sorted list or, at least, facilitate the selection of the best alternatives con- sistent with people’s preferences that are revealed in the process. In short, it is essential that technological devices, such as websites be designed so that they support calculating consumers as they study alternatives following the steps of isolation, examination,and ranking/choice.
4. Material and methods
4.1. Research setting
In this paper, we describe several kinds of Swedish public ser- vices in which citizen choice is permitted. The Swedish setting is interesting for several reasons. Although Sweden’s governing parties are on the centre-left of the political spectrum, since the 1990s, Sweden, as a country, has placed great emphasis on the principles of New Public Management (NPM) that favor market- oriented management of the public sector (Hood, 1995). Several authors (e.g., Osborne & Gaebler, 1992; Le Grand, 2007) have described NPM as a liberal project that reinvents government. How- ever, NPM remains a controversial reform in Sweden.
Whatever the pros and cons of NPM in public services, it is clear that Swedish citizens are offered choice in many areas, including education, healthcare, daycare, welfare services for the disabled, elder care, and public pension investment. It is also clear from pol- icy documents that large public and private agencies are working to increase greater citizen choice through the use of technology
(Ministry of Education and Science, 2012). One element of this reform is the use of a voucher system (or something similar). Under this system, citizens can choose any public service provider so long as the public treasury finances the services (i.e., by taxation) (Le Grand, 2007).
In this paper, we look at how Swedish public services are offered in the following areas: education, healthcare, elder care and public pension systems. The first three areas have been addressed in liter- ature on choice reform (see, e.g., Le Grand, 2007). The fourth area, the public pension system, is somewhat different from the others because of its empirical character although it is still a public service. Together, the four areas represent a broad spectrum (as well as a significant portion) of public services in Sweden.
A number of countries, besides Sweden, have introduced citizen choice in education and healthcare in recent decades. For example, UK, Chile, Denmark, and New Zealand now allow choice in educa- tion. And UK, Denmark, New Zealand, and Norway allow choice in public healthcare. Sweden and Denmark also allow choice in elder care and in the public pension system.
Our study examines 14 cases of Web-based decision support for choice in four public service areas (see Tables 1–4). The major- ity of these 14 cases are standard e-Government services of the G2C or G2B type (Beynon-Davies, 2005) that are owned and oper- ated by public sector agencies. However, we also look at cases in which the services are owned and operated by private agencies or by a mix of public–private agencies (a public–private partnership or PPP) (Josefsson & Ranerup, 2003; Karpik, 2010). Our goal in exam- ining this broad mixture is to describe the significant variations among the choice providers and in their decision support designs. Our intention is to achieve saturation on these two aspects.
4.2. Data collection and analysis
Our data collection and analysis consisted of four steps. First, we conducted 14 semi-structured interviews. The interviewees (project leaders, managers, and others) all had extensive knowl- edge of the past, current, and future activities of their agencies, plus an understanding of how the Web-based decision support for choice works. We conducted our interviews between December 2012 and May 2014. All interviews (between 30 and 70 min each) were audio-recorded and later transcribed. We asked the inter- viewees to describe the general background of their decision support systems as well as their basic features related to the com- ponents of our theoretical model (“Isolating, Examining, Ranking and choosing”). Second, we analyzed some of the providers’ pol- icy documents. Third, we examined the design and content of the decision support systems. In this step we examined the systems’ practical features in terms of Isolating, Examining, and Ranking: Here, Isolating refers to the provision of technological devices that describe the framework for choice of, for example, a primary health care provider or a school, and the search for available units. Examin- ing refers to the provision of technological devices that investigate and compare available choices based on, for example, waiting times and quality indicators. Ranking refers to the provision of technolog- ical devices for sorting and choosing among selected alternatives. Fourth, we compared and summarized the 14 cases. Our focus was their theoretical and practical contributions to technological design for choice in public services.
As MacKenzie (2009) states in a very relevant publication on “material markets”, the preferred method for studying data collec- tion that uses technology is to observe how the technology is used “in action”. In order to study the public service areas addressed in this paper, we made the alternative decision to use a multiple-case study of 14 cases with interviews, technologies, and policy doc- uments as our data. Thus, we rely on both the interviewees’ and our own descriptions of the technology rather than on an ethno-
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Table 1 Web-based decision support in education.
1. 13 municipalities in cooperation: The Gothenburg Region Association of Local Authorities (GR)
2. The public–private partnership: The Swedish Association of Local Authorities and Regions (SALAR), Svenskt Näringsliv, the Swedish Association of Independent Schools
3. A national public authority: The Swedish National Agency for Education
4. A local government: the local public administration of education in the municipality of Gothenburg
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Information about the rights of choice
Search for units of upper secondary schools in the GR region (13 municipalities) selecting municipality, educational program, ownership
Search for units of secondary (and upper secondary) schools in the country selecting municipality, distance, location on map
Search for units of upper secondary schools in the country selecting municipality, educational program, ownership, and a device where specific preferred criteria can be chosen as a basis for selecting (grading, competence of teachers, number of pupils in class, grading needed for acceptance etc.)
Browsing in a list and texts about units of upper secondary schools owned by the municipality of Gothenburg
Examining alternatives Indirect comparisons of schools and educational programs based on link to schools with same type of education as well as schools own websites
Direct comparisons of schools based on numerical information and diagrams in columns covering grading, results in national tests, competence for further studies, student investigations about satisfaction applied to a few selected schools
Direct comparison of schools based on all types of above numerical information in columns applied to a few selected schools
Indirect comparisons of schools and educational programs based on online marketing brochure and link to schools own websites
Ranking and choosing alternatives
Manual ranking, IT-supported choice
Manual ranking, no choice Manual ranking, no choice Manual ranking, link to IT-supported choice (in Case No. 1)
5. A local government: The municipality of Gothenburg
6. An association: Svenskt Näringsliv i.e., the Swedish national association for promoting free enterprise
7. A private company: The Metro Corporation
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Search for units of upper secondary schools in the municipality of Gothenburg selecting part of the municipality, ownership, map
Search for units of upper secondary schools in the country selecting educational programs, municipality and name of school
Search for units of upper secondary schools in the country selecting educational programs and municipality or region
Examining alternatives Indirect comparisons of schools and educational programs based on contact information and schools own websites
Direct comparisons of schools and educational programs based on numerical information in columns about grading, qualification to university studies, results of national tests, future income opportunities, unemployment etc. applied to a few selected units
Indirect comparisons of the same educational program in one municipality based on brief textual information, contact information and links to schools own websites, links to other schools with same program. Information about future opportunities regarding, e.g., salary levels (monthly wages), chat during period of choice
Ranking and choosing alternatives
Manual ranking, link to IT-supported choice (in Case No. 1)
The device for comparisons supports ranking through colors indicating whether selected alternatives belong to the 25% best, middle or worst units in the country No choice
Manual ranking, link to IT-supported choice (in no. 1 or similar regional support in other parts of the country)
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Table 2 Web-based decision support in healthcare.
8. An association for all public regional authorities: SALAR and its IT-department Cehis
9. An association: Svenskt Näringsliv i.e., the Swedish national association for promoting free enterprise
10. A public regional authority: The county council of Halland
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Search for units of primary care clinics using a map or search of, e.g., municipality or name of clinic
Search for units of primary care clinics indicating preferences regarding perceived importance of satisfaction, waiting-times and actual physical location
Search for units of primary care clinic by names of municipalities, needed access (day, weekend, nights)
Examining alternatives Direct comparison of clinics based on numerical information and diagrams in columns showing contact information, measured telephone access, first visit, patient investigations about: general reception, experienced usefulness, information, participation in care, confidence, willingness to recommend, overall perception of a few selected centres
Direct comparison of clinics in a sorted list based on all of above aspects and occasional personal judgments from patients. Detailed information about each one of the suggested clinics in percentages and available diagrams
Direct comparison as in Case No. 8 as well as additional information about competence (pediatrics, diabetes, etc.), available e-services of a few selected centres in format yes-no
Ranking and choosing alternatives
Manual ranking, IT-supported choice
Ranking in list by indicating preferred aspects as above
Manual ranking, IT-supported choice
No choice
Table 3 Web-based decision support in elder care.
11. A national public authority: The National Board of Health and Welfare
12. A local government: The municipality of Stockholm
Isolating alternatives Information about the rights of choice Information about the rights of choice Search for units (local government, part of local government in large city, private company) of provider of help in home to elderly based on municipality, type of owner (public, private), type of help (service, personal care)
Search for units (part of local government, private company) of provider of help in home to elderly in Stockholm based on distance, owner (public, private, cooperative) that can be sorted according to one preferred criteria (randomly or client investigation of participation, safety, satisfaction etc.) before selecting instances to compare
Examining alternatives Direct comparison of units based on textual and numerical information in columns covering type of owner, detailed information regarding participation, protective routines of a few selected units
Direct comparison of units based on textual information, diagrams, and numerical information in columns showing client investigations as well as information about provided services (meals, shopping, laundry, night service etc.) of a few selected units
Ranking and choosing alternatives
Manual ranking Manual ranking but the phase of isolating supports selecting a criteria by which to sort lists of units of providers as above
No choice IT-supported choice
Table 4 Web-based decision support in public pension.
13. A national public authority: The Swedish Pensions Agency
14. A public–private partnership: Minpension that includes The Swedish Pensions Agency, Banks, Fund companies
Isolating alternatives Information about the rights of choice Information about the rights of choice and the pension system as a whole
Search for units of pension funds in the public pension based on risk, fee, increase in value, category, etc. These categories can be used for ranking (i.e., sorting) according to preferred criteria
No search for funds
Examining alternatives Direct comparisons of selected alternatives in lists based on numerical information and diagrams based on the selected criteria
Overview of choices made and their result (total savings) Personal forecasts based on future salary and activity
Ranking and choosing alternatives Direct ranking before selection as above as well as in diagrams showing increase in value. An advanced DSS incorporating personal preferences regarding risk, fees, time, etc., supports comparing current and future portfolios
No ranking
IT-supported choice No choice
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graphic observation of its actual use. However, for our purposes, we think our methodology is “good enough” because our intention is to describe the potential agency embedded in the technologyı́s material product as well as its textual content (Siles & Boczkowski, 2012).
5. Results
5.1. Education
In Swedish education, choice reform was introduced in the primary and lower secondary schools in 1992 and in the upper secondary schools in 1994. In each municipality, various tax- funded agencies (public, semi-private, or private) supervise the school choice system. The mandate for this reform was stated in the national government proposition 1991/92:95: “Choice and independent schools” (Ministry of Education and Science, 1991/1992Ministry of Education and Science, 1991/1992). In some regions, a number of municipalities cooperate around choice in upper secondary education.
Table 1 presents the Web-based decision support for upper sec- ondary schools and education programs. Local authorities, national public authorities, and public–private partnerships (PPPs) provide the support. The PPPs are entities associated with Svensk Näringsliv [Swedish Business Life], which promotes free enterprise and pri- vate companies. As far as Isolating alternatives, five cases provide information about the right of choice. Case No. 2 (a PPP) and Case No. 6 (owned by Svenskt Näringsliv) do not provide this information. Of the seven cases, six support the search among all schools (pub- lic or private) and/or education programmes using various criteria. Case No. 4 supports the search only among the municipality’s own schools. This is a large municipality where school choice is highly competitive. In addition, in Case No. 4, the description of choice has a greater market orientation than in the other cases.
Other significant differences exist among the cases in the area of education. Case No. 3 (a new national public support for comparing schools operated by The Swedish National Agency for Education) has a device with different personal preference criteria for use in comparing schools (distance, size, qualification of teachers, grad- ing, etc.) (see Fig. 1). The other cases feature indirect comparisons using a list of separate schools. However, Case No. 3 still has columns with selected schools including all provided criteria or types of information. Case No. 2 allows comparisons of a few schools, arranged in columns based on all types of information (including diagrams and numerical data). Case No. 6 (financed by Svenskt Näringsliv) is the only case that supports ranking of options. In the other cases, the user must sort among the alternatives (“Man- ual ranking”). Case No. 1 is the only case that permits direct choice among all upper secondary schools in the 13 municipalities. Case No. 4 and Case No. 5 (owned by the municipality of Gothenburg) permit indirect choice among the regional schools through a link to Case No. 1’s device. In Case No. 7, the Metro Corporation offers Web-based decision support that is linked to Case No. 1 or to similar regional support.
5.2. Healthcare
Sweden introduced choice reform in primary care in 2010 (Ministry of Health and Social Affairs, 2008/2009Ministry of Health and Social Affairs, 2008/2009). With this reform, all citizens are allowed to choose among the primary care centers in a county coun- cil, although choice of doctors is not an option. The county councils or private healthcare agencies operate these centers. In healthcare, Case No. 8, operated by the national association (SALAR) and Case No. 10, operated by an individual county council, provide infor-
mation about the right of choice. Case No. 9, operated by Svenskt Näringsliv, is more concerned with allowing citizens to make com- parisons (see Table 2). All three cases support comparisons based on contact information and patient investigations. Case No. 9 is the most advanced because of its ranking device that allows a user to decide on the importance of basic features (e.g., distance, patient satisfaction, ownership, waiting time before contact) (see Fig. 2). The user may also add a personal evaluation that others may read. However, Case No. 9 does not permit the user to make a choice whereas Case No. 8 and Case No. 10 permit a choice selection.
5.3. Elder care
Choice in elder care (home help for the elderly) was introduced in Sweden broadly in 2009 in connection with LOV (Law on the Right to Choose) (Ministry of Health and Social Affairs, 2009). How- ever, each municipality may choose whether to offer choice in elder care. Approximately 60% of the municipalities have introduced the choice option (Swedish Association of Local Authorities and Regions, 2013).
Public agencies own both elder care cases (see Table 3). Regarding Isolating alternatives, both Case No. 11 and Case No. 12 provide information about the right of choice. Both cases per- mit searches among provided services according to simple criteria (e.g., type of care, municipality). Case No. 12, owned by the Stock- holm municipality, has the capacity for sorting among the often rather long list of private and public providers in particular areas of the municipality. Selected criteria are used in the sorting step. Regarding Examining alternatives, both Case No. 11 and Case No. 12 permit comparisons according to a list of features (e.g., organization type or available services). However, Case No. 12 also permits more direct user searches. Regarding Ranking and choosing alternatives, specific ranking is not possible in either case. Case No. 12 permits choice in the Stockholm municipality, but Case No. 11 does not.
5.4. The public pension system
In 2000, pension reform in Sweden offered a choice compo- nent for the public pension system. People were offered a choice of investing in approximately 800 premium pension funds. These funds charge an obligatory fee on all earnings. Employees con- tribute 16% of their earnings to general public pension fund, and 2.5% of their earnings to the premium pension system fund (SOU, 2005).
Table 4 presents two cases: Case No. 13, owned by a national public agency, The Swedish Pension Authority, and Case No. 14, a PPP (Minpension.se). Regarding Isolating alternatives, both cases include information about choice. However, Case No. 13 supports searches for alternatives using many criteria. These criteria include a Decision Support System (DSS) to make advanced comparisons for Ranking and choosing premium pension funds. In contrast, Case No. 14, which offers a more indirect form of support for choice, shows the results of choices made in the premium pension plan as well as how the choices fit into the individual’s entire pension portfolio, including the individual’s private retirement savings (see Fig. 3). Case No. 14 does not offer the Ranking and choosing alternative. Despite its indirect support, Case No. 14 clearly intends the decision support to be used for choice.
5.5. Isolating alternatives
In this section, we summarize the sociomaterial process of making choices that the joint activities of technology and people support. Eleven of the 14 cases have information about the right of choice of, for example, a school, a primary care centre, elder care in the home, or a pension fund. This information isolates the avail-
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Fig. 1. Case No. 3 with its device to select types of information that are important to the individual for closer examination (to the right).
Fig. 2. Case No. 9 with its ranking of the primary care clinics.
able options in a very simple but important way. Case Nos. 2, 6, and 9 that are, or were, at least partly owned by Svenskt Näringsliv do not provide such information. Therefore, a broader context for choice and the related individual rights of citizens is often sup- ported. Generally speaking, Swedish society firmly supports this concept. However, the Swedish Association of Independent Schools states:
Unfortunately there is still [in some regions and municipalities] a lack of knowledge about the rights of school choice. As a result, often the school that is closest to home is “chosen”. Thus, it is important to address this lack of knowledge so that everybody knows about their rights (Hamilton, 2015).
It is of equal importance (as observed in all cases except Case No. 4 related to the marketing of the municipal upper secondary schools) that support for searching alternatives is available.
5.6. Examining alternatives
Case Nos. 3, 6, and 11 provide numerical and textual data that can be used for examining alternatives. Case Nos. 2, 8, 12, and 13 provide diagrams or graphic information. Furthermore, many cases enable comparisons based on neutral information with the exception of links to a provider’s website. However, the website for Case No. 4 markets the municipality’s upper secondary schools. Some cases in education, healthcare, and elder care present evalu- ations, such as student, patient, or user views. Other information is available about various entities and their capacities (e.g., location, access, services, etc.). According to Jeacle and Carter (2011), it is somewhat unusual to find personal and spontaneous evaluations from users in decision support design. In our study, only Case No. 9 permits such evaluations (in healthcare only). Such user evalu- ations use the material capacity of information technology, unlike
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Fig. 3. Case No. 14 shows all the savings in the pension portfolio including public pensions, occupational pensions, private pensions, and a pension forecasts.
historical technologies, (e.g., hotel evaluations by guests) to make judgements visible (Orlikowski & Scott, 2014).
Many of the 14 cases provide direct support for making compar- isons (see Tables 1–4). Case Nos. 1, 4, 5, and 7 permit comparisons more indirectly; a user has to check each alternative and then com- pare it with others. Some cases offer more advanced devices for comparing alternatives. Often this support appears as information about a few selected entities, arranged in columns. In Case No. 3 (see Fig. 1) and Case No. 12, the designs allow selection of preferred information that can be used for making comparisons. Case No. 9 allows the selection of preferred information that can be used to create a sorted list of comparisons (see Fig. 2). Additionally, Case No. 13 has a device consisting of different steps that can be used to indicate various preferences (e.g., preferences about risk level, fees, and search time results). It also permits examination of a citizen’s current pension portfolio and comparison of it with a potential new portfolio of pension funds.
Case No. 14 has less sophisticated devices for comparing and examining alternatives (see Table 4). However, its design allows evaluation of pension fund choices in the context of other choices, from both short- and long-term perspectives (see Fig. 3). Of course, pension funding is, by its very nature, a long-term activity. How- ever, so are many of the other choices described in this study, for example, education. Interestingly, the designs in Case Nos. 6 and 7 project future salary levels. This alternative takes a more long-term perspective as well as a broader perspective on calculated choice than a temporary choice made at one moment in time. An interest- ing issue is whether this long-term perspective on choice is relevant in other areas. For example, in healthcare is the long-term perspec- tive useful for a patient with a chronic illness who is being treated at a primary healthcare clinic? Would such a perspective allow the patient to evaluate data on treatment results for a specific illness at a specific clinic?
5.7. Ranking and choosing alternatives
Comparatively few of our 14 cases offer devices for ranking alternatives on their Web-based screens in terms of specified or preferred criteria that would make choice a simpler decision. Callon and Muniesa (2005, p. 1231) describe the theoretical basis of rank- ing as follows:
A new entity must be produced (a sum, an ordered list, an evaluation, a binary choice, etc.) that corresponds precisely to the manipulations effected in the calculative space and, con- sequently, links (summarizes) the entities taken into account. This resulting entity is not new, in the sense of springing from nowhere; it is prefigured by the considerations described above.
Our cases show alternative ways to make rankings using socio- material constellations related to choice in quasi-markets (see Tables 1–4). Case No. 12 (elder care) and Case No. 13 (public pen- sion funds) show (indirectly) ordered lists that have been ranked by preferred types of information. The ranking step thus precedes the selection of alternatives for comparison. Case No. 9 (healthcare) summarizes (more directly) several criteria or types of informa- tion as a joint list. Case No. 13 shows diagrams that compare the increase in the value of selected alternatives. Alternatively, Case No. 6 (education) even more directly offers a form of holistic eval- uation that ranks the 25% top, middle, or bottom alternatives using graphics and colors. Case No. 13 permits a full comparison of a new portfolio using graphics and information in a multifaceted DSS that constructs a carefully selected portfolio of alternatives for compari- son with the citizen’s current portfolio. Thus, here we see how lists and graphics (Pollock & Dı́Adderio, 2012) can be used in various ways for rankings in quasi-markets.
There are several possible reasons why relatively few of our 14 cases have a design that supports ranking. One reason is that ranking may be perceived as controversial because it points to the “best” and the “worst” alternatives in a very obvious manner (!). Another reason is that ranking must be based on available data rather than on unavailable data that may be still more relevant. Ranking is also a controversial issue because the available data may be unclear about new service providers (The Swedish Agency for Public Management, 2007). However, this issue, which relates to the contradictory role of public authorities in providing clear messages for choice, is under discussion. An interviewee stated:
[The] authority must offer a support for choice. [. . .] It is a conscious strategy from our side that we do this quite clearly. [However] we still can not provide anything that seems like advice. (Project leader, Pension Authority, May 27, 2013)
Some research claims that ranking also influences the activities of those who are ranked by causing them to try to improve their position by manipulating or concealing information. The use of the
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ranking technologies can also affect which options (e.g., service providers) are shown when there are multiple options available (Pollock & Dı́Adderio, 2012). The issue of technologies for rank- ing and their interaction with people is, thus, an issue for further research. Nevertheless, a severe problem may result from the rela- tively minimal use of devices that support ranking. An abundance of information, which cannot be used in ranking, may influence choice negatively. More confusion, rather than simplification, may be the result. Last, but not least, our theoretical model represents the activity of making choices. Surprisingly, only eight of our cases support actual choice via Web-based support (see Tables 1–4).
5.8. Comparing the 14 cases
What conclusions can we draw about the sociomaterial constel- lations in our 14 cases related to calculated choice in the areas of education, healthcare, elder care, and public pension funds? Edu- cation has the largest repertoire of Web-based support for choice as well as agencies that provide support. Choice reform has existed in education in Sweden since the beginning of the 1990s. By contrast, choice reform was introduced for primary healthcare and elder care in 2010 in Sweden. The diversity of support in the various public service areas, especially in education, indicates a “battle of judge- ments” (Karpik, 2010). In education, citizens can choose among the education alternatives. However, they must choose among one or several systems of Web-based support for choice (!) before they can locate the available options and make comparisons. In educa- tion, quite recently (2013–2014), a PPP (Case No. 2) and a national public authority (Case No. 3) revealed a positive move toward sup- port for more citizen choice. This new support movement can be contrasted with support for school leaders, also used by parents for choice (Ranerup, 2006), and Case No. 6 (which ended in 2013). However, as Section 5.7 discusses, this long tradition of choice does not mean that education has devices that support calculation with sophisticated ranking mechanisms.
We conclude that, increasingly, in education as well as in healthcare and public pension funds, private agencies (e.g., Svenskt Näringsliv and the Metro Corporation) provide support (Case Nos. 2, 6, 7, 9, and 14). In fact, in Case Nos. 2 and 14, these agencies work in cooperation with public agencies. In other words, they take an active part in what we usually see as the technological con- struction of the relationship between the state and the individual. This relationship is featured in the research field of e-Government that often, we argue, is implicitly assumed to be an area for public agencies only (Beynon-Davies, 2005).
We also conclude there are a number of areas where there are differences between the cases. With Isolating, differences exist as far as the availability of information about rights and in the search devices for alternatives. With Examining, differences exist as far as the kind and availability of information and the types of devices for making comparisons. With Ranking, differences exist in the outlay of available alternatives, and in the support for choice. These dif- ferences may be of use for designers interested in understanding how calculated choice may be supported.
Another conclusion is, despite the details about available sup- port in the 14 cases, enabling calculated choice, the support is somewhat lacking, especially when it comes to devices that offer ranking and choosing. The main exception is Case No. 13 where the choice of pension funds is supported. Pension fund reform introduc- ing choice, which began in 2000, involved a leading national public pension authority as well as a number of banks and investment firms. Thus, organizations quite accustomed to making choices were involved with the reform from its beginning. Interestingly, instead of a “battle of judgements”, such as we find in education where there are many instances of available support, in public pen-
sion a number of companies offer pension fund investment advice “for a small fee”.
Ranking is an activity that very obviously shows the author- ity of materiality. In ranking, technology is a powerful actor that influences choice (Pollock & Dı́Adderio, 2012). Although ranking, in perhaps its most important use as a producer of a sorted list (Case No. 9), is not common in our 14 cases, many devices, in inter- action with their users, enable calculation through a clear use of technologyı́s discretionary power. The simplest example is tech- nology’s capacity to enable a selection of a few instances for further comparisons in columns based on various types of data. While this capacity appears in many of our cases, there are examples more directly related to ranking (Section 5.7). The design in each case influences the joint activities of technology and people. The opera- tor or owner of the technology is yet another “actor” who appears between the consumer and a market (Pollock & Dı́Adderio, 2012) that consists of many service providers. This is important because various public agencies operate the support systems in many of our cases. These agencies have, generally speaking, higher status than commercial actors, or are themselves commercial actors with access to public data.
A final conclusion of our study is that that the sociomaterial constellation in the 14 cases very clearly shows variations in the division of labor between people and technology. When we look at Isolating alternatives, people have a larger role because technol- ogy only reveals a general aspect such as the right of choice and a number of instances of the requested services (Section 5.5). When we look at Examining alternatives, sometimes people have to do most of the work compared to situations in which technological devices, to some degree, exist to support examinations and com- parisons. However, people must make a significant part of these examinations and comparisons because each alternative has many different kinds of information even when it is structured in columns (Section 5.6). In contrast, in the various ranking displays (Section 5.7), materiality plays a larger role.
5.9. Contributions
Our study’s contribution to previous research on decision sup- port for choice in quasi-markets (see Section 2) is its theoretically informed discussion of how more sophisticated Web-based sup- port designs for choice are developing in several public service areas. Sweden is a good context for such as study because of its long tradition of school choice and its experience with choice reform in many public service areas. In contrast to some previous studies, our intention is not to show how these designs influence choice in practice (cf. Gomez et al., 2012; Koning & van der Wiel, 2013) or to discuss how citizens can use these online channels (Van de Wijngaert, Pieterson, & Teerling, 2011). Our technological focus contributes to research into sociomateriality in a general sense, and to research on the material construction of markets in a particular sense (Callon & Muniesa, 2005; MacKenzie, 2009).
In addition, unlike many other studies that apply theories about sociomateriality (Cecez-Kecmanovik et al., 2014), our conclusions derive from empirical data (Jones, 2014). Our study is also of practi- cal relevance for the politicians, project leaders, and designers who today are responsible for the improvement of public services as a whole (Panagiotopoulos, Al-Debei, Fitzgerald, & Ellliman, 2012). We provide a view of potential technological outlay of 14 instances of decision support and make a comparative, structured analysis of their functions (Section 5 and 5.5–5.8). This is of special value, we argue, because previous research deals with public service areas individually.
Therefore, three design principles can be extracted from our cases.
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a The provision of information about the right of choice is impor- tant. In fact, this right appears in many public service areas where public and private entities, such as those in our study, provide decision support. The exception is Svensk Näringsliv. Interest- ingly, as Gingrich (2014) concludes, providing information also has significant influence on people’s values and participation in elections.
b The awareness of the full repertoire of potential types of infor- mation is important. Our study of cases in several areas indicates that an extensive amount of information can be provided about available options and opportunities via Web-based decision sup- port. This information may be presented, for example, in numeric, textual, or graphic form [“format”]. This repertoire may use neu- tral information (vs. marketing information), information about present circumstances (vs. future opportunities), and user evalu- ations from official investigations (vs. more personal evaluations of opportunities [“aim”]). In this manner, information designers’ choice of information can be based on a more complete and com- plex understanding than that described in previous studies (Allen & Burgess, 2011; Leckie & Goldstein, 2011; Ranganathan et al., 2009).
c The awareness of the full repertoire of available ways of sorting and ranking is important. Because of risk of information over- load in choice situations, providing comparison devices for use in selecting alternatives is necessary. However, making compar- isons of long columns of data on relatively few alternatives may still be unsatisfactory. In contrast to studies of single cases in single areas (Pollock & Dı́Adderio, 2012; Pollock and Dı́Adderio, 2012), our study discusses a number of ways to reduce this com- plexity. For example, user preferences on service options and opportunities for certain aspects or types of information can be highlighted before users examine a few selected alternatives. Or, sorted lists can be prepared for users based on these preferences. Our study also shows that ranking can be achieved by presenting graphic information and examples as well as by sorted lists.
Last, but not least, our results are theoretically relevant to the technological construction of the relationship between the state and its citizens (Gauld et al., 2010; Lips, 2007), for example, in the context of NPM reforms. Our results contribute with a new per- spective on these reforms in their focus on the role of citizens as consumers or customers (Mosse & Whitley, 2009). Thus, our results depict the design of quasi-markets and their technologies that, in part, aim to support citizens in their more traditional democratic role as well as in other roles such as consumers.
5.10. Limitations and further studies
A limitation in our research methodology, as noted above, is that we have not studied the actual use of decision support designs (MacKenzie, 2009). However, as Gad and Jensen (2010) argue, research goals allow differences in applying theoretical and methodological concepts in the study of sociomateriality. We have tried to present a theory-based, comprehensive view of several areas of public services by describing the content of information provided and the design or general outlay of the functionality as a representation of the sociomateriality of (quasi-) markets in Web- based decision support.
A study, such as ours, which applies Callon and Muniesa’s (2005) framework, is not neutral. Therefore, it may create critical discus- sion of the world that we would like to design (Roscoe & Chillas, 2013). One very relevant issue in this context is the strengthening of the citizen’s role as a consumer or customer (Clarke, Newman, Smith, Vidler, & Westmarland, 2007; Mosse & Whitley, 2009). The technological decision support for choice very obviously has this dimension and aim. Other technologies dedicated to citizens’
collective discussion and action might well complement the tech- nologies we describe. On the other hand, all but a few of the 14 cases we studied had information about the rights of citizens as a part of the Isolating alternatives.
We suggest that researchers more closely examine the perfor- mative implications when technologies and people are involved (Cecez-Kecmanovik et al., 2014). The most urgent question con- cerns how the value of the services and their ranking are constructed in actual use.
6. Conclusion
In this paper we examined how Web-based decision support and citizens jointly contribute to calculated public service choices in quasi-markets, using Sweden as our setting. The area of edu- cation has the greatest amount of support, perhaps reflecting the “battle of judgements” Karpik (2010) refers to. However, decision support also appears in many other public service areas. Regarding Isolating alternatives, the majority of our 14 cases include informa- tion about the right of choice as well simple devices for searching among and listing alternatives. Regarding Examining alternatives, the majority of our 14 cases permit direct comparisons based on various kinds of information although a few support more indi- rect comparisons. Regarding Ranking and choosing alternatives, all 14 cases explain how to make a choice although relatively few have ranking devices. Nevertheless, our cases provide a reasonable summary of the available sociomaterial designs of ranking devices. Ranking is an activity that very obviously shows the authority of materiality and how it mutually influences, or controls, citizens when they make choices.
Therefore, the studied Web-based support for choice in quasi- markets is not consistent with the theoretical model of calculated choice in all its aspects. Nevertheless, there is a clear trend in this direction. On the other hand, our cases do, in interaction with their users, enable calculation through a clear use of discretionary power.
Our results call for a critical discussion of “the world we like to design”. An important issue in this discussion issue is the increas- ingly evident role of citizens as consumers or customers in their relationship with public services.
Acknowledgement
The Swedish Research Council is greatly acknowledged for fund- ing our research.
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- How are citizens' public service choices supported in quasi-markets?
- 1 Introduction
- 2 Previous research on decision support for citizens' choice
- 3 Theory
- 4 Material and methods
- 4.1 Research setting
- 4.2 Data collection and analysis
- 5 Results
- 5.1 Education
- 5.2 Healthcare
- 5.3 Elder care
- 5.4 The public pension system
- 5.5 Isolating alternatives
- 5.6 Examining alternatives
- 5.7 Ranking and choosing alternatives
- 5.8 Comparing the 14 cases
- 5.9 Contributions
- 5.10 Limitations and further studies
- 6 Conclusion
- Acknowledgement
- References
Socializing-in-emergencies-A-review-of-the-use_2015_International-Journal-of.pdf
International Journal of Information Management 35 (2015) 609–619
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International Journal of Information Management
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Review
Socializing in emergencies—A review of the use of social media in emergency situations
Tomer Simon a,b,∗, Avishay Goldberg b,c, Bruria Adini a,b
a Emergency Medicine Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel b PREPARED Center for Emergency Response Research, Ben Gurion University of the Negev, Beer Sheba, Israel c Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
a r t i c l e i n f o
Article history: Received 26 June 2015 Accepted 9 July 2015 Available online 31 July 2015
a b s t r a c t
Social media tools are integrated in most parts of our daily lives, as citizens, netizens, researchers or emergency responders. Lessons learnt from disasters and emergencies that occurred globally in the last few years have shown that social media tools may serve as an integral and significant component of crisis response. Communication is one of the fundamental tools of emergency management. It becomes crucial when there are dozens of agencies and organizations responding to a disaster. Regardless of the type of emergency, whether a terrorist attack, a hurricane or an earthquake, communication lines may be overloaded and cellular networks overwhelmed as too many people attempt to use them to access information. Social scientists have presented that post-disaster active public participation was largely altruistic, including activities such as search and rescue, first aid treatment, victim evacuation, and on- line help. Social media provides opportunities for engaging citizens in the emergency management by both disseminating information to the public and accessing information from them. During emergency events, individuals are exposed to large quantities of information without being aware of their validity or risk of misinformation, but users are usually swift to correct them, thus making the social media “self-regulating”.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.1. Disaster characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.2. Social order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.3. Disaster management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.4. Communication challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.5. Loss of communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 1.6. Public participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 1.7. The need for information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
2. Social media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 2.1. Short introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 2.2. Social media for emergency management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.3. Social media and preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.4. Technology adoption and usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.5. Remote islands of innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 2.6. Recruiting the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
∗ Corresponding author at: Emergency Medicine Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheba, 84105, Israel. Fax: +972 8 6472136.
E-mail address: [email protected] (T. Simon).
http://dx.doi.org/10.1016/j.ijinfomgt.2015.07.001 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
610 T. Simon et al. / International Journal of Information Management 35 (2015) 609–619
2.7. Crowdsourcing in disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 2.8. Information categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.9. Location based information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.10. Information dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.11. Disinformation and inaccuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615 2.12. Emergency responders and social media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615 2.12.1. Budget and training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 2.13. Challenges to data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 2.14. Global social sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616
3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
1. Introduction
Social media (SM) tools, especially Facebook and Twitter, are taking an ever growing part in disaster response (Cohen, 2013; Sarcevic et al., 2012). SM during disasters and emergencies was initially utilized by the general public to communicate, and is now being adopted by emergency responders, governments and non-governmental organizations as an integral tool for disaster management (DM).
This paper reviews how SM tools are used in disasters by the public, emergency organizations and academic institutions. This paper reviews the literature concerning utilization of social media in emergencies between 2007 and 2014. Some of the reviewed arti- cles reference earlier materials and these are noted in the review concerning specific topics.
1.1. Disaster characteristics
In the last few decades, numerous regions worldwide have been stricken by severe natural disasters, such as earthquakes, floods and hurricanes, causing extensive damages to human lives and infras- tructures.
Disasters have been defined as a state in which the social fab- ric is disrupted and becomes dysfunctional to a greater or lesser extent causing “maximum community disruption and dislocation” (Britton, 1988; Fritz, 1961).
Natural disasters have spatial characteristics such as extent and boundaries. This configuration is disrupted during the onset of a sudden disaster which adversely affects the natural and human resources, as well as the social relationships in the region (Jigyasu, 2005; Palen & Liu, 2007). At present there seems to be a consensus among researchers that a disaster cannot be explained by a number of recognizable factors, and efforts are being made to understand why and when people perceive a certain period or common expe- rience as a disaster (Boin, 2005).
In response to disasters, numerous agencies and organizations often work together and direct their efforts towards a common goal (Reddy et al., 2009; Kopena et al., 2008). Frequently, the public- private interface is strengthened to support crisis management, and governments may simplify processes to access resources and goods without due process (Quarantelli, 2006).
1.2. Social order
According to Alexander (2005) an average day in the world “would see two to three disasters in their emergency phases, 15–20 in their recovery periods, and about a dozen conflict-based emergencies in progress”. These include events such as wars, earth- quakes, and extreme weather conditions. Coupled with the loss of communications, it becomes a period of uncertainty that may cause collective stress resulting from deprivation of a large portion of the society from expected routine conditions. These conditions,
deprived from many, are socially defined as normal human needs (Barton, 2005). However, the general public often takes an active role in disasters and their involvement is becoming more and more visible, through the use of Information and Communication Tech- nologies (ICT) (Palen & Liu, 2007).
1.3. Disaster management
An organized response to disaster management (DM) is cru- cial to mitigating loss of lives and damage to infrastructure. Dynes (1970) described both theoretical and practical aspects of an orga- nized response, including staffing, strategy, tasks, and relationships between various responding organizations and the social environ- ment itself.
Information sharing and coordination are a critical factor in DM, especially among responding organizations (Yates & Paquette, 2011; Bharosa, Lee, & Janssen, 2010). In his research, Bharosa et al. (2010) found that responders prefer to receive information and are reluctant to share it with others. Also, even when for- mal information flows through the command structure, ad hoc and personal-basis channels are created to support multi-level infor- mation sharing (Bharosa et al., 2010). The US National Incident Management System (NIMS) is based on a hierarchical command structure to “divide responsibility of labor and support inter- jurisdictional coordination” (Palen & Liu, 2007). According to this model, there is a single official, the Incident Commander (IC), to whom all responding organizations report, and he has the author- ity and overall responsibility to maintain a unified command during the entire event.
An integral part of DM is situational awareness (SA), described by Vieweg, Hughes, Starbird, and Palen (2010) as features contributing to the understanding of the emergency situation, especially in respect to the operational needs of command and con- trol. SA reports can originate from local residents, reporters, first responders or from authorized information sources (Qu, Huang, & Zhang, 2010).
1.4. Communication challenges
Communication is one of the fundamental tools of emergency management. It becomes crucial when there are dozens of agencies and organizations responding to a disaster. DM requires that these organizations’ rapid response, along with their own set of roles and responsibilities, be coordinated within and between sectors (Reddy et al., 2009).
Each organization operates its own radio frequencies, making it difficult to create a unified and synchronized response. The pri- mary challenge is technological, ranging from rapid deployment of a communications system for first responders, to interoperability between various organizations. Communication systems must be able to withstand a disaster and enable devices to function effec- tively even when communication networks have collapsed (Manoj
T. Simon et al. / International Journal of Information Management 35 (2015) 609–619 611
& Baker, 2007). These findings were further reinforced by Reddy et al. (2009) who found that current technologies are ineffective and inadequate to support the flow of information within and between coordinating teams during a disaster.
1.5. Loss of communication
Most disasters cause severe damage to communication infra- structure (Low et al., 2010). Phone switches and cell phone towers might collapse, fully or partially, thus disrupting the much needed communication (Palen & Liu, 2007). Regardless of the type of emer- gency, whether a terrorist attack, a hurricane or an earthquake, communication lines may be overloaded and cellular networks overwhelmed as too many people attempt to use them to access information. Severe natural disasters may cause the entire com- munications grid to blackout, as infrastructure is severely damaged (Stiegler, Tilley, & Parveen, 2011). In some cases the disaster may strike a geographic region that lacks communication infrastructure; but even in places where partial communication infrastructure remains intact, deployment of new systems may be found to be complex (Manoj & Baker, 2007). As the conventional means of com- munication become irrelevant during and immediately following a disaster, alternate means such as social networks become an impor- tant conduit for information gathering and sharing (Hughes, Palen, Sutton, Liu, & Vieweg, 2008; Bird, Ling, & Haynes, 2012; Huang, Chan, & Hyder, 2010).
1.6. Public participation
People have experienced disasters since the dawn of humanity, and as such their high involvement in the response phase is not new. The public’s part in disasters has been studied by many soci- ologists since the 1950s, including emergent behavior as a means to substitute and form important societal functions after a disas- ter strikes. Individuals and groups agree that action must be taken in response to an event (Drabek & McEntire, 2002). This usually materializes as volunteerism, both emergent and organized, with different manifestations depending on the type of disaster, stage of the response, region and society. Some volunteer from per- sonal reasons and some for altruistic causes (Wolensky, 1979). Studies have presented that while victims of physical disasters such as earthquakes engage in active self-help, victims from other situations of mass deprivation (i.e. starvation, economic crash or oppression) seem to generate fatalism, lack of active self-help, self- blame, or an irrational search for a guilty party (Barton, 2005).
Most social scientists have presented that post-disaster active public participation was largely altruistic, including activities such as search and rescue, first aid treatment, victim evacuation, and on-line help (Kendra & Wachtendorf, 2003; Palen & Liu, 2007). The general public serves as the true “First responders”, with a visible, active, and extensive high involvement. Today, through the use of new ICTs, their role offers additional ways to participate and com- municate (Palen & Liu, 2007; Lu & Yang, 2010). Researchers have compared the physical convergence of people to a geographical site after a disaster to the convergence to online SM tools, and found similarities in the population’s behavior. At present, there are no limitations to the locations or number of people that can participate in the on-line convergence (Hughes et al., 2008).
1.7. The need for information
People are natural information seekers, relying primarily on their own social networks (Palen & Liu, 2007). Following a disaster, the public initially seeks the most common and familiar chan- nels; phone calls, emails, or text messages. If unsuccessful, they turn to alternative and/or official sources of information (Stiegler
et al., 2011). Mileti & Darlington, 1997 presented that individuals in emergency situations use whatever means available to find infor- mation. People seek information for themselves, to learn about the emergency event, locate their family and friends, and reduce uncertainty regarding what has happened; they will seek any avail- able venue of information including newspapers, television, and the Internet (Boyle et al., 2004; Stiegler et al., 2011; Hughes et al., 2008). Skinner (2013) describes how she as a researcher collects and aggregates information from different sources during emer- gencies, and publishes it in order to inform those who are affected by the event. In events that endanger the public’s health there is high importance to the ability to act, especially when expected to take ameliorative actions, or actions to identify the risk (Maxwell, 2003). Messages should be disseminated quickly and be simple enough so that people with high anxiety would be able to com- prehend and comply appropriately (Wray et al., 2008).
With the advancement of internet technologies and tools, users in crises surfed online to seek information specific to their neigh- borhoods and activate weak ties in their social networks (Abbasi, Hossain, Hamra, & Owen, 2010). These novel capabilities have cre- ated a new form of “civilian journalism” that enables participation during emergency events (Laituri & Kodrich, 2008). The internet is becoming a more reliable tool as traditional media channels suffer disruptions and damage caused by the crisis (Procopio & Procopio, 2007).
People have identified forums as a communication and infor- mation sharing platform through which they can seek, share, and synthesize information (Qu, 2009). The next step in the evolution was the massive use of social network sites, such as Facebook and Twitter.
2. Social media
2.1. Short introduction
Social media (SM) consists of tools that enable open and online exchange of information through conversation, interaction and exchange of user generated content (Huang et al., 2010; Abbasi et al., 2010; Kavanaugh et al., 2011). Unlike traditional ICTs, SM manages the content of the conversation or interaction as an infor- mation artifact in the online environment (post or tweet) (Yates & Paquette, 2011).
SM allows people to establish connections and links with other individuals who are similar to them, or whom they find interesting. Users can post news or links, discuss them, and share their opinions during real times. The SM can be utilized to mobilize and organize populations in order to achieve various objectives, and update them with the most up-to-date information, which might not be available through alternate official channels (Lerman & Ghosh, 2010).
During natural disasters SM provides access to relevant and timely information from both official and non-official sources, and facilitates a feeling of connectedness (Taylor, Wells, Howell, & Raphael, 2012). This connectivity to loved ones and the commu- nity provides reassurance, support and assistance to potentially distressed individuals and populations (Taylor et al., 2012).
Facebook is the largest SM network, with 1.35 billion monthly active users (Facebook Newsroom, 2014). The users of Facebook have the ability to connect and share thoughts and information with friends, join common interest groups and state their prefer- ences (signify ‘like’). People mark ‘like’ in posts, pages and groups they want to follow and publish their agreement, or support, of the content published (Bird et al., 2012).
Twitter is a service through which users can post short messages of up to 140 characters, called tweets, from web- and mobile- based clients. Twitter has 284 million monthly active users (Twitter,
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2014). Users establish a network by “following” other Twitterers, and having others “follow” them (Vieweg et al., 2010). Users often mark their posts with topic labels, named “hashtags”, which are used as operational proxies to identify messages (Weng, Flammini, Vespignani, & Menczer, 2012), and help others understand the con- text of the message (Starbird & Palen, 2010). Information can be redistributed by users in the form of re-tweets, which are a conven- tion in Twitter to pass on already published information. Usually re-tweets are a response to tweets that users find more interesting or important (Vieweg et al., 2010).
Twitter provides an Application Programming Interface (API) that can be used to perform searches according to keywords and hashtags (Abbasi et al., 2010), but it is limited to accessing only a restricted number of entities (Lerman & Ghosh, 2010) These key- words have to be extracted from the public’s Twitter stream, as conducted by Vieweg et al. (2010) in their research. The results can be traced back to the Twitterer and from there, the entire stream of tweets, replies and re-tweets can be accessed. There are many available tools on the internet that enable visualization of data from Twitter. Social networks’ information exchange supports the per- sistence requirement stated by Palen & Liu, 2007 regarding forms of communications that emerge during or after an onset of a disaster. Persistency refers to communications that are visible, recordable, and/or transferable to other people over time.
Another advantage of the SM compared to the traditional media is the simplicity of collecting and disseminating information. Utilization of traditional media websites and channels necessi- tates an active search for information, while the SM accesses the information newsfeeds at live and real times (Bird et al., 2012). Coupled with an internet connection that has become available to all, individuals are connected almost regularly and continuously (Jansen, Zhang, Sobel, & Chowdury, 2009), which enables them to share, coordinate and distribute information regarding events in real time (Gupta, Lamba, Kumaraguru, & Joshi, 2013). SM provides unprecedented access to information that is published online by various users (Hale, Gaffney, & Graham, 2012). During emergencies, the amount of available informa- tion in SM exceeds the capacity of the public to consume it, and thus a competition over the attention of the individual and the public is created (Weng, Flammini, Vespignani, & Menczer, 2012).
2.2. Social media for emergency management
The utilization of SM for communicating during emergencies was initiated by the public before its utilization by emergency authorities. It is possible that the way emergencies are managed and the uni-directional communication coerced the public to find alternate ways to search and publish relevant and updated infor- mation concerning the event (Sutton, Palen, & Shklovski, 2008). According to Latonero & Shklovski, 2010, two main branches of research deal with the uses of social media during an emergency; the first focuses on ways in which emergency organizations use it to coordinate activities during their response actions, and the sec- ond deals with the ways the public and victims share information during emergencies. This review article is based on 57 research articles that delineate various aspects of the use of SM during emergencies. Table 1 classifies these articles according to the emer- gency/disaster type they address (natural disaster, terror attack, communicable disease, public order and non-specific events), the research methodology utilized (quantitative or qualitative), the SM they cover (Twitter, Facebook, Flickr, or other), the research type (active, passive, simulated, or exercise), and the year of the event. The research type relates to the method the data was collected by, where passive indicates using any computational way to collect SM data (i.e. Twitter API). Active means that the researchers made an
Table 1 Classification of articles according to topics analyzed in each manuscript.
# Of articles Percentage Comments
Type of disaster covered Natural disaster 26 46% Terror attack 3 5% Communicable disease 3 5% Public order 2 4% Non-specific 23 40%
Research methodology Quantitative 31 54% Qualitative 26 46%
Social media analyzed Some articles cover several types of SM
Twitter 35 61% Facebook 11 19% Flickr 2 3% Other 17 30%
Research type Active 34 60% Passive 19 33% Simulated 2 3.5% Exercise 2 3.5%
Years of occurrence 2007–2008 5 9% 2009–2010 19 33% 2011–2012 9 15% 2013–2014 3 5%
‘active’ effort to collect the data/information (i.e. interviews); sim- ulated generally refers to computer models who do not deploy real information to run; exercise refers to research that used an exercise to test a theory and collect the information.
Fig. 1 presents the total number of tweets in four major emer- gency events that occurred between 2010 and 2013, and a trend line showing the rise in SM adoption during such events. Following the Haiti earthquake, 3.28 million tweets were posted (Sarcevic et al., 2012); 20 million tweets were posted during hurricane “Sandy” in 2012 (Olanoff, 2012); 27.8 million tweets were posted following the Boston Marathon bombing in 2013 (Rovell, 2013); and, 5.72 mil- lion tweets were posted during typhoon “Haiyan” in 2013 (Levine, 2013).
2.3. Social media and preparedness
SM provides opportunities for engaging citizens in the emer- gency management by both disseminating information to the public and accessing information from them. These tools have been used to improve preparedness by linking the public with day-to-day, real-time information, as was well presented during the 2009H1N1 pandemic. A few minutes after the Alexandria, Virginia health department tweeted regarding availability and loca- tion of vaccines, people rushed to the vaccination sites (Merchant, Elmer, & Lurie, 2011). This has presented that integration of social tools into preparedness activities could facilitate an effec- tive emergency response for professional responders as well as the citizens, using familiar tools during a crisis (Merchant et al., 2011). Despite the low cost, wide reach and proven advantages before, during and following crises, SM tools have been shown to be underused by health professionals (Vance, Howe, & Dellavalle, 2009).
2.4. Technology adoption and usage
Most individuals tend to use technologies that they are famil- iar with (such as mobile phones, email and known news websites)
T. Simon et al. / International Journal of Information Management 35 (2015) 609–619 613
Fig. 1. Total number of tweets posted during emergencies between 2010 and 2013.
prior to an emergency to access information, but some adopt new ICTs during an event. The goal is not the utilization of the technol- ogy itself but rather how communities fulfill unmet needs through adaptation and innovative uses of ICT (Shklovski, Palen, & Sutton, 2008). ICT offers a means for those living under extreme circum- stances to reconnect with other residents, solicit and aggregate information that affects them all. It has been implied that people have “found community” (though a virtual one) through the use of ICT, in which they actively seek others with similar needs and con- cerns regarding their geographical communities (Shklovski et al., 2008).
There are significant differences in the adoption of Facebook and Twitter in terms of usage, news consumption, demographics and the country. A Princeton led survey found that 70% of Face- book users receive their news from friends and family and 13% from news organizations. On Twitter, 36% of the users receive news from friends and family, while 27% from news organizations. The survey also found that despite the rise of news consumption through SM, it does not come at the expense of direct access to news sites. 71% of Facebook users and 76% of Twitter users still get news directly from news sites or apps (Mitchell, Rosenstiel, & Christian, 2012).
2.5. Remote islands of innovation
Media coverage of an affected area is not equal in all disasters; while central locations are widely covered; remote sites with inad- equate access tend to receive little or no coverage at all (Fernando, 2010). The need for local and reliable information can moti- vate residents with technical skills to create simple solutions for their community, facilitate exchange of information and promote humanitarian relief efforts in their area. These actions can accel- erate empowerment of the community, provide support during and between variable emergency events, serve as a communication platform during a specific emergency (Procopio & Procopio, 2007), and shut down not long after the emergency has subsided. The out- come depends on the maturity and experience of the community (Shklovski et al., 2008). If the public will not find or receive infor- mation from official sources, they will turn to unofficial sources in order to access it in real time (Hagar, 2013). Community solu- tions appeared almost immediately following the floods that were experienced in Australia during 2011. The local residents accessed community Facebook pages in order to assist their families and allow others to share photos. Though formal administrations inte- grated official information into their web pages, the most important source of information was accessed from local residents (Bird et al., 2012).
2.6. Recruiting the public
Once sources of information have been recognized, technologi- cally competent residents in the disaster area are able to utilize a range of SM to redistribute information to community members who might not have the same access. These community mecha- nisms, information hubs and repositories of local information are available resulting from the common concern and joint actions of local area residents. Twitter users have frequently filled the func- tion of information hubs following disasters (Hughes et al., 2008). The unidirectional communication and information distribution of emergency authorities might have ‘compelled’ the public to find alternative ways to search for and disseminate updated and rele- vant information regarding the event (Sutton, Palen, & Shklovski, 2008). People have reported feeling compelled to collect and dis- seminate information as a way of alleviating concerns of those around them (Shklovski et al., 2008; Bird et al., 2012). Using an online survey Bird et al., (2012) discovered that most people iden- tified relevant community pages through friends’ invitations, or a Facebook search. She also presented that two-thirds of the respon- dents accessed Facebook groups to find information regarding their own community. Taylor et al. (2012) claimed that the activity of people utilizing SM mirrors their actual needs, whether searching and seeking information about what was happening, or actively asking for information and providing assistance to others.
2.7. Crowdsourcing in disasters
The term “crowdsourcing” was first coined in 2006 refer- ring to organizations outsourcing tasks to the connected crowd, irrelevant of their location or identity (Howe, 2006). It is also defined as an “online, distributed problem-solving and production model” (Brabham, 2008), allowing “capable crowds to participate in various tasks, from simply ‘validating’ a piece of information or pho- tograph to complicated editing and management” (Gao, Barbier, & Goolsby, 2011).
Following the 2011 Haiti earthquake, an unprecedented activity was observed in which many communities world-wide under- stood that they did not need to be in Haiti physically, in order to provide assistance. Through common workgroups established in 2009, as CrisisCamps and CrisisCommons, civilians, NGOs, gov- ernments and private companies combined their efforts to collect massive amounts of data to create maps. These maps were dissem- inated directly to the Haitian government, emergency responders and the US Army that were on site (Zook, Graham, Shelton, & Gorman, 2010). Crowdsourcing was incorporated to the DM field
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following the 2010 Haiti earthquake when Ushahidi’s crowd-map1
became a shared social disaster response tool for responders lever- aging information from the “crowd” (Starbird, 2011; Abbasi et al., 2010). Crowdsourcing platforms enable the creation of different types of maps rapidly, thus facilitating the shift of existing limited resources to other tasks (Zook et al., 2010), as well as collection and analysis of information concerning damages in the area of the event (Yang et al., 2014). These platforms include two types of users – those located at the scene of the event (on-site) that perform rescue and management operations and need updated information, and remote users (off-site) that are able to perform different tasks in order to assist the on-site users, such as the infor- mation analysis and provision of updated information. This form of work may provide real-time or per-request information to the field emergency management personnel (Yang et al., 2014), and enable the creation of a virtual teams, or virtual operation support team (VOST), which can assist the response efforts (Denis, Hughes, & Palen, 2012).
2.8. Information categories
The public can assist during emergencies in classifying and sor- ting the large amounts of information flowing through SM, enabling simplification of its analysis and processing (White, Plotnick, Kushma, Hiltz, & Turoff, 2009). Information disseminating on SM can include updates regarding the writers’ status, links to news sites, and emotional messages to those affected by the event, as well as humoristic messages (Skinner, 2013). Chew & Eysenbach, 2010 presented in their research that the public publishes 14 dif- ferent types of information through SM – news, information or updates about the event; personal experiences; personal opinion and interest; jokes; marketing and advertising; spam and irrelevant information to the event; humor and sarcasm; joy; risk reduction; concern, fear, anxiety and/or sadness of the writers towards oth- ers; despair and anger; misinformation; and questions about the event/subject. Each piece of information on SM can be assigned to one or more categories as it includes both direct information derived from the text, as well as information derived from its anal- ysis, such as the mood and attitude of the writer (Jansen et al., 2009). In contrast, another group of researchers (Imran, Elbassuoni, Castillo, Diaz, & Meier, 2013) stated that it is sufficient to divide the information during emergencies to two main categories – personal (relevant to family and friends of the writer) versus informative information (relevant to the public).
2.9. Location based information
Following a disaster, there is a significant demand and need for maps and spatial information, as presented after the Haiti earthquake in 2010. In order to implement an effective response, the emergency responders need to receive information as to the location of the afflicted population and how best to reach them promptly (Zook et al., 2010; Abbasi et al., 2010)
MacEachren et al. (2011) found that “social media is becoming increasingly geographic” and the potential use of this information in emergencies had been recognized by both academic institutions and the emergency organizations themselves (MacEachren et al., 2011; Palen & Liu, 2007).
Tweets and Facebook posts can provide two types of loca- tion based information. The first is Geo-location data which is clearly identifiable information that includes street addresses and
1 Ushaidi’s platform is based on Web 2.0 technologies which handle data inte- gration from a variety of social media sources using crowdsourcing techniques to (Denis et al., 2012) create SA reports and cooperation (Gao et al., 2011).
intersections, city and county names, highways and place-names, whether precise or more general. This type of information not only aids those who access it, but also accommodates automatic retrieval of relevant information regarding a specific emergency event (MacEachren et al., 2011). The second type is Location- referencing which refers to information that uses one place as a replacement for another, or mention of location via a landmark. These do not contain easily extractable geo-location information, but rather data concerning the location of both individuals and the emergency (Vieweg et al., 2010). In events where the two types are not available, it is possible to extract the location of the user’s residence from his personal profile, and assume that he publishes information from the same area. This assumption carries the risk of placing events in the wrong location, as the user might publish information while located in a different region/country completely (Earle, Bowden, & Guy, 2011; Hale et al., 2012). It was also found that analyzing tweets for geographic location according to language analysis is difficult, with low accuracy rates, and necessitates fur- ther research (Hale et al., 2012). The stage of emergency has an important effect on geo-location information, as during the initial warning/alert stage people do not as yet know the entities or loca- tions that will be affected; these are crucial during the impact and recovery stages as there is a need for information regarding the locations of hazards, evacuation routes, availability of resources and efforts that are invested to manage the situation and provide relief to the population (Vieweg et al., 2010). There are numerous tools and platforms available that aim at locating, capturing and display- ing geo-information based on SM (MacEachren et al., 2011). Social mapping platforms utilize crowdsourcing capabilities to map entire areas for roads, buildings and damage (Zook et al., 2010; Starbird, 2011). The resulting maps can be used to allow responding organi- zations to promote collaboration between them, share information and enhance coordination during implementation of their missions (Gao et al., 2011). Chatfield & Brajawidagda, 2012 presented that 47% of users included their location in tweets, a fact that enabled placing them on maps, while in the research of Vieweg et al. (2010) it was shown that the numbers are 40%. It seems that less and less users are adding their location to tweets, as can be seen in the research of Starbird, Muzny, & Palen (2012) where the numbers dropped to 0.23% out of all tweets. Hale et al. (2012) showed that approximately 16% of the users do not include information about their location in their personal profile. Local populations may rec- ognize and refer to places and regions under different names, and in fact replace the official name with a known alternative. To resolve this issue researchers have developed an information system that analyzes information from Twitter in order to create a database of such names (Chan, Vasardani, & Winter, 2014). This information may assist emergency responders in identifying the places that the public uses without the need to mention the exact official address.
2.10. Information dissemination
In the traditional disaster management model, information flowed from emergency organizations to the public (Low et al., 2010). After analyzing millions of tweets Shklovski et al. (2008) extracted and coded situational features on Twitter communica- tion elaborating the standard information categories of emergency management (warning, preparatory activity, fire line/hazard loca- tion, flood level, weather, visibility, road conditions, advice, evacuation information, volunteer information, animal manage- ment, and damage/injury reports). The incorporation of SM tools has changed the traditional information dissemination pathways during emergencies. Today there are many more information providers and a higher involvement of the public using official and unofficial sources (Zook et al., 2010).
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The mechanism for spreading information during different disasters is similar, namely, users watch their friends’ activities or their reported behavior, and through messaging actions, they make this information visible to their own fans or followers (Lerman & Ghosh, 2010). In a survey conducted by Bird et al. (2012), 97% of the respondents claimed to have communicated and forwarded directly the information they accessed from Facebook pages to their family and friends. In some instances, reports issued through SM tools appeared much earlier than through the news channels (Qu, Huang, Zhang, & Zhang, 2011; Lerman & Ghosh, 2010). SM tools present an excellent mechanism for information dissemination. In Twitter, re-tweeting can cause an exponential proliferation and dissemination of the information (Tamura & Fukuda, 2011).
A government organization that wants to use social tools during a crisis to communicate with the public should first define its poli- cies, receive the support of the managers, define what information should be shared and through which channels (Kavanaugh et al., 2011).
During the 2011 floods in Queensland and Victoria, Australia, Facebook became the primary tool to disseminate information to the public. In the 24 h following the flash floods, the number of ‘likes’ to the Queensland Police Service (QPS) Facebook page increased exponentially from 17,000 to 100,000, and two days later it had more than 160,000 ‘likes’. Traditional media channels, such as radio and TV, relied on the information posted on Facebook, and reported it within minutes after it was published on the QPS page (Bird et al., 2012). In a different study, Taylor et al. (2012) found that although SM are popular, people are still likely to turn to the television for emergency information. Nevertheless, the research also shows that SM serve as a conduit, directing people “to official sources of information and amplifying these messages to a broader audience” (Taylor et al., 2012).
2.11. Disinformation and inaccuracy
The identity of users and accuracy of the information they post on SM sites cannot be guaranteed (Merchant et al., 2011). During emergency events, individuals are exposed to large quantities of information without being aware of their validity or risk of misin- formation (Lu & Yang, 2010).
Zook et al. (2010) wrote that for recovery operations follow- ing a disaster, only “Good enough” geographic information can be sufficient, and that crowdsourced information is as useful as infor- mation produced by an expert. Zook et al. (2010) added that “with enough people working together, any errors by one individual can easily be corrected by another” (Zook et al., 2010).
Even though rumors and inaccurate information can be dis- seminated during the peak of a disaster, users are usually swift to correct them, thus making the SM “self-regulating”. More so, offi- cial authorities publish corrections to disinformation and rumors using their own SM sites (Bird et al., 2012). In their work, Mendoza, Poblete, & Castillo, 2010 followed the propagation ‘confirmed truths’ and ‘false rumors’ on Twitter after an earthquake in Chile. They found that approximately 95.5% of tweets validated the ‘con- firm truths’, and only 29.8% validated the ‘false rumors’; while more than 60% denied or questioned them (Mendoza et al., 2010). According to Taylor et al. (2012) research found that only a very small percentage (6%) of the population will rely solely on SM for information, resulting from their suspicion of the validity of infor- mation. It was also stated that in order to maintain integrity and trust, the administrators of the SM pages must identify and ban as early as possible ‘trolls’2 and other disturbances. It should though
2 A ‘troll’ is internet slang for those who provoke other users and disrupt discus- sion (Taylor et al., 2012).
be taken under consideration that maintaining trust and rebutting misinformation, requires a high level of active management that can be challenging to community-based SM channels (Taylor et al., 2012).
In their research, Latonero & Shklovski, 2011 presented that val- idating information accessed from the public poses a big challenge to the emergency organizations that need to decide whether or not to commit resources, based on the information supplied. Accord- ing to their findings, the emergency management professionals that review the SM must use intuition, experience and traditional means of communication rather than innovative technological solutions (Latonero & Shklovski, 2011). As the information flow increases, emergency authorities have less control over it, and might be pres- sured to validate and authenticate the information generated by the public (Zook et al., 2010)
2.12. Emergency responders and social media
Only limited scientific literature focus on emergency respon- ders and their use of social media. Nonetheless, many researchers have noted the potential use of this media by emergency respon- ders, and stated that if used, their ability to reach larger crowds faster will increase significantly (Denis et al., 2012). The London Police started using social media as an additional communication channel with the public during the riots of 2008 (Crump, 2011), and again in the riots of 2011 (Denef, Bayerl, & Kaptein, 2013). Since the 2010 earthquake in Haiti, emergency responders around the world have adopted social media as an important additional communica- tion channel with the public (Bird et al., 2012; Sarcevic et al., 2012). Hurricane “Sandy” in 2012 was a turning point where the majority of emergency authorities and first responders from the East Coast in the United States adopted social media as the main communication channel with the public (2013). In Kenya, all of the first respon- der organizations use social media as the major communication channel with the public during emergencies, as manifested in the Westgate Mall terror attack in 2013 (Simon, Goldberg, Aharonson- Daniel, Leykin, & Adini, 2014).
Rapid assessment of critical information, such as the affected area, distribution of damage, locations of the population and poten- tial areas where search and rescue missions are likely to be required, are of high priority in DM (Durham, Johari, & Bausch, 2008). Emergency authorities must verify the information they publish, so there is an eventual delay until it is delivered to the public (Bird et al., 2012), but it will be needed and requested on a near real-time basis (Zook et al., 2010).
The decision making process for official emergency response that is provided by the various organizations are part of the government’s responsibility; political considerations may make large-scale adoption of technologies complex (Latonero & Shklovski, 2011).
Emergency authorities are often structured in hierarchical, rank-based organizations which operate according to specific “silos” with particular expertise, as described by Yates & Paquette, 2011. During the Haiti earthquake in 2010, the US Government and Armed Forces relied almost completely on organizational SM tools (Microsoft SharePoint) to coordinate knowledge and actions between cooperating response agencies (Yates & Paquette, 2011). The traditional risk and crisis communication was one-way from the emergency organizations to the public through the news media (TV and radio), acting as intermediaries. Although these chan- nels remain the primary means of communication, integrating SM provides the potential for “interactive, participatory, synchronic, two-way communication” (Latonero & Shklovski, 2011; Palen & Liu, 2007).
A government organization that wants to use social tools during a crisis to communicate with the public should first define poli-
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cies, receive support of the management, define what information should be shared and through which channels (Kavanaugh et al., 2011).
It has been recommended that every organization utilizing tech- nological solutions and integrating SM for emergency response, should incorporate professionals with Information Technology (IT) expertise, as Public Information Officers (PIO) and technology ‘evangelists’ (Latonero & Shklovski, 2011), SM moderators (Bird et al., 2012; Qu et al., 2011), or a Communications and Informa- tion Technology expert to configure SM tools (Yates & Paquette, 2011). Nevertheless, emergency managers also do not want to be distracted by too much information that might be irrelevant or not-critical (Bharosa et al., 2010).
Understanding the “overall picture” during a disaster may be difficult as the ever-growing information flow is being updated constantly, while large portions of it are redundant (Qu et al., 2011). Kavanaugh et al. (2011) stated that emergency managers can “detect meaningful patterns and trends in the stream of messages and information flow”, and emergency events “can be identified as spikes in activity, while meaning can be deciphered through changes in content” (Kavanaugh et al., 2011).
2.12.1. Budget and training Using SM entails two types of costs that should be considered.
The first is the cost of training employees that will operate and pub- lish information through SM tools, although it has been shown that most government employees have a profile on at least one SM tool. This might reduce costs and shorten training programmes. The sec- ond is more covert, referring to the return-on-investment (ROI) of using SM tools (Kavanaugh et al., 2011). Latonero & Shklovski, 2011 presented in their case study that emergency organizations lever- aging SM do not train their PIOs, relying solely on their self-learning skills, and depending on “their ability to utilize social media effec- tively”. Furthermore, Denef et al. (2013) stated that as SM are novel communication channels for the emergency responders and there are almost no available guides or procedures, they are required to practice their use. There are guiding principles that emergency organizations provide to their employees regarding the need to separate their personal profile from their organizational presence (Beneito-Montagut, Anson, Shaw, & Brewster, 2013).
To effectively use SM tools in disaster situations, they should be utilized by the involved parties during routine times and incorpo- rated in daily activities. In the last three years, disaster simulation games were encouraged in order to test the ability to collect infor- mation from SM tools during different stages of a disaster. During these exercises, people posted messages through SM tools and took part in crowdsourcing tasks (Abbasi et al., 2010). Another exer- cise leveraged social media tools in response to an earthquake. The exercise was performed by actual first responders who used social media, on top of in addition to conventional communica- tion technologies, to improve their search and rescue operations (Simon, Adini, El-Hadid, & Aharonson-Daniel, 2013). In the last few years, the organizers of the Great California Shakeout Drill have used social media to enhance communications prior to and dur- ing the drill, as well as to extract feedback from participants. The use of social media enables the organizers to reduce the number of resources required (Wood & Glik, 2013).
2.13. Challenges to data analysis
On August 22nd, 2012 Facebook revealed some statistics regarding its daily information flow. Facebook ingests daily more than 500 terabytes of data, 2.5 billion pieces of content, 2.7 bil- lion ‘likes’ and 300 million photo uploads (Constine, 2012). Twitter has more than 400 million tweets daily, and above 140 million active users, most of which use Twitter via mobile devices (Farber,
2012). SM sites constantly produce vast amounts of information, both relevant and irrelevant. Using filtering and pattern recognition on the data streams, emergency managers can access important and meaningful information in real-time, and be able to provide an immediate response, and understand events as they unfold (Abbasi et al., 2010; Kavanaugh et al., 2011; Sheth, Purohit, Jadhav, Kapanipathi, & Chen, 2011). Over time, the detected patterns can provide responders with perceptions and trends of communities. Conducting surveys via phone or mail requires substantial efforts prior to and during data collection, as well as substantial funding. Analyzing the results often takes months to complete. Information flow through social tools is a much more effective and economical method to gather data in real time. In 2009 the American Red Cross conducted a survey which presented that 75% of the population reported that they will use SM during a crisis situation; approxi- mately 50% would let others know that they were safe through SM; 86% would use Facebook; and 28% would use Twitter (Kavanaugh et al., 2011).
Studying Twitter communication during emergency events is challenging as access to tweets is short-lived, requiring quick deci- sions regarding what information to collect while the event is still in progress, but before its scope and data produced are fully under- stood (Vieweg et al., 2010).
SM sites continuously create large amounts of information with different degrees of relevancy. For example, during hurri- cane “Sandy”, approximately 20 million tweets were published on Twitter, and about 10 photos related to the storm were uploaded to instagram every second. Numerous entities, both official and non-official, publish information simultaneously, including civil- ians, government or private organizations, journalists, news sites and others that create an information overload during emergen- cies, making it difficult to find, organize, understand and act upon it (Hagar, 2013; Verma et al., 2011; Kavanaugh et al., 2011).
Approximately 300 million users publish hundreds of millions of tweets daily (Hale et al., 2012). Manual analysis on such amounts of information is not possible, especially in times of stress during emergency management, and thus automated systems that enable real-time monitoring of the flow of information are required (Pohl, Bouchachia, & Hellwagner, 2012). At the same time, there is a need to prevent cognitive overload of the commanders and decision makers by flooding them with such unlimited information (Blum, Eichhorn, Smith, Sterle-Contala, & Cooperstock, 2013). The writing style of tweets, due to the length constraints and the use of natural language, complicates the automatic analysis capabilities, such as different names people assign to events and locations (Chan et al., 2014).
2.14. Global social sensors
SM that connect millions of users worldwide and enables rapid communications can be leveraged as an effective mechanism to transfer information without delay (Chatfield & Brajawidagda, 2012). Furthermore, the internet and SM tools enable health profes- sionals to transform the ways in which disease outbreaks and other disasters are tracked and responded to (Schmidt, 2012; Cookson et al., 2008). It was even shown that using Twitter, H1N1 out- breaks and activity can be identified in real-time, 1-2 weeks prior to detection based on the Centers for Disease Control and Prevention’s (CDC) surveillance system (Signorini, Segre, & Polgreen, 2011).
The US Geological Survey (USGS) has reported that 75% of earth- quake detections through tracking tweets containing the word “earthquake” were made within 2 min of the origin time. This rep- resents a much faster identification than seismographic detections in many regions in the world, and has a low rate of false triggers (Earle et al., 2011).
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The first indication of a number of emergencies throughout the world was published on Twitter, which enabled the publica- tion of information to large crowds in real time. The World’s first posts on two terrorist incidents in 2013 were published initially via Twitter: the Boston Marathon bombing (Cassa, Chunara, Mandl, & Brownstein, 2013), and the Westgate mall terror attack in Nairobi, Kenya (Simon et al., 2014).
On August 8th, 2014 the World Health Organization (WHO) declared the Ebola epidemic outbreak in West Africa as an inter- national emergency (WHO, 2014). From reading traditional media websites, it is clear that social media takes an active and impor- tant role, whether in the dissemination of news and information by government agencies (Murphy, 2014), and in the spread of rumors and misinformation that might even put the lives of their read- ers at risk (Blair, 2014). Crowdsourcing platforms are also active in tracking the Ebola outbreak on social media, and assist in locat- ing suspected Ebola cases (Morgan, 2014). The research papers that have been published to date, focus mainly on the risks of rumors and misinformation spreading on Twitter (Oyeyemi, Gabarron, & Wynn, 2014).
3. Conclusions
SM tools are integrated in most parts of our daily lives, as citizens, netizens, researchers or emergency responders. Lessons learnt from disasters and emergencies that occurred globally in the last few years have shown that SM tools may serve as an integral and significant component of crisis response.
Emergency managers who were formerly used to one- directional dissemination of information to the population are now exposed to vast amounts of information, originating from the pub- lic. This crowd-information precedes any other formal available information and exposes emergency managers to a large influx of information.
The innovative usages of SM tools during disasters were initiated by resourceful individuals and then incorporated by the public for their own objectives. During and mostly after a disaster, new ways of utilizing SM tools to collect, share, and disseminate information, were witnessed. Emergency authorities, NGOs and governments were “coerced” by the public’s demands and needs to use the SM. Researchers from different academic professions, such as sociol- ogy, psychology, computer sciences, health sciences, emergency management and communication strive to develop new tools to analyze trends in the extensive data flows and transform them into knowledge.
Four main types of SM users during disasters have been iden- tified including: (1) Innovative – users who improve and adjust SM for their special circumstances; (2) Reactive – users who try to respond and assist the afflicted population using SM tools for the first time; (3) Responsive – emergency responders that use SM tools regularly, but step-up and leverage them during disasters; (4) Proactive – users or emergency organizations that use SM tools to promote preparedness in routine and are able to leverage them during emergencies.
Twitter is currently the most widely researched SM tool, proba- bly due to the ease of extracting information, while Facebook does not provide an effective option to search or collect information from its pages. These differences might cause a “selection bias” in the research, thus not representing the population’s true SM behavior during emergencies.
Further studies of the potential utilization of the social media by first responders and governmental agencies prior to and during disasters, are highly recommended.
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- Socializing in emergencies-A review of the use of social media in emergency situations
- 1 Introduction
- 1.1 Disaster characteristics
- 1.2 Social order
- 1.3 Disaster management
- 1.4 Communication challenges
- 1.5 Loss of communication
- 1.6 Public participation
- 1.7 The need for information
- 2 Social media
- 2.1 Short introduction
- 2.2 Social media for emergency management
- 2.3 Social media and preparedness
- 2.4 Technology adoption and usage
- 2.5 Remote islands of innovation
- 2.6 Recruiting the public
- 2.7 Crowdsourcing in disasters
- 2.8 Information categories
- 2.9 Location based information
- 2.10 Information dissemination
- 2.11 Disinformation and inaccuracy
- 2.12 Emergency responders and social media
- 2.12.1 Budget and training
- 2.13 Challenges to data analysis
- 2.14 Global social sensors
- 3 Conclusions
- References
A-learning-organization-in-the-service-of-know_2015_International-Journal-of.pdf
International Journal of Information Management 35 (2015) 636–642
Contents lists available at ScienceDirect
International Journal of Information Management
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j i n f o m g t
Case study
A learning organization in the service of knowledge management among nurses: A case study
Marie-Pierre Gagnon a,b,∗, Julie Payne-Gagnon b, Jean-Paul Fortin c, Guy Paré d, José Côté e,f, François Courcy g
a Faculty of Nursing Science, Université Laval, 1050 avenue de la Médecine, Quebec City, Canada b CHU de Québec Research Center, 10 rue de l’Espinay, Quebec City G1L 3L5, Canada c CSSS de la Vieille-Capitale, 880 Père-Marquette, Quebec City G1S 2A4, Canada d Department of Information Technology Management, HEC Montréal, 3000 chemin de la Côte-Sainte-Catherine, Montreal H3T 2A7, Canada e Faculty of Nursing Science, Université de Montréal, 2375 chemin de la Côte-Ste-Catherine, Montreal H3T 1A8, Canada f CHUM Research Center, 850 rue St-Denis, Montreal H2X 0A9, Canada g Department of Psychology, Université de Sherbrooke, 2500 boulevard de l’Université, Sherbrooke J1K 2R1, Canada
a r t i c l e i n f o
Article history: Received 29 April 2015 Accepted 9 May 2015 Available online 23 May 2015
Keywords: Learning organization Knowledge management Nursing Continuous learning
a b s t r a c t
It becomes critical for health care organizations to develop strategies that aim to design new work prac- tices and to manage knowledge. The introduction of learning organizations is seen as a promising choice for better knowledge management and continuing professional development in health care. This study analyzes the effects of a learning organization on nurses’ continuing professional development, knowl- edge management, and retention in a health and social services centre in Quebec, Canada. The learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital centre. These changes were particularly pro- nounced with respect to knowledge transfer, support for nursing practices, and quality of health care, objectives that the learning organization had sought to meet since its inception. However, it seemed to have a limited effect on nurse retention.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Today’s society emerged as a result of a transformation from an industrial era to a knowledge era, leaving room for the creation, collection, and use of knowledge (Johannessen & Olsen, 2010). As highly knowledge intensive institutions requiring continuous edu- cation in order to improve their potential (Tsai, 2014), health care institutions have seen their knowledge capital increase in impor- tance with the transformation of society (Estrada, 2009; Tsai, 2014). Health care professionals are also in need of knowledge since their practice requires lifelong learning in order to improve their com- petencies and provide effective and quality care for their patients (Tsai, 2014).
∗ Corresponding author at: Faculty of Nursing Science, Université Laval, 1050 avenue de la Médecine, Quebec City, Canada. Tel.: +1 4185254444×53169; fax: +1 4185254194.
E-mail addresses: [email protected] (M.-P. Gagnon), [email protected] (J. Payne-Gagnon), [email protected] (J.-P. Fortin), [email protected] (G. Paré), [email protected] (J. Côté), [email protected] (F. Courcy).
On the other hand, health care institutions are also facing impor- tant challenges in the area of knowledge management. Managing knowledge in health care organizations is complex since they are multi-level and multi-site networks with central management, but also strong local organizations (French et al., 2009). Also, the sheer amount and fragmentation of information, rapid expansion of knowledge, and context dependency make it impossible for a per- son to access all the available knowledge in this domain (Estrada, 2009; French et al., 2009). Additionally, the health care sector is experiencing a widespread nursing shortage in many developed and developing countries around the globe (Buchan & Aiken, 2008; Littlejohn, Campbell, & Collins-McNeil, 2012), and faces an ageing population (World Health Organization, 2010). An important loss of knowledge capital is attributed to the retirement of experienced and knowledgeable nurses across the institutions (Clauson, Wejr, Frost, McRae, & Straight, 2011). This situation is alarming due to the possible consequences that they may have on health care pro- fessionals practice as well as access, security, and quality of health care (Clauson et al., 2011; Estrada, 2009).
In this context, it is critical for health care organizations to look for innovative solutions, as well as to develop strategies that aim to design new work practices and to manage knowledge. Among the
http://dx.doi.org/10.1016/j.ijinfomgt.2015.05.001 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
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possible solutions, learning organizations are seen as an interesting and promising choice for better knowledge management (Davies, Wong, & Laschinger, 2011; Zheng, Yang, & McLean, 2010).
1.1. Learning organization
The term ‘learning organization’ was popularized in Peter Senge’s “The Fifth Discipline: The Art and Practice of the Learn- ing Organization” (Senge, 1990). A learning organization is defined as an organization that exhibits adaptability, learns from mistakes, explores situations for development, and optimizes the contribu- tion of its personnel (Wilkinson, Rushmer, & Davies, 2004). Senge outlined five personal disciplines that are key features of a learning organization: system thinking, personal mastery, mental models, shared vision, and team learning (Senge, 1990). These disciplines allow for the creation of infrastructure that promotes continuous learning, adaptation, and growth in organizations (Estrada, 2009). Consequently, one of the main goals of the learning organization is to construct an organizational culture of learning (Tsai, 2014).
The development of a learning culture in an organization involves the continuous education of its members. This process takes place by converting individual memory, which is the accu- mulated knowledge of an individual, into organizational memory, which takes the form of goals, handbooks, or standard procedures (Chen, Lee, Zhang, & Zhang, 2003). When successfully converted, it is critical to make organizational knowledge accessible to promote organizational learning (Chen et al., 2003). This knowledge needs to be transmissible, easily distributable, and comprehensive so that all members consider it valid and useful (Abel, 2008; Chen et al., 2003). Completely integrated knowledge represents a coherent, accessible, and maintained organizational memory, a vital aspect in a healthy organizational learning process (Abel, 2008).
It is believed that introducing a learning culture in health care organizations could improve the quality of professional practice, satisfaction, lifelong learning, and patient care, while also lowering costs (Bell, Robinson, & See, 2013). However, despite the impressive documentation on learning organizations, studies on this topic in health care settings remain scarce in the current literature (Bell et al., 2013).
In order to better understand the impacts of introducing a learn- ing organization in these settings, this study aims to explore its effects on nurse professional, educational, and organizational fac- tors related to continuing professional development, knowledge management, and retention in a Health and Social Services Center (French acronym: CSSS) of the province of Quebec, Canada. A CSSS is an integrated health care organization that usually comprises various types of facilities and health care services: local commu- nity services centers, residential and long-term care centers, and, where applicable, general and specialized hospital centers on a given territory (Quebec Ministry of Health, 2013). This CSSS rep- resents the only case where a formal learning organization culture was introduced in the Quebec health care context.
2. Context of study
In 2003, a major medico-nursing crisis was caused by a fail- ure to rescue event. Confronted with this situation, the Nursing Directorate put in place a clinical committee on continuous qual- ity improvement composed exclusively of nurses. Their mandate was to understand and to identify the problems experienced by their colleagues. Members of the committee quickly realized that their CSSS was ill equipped for the promotion of the education and expertise of their nurses, which threatened the quality and security of care.
The chosen solution to these issues was the implementation of a new organizational culture, the learning organization, which had three main goals: better quality and security in health care, support for nurse practice, and knowledge transfer. The imple- mentation, which began in 2005, was done in two initial phases. The first was the restructure of the continuous support to nurses in their practice through a mentoring program. The second phase, that aimed to accommodate, support, and retain employees, was realized through the development of learning strategies focused on the idea of knowledge that was there “just in time, just enough, and just for me”.
A variety of strategies assisted by information and communica- tion technology (ICT) were created to support the learning process in the organization. Among them, the most used was the video. The first projects involving knowledge transfer were the creation of four DVD videos about topics judged more problematic and that required in-depth study: newborn assessment, Plum A+ infu- sion system, CADD pump, and the maternity unit. Later, animated memos were added to the DVDs. As explained by the manager, an animated memo is a few minutes video filmed in action by a sim- ple over-the-shoulder camera. These videos are generally used to illustrate health care practice (such as delirium management) and were introduced to replace old paper memos scattered on notice- boards of the facilities. Doing so made the animated memos more accessible to employees. Other important learning strategies and programs supported the value of continuous learning and collec- tivity promoted by the learning organization: checklists, guidelines, aide-memoires, procedure sheets, lunch conferences, as well as mentoring, integration, speciality, and orientation programs.
3. Methods
3.1. Study design and participants
To investigate the learning culture implemented in this par- ticular CSSS, we conducted an exploratory case study. The study received the approval of the CHU de Québec ethical committee prior to the recruitment of participants. We used a purposive sampling approach, targeting key informants who had been involved in the learning organization, due to the exploratory nature of the study. Recruitment began from a list of ten individuals who had partic- ipated in the learning organization’s projects whose names were provided by the Nursing Directorate of the targeted CSSS. All of the individuals on the list were contacted by phone. Before the interviews, participants had to give their informed and voluntary consent by reading thoroughly and signing a consent form.
3.2. Data collection and analysis
We conducted face-to-face semi-structured interviews based on a conceptual map that was developed in the first phase of the project (Gagnon et al., 2013). The interview guide included three sections: the effects of the learning strategies and activities developed by the learning organization on nursing practices, the factors that influenced the adoption of projects developed within the learning organization, and the influence of the learning orga- nization on nurse retention. The interviews lasted approximately one hour and were audio recorded with the participants’ consent.
Interviews were transcribed verbatim producing a total of 103 pages of transcripts. We then analyzed their content with the help of the qualitative data analysis computer software NVivo (QSR International). In order to do so, we adopted a deductive–inductive thematic analysis, using the conceptual map as the starting point for the codification, and completing it with emerging themes. Two people independently analyzed the interviews and then compared
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their codification in order to reach consensus. Interview quotes presented in section 4 were translated into English from French.
4. Results
4.1. Participants’ characteristics
From the ten people contacted by phone, eight agreed to par- ticipate in the study. Two declined to participate due to heavy workload. Two more individuals, who were met at the study site, agreed to participate, bringing the total number of participants to ten. Eight face-to-face interviews were completed (seven individ- ual interviews and one with two participants), and one individual interview was done by videoconference (the participant was absent during our visit to the CSSS). All participants but one was a nurse; the other participant was an information technology technician who had an important role in the creation of various learning strate- gies assisted by ICT for the learning organization. All participants were female. This was accidental, but not surprising considering that the great majority of nurses in the province of Quebec are female (Marleau, 2013). Most nurses had more than 20 years of experience, but their tenure in their current position was more varied, ranging between 1.5 and 20 years. Finally, half of the par- ticipants were fairly new to the learning organization, working in this CSSS for less than three years. See Table 1 for more details.
4.2. Changes in nursing practice
The learning organization brought important changes to nursing practice. Specifically, it brought a new culture to the nurses based on continuous learning at work. According to six participants, the mentoring program for nurses of zero to five years of experience was a good incentive to new nurses to begin and continue working in this CSSS and a great way to promote continuous learning. Firstly, the program integrated new nurses to their environment through training on the basic procedures in place in the CSSS given by a nurse-educator. Secondly, novice nurses were paired with experi- ence colleagues in their specific field of practice in order to support
Table 1 Participants’ characteristics.
Participants’ characteristics All participants (n = 10)a
Role Nurse 3 Nurse-educator 2 Assistant chief-nurse 1 Chief-nurse 2 Manager 1 Technician 1
Gender Female 10
Years of experience (nursing) 10–14 years 1 15–19 years 1 20–24 years 2 25–29 years 4
Years in current position Less than 5 years 2 5–9 years 2 10–15 years 3 16–20 years 1
Years working with a learning organization 3 years and less 4 4–6 years 3 More than 6 years 1
a Two participants did not answer the three questions related to years of experi- ence, reducing the total number of participants for these questions to eight.
knowledge transfer and their work. Thirdly, the nurse-educator also conducted routine assessments of the novice nurse practice to ensure the progression of her integration and knowledge acqui- sition.
New nurses as well as older nurses also benefited from the learning strategies created through the learning organization, par- ticularly in the case of videos. The video format used for many projects of the learning organization was considered worthwhile by four participants since it allowed nurses to show the experien- tial knowledge in their daily practice and to describe it visually and audibly, something that could hardly be done before these video projects were carried out. The four DVD videos were distributed in the form of binder so that every installation and unit could have access to these videos. Also, some novice nurses received DVD copies if it was related to their speciality.
Six participants claimed that these strategies made it possible to learn anytime and anywhere since the videos were accessible to them at any time of the day or night on a variety of topics. Seven participants thought that the information acquisition was fast and believed that having the information quickly accessible decreased the time spent for searching it. Additionally, five par- ticipants noted that the information was customizable and eight participants pointed out that these videos represented a great infor- mation reminder for nurses. See Table 2 for a summary of the changes brought to nursing practice by the videos prepared within the learning organization.
Participants also mentioned other changes that took place in relation to their new work environment. All nurses noticed that the practice of care improved with the introduction of the learning organization. Specifically, participants observed improvements in the level of nurse autonomy; three participants noticed time sav- ings and two participants noticed a decline in the level of stress at work. Four participants believed that the learning organization sup- ported the standardization of practices, and four noticed that nurses reflected more on their practice. In terms of work satisfaction, five participants noticed an improvement in general satisfaction at work. Two participants also mentioned that a collective pride among nurses seemed to take hold. Eight participants noted that there was a feeling of recognition often associated with the learning organization’s projects. For example, some nurses noted that more colleagues referred to them after their participation in certain video projects. It is also interesting to note that all of the learning organi- zation’s projects were created by a group of chosen experts on the topic, strengthening collaboration and communication between nurses, and even with other professionals participating in these projects.
Five participants believed that the exposure to the learning organization’s programs and projects would help the process of appropriation of information by their colleagues and, ultimately, develop an intellectual curiosity that could bring them to “learn to learn” by themselves. For four of them, this curiosity could even encourage some to engage more actively to the learning organiza- tion culture through proposing new projects or themes and even participating directly in the creation of learning strategies. Table 3 summarizes the positive effects of the learning organization on nurses’ work environment.
In this CSSS, the distance between the facilities is important, and the use of ICTs was judged critical to achieve the goals of the learning organization across the points of services. According to three participants, the committee chose ICTs that were already available, but that could complete similar tasks at a more reason- able price than more expensive alternatives. The manager gave one particular example of this re-appropriation with respect to the videoconference. Instead of installing expensive videoconfer- ence systems, the organization opted to use equipment that could allow practical communication among nurses from different points
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Table 2 Summary and selected quotes related to the changes brought by the videos to nursing practice.
Changes n Selected quotes
Information reminder 8 After a while, we forget our notions and when we come back with a video that reminds us of the outlines, we can get back to the basics more easily . . . We are more aware that we have forgotten information and need to read up on it again. [. . .] Or we remember teaching that was done in the morning. The nurse can say that we will look at the video again, together. That’s its purpose. (Nurse)
Fast information acquisition 7 Suppose that you don’t know a procedure or a technique. Before, I would take my big notebook of techniques, I would browse through it until I got to. . . Oh, there it is! I would need to read the technique, memorize it, see it with someone or have someone show me. It’s the same thing now. There are cases when nurses do not remember certain procedures or techniques. They need to seek that information somewhere. What the learning organization does is to make the information available right then and there. (Nurse-educator)
Accessible knowledge 6 There are often relatively few nurses on the floor, one or two per shift. If on a Saturday evening at 10:00 PM a young nurse needs an application of the displacement pump, and she doesn’t know how to do it, well, it’s for these reasons that we created the learning videos. (Nurse-educator)
Customizable information 5 There are some people who still like paper. But if you want, I can give you another format. You can listen to it on the iPad, you can watch it at home, and you can see it directly on the computer if you know how it works. [. . .] It’s a new way to present things. It’s interesting for them. (Nurse-educator)
Demonstration of experiential knowledge
4 The nurse will do something automatically sometimes. After that, you ask her to describe the technique that she used. . . She will write it out, but the little thing she did to save time is not written. That’s experiential knowledge. We were not transmitting such knowledge. We were wondering how it was done. We would start videos and nurses noticed: “Hey I do that; I didn’t think that I was doing that. . .” We began writing things down and describing them, and we noticed that there were a lot of unspoken actions. (Chief-nurse)
of services while being economical and mobile. The chosen equip- ment for these tasks was the iPad and iPhone. These devices did not produce the same video quality as dedicated videoconference sys- tems, but they still fulfilled the functions entrusted to them. iPads and iPhones were also used for remote support of novice nurses. The novice nurse had the possibility to call the nurse-educator for a direct consultation when encountering an issue with a patient.
Additionally, these devices allowed access to the videos created by the learning organization, since all of them were integrated into the system by the technical team before giving them to the nurses. For six participants, this access was particularly interesting when it came to the transportability of information, especially in home care. For three participants, these devices were seen as easy to handle
Table 3 Summary and selected quotes related to the positive effects of the learning organization on nurses’ work environment.
Effects n Selected quotes
Improved care 10 [The learning organization] has a ripple effect, we optimize our knowledge, we train the young nurses, we transfer our knowledge and we reinforce our team. [. . .] All these projects share the concern to optimize our care and to offer a better service to our clientele. (Nurse)
Feeling of recognition 8 Since I was part of one of these projects, I helped a nurse who had to work with [the equipment the project was on]. I was also the expert that assisted a nurse for a new project [for another equipment]. New nurses, and even the older ones. . . those who are doing their bachelors, they refer to us a lot more since the project. It was enjoyable. I liked it. (Nurse)
Appropriation of information 5 It is to recognize expert nurses in their fields, the leaders. They’re the key persons to seek out. They’re the one that have credibility and those we want to see in the videos. People will identify to them. The novice that sees [the expert] in the video says: “She is in the TV, she must be quite the expert!” You recognize the person and her personality. It makes the videos enjoyable to watch. You cannot do otherwise than to understand why you need to change your practice. It has an impact. And you want to follow them in these projects. (Nurse)
Increase in work satisfaction 5 Nurses are more satisfied since they have now their say in the projects, can suggest ideas and management is more attentive to what they say. (Technician)
Engagement in the organization 4 I believe that it’s a significant project, it’s a team project. It created a synergy and pride. Because when the product is out, and we receive praises, it falls down on all the team. And it stimulates others to do projects, too. (Nurse)
Reflection on practice 4 I find that nurses will be more alert, they will raise questions on the procedures. “Is it the last version? It is really like that? Is it well like that?” I am more solicited at this level as an educator. (Nurse-educator)
Standardization of practices 4 What the learning organization allows me to do is to ensure a basis. For example, if I take work or work results that the learning organization has done for the maternity unit, it allows me to give a concrete training to young nurses or beginner nurses who will be novices in the maternity specialty. To give them the same functioning basis. (Chief-nurse)
Gains in time 3 We won’t send them [outside the region] for training on leadership. We won’t bring somebody over from outside the region for one or two full days like before. We will take someone from here, that we know she has strengths, and we will organize something short, such as a little clinic. We will film it. We will make a video, and make a tool with it. We will make something so that the nurse will be able to plan and make her daily team meetings more efficient. (Nurse-educator)
Collective pride 2 The learning organization was a process. People like it. They like the organization. It is a source of pride, collective pride. We diminished our medication errors. [. . .] Employees are committed to improve, committed to learn to learn, committed themselves. You don’t need management. It created more autonomy, more pride. We want that people be able to solve problems by themselves, all the time. (Manager)
Diminution of stress 2 It is especially the retention, the increased confidence for novices, to bring them to be expert rather quickly. That’s what we ask from them. It’s really, really stressing for them. I think that an environment where they feel good, where they feel supported by older nurses and where they can enjoy multiple tools to update or improve their competencies is important. (Nurse)
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and not requiring technical support, even though four participants believed that this support was available to the nurses.
According to all participants, the use of ICTs was gaining popularity among nurses. Indeed, they noticed that the nurses increasingly used ICTs as much for communicating than acquir- ing information in the workplace. One nurse even hoped for the complete computerization of the strategies used by the learning organization. Summary of the changes brought to nurses by the ICTs implemented within the context of the learning organization can be seen in Table 4.
As explained in Section 2, the learning organization’s commit- tee pursued three main objectives in the CSSS: better quality and security in health care, support for nurse practice, and knowledge transfer. The comments that were collected suggest that these goals were met. Indeed, all participants emphasized that the learning organization brought about an important improvement in these three fields.
4.3. Variable impact
Despite the positive effects of the implementation of a learn- ing organization on nursing practice, its impact was uneven across the CSSS. According to five participants, the involvement of other health professionals (apart from nurses) was very low. Being a nurses’ initiative, the creation of a learning culture was presented to the other professionals later in the change process and they were not always involved in learning strategies projects, which made it more difficult for these workers to take ownership of the project. Moreover, introducing the learning organization required an important process of culture change. This was not carried out symmetrically among the facilities of the CSSS. For instance, nurses from one local health center reported that they would not take part in conferences at the hospital center that is a 45-min drive away. A nurse at another facility reported that people were not conscious of being part of a learning organization; it was just another project for them.
This situation was caused in part by the role that the hospi- tal center played in the learning organization. According to the comments gathered during four interviews, the majority of the learning organization’s projects were conceived, created, and car- ried out at the hospital center. This situation provided little room for the learning organization to be integrated into the other facili- ties, which hampered its incorporation in their environment. At the hospital center, the learning organization was omnipresent on all floors, especially in the form of posters presenting past and ongo- ing projects. This presence was less noticeable in the other two facilities visited.
It should further be noted that accessibility problems caused by the fact that the organization could not equip all its facilities with new equipment and decent network access, due to a limited budget, were also an important factor explaining the dissymmetry between the hospital center and some of the other facilities. According to six participants, these deficiencies resulted in major accessibility issues when it came to using the learning strategies assisted by ICT in facilities that were not up-to-date on the technological level. Also, two participants noted that there was some resistance over the use of ICTs for communicating and for learning among certain nurses, particularly the older ones. See Table 5 for a summary of the barriers to the adoption of the learning organization in the CSSS.
Lastly, participants perceived that the effect of the learning orga- nization on nurse retention was limited. Even if seven participants highlighted that the implementation of this culture could help the retention of nurses in the CSSS, most believed that other factors were more important. Origins (ten mentions), work environment (eight mentions), and family situation (six mentions) were iden- tified as the most important incentives in the choice of nurses to work in the CSSS. Nevertheless, all the participants believed that the learning organization was important to support nursing practice and knowledge transfer.
5. Discussion
Our study identified many impacts that a learning organization has when it comes to supporting nurses. It also outlined the learning organization’s adoption factors in a CSSS in the province of Que- bec, Canada. Few studies have analyzed the effects of a learning organization in health care settings (Bell et al., 2013). This research sought to help fill this gap by contributing to the understanding of the effects of introducing a learning organization in a Canadian health care institution. This project also aimed to explain how the learning culture influenced nursing practices, the service organi- zation, and knowledge management, as well as how the evolution of the organizational culture resulted from the introduction of the learning organization.
Overall, the interviewed participants seemed to believe that the learning organization addressed the lingering issues of de- professionalization of the nursing profession and challenges related to the transfer of knowledge in this CSSS located in a remote region. One of the learning organization’s preferred learning strategies assisted by ICT for knowledge transfer is video, in the form of DVDs or animated memos. These homemade videos allowed easier transmission, not only of the explicit knowledge associated with nursing practice, but also of the experiential knowledge embedded in nursing practice that would otherwise be hard to formalize. The
Table 4 Summary and selected quotes related to the changes brought by the ICTs to nursing practice.
Changes n Selected quotes
Transportability of the information 6 There are no more nurses who go for nothing to patients’ homes, I don’t have patients who are not treated, there are no more refusals. With [an iPhone or iPad], a nurse can go to a home, see the video section she needs and program a pump. (Manager)
Available support for ICTs 4 I am not really into computers! So, we’re really lucky to have since two, three years, an intern specialist that programmed for us and show us how to work with these technologies. We also have many IT technicians. When we have an issue, or we do not know how to use it, they give us little training or information that allow us to work with them. We are very well supported at the technical level. (Nurse-educator)
Ease of handling 3 I learned [to use iPads] on the fly. I had also the technician who was there. She was very skillful, patient and kind. There were also trials and errors. I brought it at home and I played with it, then I worked with it. At first, I was embarrassed to bring it at home. It is a work instrument; I won’t have fun with it at home, go on the Internet and things like that! The technician told me that it was made for that, and after playing with it, I would master it and do a lot of things with it. . . She was right.
Technologies at reasonable costs 3 A problem we had, and a key to our success, was that we were small and we didn’t have the means. IT did not want to help us, so we went with resources from the community. These resources were: cameras, television, DVDs, iPads, iPhones. We went with the things on the market. We didn’t go with e-learning companies since it was so huge, heavy and practically counter-productive compared to our upcoming needs. (Manager)
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Table 5 Summary and selected quotes related to the unfavorable factors to the adoption of the learning organization.
Factors n Selected quotes
Inappropriate network access 6 At the hospital center, we are lucky; we have a broadband that is pretty strong. The problem is when you look into residential and long-term care centers or some local community services centers, where there are only one or two places in the facility where nurses can go and watch videos. The level of accessibility of the information is not equal everywhere. (Nurse-educator)
Low involvement of other professionals 5 There’re not a lot of multidisciplinary teams [for the projects]. It really needs to be an issue that touches everyone. [. . .] There’s maybe an influence [of the learning organization on other professionals], but I don’t see it. They don’t see which videos we do. They hear about it, but they don’t see any of it. (Nurse-educator)
Centralization around the hospital 4 There are a lot of people [outside the hospital center] who are not aware or don’t know the amplitude of [the learning organization]. They know it is something interesting, they hear about it, they know the outlines, but they’re not that involved in it. (Chief-nurse)
Resistance of nurses 2 Some nurses on the work floor, such as the older nurses, are stuck in a routine and say “[the learning organization] is not for me. I don’t have time for these things. I will go take my break and don’t bother me with it”. [. . .] Saying that they don’t have the time is a lack of interest in disguise. It’s the classic and fatal excuse: I don’t have the time. I don’t believe so. If you want to be up to date, you always have the time for something. (Nurse-educator)
latter statement is consistent with solutions proposed by Nonaka, Toyama, & Konno (2000) and followed by the learning organiza- tion committee, which consist of using observation and imitation to overcome the communication barrier surrounding this particular type of knowledge. By using videos to transfer knowledge, nurses created collective knowledge that preserved both explicit and tacit knowledge of their profession.
Moreover, peers and mentors transmitted to both young and more experienced nurses the ideas behind the learning organiza- tion and the value of “learning how to learn”. This type of transfer, adopted by the learning organization committee, follows the ideas of Marchand and Lauzon (2007) who assert that, ultimately, nurses should learn to learn and internalize the tools available in the orga- nization to improve their practice. This is also consistent with other authors who state that continuous learning in action, as seen with the learning organization, is more likely to influence behavior than other more traditional, passive and non-interactive learning meth- ods (Borbolla et al., 2013; Van Hoof & Meehan, 2011). Moreover, the literature supports the idea that continuing learning environments not only enhance the quality of work for health professionals, but also improve outcomes for clients (Pool, Poell, & ten Cate, 2013), which is in line with the objectives of the studied organization.
Other changes were brought about by the learning organiza- tion as regards nursing practice, such as improved communication among nurses, as well as their collaboration, thanks to the devel- opment of projects and the availability of ICT. Participation in learning organization initiatives also resulted in feelings of recog- nition, pride, and autonomy, as well as time savings, reductions in stress at work, standardization of practices, continuous support to nurses, and reflection. Moreover, the learning strategies assisted by the ICTs used within the context of the learning organization allowed rapid access to flexible information. These effects were also identified in the literature on ICT use in nursing education (Button, Harrington, & Belan, 2014).
Nevertheless, there are still elements that could be improved by the learning organization. At the time of this study, the imple- mentation of the learning organization was still incomplete among nurses, and even more so among other health professionals. The lack of other professionals in the learning organization is an inter- esting point to underscore, since we could easily imagine that a participatory process that promotes collaboration like the process promoted by the learning organization (Harrison-Broninski and Korhonen, 2012; Song, Jeung, & Cho, 2011) would facilitate mul- tidisciplinarity. However, some of these professionals have already participated in the projects, and the learning organization commit- tee expected that this participation would grow over time.
Finally, the learning organization had a limited effect on reten- tion of nurses in this CSSS. While the value of the learning
organization is generally acknowledged, factors such as origins, work environment, and family situation seemed more important as incentives to work in the CSSS.
5.1. Limitations
Even though this exploratory case study is not by its very nature generalizable, it could serve as a basis for comparison when study- ing other cases as well as provide evidence that could be used by others to judge the applicability of a learning organization approach for their situation. For example, this study could be included in a larger research on the influence of learning organizations on health care professionals’ practice. Moreover, we wanted to improve and deepen understanding of the effects of the learning organization using the rich and meaningful experiences and descriptions of par- ticipants, which would have been impossible with other research designs (Collingridge & Gantt, 2008). Nonetheless, this study meets the requirements of valid qualitative research, according to vari- ous quality criteria including triangulation, respondent validation, exposition of methods, reflexivity, attention to negative cases, fair dealing, rich description, and relevance (Mays & Pope, 2000).
6. Conclusion
The organizational culture change process—through a learning organization promoting knowledge transfer in the work envi- ronment and collective learning—instituted in a CSSS of Quebec brought about important and much needed changes in nursing practices and work environment. Research on new and innovative solutions to improve knowledge management and support con- tinuing professional development of health care professionals is still limited. This case study can help clarify the impacts of a learn- ing organization on health care professionals’ practices. According to the participants in this case study, the learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital center. These changes were particularly pronounced with respect to knowledge transfer, support for nursing practices, and quality of health care objectives, which the learning organi- zation had sought to meet since its inception. As a final remark, it would be interesting to study in the future the longer-term effects of the integration of a learning organization on nurses’ professional development, as well as on those of other health care professionals who are part of this new culture.
Conflict of interest
The authors are not aware of any conflict of interests.
642 M.-P. Gagnon et al. / International Journal of Information Management 35 (2015) 636–642
Acknowledgments
Funding for this research project was provided by Canadian Institutes of Health Research (CIHR) (No 200911PHE-217005-PHE- CFBA-11114). The funding source had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the arti- cle for publication. The authors thank Erik Breton who helped with the data collection and analysis and the review of this paper. They would also like to give a special thanks to the participants of this case study.
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Marie-Pierre Gagnon is Associate Professor at the Faculty of Nursing of Université Laval and researcher at the CHU de Québec Research Center. She also holds the Canadian Research Chair in Technology and Practice in Health. Her research interests include telehealth, organization of health services, professional practices and health information systems.
Julie Payne-Gagnon is a research professional at the Public Health and Practice- Changing Research Axis of CHU de Québec Research Center. An anthropologist by training, she currently works on the subject of implementation and use of informa- tion technologies in health care.
Jean-Paul Fortin is a retired Professor at the Department of Social and Preventive Medicine of Université Laval and researcher at the Centre de recherche sur les soins et services de première ligne of Vieille-Capitale Health and Social Services Centre. He developed an extensive expertise on ICTs in health and on the evaluation of health services research.
Guy Paré is Professor at the Department of Information Technology Management and holder of the Chair in Information Technology in the Health Care Sector of HEC Montréal. His research interests include change-related issues to the implementa- tion of new technologies, the effective management of these changes and the use of information technologies in support to emergent organizational forms.
José Côté is holder of the Research Chair in Innovative Nursing Practices and full pro- fessor at the Faculty of Nursing Science of Université de Montréal. She is a regular researcher at the CHUM Research Centre and the recipient of a senior researcher- clinician grant from the Fonds de recherche du Québec en santé (FRQS). Her research focuses on the development, implementation and evaluation of cyberhealth inter- ventions in the treatment of client groups living with a chronic health condition.
François Courcy is Professor at the Department of Psychology of Université de Sherbrooke. He is interested in the prediction of work-related counterproductive behaviors, the promotion of psychological health at work, the assessment and diag- nostic of organizations, as well as staff training and work performance.
- A learning organization in the service of knowledge management among nurses: A case study
- 1 Introduction
- 1.1 Learning organization
- 2 Context of study
- 3 Methods
- 3.1 Study design and participants
- 3.2 Data collection and analysis
- 4 Results
- 4.1 Participants' characteristics
- 4.2 Changes in nursing practice
- 4.3 Variable impact
- 5 Discussion
- 5.1 Limitations
- 6 Conclusion
- Conflict of interest
- Acknowledgments
- References
,
Aims–amp–Scope-Editorial-Bo_2015_International-Journal-of-Information-Mana.pdf
International Journal of
Information Management The International Journal of Information Management (IJIM) is an international, peer-reviewed journal which aims to bring its readers the very best analysis and discussion in the developing fi eld of information management. The journal: • keeps the reader briefed with major papers, reports and reviews • is topical: Viewpoint articles and other regular features including Research Notes, Case Studies and a Reviews section help keep the reader up to date with current
issues. • focusses on high quality papers that address contemporary issues for all those involved in information management and which make a contribution to advancing
information management theory and practice. Information is critical for the survival and growth of organisations and people. The challenge for Information management is now less about managing activities that collect, store and disseminate information. Rather, there is greater focus on managing activities that make changes in patterns of behaviour of customers, people, and organizations, and information that leads to changes in the way people use information to engage in knowledge focussed activities. Information management covers a wide fi eld and we encourage submissions from diverse areas of practice and settings including business, health, education and govern ment. Topics covered include: Aspects of information management in learning organisations, health care (patients as well health workers and managers), business intelligence, security in organizations, social interactions and community development, knowledge management, information design and delivery, information for health care, Information for knowledge creation, legal and regulatory issues, IS-enabled innovations in information, content and knowledge management, philosophical and methodological approaches to information management research, new and emerging agendas for information research and refl ective accounts of professional practice.
EDITOR
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INTERNATIONAL EDITORIAL BOARD
Professor Sherry Y. Chen Graduate Institute of Network Learning Technology National Central University, Taiwan, ROC Email: [email protected]
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Professor Paul Beynon-Davies Cardiff Business School Cardiff University Aberconway Building, Colum Drive Cardiff, CF10 3EU Email: [email protected]
Dr Brian Detlor DeGroote School of Business, McMaster University DSB-419, 1280 Main St. W., Hamilton Ontario, Canada, L8S 4M4 Email: [email protected]
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Professor Josef Herget Head of Center for Knowledge and Information Management Danube University Krems / Donau- Universität Krems, Dr.-Karl-Dorrek-Str.30, A-3500 Krems, Austria, Tel: + 43-2732-893-2332 Fax: + 43-2732-893-4335 www.donau-uni.ac.at/wimjosef. [email protected]
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Professor Feng Li Chaitr of Information Management Cass Business School City University 106, Bunhill Row London EC1Y 8TZ Email: [email protected]
Professor Massimo Magni Department of Management & Technology, Bocconi University, Milano 20136. Italy Email: [email protected]
Dr Linda D. Peters Associate Professor in Marketing Nottingham University Business School Jubilee Campus, Woolaton Road Nottingham, NG8 1BB, UK Email: [email protected]
Professor Yannis Pollalis Business Strategy and Policy University of Piraeus 80, Karaoli & Dimitriou Street GR-185 34 Piraeus, Greece Email: [email protected]
Dr Mark Stansfi eld School of Computing University of the West of Scotland High Street, Paisley, PA1 2BE Scotland, UK Email: Mark.Stansfi [email protected]
Colin Theakston Durham Business School, School of Economics, Finance & Business, Durham University, Mill Hill Lane, Durham DH1 3LB, UK Email: [email protected]
Professor Adam Vrechopoulos Department of Management Science and Technology, Athens University of Economics and Business, 76 Patission Street, Athens 104 34, GREECE e-mail: [email protected]
Professor David Wainwright Head of the Information Management Innovation (IMI) Research Group Professor in Information Systems School of Computing, Engineering and Information Sciences Northumbria University Pandon building Camden Street Newcastle upon Tyne NE2 1XE UK Email: [email protected]
Martin White Managing Director, Intranet Focus Ltd. 12 Allcard Close, Horsham West Sussex, RH12 5AJ Email: [email protected]
Professor Susan P. Williams Institute for Information Systems Research University of Koblenz-Landau Koblenz 56070 Germany Email: [email protected]
How-are-citizens–public-service-choices-s_2015_International-Journal-of-Inf.pdf
International Journal of Information Management 35 (2015) 527–537
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International Journal of Information Management
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j i n f o m g t
How are citizens’ public service choices supported in quasi-markets?
Agneta Ranerup a,∗, Lars Norén b,1
a Department of Applied Information Technology, University of Gothenburg SE-412 96 Göteborg, Sweden b Department of Business Administration, University of Gothenburg, PO Box 610, SE-412 96 Göteborg, Sweden
a r t i c l e i n f o
Article history: Received 30 March 2015 Received in revised form 7 May 2015 Accepted 22 May 2015 Available online 2 June 2015
Keywords: Electronic government Quasi-markets Decision support Sociomateriality Citizen
a b s t r a c t
Many countries have introduced quasi-market reforms that enable citizens’ choice in education, health- care, and other public services. The research question in this paper is the following: How can Web-based decision support help citizens to make calculated public service choices in quasi-markets? In Section 3, the paper focuses on how decision support design helps citizens make such choices as they isolate, examine, and rank alternatives. A case study, set in Sweden, explores 14 cases of decision support in education, healthcare, elder care, and the public pension system. Decision support is most evident in the area of education, but decision support is found in the other areas as well. In most cases, the support consists of information on the right of choice and instructions on how to search among alternatives. Many areas permit direct comparisons, but some areas only permit more indirect comparisons. All 14 cases explain how to make a choice, but only a few cases offer a ranking device. The decision support for choice is inconsistent with the theoretical model of calculated choice in all aspects despite the trend toward greater consistency with the model. Our results call for a critical discussion of technology design that aids citizens as consumers or customers in their relationship with public services.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
In many countries, new institutional arrangements, in the form of market reforms, have been introduced that affect the admin- istration and deliverance of public services (Le Grand, 2007). For more than two decades, different types of market reforms have been important features in education systems in many OECD countries (Grubb, 2002). Such reforms are also found in healthcare (Chauvette, 2003) and in other public service areas.
These institutional arrangements, using supply/demand mech- anisms, often strengthen citizens’ ability to make choices about the public services that affect them. Some mechanisms allow citizens to make their choice of services directly while others permit citizens to make their choices more indirectly (e.g., through a mediat- ing, contracting agency). Although the sellers, or service providers, in these markets may not necessarily strive to maximize their profits, they are very aware they exist in an environment where other sellers/providers compete for the same citizens–buyers. The citizen–buyers do not use private capital when they make their public service choices. Instead, they have vouchers that allow them
∗ Corresponding author. Tel.: +46 31 7862766. E-mail addresses: [email protected] (A. Ranerup),
[email protected] (L. Norén). 1 Tel.: +46 31 7861540.
to “shop around” for public services. These arrangements are often described as quasi-markets (Le Grand, 2007).
Clearly, the central figure in such arrangements is the citizen. Yet there is little research on how to support citizens when they make choices in quasi-markets (Greener, 2007; The Swedish Agency for Public Management, 2007; Winblad & Blomqvist, 2013). In the limited research available, the focus is the information needs of citi- zens as they choose schools or doctors, and the design of Web-based support for such choices (Allen & Burgess, 2011; Leckie & Goldstein, 2011; Ranganathan, Hibbard, Rodday, & de Brantes, 2009). It is also important to note that the design of such technological, often Web-based, decision support for citizens influences their relation- ship with the state (Chadwick & May, 2003; Gauld, Goldfinch, & Horsburgh, 2010; Lips, 2007). This relationship can be discussed in terms of citizens, patients, service users as well as customers and consumers.
The focus in this paper is the sociomaterial constellation con- sisting of technology (“web-based decision support”) and people (“citizens with a right to choose”) where the possibility of mak- ing calculated choices in quasi-markets is present. The research question is the following: how can Web-based decision support help citizens to make calculated public service choices in quasi- markets? In Section 3, we focus on the design of technological decision support, especially as it can help citizens make calculated choices (cf. Callon & Muniesa, 2005). Our study, which is set in the
http://dx.doi.org/10.1016/j.ijinfomgt.2015.05.002 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
528 A. Ranerup, L. Norén / International Journal of Information Management 35 (2015) 527–537
context of Swedish public services, contributes to the research on decision support in quasi-markets as well as the research on the materiality of markets (cf. MacKenzie, 2009) with specific reference to the sociomaterial design of Web-based support for choice.
2. Previous research on decision support for citizens’ choice
Coulter (2010) discussed the introduction of, and the need for, well-designed support for patient choice in a healthcare setting. Green, McDowell, and Potts (2008), who studied the Choose & Book system, found that doctors still retain considerable influ- ence on patients’ choices. Ranerup, Norén, and Sparud-Lundin (2012) and Damman (2010) conducted broad surveys of techni- cal support for choice in healthcare in Sweden and in Holland, respectively. Fasolo, Reutskaja, Dixon, and Boyce (2010), Moser, Korstjens, van der Weijden, and Tange (2010), and Ranganathan et al. (2009) emphasized the importance of design as an influence on choice itself. They described the various kinds of infor- mation that designs provide, such as quality information or patient evaluations. Interestingly, Angst, Agarwal, Gao, Kuhntia, McCullough (2014) discussed the voluntary provision of qual- ity information by hospitals in a study of the costs of providing such information. There is far less research on decision sup- port in elder care; furthermore, the research that is available is somewhat contradictory. Meinow, Parker, and Thorslund (2011) described cognitive difficulties that the elderly have in making choices. However, Goodwin (2011) argued that the elderly can make such choices. Winblad and Blomqvist (2013) claimed that both properly designed technologies and more information are needed.
Regarding education, research in UK focuses on how parents used quantitative information (“League Tables”) to choose schools for their children (Allen & Burgess, 2011; Leckie & Goldstein, 2011). More recent studies examine if and how quality information affects parents’ choice of schools in Chile and the Netherlands (Gomez, Chumarcero, & Paredes, 2012; Koning & van der Wiel, 2013), as well as more generally how information should be designed and provided (Allen & Burgess, 2013). A general theme in the research on choice in education is that, despite difficulties, simple perfor- mance tables are useful. More specifically, in a study of the visual and textual designs of support for school choice, Wilkins (2012) claimed these designs express cultural, historical, and pedagogical values.
In one of the few studies on choice related to public pen- sion investing, Ranerup (2007) concluded that support for choice might exist if the intention is to provide information on rather advanced knowledge levels. Sundén (2004) described technolog- ical support for choice as a complement to written information. Hagendorff, Hudson, and Keasy (2006) described the complexity or “Byzantine” logic of designing electronic support for choice and advice for pension annuities that would satisfy the various needs of retirees.
In sum, most of the research on citizen choice, which is rather “non-theoretical”, has been conducted in healthcare settings, prob- ably because of the many different kinds of healthcare choices (e.g., doctor, hospital, treatment, primary care clinic, etc.). However, to our knowledge, as yet, there is no research that examines in com- prehensive fashion, decision support for choice in several different public service areas. To fill this research gap, our intention with this theory-based, comparative case study is to provide a comprehen- sive study of available, Web-based support in four public service areas.
3. Theory
Our study falls within the current sociomaterial tradition with its focus on the joint activities of people and technology (Jones, 2014; Leonardi, 2012). This tradition is concerned with people’s use of technology in general, viewing technology as a socio-technical system that emphasizes the interdependence of social and techni- cal subsystems (Leonardi, 2012). This tradition grew out of an older tradition based on workplace studies conducted in the 1930s and developed, for example, by key figures at the Tavistock Institute, including Fred Emery, Ken Bamforth, Eric Trist, and others).
The sociomaterial tradition is more radical than this older tradi- tion because of its focus on how people and technology act together. In a discussion on the roles of people and technology, McMaster and Wastell (2005, p. 179) concluded: “[T]echnology cannot act without people, any more than people can act without technology. Agency cannot be reduced to either pure humans or pure machines.”
Leonardi (2012, p. 34) took a broader perspective in his discus- sion of sociomateriality:
[T]alking about sociomateriality is to recognize and always keep present to mind that materiality acts as a constitutive element of the social world, and vice versa. Thus, whereas materiality might be a property of a technology, sociomateriality represents that enactment of a particular set of activities that meld materiality with institutions, norms, discourses, and all other phenomena we typically define as ‘social’.
Of course, practical situations exist in which the social and the material act together or, as described by Leonardi (2012), are “constitutively entangled.” For example, several researchers are now engaged in the on-going debate on the theoretical and methodological problems in this tradition. This debate, among other things, occurs in the investigation of “mute” technology and in the investigation of agency and separation among the “hybrid” actors of people and technology (see Cecez-Kecmanovik, Galliers, Henfridsson, Newell, & Vidgen, 2014; Leonardi, 2013; Mutch, 2013; Scott & Orlikowski, 2013). Some, although not all, studies in this tra- dition combine theoretical and empirical research (Jones, 2014). In our study, we contribute to a particular stream in this research with our focus on markets and their constructed nature. This approach allows us examine the sociomaterial design of Web-based support that helps citizens make their calculated public service choices.
We call attention to other important studies that take this approach. Callon (1998), for example, studied how actors use eco- nomic theories to construct markets in which people as well as technologies are involved in choice. MacKenzie (2009) used mostly financial market case studies in his study that deals with how economic agents are constructed, often in a very material sense. In more recent publications, Jeacle and Carter (2011) and Scott and Orlikowski (2012) studied how the spread of technology in the travel sector allows people to evaluate and rank travel ser- vices using technology that displays these evaluations on computer screens. They also looked at how technology creates trust by dis- playing other people’s evaluations. In all of these cases, people’s joint activities with technology are the de facto focus, which makes technology an important component of a hybrid actor.
Taking a somewhat different perspective, Pollock and Dı́Adderio (2012) focused on technologies used in a material sense for rank- ing options via computer screens. In their study of how lists and graphic design aimed at ranking influence the actions of human actors in the market, they created an additional layer between the individual consumer and the market. In line with these perspectives, we find that technology not only provides the traditional (and neutral) decision support for choice, but also mutually influences, or controls, citizens when they make their choices.
A. Ranerup, L. Norén / International Journal of Information Management 35 (2015) 527–537 529
Callon and Muniesa (2005) designed a fundamental model of choice behavior that we use as the theoretical framework of our paper. Their model assigns technology a role that enables people to perform as calculating consumers/customers. Their theoretical framework for the model includes the concept of calculation, which refers to the general idea of how people make thoughtful and cal- culated choices in any situation. In defense of their model, Callon and Muniesa (2005) state that economists view reality as “pure” calculation. Other social scientists, they argue, try to show that real practices are more complex and leave little room for calculation practices. In contrast to that perspective, Callon and Muniesa (2005) looked at processes in which calculated choices were made in an examination of the sources of economic calculation. As followers of the sociomaterial tradition, they argue that material devices (e.g., weighing scales or supermarket shelves) as well as more abstract tools (e.g., Web portals such as those described in this article) are of critical importance in helping individuals act as calculating con- sumers (see also Callon, 1998).
More specifically, Callon and Muniesa (2005) argue that design- ers should follow certain basic principles when they construct technological devices such that choice and ranking are supported through the joint activities of technology and people. First, to enable choice, options must be detached or isolated from their context and grouped into a common framework such as on a computer screen. In public services, this means, for example, that all schools or pri- mary care clinics in a municipality are listed or shown on a screen. In this format, consumers may easily obtain a general overview of unknown or scattered options that otherwise would be unavailable. Second, once the options have been isolated in this manner, con- sumers require the means to examine and compare them. Advanced devices, some more complex than others, as well as data about the public services, support consumers in this step. For example, detailed computer screen data for all options or selected options, as well as various devices for use in comparisons of a few options, may be available. Third, designers must create a method by which consumers can use the comparisons to produce a new entity (e.g., a sum, an ordered list, or a holistic evaluation). In this manner, rank- ing/choice are enabled. The use of this method may produce a sorted list or, at least, facilitate the selection of the best alternatives con- sistent with people’s preferences that are revealed in the process. In short, it is essential that technological devices, such as websites be designed so that they support calculating consumers as they study alternatives following the steps of isolation, examination,and ranking/choice.
4. Material and methods
4.1. Research setting
In this paper, we describe several kinds of Swedish public ser- vices in which citizen choice is permitted. The Swedish setting is interesting for several reasons. Although Sweden’s governing parties are on the centre-left of the political spectrum, since the 1990s, Sweden, as a country, has placed great emphasis on the principles of New Public Management (NPM) that favor market- oriented management of the public sector (Hood, 1995). Several authors (e.g., Osborne & Gaebler, 1992; Le Grand, 2007) have described NPM as a liberal project that reinvents government. How- ever, NPM remains a controversial reform in Sweden.
Whatever the pros and cons of NPM in public services, it is clear that Swedish citizens are offered choice in many areas, including education, healthcare, daycare, welfare services for the disabled, elder care, and public pension investment. It is also clear from pol- icy documents that large public and private agencies are working to increase greater citizen choice through the use of technology
(Ministry of Education and Science, 2012). One element of this reform is the use of a voucher system (or something similar). Under this system, citizens can choose any public service provider so long as the public treasury finances the services (i.e., by taxation) (Le Grand, 2007).
In this paper, we look at how Swedish public services are offered in the following areas: education, healthcare, elder care and public pension systems. The first three areas have been addressed in liter- ature on choice reform (see, e.g., Le Grand, 2007). The fourth area, the public pension system, is somewhat different from the others because of its empirical character although it is still a public service. Together, the four areas represent a broad spectrum (as well as a significant portion) of public services in Sweden.
A number of countries, besides Sweden, have introduced citizen choice in education and healthcare in recent decades. For example, UK, Chile, Denmark, and New Zealand now allow choice in educa- tion. And UK, Denmark, New Zealand, and Norway allow choice in public healthcare. Sweden and Denmark also allow choice in elder care and in the public pension system.
Our study examines 14 cases of Web-based decision support for choice in four public service areas (see Tables 1–4). The major- ity of these 14 cases are standard e-Government services of the G2C or G2B type (Beynon-Davies, 2005) that are owned and oper- ated by public sector agencies. However, we also look at cases in which the services are owned and operated by private agencies or by a mix of public–private agencies (a public–private partnership or PPP) (Josefsson & Ranerup, 2003; Karpik, 2010). Our goal in exam- ining this broad mixture is to describe the significant variations among the choice providers and in their decision support designs. Our intention is to achieve saturation on these two aspects.
4.2. Data collection and analysis
Our data collection and analysis consisted of four steps. First, we conducted 14 semi-structured interviews. The interviewees (project leaders, managers, and others) all had extensive knowl- edge of the past, current, and future activities of their agencies, plus an understanding of how the Web-based decision support for choice works. We conducted our interviews between December 2012 and May 2014. All interviews (between 30 and 70 min each) were audio-recorded and later transcribed. We asked the inter- viewees to describe the general background of their decision support systems as well as their basic features related to the com- ponents of our theoretical model (“Isolating, Examining, Ranking and choosing”). Second, we analyzed some of the providers’ pol- icy documents. Third, we examined the design and content of the decision support systems. In this step we examined the systems’ practical features in terms of Isolating, Examining, and Ranking: Here, Isolating refers to the provision of technological devices that describe the framework for choice of, for example, a primary health care provider or a school, and the search for available units. Examin- ing refers to the provision of technological devices that investigate and compare available choices based on, for example, waiting times and quality indicators. Ranking refers to the provision of technolog- ical devices for sorting and choosing among selected alternatives. Fourth, we compared and summarized the 14 cases. Our focus was their theoretical and practical contributions to technological design for choice in public services.
As MacKenzie (2009) states in a very relevant publication on “material markets”, the preferred method for studying data collec- tion that uses technology is to observe how the technology is used “in action”. In order to study the public service areas addressed in this paper, we made the alternative decision to use a multiple-case study of 14 cases with interviews, technologies, and policy doc- uments as our data. Thus, we rely on both the interviewees’ and our own descriptions of the technology rather than on an ethno-
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Table 1 Web-based decision support in education.
1. 13 municipalities in cooperation: The Gothenburg Region Association of Local Authorities (GR)
2. The public–private partnership: The Swedish Association of Local Authorities and Regions (SALAR), Svenskt Näringsliv, the Swedish Association of Independent Schools
3. A national public authority: The Swedish National Agency for Education
4. A local government: the local public administration of education in the municipality of Gothenburg
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Information about the rights of choice
Search for units of upper secondary schools in the GR region (13 municipalities) selecting municipality, educational program, ownership
Search for units of secondary (and upper secondary) schools in the country selecting municipality, distance, location on map
Search for units of upper secondary schools in the country selecting municipality, educational program, ownership, and a device where specific preferred criteria can be chosen as a basis for selecting (grading, competence of teachers, number of pupils in class, grading needed for acceptance etc.)
Browsing in a list and texts about units of upper secondary schools owned by the municipality of Gothenburg
Examining alternatives Indirect comparisons of schools and educational programs based on link to schools with same type of education as well as schools own websites
Direct comparisons of schools based on numerical information and diagrams in columns covering grading, results in national tests, competence for further studies, student investigations about satisfaction applied to a few selected schools
Direct comparison of schools based on all types of above numerical information in columns applied to a few selected schools
Indirect comparisons of schools and educational programs based on online marketing brochure and link to schools own websites
Ranking and choosing alternatives
Manual ranking, IT-supported choice
Manual ranking, no choice Manual ranking, no choice Manual ranking, link to IT-supported choice (in Case No. 1)
5. A local government: The municipality of Gothenburg
6. An association: Svenskt Näringsliv i.e., the Swedish national association for promoting free enterprise
7. A private company: The Metro Corporation
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Search for units of upper secondary schools in the municipality of Gothenburg selecting part of the municipality, ownership, map
Search for units of upper secondary schools in the country selecting educational programs, municipality and name of school
Search for units of upper secondary schools in the country selecting educational programs and municipality or region
Examining alternatives Indirect comparisons of schools and educational programs based on contact information and schools own websites
Direct comparisons of schools and educational programs based on numerical information in columns about grading, qualification to university studies, results of national tests, future income opportunities, unemployment etc. applied to a few selected units
Indirect comparisons of the same educational program in one municipality based on brief textual information, contact information and links to schools own websites, links to other schools with same program. Information about future opportunities regarding, e.g., salary levels (monthly wages), chat during period of choice
Ranking and choosing alternatives
Manual ranking, link to IT-supported choice (in Case No. 1)
The device for comparisons supports ranking through colors indicating whether selected alternatives belong to the 25% best, middle or worst units in the country No choice
Manual ranking, link to IT-supported choice (in no. 1 or similar regional support in other parts of the country)
A. Ranerup, L. Norén / International Journal of Information Management 35 (2015) 527–537 531
Table 2 Web-based decision support in healthcare.
8. An association for all public regional authorities: SALAR and its IT-department Cehis
9. An association: Svenskt Näringsliv i.e., the Swedish national association for promoting free enterprise
10. A public regional authority: The county council of Halland
Isolating alternatives Information about the rights of choice
No information about the rights of choice
Information about the rights of choice
Search for units of primary care clinics using a map or search of, e.g., municipality or name of clinic
Search for units of primary care clinics indicating preferences regarding perceived importance of satisfaction, waiting-times and actual physical location
Search for units of primary care clinic by names of municipalities, needed access (day, weekend, nights)
Examining alternatives Direct comparison of clinics based on numerical information and diagrams in columns showing contact information, measured telephone access, first visit, patient investigations about: general reception, experienced usefulness, information, participation in care, confidence, willingness to recommend, overall perception of a few selected centres
Direct comparison of clinics in a sorted list based on all of above aspects and occasional personal judgments from patients. Detailed information about each one of the suggested clinics in percentages and available diagrams
Direct comparison as in Case No. 8 as well as additional information about competence (pediatrics, diabetes, etc.), available e-services of a few selected centres in format yes-no
Ranking and choosing alternatives
Manual ranking, IT-supported choice
Ranking in list by indicating preferred aspects as above
Manual ranking, IT-supported choice
No choice
Table 3 Web-based decision support in elder care.
11. A national public authority: The National Board of Health and Welfare
12. A local government: The municipality of Stockholm
Isolating alternatives Information about the rights of choice Information about the rights of choice Search for units (local government, part of local government in large city, private company) of provider of help in home to elderly based on municipality, type of owner (public, private), type of help (service, personal care)
Search for units (part of local government, private company) of provider of help in home to elderly in Stockholm based on distance, owner (public, private, cooperative) that can be sorted according to one preferred criteria (randomly or client investigation of participation, safety, satisfaction etc.) before selecting instances to compare
Examining alternatives Direct comparison of units based on textual and numerical information in columns covering type of owner, detailed information regarding participation, protective routines of a few selected units
Direct comparison of units based on textual information, diagrams, and numerical information in columns showing client investigations as well as information about provided services (meals, shopping, laundry, night service etc.) of a few selected units
Ranking and choosing alternatives
Manual ranking Manual ranking but the phase of isolating supports selecting a criteria by which to sort lists of units of providers as above
No choice IT-supported choice
Table 4 Web-based decision support in public pension.
13. A national public authority: The Swedish Pensions Agency
14. A public–private partnership: Minpension that includes The Swedish Pensions Agency, Banks, Fund companies
Isolating alternatives Information about the rights of choice Information about the rights of choice and the pension system as a whole
Search for units of pension funds in the public pension based on risk, fee, increase in value, category, etc. These categories can be used for ranking (i.e., sorting) according to preferred criteria
No search for funds
Examining alternatives Direct comparisons of selected alternatives in lists based on numerical information and diagrams based on the selected criteria
Overview of choices made and their result (total savings) Personal forecasts based on future salary and activity
Ranking and choosing alternatives Direct ranking before selection as above as well as in diagrams showing increase in value. An advanced DSS incorporating personal preferences regarding risk, fees, time, etc., supports comparing current and future portfolios
No ranking
IT-supported choice No choice
532 A. Ranerup, L. Norén / International Journal of Information Management 35 (2015) 527–537
graphic observation of its actual use. However, for our purposes, we think our methodology is “good enough” because our intention is to describe the potential agency embedded in the technologyı́s material product as well as its textual content (Siles & Boczkowski, 2012).
5. Results
5.1. Education
In Swedish education, choice reform was introduced in the primary and lower secondary schools in 1992 and in the upper secondary schools in 1994. In each municipality, various tax- funded agencies (public, semi-private, or private) supervise the school choice system. The mandate for this reform was stated in the national government proposition 1991/92:95: “Choice and independent schools” (Ministry of Education and Science, 1991/1992Ministry of Education and Science, 1991/1992). In some regions, a number of municipalities cooperate around choice in upper secondary education.
Table 1 presents the Web-based decision support for upper sec- ondary schools and education programs. Local authorities, national public authorities, and public–private partnerships (PPPs) provide the support. The PPPs are entities associated with Svensk Näringsliv [Swedish Business Life], which promotes free enterprise and pri- vate companies. As far as Isolating alternatives, five cases provide information about the right of choice. Case No. 2 (a PPP) and Case No. 6 (owned by Svenskt Näringsliv) do not provide this information. Of the seven cases, six support the search among all schools (pub- lic or private) and/or education programmes using various criteria. Case No. 4 supports the search only among the municipality’s own schools. This is a large municipality where school choice is highly competitive. In addition, in Case No. 4, the description of choice has a greater market orientation than in the other cases.
Other significant differences exist among the cases in the area of education. Case No. 3 (a new national public support for comparing schools operated by The Swedish National Agency for Education) has a device with different personal preference criteria for use in comparing schools (distance, size, qualification of teachers, grad- ing, etc.) (see Fig. 1). The other cases feature indirect comparisons using a list of separate schools. However, Case No. 3 still has columns with selected schools including all provided criteria or types of information. Case No. 2 allows comparisons of a few schools, arranged in columns based on all types of information (including diagrams and numerical data). Case No. 6 (financed by Svenskt Näringsliv) is the only case that supports ranking of options. In the other cases, the user must sort among the alternatives (“Man- ual ranking”). Case No. 1 is the only case that permits direct choice among all upper secondary schools in the 13 municipalities. Case No. 4 and Case No. 5 (owned by the municipality of Gothenburg) permit indirect choice among the regional schools through a link to Case No. 1’s device. In Case No. 7, the Metro Corporation offers Web-based decision support that is linked to Case No. 1 or to similar regional support.
5.2. Healthcare
Sweden introduced choice reform in primary care in 2010 (Ministry of Health and Social Affairs, 2008/2009Ministry of Health and Social Affairs, 2008/2009). With this reform, all citizens are allowed to choose among the primary care centers in a county coun- cil, although choice of doctors is not an option. The county councils or private healthcare agencies operate these centers. In healthcare, Case No. 8, operated by the national association (SALAR) and Case No. 10, operated by an individual county council, provide infor-
mation about the right of choice. Case No. 9, operated by Svenskt Näringsliv, is more concerned with allowing citizens to make com- parisons (see Table 2). All three cases support comparisons based on contact information and patient investigations. Case No. 9 is the most advanced because of its ranking device that allows a user to decide on the importance of basic features (e.g., distance, patient satisfaction, ownership, waiting time before contact) (see Fig. 2). The user may also add a personal evaluation that others may read. However, Case No. 9 does not permit the user to make a choice whereas Case No. 8 and Case No. 10 permit a choice selection.
5.3. Elder care
Choice in elder care (home help for the elderly) was introduced in Sweden broadly in 2009 in connection with LOV (Law on the Right to Choose) (Ministry of Health and Social Affairs, 2009). How- ever, each municipality may choose whether to offer choice in elder care. Approximately 60% of the municipalities have introduced the choice option (Swedish Association of Local Authorities and Regions, 2013).
Public agencies own both elder care cases (see Table 3). Regarding Isolating alternatives, both Case No. 11 and Case No. 12 provide information about the right of choice. Both cases per- mit searches among provided services according to simple criteria (e.g., type of care, municipality). Case No. 12, owned by the Stock- holm municipality, has the capacity for sorting among the often rather long list of private and public providers in particular areas of the municipality. Selected criteria are used in the sorting step. Regarding Examining alternatives, both Case No. 11 and Case No. 12 permit comparisons according to a list of features (e.g., organization type or available services). However, Case No. 12 also permits more direct user searches. Regarding Ranking and choosing alternatives, specific ranking is not possible in either case. Case No. 12 permits choice in the Stockholm municipality, but Case No. 11 does not.
5.4. The public pension system
In 2000, pension reform in Sweden offered a choice compo- nent for the public pension system. People were offered a choice of investing in approximately 800 premium pension funds. These funds charge an obligatory fee on all earnings. Employees con- tribute 16% of their earnings to general public pension fund, and 2.5% of their earnings to the premium pension system fund (SOU, 2005).
Table 4 presents two cases: Case No. 13, owned by a national public agency, The Swedish Pension Authority, and Case No. 14, a PPP (Minpension.se). Regarding Isolating alternatives, both cases include information about choice. However, Case No. 13 supports searches for alternatives using many criteria. These criteria include a Decision Support System (DSS) to make advanced comparisons for Ranking and choosing premium pension funds. In contrast, Case No. 14, which offers a more indirect form of support for choice, shows the results of choices made in the premium pension plan as well as how the choices fit into the individual’s entire pension portfolio, including the individual’s private retirement savings (see Fig. 3). Case No. 14 does not offer the Ranking and choosing alternative. Despite its indirect support, Case No. 14 clearly intends the decision support to be used for choice.
5.5. Isolating alternatives
In this section, we summarize the sociomaterial process of making choices that the joint activities of technology and people support. Eleven of the 14 cases have information about the right of choice of, for example, a school, a primary care centre, elder care in the home, or a pension fund. This information isolates the avail-
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Fig. 1. Case No. 3 with its device to select types of information that are important to the individual for closer examination (to the right).
Fig. 2. Case No. 9 with its ranking of the primary care clinics.
able options in a very simple but important way. Case Nos. 2, 6, and 9 that are, or were, at least partly owned by Svenskt Näringsliv do not provide such information. Therefore, a broader context for choice and the related individual rights of citizens is often sup- ported. Generally speaking, Swedish society firmly supports this concept. However, the Swedish Association of Independent Schools states:
Unfortunately there is still [in some regions and municipalities] a lack of knowledge about the rights of school choice. As a result, often the school that is closest to home is “chosen”. Thus, it is important to address this lack of knowledge so that everybody knows about their rights (Hamilton, 2015).
It is of equal importance (as observed in all cases except Case No. 4 related to the marketing of the municipal upper secondary schools) that support for searching alternatives is available.
5.6. Examining alternatives
Case Nos. 3, 6, and 11 provide numerical and textual data that can be used for examining alternatives. Case Nos. 2, 8, 12, and 13 provide diagrams or graphic information. Furthermore, many cases enable comparisons based on neutral information with the exception of links to a provider’s website. However, the website for Case No. 4 markets the municipality’s upper secondary schools. Some cases in education, healthcare, and elder care present evalu- ations, such as student, patient, or user views. Other information is available about various entities and their capacities (e.g., location, access, services, etc.). According to Jeacle and Carter (2011), it is somewhat unusual to find personal and spontaneous evaluations from users in decision support design. In our study, only Case No. 9 permits such evaluations (in healthcare only). Such user evalu- ations use the material capacity of information technology, unlike
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Fig. 3. Case No. 14 shows all the savings in the pension portfolio including public pensions, occupational pensions, private pensions, and a pension forecasts.
historical technologies, (e.g., hotel evaluations by guests) to make judgements visible (Orlikowski & Scott, 2014).
Many of the 14 cases provide direct support for making compar- isons (see Tables 1–4). Case Nos. 1, 4, 5, and 7 permit comparisons more indirectly; a user has to check each alternative and then com- pare it with others. Some cases offer more advanced devices for comparing alternatives. Often this support appears as information about a few selected entities, arranged in columns. In Case No. 3 (see Fig. 1) and Case No. 12, the designs allow selection of preferred information that can be used for making comparisons. Case No. 9 allows the selection of preferred information that can be used to create a sorted list of comparisons (see Fig. 2). Additionally, Case No. 13 has a device consisting of different steps that can be used to indicate various preferences (e.g., preferences about risk level, fees, and search time results). It also permits examination of a citizen’s current pension portfolio and comparison of it with a potential new portfolio of pension funds.
Case No. 14 has less sophisticated devices for comparing and examining alternatives (see Table 4). However, its design allows evaluation of pension fund choices in the context of other choices, from both short- and long-term perspectives (see Fig. 3). Of course, pension funding is, by its very nature, a long-term activity. How- ever, so are many of the other choices described in this study, for example, education. Interestingly, the designs in Case Nos. 6 and 7 project future salary levels. This alternative takes a more long-term perspective as well as a broader perspective on calculated choice than a temporary choice made at one moment in time. An interest- ing issue is whether this long-term perspective on choice is relevant in other areas. For example, in healthcare is the long-term perspec- tive useful for a patient with a chronic illness who is being treated at a primary healthcare clinic? Would such a perspective allow the patient to evaluate data on treatment results for a specific illness at a specific clinic?
5.7. Ranking and choosing alternatives
Comparatively few of our 14 cases offer devices for ranking alternatives on their Web-based screens in terms of specified or preferred criteria that would make choice a simpler decision. Callon and Muniesa (2005, p. 1231) describe the theoretical basis of rank- ing as follows:
A new entity must be produced (a sum, an ordered list, an evaluation, a binary choice, etc.) that corresponds precisely to the manipulations effected in the calculative space and, con- sequently, links (summarizes) the entities taken into account. This resulting entity is not new, in the sense of springing from nowhere; it is prefigured by the considerations described above.
Our cases show alternative ways to make rankings using socio- material constellations related to choice in quasi-markets (see Tables 1–4). Case No. 12 (elder care) and Case No. 13 (public pen- sion funds) show (indirectly) ordered lists that have been ranked by preferred types of information. The ranking step thus precedes the selection of alternatives for comparison. Case No. 9 (healthcare) summarizes (more directly) several criteria or types of informa- tion as a joint list. Case No. 13 shows diagrams that compare the increase in the value of selected alternatives. Alternatively, Case No. 6 (education) even more directly offers a form of holistic eval- uation that ranks the 25% top, middle, or bottom alternatives using graphics and colors. Case No. 13 permits a full comparison of a new portfolio using graphics and information in a multifaceted DSS that constructs a carefully selected portfolio of alternatives for compari- son with the citizen’s current portfolio. Thus, here we see how lists and graphics (Pollock & Dı́Adderio, 2012) can be used in various ways for rankings in quasi-markets.
There are several possible reasons why relatively few of our 14 cases have a design that supports ranking. One reason is that ranking may be perceived as controversial because it points to the “best” and the “worst” alternatives in a very obvious manner (!). Another reason is that ranking must be based on available data rather than on unavailable data that may be still more relevant. Ranking is also a controversial issue because the available data may be unclear about new service providers (The Swedish Agency for Public Management, 2007). However, this issue, which relates to the contradictory role of public authorities in providing clear messages for choice, is under discussion. An interviewee stated:
[The] authority must offer a support for choice. [. . .] It is a conscious strategy from our side that we do this quite clearly. [However] we still can not provide anything that seems like advice. (Project leader, Pension Authority, May 27, 2013)
Some research claims that ranking also influences the activities of those who are ranked by causing them to try to improve their position by manipulating or concealing information. The use of the
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ranking technologies can also affect which options (e.g., service providers) are shown when there are multiple options available (Pollock & Dı́Adderio, 2012). The issue of technologies for rank- ing and their interaction with people is, thus, an issue for further research. Nevertheless, a severe problem may result from the rela- tively minimal use of devices that support ranking. An abundance of information, which cannot be used in ranking, may influence choice negatively. More confusion, rather than simplification, may be the result. Last, but not least, our theoretical model represents the activity of making choices. Surprisingly, only eight of our cases support actual choice via Web-based support (see Tables 1–4).
5.8. Comparing the 14 cases
What conclusions can we draw about the sociomaterial constel- lations in our 14 cases related to calculated choice in the areas of education, healthcare, elder care, and public pension funds? Edu- cation has the largest repertoire of Web-based support for choice as well as agencies that provide support. Choice reform has existed in education in Sweden since the beginning of the 1990s. By contrast, choice reform was introduced for primary healthcare and elder care in 2010 in Sweden. The diversity of support in the various public service areas, especially in education, indicates a “battle of judge- ments” (Karpik, 2010). In education, citizens can choose among the education alternatives. However, they must choose among one or several systems of Web-based support for choice (!) before they can locate the available options and make comparisons. In educa- tion, quite recently (2013–2014), a PPP (Case No. 2) and a national public authority (Case No. 3) revealed a positive move toward sup- port for more citizen choice. This new support movement can be contrasted with support for school leaders, also used by parents for choice (Ranerup, 2006), and Case No. 6 (which ended in 2013). However, as Section 5.7 discusses, this long tradition of choice does not mean that education has devices that support calculation with sophisticated ranking mechanisms.
We conclude that, increasingly, in education as well as in healthcare and public pension funds, private agencies (e.g., Svenskt Näringsliv and the Metro Corporation) provide support (Case Nos. 2, 6, 7, 9, and 14). In fact, in Case Nos. 2 and 14, these agencies work in cooperation with public agencies. In other words, they take an active part in what we usually see as the technological con- struction of the relationship between the state and the individual. This relationship is featured in the research field of e-Government that often, we argue, is implicitly assumed to be an area for public agencies only (Beynon-Davies, 2005).
We also conclude there are a number of areas where there are differences between the cases. With Isolating, differences exist as far as the availability of information about rights and in the search devices for alternatives. With Examining, differences exist as far as the kind and availability of information and the types of devices for making comparisons. With Ranking, differences exist in the outlay of available alternatives, and in the support for choice. These dif- ferences may be of use for designers interested in understanding how calculated choice may be supported.
Another conclusion is, despite the details about available sup- port in the 14 cases, enabling calculated choice, the support is somewhat lacking, especially when it comes to devices that offer ranking and choosing. The main exception is Case No. 13 where the choice of pension funds is supported. Pension fund reform introduc- ing choice, which began in 2000, involved a leading national public pension authority as well as a number of banks and investment firms. Thus, organizations quite accustomed to making choices were involved with the reform from its beginning. Interestingly, instead of a “battle of judgements”, such as we find in education where there are many instances of available support, in public pen-
sion a number of companies offer pension fund investment advice “for a small fee”.
Ranking is an activity that very obviously shows the author- ity of materiality. In ranking, technology is a powerful actor that influences choice (Pollock & Dı́Adderio, 2012). Although ranking, in perhaps its most important use as a producer of a sorted list (Case No. 9), is not common in our 14 cases, many devices, in inter- action with their users, enable calculation through a clear use of technologyı́s discretionary power. The simplest example is tech- nology’s capacity to enable a selection of a few instances for further comparisons in columns based on various types of data. While this capacity appears in many of our cases, there are examples more directly related to ranking (Section 5.7). The design in each case influences the joint activities of technology and people. The opera- tor or owner of the technology is yet another “actor” who appears between the consumer and a market (Pollock & Dı́Adderio, 2012) that consists of many service providers. This is important because various public agencies operate the support systems in many of our cases. These agencies have, generally speaking, higher status than commercial actors, or are themselves commercial actors with access to public data.
A final conclusion of our study is that that the sociomaterial constellation in the 14 cases very clearly shows variations in the division of labor between people and technology. When we look at Isolating alternatives, people have a larger role because technol- ogy only reveals a general aspect such as the right of choice and a number of instances of the requested services (Section 5.5). When we look at Examining alternatives, sometimes people have to do most of the work compared to situations in which technological devices, to some degree, exist to support examinations and com- parisons. However, people must make a significant part of these examinations and comparisons because each alternative has many different kinds of information even when it is structured in columns (Section 5.6). In contrast, in the various ranking displays (Section 5.7), materiality plays a larger role.
5.9. Contributions
Our study’s contribution to previous research on decision sup- port for choice in quasi-markets (see Section 2) is its theoretically informed discussion of how more sophisticated Web-based sup- port designs for choice are developing in several public service areas. Sweden is a good context for such as study because of its long tradition of school choice and its experience with choice reform in many public service areas. In contrast to some previous studies, our intention is not to show how these designs influence choice in practice (cf. Gomez et al., 2012; Koning & van der Wiel, 2013) or to discuss how citizens can use these online channels (Van de Wijngaert, Pieterson, & Teerling, 2011). Our technological focus contributes to research into sociomateriality in a general sense, and to research on the material construction of markets in a particular sense (Callon & Muniesa, 2005; MacKenzie, 2009).
In addition, unlike many other studies that apply theories about sociomateriality (Cecez-Kecmanovik et al., 2014), our conclusions derive from empirical data (Jones, 2014). Our study is also of practi- cal relevance for the politicians, project leaders, and designers who today are responsible for the improvement of public services as a whole (Panagiotopoulos, Al-Debei, Fitzgerald, & Ellliman, 2012). We provide a view of potential technological outlay of 14 instances of decision support and make a comparative, structured analysis of their functions (Section 5 and 5.5–5.8). This is of special value, we argue, because previous research deals with public service areas individually.
Therefore, three design principles can be extracted from our cases.
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a The provision of information about the right of choice is impor- tant. In fact, this right appears in many public service areas where public and private entities, such as those in our study, provide decision support. The exception is Svensk Näringsliv. Interest- ingly, as Gingrich (2014) concludes, providing information also has significant influence on people’s values and participation in elections.
b The awareness of the full repertoire of potential types of infor- mation is important. Our study of cases in several areas indicates that an extensive amount of information can be provided about available options and opportunities via Web-based decision sup- port. This information may be presented, for example, in numeric, textual, or graphic form [“format”]. This repertoire may use neu- tral information (vs. marketing information), information about present circumstances (vs. future opportunities), and user evalu- ations from official investigations (vs. more personal evaluations of opportunities [“aim”]). In this manner, information designers’ choice of information can be based on a more complete and com- plex understanding than that described in previous studies (Allen & Burgess, 2011; Leckie & Goldstein, 2011; Ranganathan et al., 2009).
c The awareness of the full repertoire of available ways of sorting and ranking is important. Because of risk of information over- load in choice situations, providing comparison devices for use in selecting alternatives is necessary. However, making compar- isons of long columns of data on relatively few alternatives may still be unsatisfactory. In contrast to studies of single cases in single areas (Pollock & Dı́Adderio, 2012; Pollock and Dı́Adderio, 2012), our study discusses a number of ways to reduce this com- plexity. For example, user preferences on service options and opportunities for certain aspects or types of information can be highlighted before users examine a few selected alternatives. Or, sorted lists can be prepared for users based on these preferences. Our study also shows that ranking can be achieved by presenting graphic information and examples as well as by sorted lists.
Last, but not least, our results are theoretically relevant to the technological construction of the relationship between the state and its citizens (Gauld et al., 2010; Lips, 2007), for example, in the context of NPM reforms. Our results contribute with a new per- spective on these reforms in their focus on the role of citizens as consumers or customers (Mosse & Whitley, 2009). Thus, our results depict the design of quasi-markets and their technologies that, in part, aim to support citizens in their more traditional democratic role as well as in other roles such as consumers.
5.10. Limitations and further studies
A limitation in our research methodology, as noted above, is that we have not studied the actual use of decision support designs (MacKenzie, 2009). However, as Gad and Jensen (2010) argue, research goals allow differences in applying theoretical and methodological concepts in the study of sociomateriality. We have tried to present a theory-based, comprehensive view of several areas of public services by describing the content of information provided and the design or general outlay of the functionality as a representation of the sociomateriality of (quasi-) markets in Web- based decision support.
A study, such as ours, which applies Callon and Muniesa’s (2005) framework, is not neutral. Therefore, it may create critical discus- sion of the world that we would like to design (Roscoe & Chillas, 2013). One very relevant issue in this context is the strengthening of the citizen’s role as a consumer or customer (Clarke, Newman, Smith, Vidler, & Westmarland, 2007; Mosse & Whitley, 2009). The technological decision support for choice very obviously has this dimension and aim. Other technologies dedicated to citizens’
collective discussion and action might well complement the tech- nologies we describe. On the other hand, all but a few of the 14 cases we studied had information about the rights of citizens as a part of the Isolating alternatives.
We suggest that researchers more closely examine the perfor- mative implications when technologies and people are involved (Cecez-Kecmanovik et al., 2014). The most urgent question con- cerns how the value of the services and their ranking are constructed in actual use.
6. Conclusion
In this paper we examined how Web-based decision support and citizens jointly contribute to calculated public service choices in quasi-markets, using Sweden as our setting. The area of edu- cation has the greatest amount of support, perhaps reflecting the “battle of judgements” Karpik (2010) refers to. However, decision support also appears in many other public service areas. Regarding Isolating alternatives, the majority of our 14 cases include informa- tion about the right of choice as well simple devices for searching among and listing alternatives. Regarding Examining alternatives, the majority of our 14 cases permit direct comparisons based on various kinds of information although a few support more indi- rect comparisons. Regarding Ranking and choosing alternatives, all 14 cases explain how to make a choice although relatively few have ranking devices. Nevertheless, our cases provide a reasonable summary of the available sociomaterial designs of ranking devices. Ranking is an activity that very obviously shows the authority of materiality and how it mutually influences, or controls, citizens when they make choices.
Therefore, the studied Web-based support for choice in quasi- markets is not consistent with the theoretical model of calculated choice in all its aspects. Nevertheless, there is a clear trend in this direction. On the other hand, our cases do, in interaction with their users, enable calculation through a clear use of discretionary power.
Our results call for a critical discussion of “the world we like to design”. An important issue in this discussion issue is the increas- ingly evident role of citizens as consumers or customers in their relationship with public services.
Acknowledgement
The Swedish Research Council is greatly acknowledged for fund- ing our research.
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- How are citizens' public service choices supported in quasi-markets?
- 1 Introduction
- 2 Previous research on decision support for citizens' choice
- 3 Theory
- 4 Material and methods
- 4.1 Research setting
- 4.2 Data collection and analysis
- 5 Results
- 5.1 Education
- 5.2 Healthcare
- 5.3 Elder care
- 5.4 The public pension system
- 5.5 Isolating alternatives
- 5.6 Examining alternatives
- 5.7 Ranking and choosing alternatives
- 5.8 Comparing the 14 cases
- 5.9 Contributions
- 5.10 Limitations and further studies
- 6 Conclusion
- Acknowledgement
- References
Socializing-in-emergencies-A-review-of-the-use_2015_International-Journal-of.pdf
International Journal of Information Management 35 (2015) 609–619
Contents lists available at ScienceDirect
International Journal of Information Management
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j i n f o m g t
Review
Socializing in emergencies—A review of the use of social media in emergency situations
Tomer Simon a,b,∗, Avishay Goldberg b,c, Bruria Adini a,b
a Emergency Medicine Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel b PREPARED Center for Emergency Response Research, Ben Gurion University of the Negev, Beer Sheba, Israel c Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
a r t i c l e i n f o
Article history: Received 26 June 2015 Accepted 9 July 2015 Available online 31 July 2015
a b s t r a c t
Social media tools are integrated in most parts of our daily lives, as citizens, netizens, researchers or emergency responders. Lessons learnt from disasters and emergencies that occurred globally in the last few years have shown that social media tools may serve as an integral and significant component of crisis response. Communication is one of the fundamental tools of emergency management. It becomes crucial when there are dozens of agencies and organizations responding to a disaster. Regardless of the type of emergency, whether a terrorist attack, a hurricane or an earthquake, communication lines may be overloaded and cellular networks overwhelmed as too many people attempt to use them to access information. Social scientists have presented that post-disaster active public participation was largely altruistic, including activities such as search and rescue, first aid treatment, victim evacuation, and on- line help. Social media provides opportunities for engaging citizens in the emergency management by both disseminating information to the public and accessing information from them. During emergency events, individuals are exposed to large quantities of information without being aware of their validity or risk of misinformation, but users are usually swift to correct them, thus making the social media “self-regulating”.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.1. Disaster characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.2. Social order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.3. Disaster management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.4. Communication challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 1.5. Loss of communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 1.6. Public participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 1.7. The need for information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
2. Social media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 2.1. Short introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 2.2. Social media for emergency management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.3. Social media and preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.4. Technology adoption and usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 2.5. Remote islands of innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 2.6. Recruiting the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
∗ Corresponding author at: Emergency Medicine Department, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheba, 84105, Israel. Fax: +972 8 6472136.
E-mail address: [email protected] (T. Simon).
http://dx.doi.org/10.1016/j.ijinfomgt.2015.07.001 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
610 T. Simon et al. / International Journal of Information Management 35 (2015) 609–619
2.7. Crowdsourcing in disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 2.8. Information categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.9. Location based information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.10. Information dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 2.11. Disinformation and inaccuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615 2.12. Emergency responders and social media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615 2.12.1. Budget and training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 2.13. Challenges to data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 2.14. Global social sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616
3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
1. Introduction
Social media (SM) tools, especially Facebook and Twitter, are taking an ever growing part in disaster response (Cohen, 2013; Sarcevic et al., 2012). SM during disasters and emergencies was initially utilized by the general public to communicate, and is now being adopted by emergency responders, governments and non-governmental organizations as an integral tool for disaster management (DM).
This paper reviews how SM tools are used in disasters by the public, emergency organizations and academic institutions. This paper reviews the literature concerning utilization of social media in emergencies between 2007 and 2014. Some of the reviewed arti- cles reference earlier materials and these are noted in the review concerning specific topics.
1.1. Disaster characteristics
In the last few decades, numerous regions worldwide have been stricken by severe natural disasters, such as earthquakes, floods and hurricanes, causing extensive damages to human lives and infras- tructures.
Disasters have been defined as a state in which the social fab- ric is disrupted and becomes dysfunctional to a greater or lesser extent causing “maximum community disruption and dislocation” (Britton, 1988; Fritz, 1961).
Natural disasters have spatial characteristics such as extent and boundaries. This configuration is disrupted during the onset of a sudden disaster which adversely affects the natural and human resources, as well as the social relationships in the region (Jigyasu, 2005; Palen & Liu, 2007). At present there seems to be a consensus among researchers that a disaster cannot be explained by a number of recognizable factors, and efforts are being made to understand why and when people perceive a certain period or common expe- rience as a disaster (Boin, 2005).
In response to disasters, numerous agencies and organizations often work together and direct their efforts towards a common goal (Reddy et al., 2009; Kopena et al., 2008). Frequently, the public- private interface is strengthened to support crisis management, and governments may simplify processes to access resources and goods without due process (Quarantelli, 2006).
1.2. Social order
According to Alexander (2005) an average day in the world “would see two to three disasters in their emergency phases, 15–20 in their recovery periods, and about a dozen conflict-based emergencies in progress”. These include events such as wars, earth- quakes, and extreme weather conditions. Coupled with the loss of communications, it becomes a period of uncertainty that may cause collective stress resulting from deprivation of a large portion of the society from expected routine conditions. These conditions,
deprived from many, are socially defined as normal human needs (Barton, 2005). However, the general public often takes an active role in disasters and their involvement is becoming more and more visible, through the use of Information and Communication Tech- nologies (ICT) (Palen & Liu, 2007).
1.3. Disaster management
An organized response to disaster management (DM) is cru- cial to mitigating loss of lives and damage to infrastructure. Dynes (1970) described both theoretical and practical aspects of an orga- nized response, including staffing, strategy, tasks, and relationships between various responding organizations and the social environ- ment itself.
Information sharing and coordination are a critical factor in DM, especially among responding organizations (Yates & Paquette, 2011; Bharosa, Lee, & Janssen, 2010). In his research, Bharosa et al. (2010) found that responders prefer to receive information and are reluctant to share it with others. Also, even when for- mal information flows through the command structure, ad hoc and personal-basis channels are created to support multi-level infor- mation sharing (Bharosa et al., 2010). The US National Incident Management System (NIMS) is based on a hierarchical command structure to “divide responsibility of labor and support inter- jurisdictional coordination” (Palen & Liu, 2007). According to this model, there is a single official, the Incident Commander (IC), to whom all responding organizations report, and he has the author- ity and overall responsibility to maintain a unified command during the entire event.
An integral part of DM is situational awareness (SA), described by Vieweg, Hughes, Starbird, and Palen (2010) as features contributing to the understanding of the emergency situation, especially in respect to the operational needs of command and con- trol. SA reports can originate from local residents, reporters, first responders or from authorized information sources (Qu, Huang, & Zhang, 2010).
1.4. Communication challenges
Communication is one of the fundamental tools of emergency management. It becomes crucial when there are dozens of agencies and organizations responding to a disaster. DM requires that these organizations’ rapid response, along with their own set of roles and responsibilities, be coordinated within and between sectors (Reddy et al., 2009).
Each organization operates its own radio frequencies, making it difficult to create a unified and synchronized response. The pri- mary challenge is technological, ranging from rapid deployment of a communications system for first responders, to interoperability between various organizations. Communication systems must be able to withstand a disaster and enable devices to function effec- tively even when communication networks have collapsed (Manoj
T. Simon et al. / International Journal of Information Management 35 (2015) 609–619 611
& Baker, 2007). These findings were further reinforced by Reddy et al. (2009) who found that current technologies are ineffective and inadequate to support the flow of information within and between coordinating teams during a disaster.
1.5. Loss of communication
Most disasters cause severe damage to communication infra- structure (Low et al., 2010). Phone switches and cell phone towers might collapse, fully or partially, thus disrupting the much needed communication (Palen & Liu, 2007). Regardless of the type of emer- gency, whether a terrorist attack, a hurricane or an earthquake, communication lines may be overloaded and cellular networks overwhelmed as too many people attempt to use them to access information. Severe natural disasters may cause the entire com- munications grid to blackout, as infrastructure is severely damaged (Stiegler, Tilley, & Parveen, 2011). In some cases the disaster may strike a geographic region that lacks communication infrastructure; but even in places where partial communication infrastructure remains intact, deployment of new systems may be found to be complex (Manoj & Baker, 2007). As the conventional means of com- munication become irrelevant during and immediately following a disaster, alternate means such as social networks become an impor- tant conduit for information gathering and sharing (Hughes, Palen, Sutton, Liu, & Vieweg, 2008; Bird, Ling, & Haynes, 2012; Huang, Chan, & Hyder, 2010).
1.6. Public participation
People have experienced disasters since the dawn of humanity, and as such their high involvement in the response phase is not new. The public’s part in disasters has been studied by many soci- ologists since the 1950s, including emergent behavior as a means to substitute and form important societal functions after a disas- ter strikes. Individuals and groups agree that action must be taken in response to an event (Drabek & McEntire, 2002). This usually materializes as volunteerism, both emergent and organized, with different manifestations depending on the type of disaster, stage of the response, region and society. Some volunteer from per- sonal reasons and some for altruistic causes (Wolensky, 1979). Studies have presented that while victims of physical disasters such as earthquakes engage in active self-help, victims from other situations of mass deprivation (i.e. starvation, economic crash or oppression) seem to generate fatalism, lack of active self-help, self- blame, or an irrational search for a guilty party (Barton, 2005).
Most social scientists have presented that post-disaster active public participation was largely altruistic, including activities such as search and rescue, first aid treatment, victim evacuation, and on-line help (Kendra & Wachtendorf, 2003; Palen & Liu, 2007). The general public serves as the true “First responders”, with a visible, active, and extensive high involvement. Today, through the use of new ICTs, their role offers additional ways to participate and com- municate (Palen & Liu, 2007; Lu & Yang, 2010). Researchers have compared the physical convergence of people to a geographical site after a disaster to the convergence to online SM tools, and found similarities in the population’s behavior. At present, there are no limitations to the locations or number of people that can participate in the on-line convergence (Hughes et al., 2008).
1.7. The need for information
People are natural information seekers, relying primarily on their own social networks (Palen & Liu, 2007). Following a disaster, the public initially seeks the most common and familiar chan- nels; phone calls, emails, or text messages. If unsuccessful, they turn to alternative and/or official sources of information (Stiegler
et al., 2011). Mileti & Darlington, 1997 presented that individuals in emergency situations use whatever means available to find infor- mation. People seek information for themselves, to learn about the emergency event, locate their family and friends, and reduce uncertainty regarding what has happened; they will seek any avail- able venue of information including newspapers, television, and the Internet (Boyle et al., 2004; Stiegler et al., 2011; Hughes et al., 2008). Skinner (2013) describes how she as a researcher collects and aggregates information from different sources during emer- gencies, and publishes it in order to inform those who are affected by the event. In events that endanger the public’s health there is high importance to the ability to act, especially when expected to take ameliorative actions, or actions to identify the risk (Maxwell, 2003). Messages should be disseminated quickly and be simple enough so that people with high anxiety would be able to com- prehend and comply appropriately (Wray et al., 2008).
With the advancement of internet technologies and tools, users in crises surfed online to seek information specific to their neigh- borhoods and activate weak ties in their social networks (Abbasi, Hossain, Hamra, & Owen, 2010). These novel capabilities have cre- ated a new form of “civilian journalism” that enables participation during emergency events (Laituri & Kodrich, 2008). The internet is becoming a more reliable tool as traditional media channels suffer disruptions and damage caused by the crisis (Procopio & Procopio, 2007).
People have identified forums as a communication and infor- mation sharing platform through which they can seek, share, and synthesize information (Qu, 2009). The next step in the evolution was the massive use of social network sites, such as Facebook and Twitter.
2. Social media
2.1. Short introduction
Social media (SM) consists of tools that enable open and online exchange of information through conversation, interaction and exchange of user generated content (Huang et al., 2010; Abbasi et al., 2010; Kavanaugh et al., 2011). Unlike traditional ICTs, SM manages the content of the conversation or interaction as an infor- mation artifact in the online environment (post or tweet) (Yates & Paquette, 2011).
SM allows people to establish connections and links with other individuals who are similar to them, or whom they find interesting. Users can post news or links, discuss them, and share their opinions during real times. The SM can be utilized to mobilize and organize populations in order to achieve various objectives, and update them with the most up-to-date information, which might not be available through alternate official channels (Lerman & Ghosh, 2010).
During natural disasters SM provides access to relevant and timely information from both official and non-official sources, and facilitates a feeling of connectedness (Taylor, Wells, Howell, & Raphael, 2012). This connectivity to loved ones and the commu- nity provides reassurance, support and assistance to potentially distressed individuals and populations (Taylor et al., 2012).
Facebook is the largest SM network, with 1.35 billion monthly active users (Facebook Newsroom, 2014). The users of Facebook have the ability to connect and share thoughts and information with friends, join common interest groups and state their prefer- ences (signify ‘like’). People mark ‘like’ in posts, pages and groups they want to follow and publish their agreement, or support, of the content published (Bird et al., 2012).
Twitter is a service through which users can post short messages of up to 140 characters, called tweets, from web- and mobile- based clients. Twitter has 284 million monthly active users (Twitter,
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2014). Users establish a network by “following” other Twitterers, and having others “follow” them (Vieweg et al., 2010). Users often mark their posts with topic labels, named “hashtags”, which are used as operational proxies to identify messages (Weng, Flammini, Vespignani, & Menczer, 2012), and help others understand the con- text of the message (Starbird & Palen, 2010). Information can be redistributed by users in the form of re-tweets, which are a conven- tion in Twitter to pass on already published information. Usually re-tweets are a response to tweets that users find more interesting or important (Vieweg et al., 2010).
Twitter provides an Application Programming Interface (API) that can be used to perform searches according to keywords and hashtags (Abbasi et al., 2010), but it is limited to accessing only a restricted number of entities (Lerman & Ghosh, 2010) These key- words have to be extracted from the public’s Twitter stream, as conducted by Vieweg et al. (2010) in their research. The results can be traced back to the Twitterer and from there, the entire stream of tweets, replies and re-tweets can be accessed. There are many available tools on the internet that enable visualization of data from Twitter. Social networks’ information exchange supports the per- sistence requirement stated by Palen & Liu, 2007 regarding forms of communications that emerge during or after an onset of a disaster. Persistency refers to communications that are visible, recordable, and/or transferable to other people over time.
Another advantage of the SM compared to the traditional media is the simplicity of collecting and disseminating information. Utilization of traditional media websites and channels necessi- tates an active search for information, while the SM accesses the information newsfeeds at live and real times (Bird et al., 2012). Coupled with an internet connection that has become available to all, individuals are connected almost regularly and continuously (Jansen, Zhang, Sobel, & Chowdury, 2009), which enables them to share, coordinate and distribute information regarding events in real time (Gupta, Lamba, Kumaraguru, & Joshi, 2013). SM provides unprecedented access to information that is published online by various users (Hale, Gaffney, & Graham, 2012). During emergencies, the amount of available informa- tion in SM exceeds the capacity of the public to consume it, and thus a competition over the attention of the individual and the public is created (Weng, Flammini, Vespignani, & Menczer, 2012).
2.2. Social media for emergency management
The utilization of SM for communicating during emergencies was initiated by the public before its utilization by emergency authorities. It is possible that the way emergencies are managed and the uni-directional communication coerced the public to find alternate ways to search and publish relevant and updated infor- mation concerning the event (Sutton, Palen, & Shklovski, 2008). According to Latonero & Shklovski, 2010, two main branches of research deal with the uses of social media during an emergency; the first focuses on ways in which emergency organizations use it to coordinate activities during their response actions, and the sec- ond deals with the ways the public and victims share information during emergencies. This review article is based on 57 research articles that delineate various aspects of the use of SM during emergencies. Table 1 classifies these articles according to the emer- gency/disaster type they address (natural disaster, terror attack, communicable disease, public order and non-specific events), the research methodology utilized (quantitative or qualitative), the SM they cover (Twitter, Facebook, Flickr, or other), the research type (active, passive, simulated, or exercise), and the year of the event. The research type relates to the method the data was collected by, where passive indicates using any computational way to collect SM data (i.e. Twitter API). Active means that the researchers made an
Table 1 Classification of articles according to topics analyzed in each manuscript.
# Of articles Percentage Comments
Type of disaster covered Natural disaster 26 46% Terror attack 3 5% Communicable disease 3 5% Public order 2 4% Non-specific 23 40%
Research methodology Quantitative 31 54% Qualitative 26 46%
Social media analyzed Some articles cover several types of SM
Twitter 35 61% Facebook 11 19% Flickr 2 3% Other 17 30%
Research type Active 34 60% Passive 19 33% Simulated 2 3.5% Exercise 2 3.5%
Years of occurrence 2007–2008 5 9% 2009–2010 19 33% 2011–2012 9 15% 2013–2014 3 5%
‘active’ effort to collect the data/information (i.e. interviews); sim- ulated generally refers to computer models who do not deploy real information to run; exercise refers to research that used an exercise to test a theory and collect the information.
Fig. 1 presents the total number of tweets in four major emer- gency events that occurred between 2010 and 2013, and a trend line showing the rise in SM adoption during such events. Following the Haiti earthquake, 3.28 million tweets were posted (Sarcevic et al., 2012); 20 million tweets were posted during hurricane “Sandy” in 2012 (Olanoff, 2012); 27.8 million tweets were posted following the Boston Marathon bombing in 2013 (Rovell, 2013); and, 5.72 mil- lion tweets were posted during typhoon “Haiyan” in 2013 (Levine, 2013).
2.3. Social media and preparedness
SM provides opportunities for engaging citizens in the emer- gency management by both disseminating information to the public and accessing information from them. These tools have been used to improve preparedness by linking the public with day-to-day, real-time information, as was well presented during the 2009H1N1 pandemic. A few minutes after the Alexandria, Virginia health department tweeted regarding availability and loca- tion of vaccines, people rushed to the vaccination sites (Merchant, Elmer, & Lurie, 2011). This has presented that integration of social tools into preparedness activities could facilitate an effec- tive emergency response for professional responders as well as the citizens, using familiar tools during a crisis (Merchant et al., 2011). Despite the low cost, wide reach and proven advantages before, during and following crises, SM tools have been shown to be underused by health professionals (Vance, Howe, & Dellavalle, 2009).
2.4. Technology adoption and usage
Most individuals tend to use technologies that they are famil- iar with (such as mobile phones, email and known news websites)
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Fig. 1. Total number of tweets posted during emergencies between 2010 and 2013.
prior to an emergency to access information, but some adopt new ICTs during an event. The goal is not the utilization of the technol- ogy itself but rather how communities fulfill unmet needs through adaptation and innovative uses of ICT (Shklovski, Palen, & Sutton, 2008). ICT offers a means for those living under extreme circum- stances to reconnect with other residents, solicit and aggregate information that affects them all. It has been implied that people have “found community” (though a virtual one) through the use of ICT, in which they actively seek others with similar needs and con- cerns regarding their geographical communities (Shklovski et al., 2008).
There are significant differences in the adoption of Facebook and Twitter in terms of usage, news consumption, demographics and the country. A Princeton led survey found that 70% of Face- book users receive their news from friends and family and 13% from news organizations. On Twitter, 36% of the users receive news from friends and family, while 27% from news organizations. The survey also found that despite the rise of news consumption through SM, it does not come at the expense of direct access to news sites. 71% of Facebook users and 76% of Twitter users still get news directly from news sites or apps (Mitchell, Rosenstiel, & Christian, 2012).
2.5. Remote islands of innovation
Media coverage of an affected area is not equal in all disasters; while central locations are widely covered; remote sites with inad- equate access tend to receive little or no coverage at all (Fernando, 2010). The need for local and reliable information can moti- vate residents with technical skills to create simple solutions for their community, facilitate exchange of information and promote humanitarian relief efforts in their area. These actions can accel- erate empowerment of the community, provide support during and between variable emergency events, serve as a communication platform during a specific emergency (Procopio & Procopio, 2007), and shut down not long after the emergency has subsided. The out- come depends on the maturity and experience of the community (Shklovski et al., 2008). If the public will not find or receive infor- mation from official sources, they will turn to unofficial sources in order to access it in real time (Hagar, 2013). Community solu- tions appeared almost immediately following the floods that were experienced in Australia during 2011. The local residents accessed community Facebook pages in order to assist their families and allow others to share photos. Though formal administrations inte- grated official information into their web pages, the most important source of information was accessed from local residents (Bird et al., 2012).
2.6. Recruiting the public
Once sources of information have been recognized, technologi- cally competent residents in the disaster area are able to utilize a range of SM to redistribute information to community members who might not have the same access. These community mecha- nisms, information hubs and repositories of local information are available resulting from the common concern and joint actions of local area residents. Twitter users have frequently filled the func- tion of information hubs following disasters (Hughes et al., 2008). The unidirectional communication and information distribution of emergency authorities might have ‘compelled’ the public to find alternative ways to search for and disseminate updated and rele- vant information regarding the event (Sutton, Palen, & Shklovski, 2008). People have reported feeling compelled to collect and dis- seminate information as a way of alleviating concerns of those around them (Shklovski et al., 2008; Bird et al., 2012). Using an online survey Bird et al., (2012) discovered that most people iden- tified relevant community pages through friends’ invitations, or a Facebook search. She also presented that two-thirds of the respon- dents accessed Facebook groups to find information regarding their own community. Taylor et al. (2012) claimed that the activity of people utilizing SM mirrors their actual needs, whether searching and seeking information about what was happening, or actively asking for information and providing assistance to others.
2.7. Crowdsourcing in disasters
The term “crowdsourcing” was first coined in 2006 refer- ring to organizations outsourcing tasks to the connected crowd, irrelevant of their location or identity (Howe, 2006). It is also defined as an “online, distributed problem-solving and production model” (Brabham, 2008), allowing “capable crowds to participate in various tasks, from simply ‘validating’ a piece of information or pho- tograph to complicated editing and management” (Gao, Barbier, & Goolsby, 2011).
Following the 2011 Haiti earthquake, an unprecedented activity was observed in which many communities world-wide under- stood that they did not need to be in Haiti physically, in order to provide assistance. Through common workgroups established in 2009, as CrisisCamps and CrisisCommons, civilians, NGOs, gov- ernments and private companies combined their efforts to collect massive amounts of data to create maps. These maps were dissem- inated directly to the Haitian government, emergency responders and the US Army that were on site (Zook, Graham, Shelton, & Gorman, 2010). Crowdsourcing was incorporated to the DM field
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following the 2010 Haiti earthquake when Ushahidi’s crowd-map1
became a shared social disaster response tool for responders lever- aging information from the “crowd” (Starbird, 2011; Abbasi et al., 2010). Crowdsourcing platforms enable the creation of different types of maps rapidly, thus facilitating the shift of existing limited resources to other tasks (Zook et al., 2010), as well as collection and analysis of information concerning damages in the area of the event (Yang et al., 2014). These platforms include two types of users – those located at the scene of the event (on-site) that perform rescue and management operations and need updated information, and remote users (off-site) that are able to perform different tasks in order to assist the on-site users, such as the infor- mation analysis and provision of updated information. This form of work may provide real-time or per-request information to the field emergency management personnel (Yang et al., 2014), and enable the creation of a virtual teams, or virtual operation support team (VOST), which can assist the response efforts (Denis, Hughes, & Palen, 2012).
2.8. Information categories
The public can assist during emergencies in classifying and sor- ting the large amounts of information flowing through SM, enabling simplification of its analysis and processing (White, Plotnick, Kushma, Hiltz, & Turoff, 2009). Information disseminating on SM can include updates regarding the writers’ status, links to news sites, and emotional messages to those affected by the event, as well as humoristic messages (Skinner, 2013). Chew & Eysenbach, 2010 presented in their research that the public publishes 14 dif- ferent types of information through SM – news, information or updates about the event; personal experiences; personal opinion and interest; jokes; marketing and advertising; spam and irrelevant information to the event; humor and sarcasm; joy; risk reduction; concern, fear, anxiety and/or sadness of the writers towards oth- ers; despair and anger; misinformation; and questions about the event/subject. Each piece of information on SM can be assigned to one or more categories as it includes both direct information derived from the text, as well as information derived from its anal- ysis, such as the mood and attitude of the writer (Jansen et al., 2009). In contrast, another group of researchers (Imran, Elbassuoni, Castillo, Diaz, & Meier, 2013) stated that it is sufficient to divide the information during emergencies to two main categories – personal (relevant to family and friends of the writer) versus informative information (relevant to the public).
2.9. Location based information
Following a disaster, there is a significant demand and need for maps and spatial information, as presented after the Haiti earthquake in 2010. In order to implement an effective response, the emergency responders need to receive information as to the location of the afflicted population and how best to reach them promptly (Zook et al., 2010; Abbasi et al., 2010)
MacEachren et al. (2011) found that “social media is becoming increasingly geographic” and the potential use of this information in emergencies had been recognized by both academic institutions and the emergency organizations themselves (MacEachren et al., 2011; Palen & Liu, 2007).
Tweets and Facebook posts can provide two types of loca- tion based information. The first is Geo-location data which is clearly identifiable information that includes street addresses and
1 Ushaidi’s platform is based on Web 2.0 technologies which handle data inte- gration from a variety of social media sources using crowdsourcing techniques to (Denis et al., 2012) create SA reports and cooperation (Gao et al., 2011).
intersections, city and county names, highways and place-names, whether precise or more general. This type of information not only aids those who access it, but also accommodates automatic retrieval of relevant information regarding a specific emergency event (MacEachren et al., 2011). The second type is Location- referencing which refers to information that uses one place as a replacement for another, or mention of location via a landmark. These do not contain easily extractable geo-location information, but rather data concerning the location of both individuals and the emergency (Vieweg et al., 2010). In events where the two types are not available, it is possible to extract the location of the user’s residence from his personal profile, and assume that he publishes information from the same area. This assumption carries the risk of placing events in the wrong location, as the user might publish information while located in a different region/country completely (Earle, Bowden, & Guy, 2011; Hale et al., 2012). It was also found that analyzing tweets for geographic location according to language analysis is difficult, with low accuracy rates, and necessitates fur- ther research (Hale et al., 2012). The stage of emergency has an important effect on geo-location information, as during the initial warning/alert stage people do not as yet know the entities or loca- tions that will be affected; these are crucial during the impact and recovery stages as there is a need for information regarding the locations of hazards, evacuation routes, availability of resources and efforts that are invested to manage the situation and provide relief to the population (Vieweg et al., 2010). There are numerous tools and platforms available that aim at locating, capturing and display- ing geo-information based on SM (MacEachren et al., 2011). Social mapping platforms utilize crowdsourcing capabilities to map entire areas for roads, buildings and damage (Zook et al., 2010; Starbird, 2011). The resulting maps can be used to allow responding organi- zations to promote collaboration between them, share information and enhance coordination during implementation of their missions (Gao et al., 2011). Chatfield & Brajawidagda, 2012 presented that 47% of users included their location in tweets, a fact that enabled placing them on maps, while in the research of Vieweg et al. (2010) it was shown that the numbers are 40%. It seems that less and less users are adding their location to tweets, as can be seen in the research of Starbird, Muzny, & Palen (2012) where the numbers dropped to 0.23% out of all tweets. Hale et al. (2012) showed that approximately 16% of the users do not include information about their location in their personal profile. Local populations may rec- ognize and refer to places and regions under different names, and in fact replace the official name with a known alternative. To resolve this issue researchers have developed an information system that analyzes information from Twitter in order to create a database of such names (Chan, Vasardani, & Winter, 2014). This information may assist emergency responders in identifying the places that the public uses without the need to mention the exact official address.
2.10. Information dissemination
In the traditional disaster management model, information flowed from emergency organizations to the public (Low et al., 2010). After analyzing millions of tweets Shklovski et al. (2008) extracted and coded situational features on Twitter communica- tion elaborating the standard information categories of emergency management (warning, preparatory activity, fire line/hazard loca- tion, flood level, weather, visibility, road conditions, advice, evacuation information, volunteer information, animal manage- ment, and damage/injury reports). The incorporation of SM tools has changed the traditional information dissemination pathways during emergencies. Today there are many more information providers and a higher involvement of the public using official and unofficial sources (Zook et al., 2010).
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The mechanism for spreading information during different disasters is similar, namely, users watch their friends’ activities or their reported behavior, and through messaging actions, they make this information visible to their own fans or followers (Lerman & Ghosh, 2010). In a survey conducted by Bird et al. (2012), 97% of the respondents claimed to have communicated and forwarded directly the information they accessed from Facebook pages to their family and friends. In some instances, reports issued through SM tools appeared much earlier than through the news channels (Qu, Huang, Zhang, & Zhang, 2011; Lerman & Ghosh, 2010). SM tools present an excellent mechanism for information dissemination. In Twitter, re-tweeting can cause an exponential proliferation and dissemination of the information (Tamura & Fukuda, 2011).
A government organization that wants to use social tools during a crisis to communicate with the public should first define its poli- cies, receive the support of the managers, define what information should be shared and through which channels (Kavanaugh et al., 2011).
During the 2011 floods in Queensland and Victoria, Australia, Facebook became the primary tool to disseminate information to the public. In the 24 h following the flash floods, the number of ‘likes’ to the Queensland Police Service (QPS) Facebook page increased exponentially from 17,000 to 100,000, and two days later it had more than 160,000 ‘likes’. Traditional media channels, such as radio and TV, relied on the information posted on Facebook, and reported it within minutes after it was published on the QPS page (Bird et al., 2012). In a different study, Taylor et al. (2012) found that although SM are popular, people are still likely to turn to the television for emergency information. Nevertheless, the research also shows that SM serve as a conduit, directing people “to official sources of information and amplifying these messages to a broader audience” (Taylor et al., 2012).
2.11. Disinformation and inaccuracy
The identity of users and accuracy of the information they post on SM sites cannot be guaranteed (Merchant et al., 2011). During emergency events, individuals are exposed to large quantities of information without being aware of their validity or risk of misin- formation (Lu & Yang, 2010).
Zook et al. (2010) wrote that for recovery operations follow- ing a disaster, only “Good enough” geographic information can be sufficient, and that crowdsourced information is as useful as infor- mation produced by an expert. Zook et al. (2010) added that “with enough people working together, any errors by one individual can easily be corrected by another” (Zook et al., 2010).
Even though rumors and inaccurate information can be dis- seminated during the peak of a disaster, users are usually swift to correct them, thus making the SM “self-regulating”. More so, offi- cial authorities publish corrections to disinformation and rumors using their own SM sites (Bird et al., 2012). In their work, Mendoza, Poblete, & Castillo, 2010 followed the propagation ‘confirmed truths’ and ‘false rumors’ on Twitter after an earthquake in Chile. They found that approximately 95.5% of tweets validated the ‘con- firm truths’, and only 29.8% validated the ‘false rumors’; while more than 60% denied or questioned them (Mendoza et al., 2010). According to Taylor et al. (2012) research found that only a very small percentage (6%) of the population will rely solely on SM for information, resulting from their suspicion of the validity of infor- mation. It was also stated that in order to maintain integrity and trust, the administrators of the SM pages must identify and ban as early as possible ‘trolls’2 and other disturbances. It should though
2 A ‘troll’ is internet slang for those who provoke other users and disrupt discus- sion (Taylor et al., 2012).
be taken under consideration that maintaining trust and rebutting misinformation, requires a high level of active management that can be challenging to community-based SM channels (Taylor et al., 2012).
In their research, Latonero & Shklovski, 2011 presented that val- idating information accessed from the public poses a big challenge to the emergency organizations that need to decide whether or not to commit resources, based on the information supplied. Accord- ing to their findings, the emergency management professionals that review the SM must use intuition, experience and traditional means of communication rather than innovative technological solutions (Latonero & Shklovski, 2011). As the information flow increases, emergency authorities have less control over it, and might be pres- sured to validate and authenticate the information generated by the public (Zook et al., 2010)
2.12. Emergency responders and social media
Only limited scientific literature focus on emergency respon- ders and their use of social media. Nonetheless, many researchers have noted the potential use of this media by emergency respon- ders, and stated that if used, their ability to reach larger crowds faster will increase significantly (Denis et al., 2012). The London Police started using social media as an additional communication channel with the public during the riots of 2008 (Crump, 2011), and again in the riots of 2011 (Denef, Bayerl, & Kaptein, 2013). Since the 2010 earthquake in Haiti, emergency responders around the world have adopted social media as an important additional communica- tion channel with the public (Bird et al., 2012; Sarcevic et al., 2012). Hurricane “Sandy” in 2012 was a turning point where the majority of emergency authorities and first responders from the East Coast in the United States adopted social media as the main communication channel with the public (2013). In Kenya, all of the first respon- der organizations use social media as the major communication channel with the public during emergencies, as manifested in the Westgate Mall terror attack in 2013 (Simon, Goldberg, Aharonson- Daniel, Leykin, & Adini, 2014).
Rapid assessment of critical information, such as the affected area, distribution of damage, locations of the population and poten- tial areas where search and rescue missions are likely to be required, are of high priority in DM (Durham, Johari, & Bausch, 2008). Emergency authorities must verify the information they publish, so there is an eventual delay until it is delivered to the public (Bird et al., 2012), but it will be needed and requested on a near real-time basis (Zook et al., 2010).
The decision making process for official emergency response that is provided by the various organizations are part of the government’s responsibility; political considerations may make large-scale adoption of technologies complex (Latonero & Shklovski, 2011).
Emergency authorities are often structured in hierarchical, rank-based organizations which operate according to specific “silos” with particular expertise, as described by Yates & Paquette, 2011. During the Haiti earthquake in 2010, the US Government and Armed Forces relied almost completely on organizational SM tools (Microsoft SharePoint) to coordinate knowledge and actions between cooperating response agencies (Yates & Paquette, 2011). The traditional risk and crisis communication was one-way from the emergency organizations to the public through the news media (TV and radio), acting as intermediaries. Although these chan- nels remain the primary means of communication, integrating SM provides the potential for “interactive, participatory, synchronic, two-way communication” (Latonero & Shklovski, 2011; Palen & Liu, 2007).
A government organization that wants to use social tools during a crisis to communicate with the public should first define poli-
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cies, receive support of the management, define what information should be shared and through which channels (Kavanaugh et al., 2011).
It has been recommended that every organization utilizing tech- nological solutions and integrating SM for emergency response, should incorporate professionals with Information Technology (IT) expertise, as Public Information Officers (PIO) and technology ‘evangelists’ (Latonero & Shklovski, 2011), SM moderators (Bird et al., 2012; Qu et al., 2011), or a Communications and Informa- tion Technology expert to configure SM tools (Yates & Paquette, 2011). Nevertheless, emergency managers also do not want to be distracted by too much information that might be irrelevant or not-critical (Bharosa et al., 2010).
Understanding the “overall picture” during a disaster may be difficult as the ever-growing information flow is being updated constantly, while large portions of it are redundant (Qu et al., 2011). Kavanaugh et al. (2011) stated that emergency managers can “detect meaningful patterns and trends in the stream of messages and information flow”, and emergency events “can be identified as spikes in activity, while meaning can be deciphered through changes in content” (Kavanaugh et al., 2011).
2.12.1. Budget and training Using SM entails two types of costs that should be considered.
The first is the cost of training employees that will operate and pub- lish information through SM tools, although it has been shown that most government employees have a profile on at least one SM tool. This might reduce costs and shorten training programmes. The sec- ond is more covert, referring to the return-on-investment (ROI) of using SM tools (Kavanaugh et al., 2011). Latonero & Shklovski, 2011 presented in their case study that emergency organizations lever- aging SM do not train their PIOs, relying solely on their self-learning skills, and depending on “their ability to utilize social media effec- tively”. Furthermore, Denef et al. (2013) stated that as SM are novel communication channels for the emergency responders and there are almost no available guides or procedures, they are required to practice their use. There are guiding principles that emergency organizations provide to their employees regarding the need to separate their personal profile from their organizational presence (Beneito-Montagut, Anson, Shaw, & Brewster, 2013).
To effectively use SM tools in disaster situations, they should be utilized by the involved parties during routine times and incorpo- rated in daily activities. In the last three years, disaster simulation games were encouraged in order to test the ability to collect infor- mation from SM tools during different stages of a disaster. During these exercises, people posted messages through SM tools and took part in crowdsourcing tasks (Abbasi et al., 2010). Another exer- cise leveraged social media tools in response to an earthquake. The exercise was performed by actual first responders who used social media, on top of in addition to conventional communica- tion technologies, to improve their search and rescue operations (Simon, Adini, El-Hadid, & Aharonson-Daniel, 2013). In the last few years, the organizers of the Great California Shakeout Drill have used social media to enhance communications prior to and dur- ing the drill, as well as to extract feedback from participants. The use of social media enables the organizers to reduce the number of resources required (Wood & Glik, 2013).
2.13. Challenges to data analysis
On August 22nd, 2012 Facebook revealed some statistics regarding its daily information flow. Facebook ingests daily more than 500 terabytes of data, 2.5 billion pieces of content, 2.7 bil- lion ‘likes’ and 300 million photo uploads (Constine, 2012). Twitter has more than 400 million tweets daily, and above 140 million active users, most of which use Twitter via mobile devices (Farber,
2012). SM sites constantly produce vast amounts of information, both relevant and irrelevant. Using filtering and pattern recognition on the data streams, emergency managers can access important and meaningful information in real-time, and be able to provide an immediate response, and understand events as they unfold (Abbasi et al., 2010; Kavanaugh et al., 2011; Sheth, Purohit, Jadhav, Kapanipathi, & Chen, 2011). Over time, the detected patterns can provide responders with perceptions and trends of communities. Conducting surveys via phone or mail requires substantial efforts prior to and during data collection, as well as substantial funding. Analyzing the results often takes months to complete. Information flow through social tools is a much more effective and economical method to gather data in real time. In 2009 the American Red Cross conducted a survey which presented that 75% of the population reported that they will use SM during a crisis situation; approxi- mately 50% would let others know that they were safe through SM; 86% would use Facebook; and 28% would use Twitter (Kavanaugh et al., 2011).
Studying Twitter communication during emergency events is challenging as access to tweets is short-lived, requiring quick deci- sions regarding what information to collect while the event is still in progress, but before its scope and data produced are fully under- stood (Vieweg et al., 2010).
SM sites continuously create large amounts of information with different degrees of relevancy. For example, during hurri- cane “Sandy”, approximately 20 million tweets were published on Twitter, and about 10 photos related to the storm were uploaded to instagram every second. Numerous entities, both official and non-official, publish information simultaneously, including civil- ians, government or private organizations, journalists, news sites and others that create an information overload during emergen- cies, making it difficult to find, organize, understand and act upon it (Hagar, 2013; Verma et al., 2011; Kavanaugh et al., 2011).
Approximately 300 million users publish hundreds of millions of tweets daily (Hale et al., 2012). Manual analysis on such amounts of information is not possible, especially in times of stress during emergency management, and thus automated systems that enable real-time monitoring of the flow of information are required (Pohl, Bouchachia, & Hellwagner, 2012). At the same time, there is a need to prevent cognitive overload of the commanders and decision makers by flooding them with such unlimited information (Blum, Eichhorn, Smith, Sterle-Contala, & Cooperstock, 2013). The writing style of tweets, due to the length constraints and the use of natural language, complicates the automatic analysis capabilities, such as different names people assign to events and locations (Chan et al., 2014).
2.14. Global social sensors
SM that connect millions of users worldwide and enables rapid communications can be leveraged as an effective mechanism to transfer information without delay (Chatfield & Brajawidagda, 2012). Furthermore, the internet and SM tools enable health profes- sionals to transform the ways in which disease outbreaks and other disasters are tracked and responded to (Schmidt, 2012; Cookson et al., 2008). It was even shown that using Twitter, H1N1 out- breaks and activity can be identified in real-time, 1-2 weeks prior to detection based on the Centers for Disease Control and Prevention’s (CDC) surveillance system (Signorini, Segre, & Polgreen, 2011).
The US Geological Survey (USGS) has reported that 75% of earth- quake detections through tracking tweets containing the word “earthquake” were made within 2 min of the origin time. This rep- resents a much faster identification than seismographic detections in many regions in the world, and has a low rate of false triggers (Earle et al., 2011).
T. Simon et al. / International Journal of Information Management 35 (2015) 609–619 617
The first indication of a number of emergencies throughout the world was published on Twitter, which enabled the publica- tion of information to large crowds in real time. The World’s first posts on two terrorist incidents in 2013 were published initially via Twitter: the Boston Marathon bombing (Cassa, Chunara, Mandl, & Brownstein, 2013), and the Westgate mall terror attack in Nairobi, Kenya (Simon et al., 2014).
On August 8th, 2014 the World Health Organization (WHO) declared the Ebola epidemic outbreak in West Africa as an inter- national emergency (WHO, 2014). From reading traditional media websites, it is clear that social media takes an active and impor- tant role, whether in the dissemination of news and information by government agencies (Murphy, 2014), and in the spread of rumors and misinformation that might even put the lives of their read- ers at risk (Blair, 2014). Crowdsourcing platforms are also active in tracking the Ebola outbreak on social media, and assist in locat- ing suspected Ebola cases (Morgan, 2014). The research papers that have been published to date, focus mainly on the risks of rumors and misinformation spreading on Twitter (Oyeyemi, Gabarron, & Wynn, 2014).
3. Conclusions
SM tools are integrated in most parts of our daily lives, as citizens, netizens, researchers or emergency responders. Lessons learnt from disasters and emergencies that occurred globally in the last few years have shown that SM tools may serve as an integral and significant component of crisis response.
Emergency managers who were formerly used to one- directional dissemination of information to the population are now exposed to vast amounts of information, originating from the pub- lic. This crowd-information precedes any other formal available information and exposes emergency managers to a large influx of information.
The innovative usages of SM tools during disasters were initiated by resourceful individuals and then incorporated by the public for their own objectives. During and mostly after a disaster, new ways of utilizing SM tools to collect, share, and disseminate information, were witnessed. Emergency authorities, NGOs and governments were “coerced” by the public’s demands and needs to use the SM. Researchers from different academic professions, such as sociol- ogy, psychology, computer sciences, health sciences, emergency management and communication strive to develop new tools to analyze trends in the extensive data flows and transform them into knowledge.
Four main types of SM users during disasters have been iden- tified including: (1) Innovative – users who improve and adjust SM for their special circumstances; (2) Reactive – users who try to respond and assist the afflicted population using SM tools for the first time; (3) Responsive – emergency responders that use SM tools regularly, but step-up and leverage them during disasters; (4) Proactive – users or emergency organizations that use SM tools to promote preparedness in routine and are able to leverage them during emergencies.
Twitter is currently the most widely researched SM tool, proba- bly due to the ease of extracting information, while Facebook does not provide an effective option to search or collect information from its pages. These differences might cause a “selection bias” in the research, thus not representing the population’s true SM behavior during emergencies.
Further studies of the potential utilization of the social media by first responders and governmental agencies prior to and during disasters, are highly recommended.
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- Socializing in emergencies-A review of the use of social media in emergency situations
- 1 Introduction
- 1.1 Disaster characteristics
- 1.2 Social order
- 1.3 Disaster management
- 1.4 Communication challenges
- 1.5 Loss of communication
- 1.6 Public participation
- 1.7 The need for information
- 2 Social media
- 2.1 Short introduction
- 2.2 Social media for emergency management
- 2.3 Social media and preparedness
- 2.4 Technology adoption and usage
- 2.5 Remote islands of innovation
- 2.6 Recruiting the public
- 2.7 Crowdsourcing in disasters
- 2.8 Information categories
- 2.9 Location based information
- 2.10 Information dissemination
- 2.11 Disinformation and inaccuracy
- 2.12 Emergency responders and social media
- 2.12.1 Budget and training
- 2.13 Challenges to data analysis
- 2.14 Global social sensors
- 3 Conclusions
- References
A-learning-organization-in-the-service-of-know_2015_International-Journal-of.pdf
International Journal of Information Management 35 (2015) 636–642
Contents lists available at ScienceDirect
International Journal of Information Management
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / i j i n f o m g t
Case study
A learning organization in the service of knowledge management among nurses: A case study
Marie-Pierre Gagnon a,b,∗, Julie Payne-Gagnon b, Jean-Paul Fortin c, Guy Paré d, José Côté e,f, François Courcy g
a Faculty of Nursing Science, Université Laval, 1050 avenue de la Médecine, Quebec City, Canada b CHU de Québec Research Center, 10 rue de l’Espinay, Quebec City G1L 3L5, Canada c CSSS de la Vieille-Capitale, 880 Père-Marquette, Quebec City G1S 2A4, Canada d Department of Information Technology Management, HEC Montréal, 3000 chemin de la Côte-Sainte-Catherine, Montreal H3T 2A7, Canada e Faculty of Nursing Science, Université de Montréal, 2375 chemin de la Côte-Ste-Catherine, Montreal H3T 1A8, Canada f CHUM Research Center, 850 rue St-Denis, Montreal H2X 0A9, Canada g Department of Psychology, Université de Sherbrooke, 2500 boulevard de l’Université, Sherbrooke J1K 2R1, Canada
a r t i c l e i n f o
Article history: Received 29 April 2015 Accepted 9 May 2015 Available online 23 May 2015
Keywords: Learning organization Knowledge management Nursing Continuous learning
a b s t r a c t
It becomes critical for health care organizations to develop strategies that aim to design new work prac- tices and to manage knowledge. The introduction of learning organizations is seen as a promising choice for better knowledge management and continuing professional development in health care. This study analyzes the effects of a learning organization on nurses’ continuing professional development, knowl- edge management, and retention in a health and social services centre in Quebec, Canada. The learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital centre. These changes were particularly pro- nounced with respect to knowledge transfer, support for nursing practices, and quality of health care, objectives that the learning organization had sought to meet since its inception. However, it seemed to have a limited effect on nurse retention.
© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Today’s society emerged as a result of a transformation from an industrial era to a knowledge era, leaving room for the creation, collection, and use of knowledge (Johannessen & Olsen, 2010). As highly knowledge intensive institutions requiring continuous edu- cation in order to improve their potential (Tsai, 2014), health care institutions have seen their knowledge capital increase in impor- tance with the transformation of society (Estrada, 2009; Tsai, 2014). Health care professionals are also in need of knowledge since their practice requires lifelong learning in order to improve their com- petencies and provide effective and quality care for their patients (Tsai, 2014).
∗ Corresponding author at: Faculty of Nursing Science, Université Laval, 1050 avenue de la Médecine, Quebec City, Canada. Tel.: +1 4185254444×53169; fax: +1 4185254194.
E-mail addresses: [email protected] (M.-P. Gagnon), [email protected] (J. Payne-Gagnon), [email protected] (J.-P. Fortin), [email protected] (G. Paré), [email protected] (J. Côté), [email protected] (F. Courcy).
On the other hand, health care institutions are also facing impor- tant challenges in the area of knowledge management. Managing knowledge in health care organizations is complex since they are multi-level and multi-site networks with central management, but also strong local organizations (French et al., 2009). Also, the sheer amount and fragmentation of information, rapid expansion of knowledge, and context dependency make it impossible for a per- son to access all the available knowledge in this domain (Estrada, 2009; French et al., 2009). Additionally, the health care sector is experiencing a widespread nursing shortage in many developed and developing countries around the globe (Buchan & Aiken, 2008; Littlejohn, Campbell, & Collins-McNeil, 2012), and faces an ageing population (World Health Organization, 2010). An important loss of knowledge capital is attributed to the retirement of experienced and knowledgeable nurses across the institutions (Clauson, Wejr, Frost, McRae, & Straight, 2011). This situation is alarming due to the possible consequences that they may have on health care pro- fessionals practice as well as access, security, and quality of health care (Clauson et al., 2011; Estrada, 2009).
In this context, it is critical for health care organizations to look for innovative solutions, as well as to develop strategies that aim to design new work practices and to manage knowledge. Among the
http://dx.doi.org/10.1016/j.ijinfomgt.2015.05.001 0268-4012/© 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).
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possible solutions, learning organizations are seen as an interesting and promising choice for better knowledge management (Davies, Wong, & Laschinger, 2011; Zheng, Yang, & McLean, 2010).
1.1. Learning organization
The term ‘learning organization’ was popularized in Peter Senge’s “The Fifth Discipline: The Art and Practice of the Learn- ing Organization” (Senge, 1990). A learning organization is defined as an organization that exhibits adaptability, learns from mistakes, explores situations for development, and optimizes the contribu- tion of its personnel (Wilkinson, Rushmer, & Davies, 2004). Senge outlined five personal disciplines that are key features of a learning organization: system thinking, personal mastery, mental models, shared vision, and team learning (Senge, 1990). These disciplines allow for the creation of infrastructure that promotes continuous learning, adaptation, and growth in organizations (Estrada, 2009). Consequently, one of the main goals of the learning organization is to construct an organizational culture of learning (Tsai, 2014).
The development of a learning culture in an organization involves the continuous education of its members. This process takes place by converting individual memory, which is the accu- mulated knowledge of an individual, into organizational memory, which takes the form of goals, handbooks, or standard procedures (Chen, Lee, Zhang, & Zhang, 2003). When successfully converted, it is critical to make organizational knowledge accessible to promote organizational learning (Chen et al., 2003). This knowledge needs to be transmissible, easily distributable, and comprehensive so that all members consider it valid and useful (Abel, 2008; Chen et al., 2003). Completely integrated knowledge represents a coherent, accessible, and maintained organizational memory, a vital aspect in a healthy organizational learning process (Abel, 2008).
It is believed that introducing a learning culture in health care organizations could improve the quality of professional practice, satisfaction, lifelong learning, and patient care, while also lowering costs (Bell, Robinson, & See, 2013). However, despite the impressive documentation on learning organizations, studies on this topic in health care settings remain scarce in the current literature (Bell et al., 2013).
In order to better understand the impacts of introducing a learn- ing organization in these settings, this study aims to explore its effects on nurse professional, educational, and organizational fac- tors related to continuing professional development, knowledge management, and retention in a Health and Social Services Center (French acronym: CSSS) of the province of Quebec, Canada. A CSSS is an integrated health care organization that usually comprises various types of facilities and health care services: local commu- nity services centers, residential and long-term care centers, and, where applicable, general and specialized hospital centers on a given territory (Quebec Ministry of Health, 2013). This CSSS rep- resents the only case where a formal learning organization culture was introduced in the Quebec health care context.
2. Context of study
In 2003, a major medico-nursing crisis was caused by a fail- ure to rescue event. Confronted with this situation, the Nursing Directorate put in place a clinical committee on continuous qual- ity improvement composed exclusively of nurses. Their mandate was to understand and to identify the problems experienced by their colleagues. Members of the committee quickly realized that their CSSS was ill equipped for the promotion of the education and expertise of their nurses, which threatened the quality and security of care.
The chosen solution to these issues was the implementation of a new organizational culture, the learning organization, which had three main goals: better quality and security in health care, support for nurse practice, and knowledge transfer. The imple- mentation, which began in 2005, was done in two initial phases. The first was the restructure of the continuous support to nurses in their practice through a mentoring program. The second phase, that aimed to accommodate, support, and retain employees, was realized through the development of learning strategies focused on the idea of knowledge that was there “just in time, just enough, and just for me”.
A variety of strategies assisted by information and communica- tion technology (ICT) were created to support the learning process in the organization. Among them, the most used was the video. The first projects involving knowledge transfer were the creation of four DVD videos about topics judged more problematic and that required in-depth study: newborn assessment, Plum A+ infu- sion system, CADD pump, and the maternity unit. Later, animated memos were added to the DVDs. As explained by the manager, an animated memo is a few minutes video filmed in action by a sim- ple over-the-shoulder camera. These videos are generally used to illustrate health care practice (such as delirium management) and were introduced to replace old paper memos scattered on notice- boards of the facilities. Doing so made the animated memos more accessible to employees. Other important learning strategies and programs supported the value of continuous learning and collec- tivity promoted by the learning organization: checklists, guidelines, aide-memoires, procedure sheets, lunch conferences, as well as mentoring, integration, speciality, and orientation programs.
3. Methods
3.1. Study design and participants
To investigate the learning culture implemented in this par- ticular CSSS, we conducted an exploratory case study. The study received the approval of the CHU de Québec ethical committee prior to the recruitment of participants. We used a purposive sampling approach, targeting key informants who had been involved in the learning organization, due to the exploratory nature of the study. Recruitment began from a list of ten individuals who had partic- ipated in the learning organization’s projects whose names were provided by the Nursing Directorate of the targeted CSSS. All of the individuals on the list were contacted by phone. Before the interviews, participants had to give their informed and voluntary consent by reading thoroughly and signing a consent form.
3.2. Data collection and analysis
We conducted face-to-face semi-structured interviews based on a conceptual map that was developed in the first phase of the project (Gagnon et al., 2013). The interview guide included three sections: the effects of the learning strategies and activities developed by the learning organization on nursing practices, the factors that influenced the adoption of projects developed within the learning organization, and the influence of the learning orga- nization on nurse retention. The interviews lasted approximately one hour and were audio recorded with the participants’ consent.
Interviews were transcribed verbatim producing a total of 103 pages of transcripts. We then analyzed their content with the help of the qualitative data analysis computer software NVivo (QSR International). In order to do so, we adopted a deductive–inductive thematic analysis, using the conceptual map as the starting point for the codification, and completing it with emerging themes. Two people independently analyzed the interviews and then compared
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their codification in order to reach consensus. Interview quotes presented in section 4 were translated into English from French.
4. Results
4.1. Participants’ characteristics
From the ten people contacted by phone, eight agreed to par- ticipate in the study. Two declined to participate due to heavy workload. Two more individuals, who were met at the study site, agreed to participate, bringing the total number of participants to ten. Eight face-to-face interviews were completed (seven individ- ual interviews and one with two participants), and one individual interview was done by videoconference (the participant was absent during our visit to the CSSS). All participants but one was a nurse; the other participant was an information technology technician who had an important role in the creation of various learning strate- gies assisted by ICT for the learning organization. All participants were female. This was accidental, but not surprising considering that the great majority of nurses in the province of Quebec are female (Marleau, 2013). Most nurses had more than 20 years of experience, but their tenure in their current position was more varied, ranging between 1.5 and 20 years. Finally, half of the par- ticipants were fairly new to the learning organization, working in this CSSS for less than three years. See Table 1 for more details.
4.2. Changes in nursing practice
The learning organization brought important changes to nursing practice. Specifically, it brought a new culture to the nurses based on continuous learning at work. According to six participants, the mentoring program for nurses of zero to five years of experience was a good incentive to new nurses to begin and continue working in this CSSS and a great way to promote continuous learning. Firstly, the program integrated new nurses to their environment through training on the basic procedures in place in the CSSS given by a nurse-educator. Secondly, novice nurses were paired with experi- ence colleagues in their specific field of practice in order to support
Table 1 Participants’ characteristics.
Participants’ characteristics All participants (n = 10)a
Role Nurse 3 Nurse-educator 2 Assistant chief-nurse 1 Chief-nurse 2 Manager 1 Technician 1
Gender Female 10
Years of experience (nursing) 10–14 years 1 15–19 years 1 20–24 years 2 25–29 years 4
Years in current position Less than 5 years 2 5–9 years 2 10–15 years 3 16–20 years 1
Years working with a learning organization 3 years and less 4 4–6 years 3 More than 6 years 1
a Two participants did not answer the three questions related to years of experi- ence, reducing the total number of participants for these questions to eight.
knowledge transfer and their work. Thirdly, the nurse-educator also conducted routine assessments of the novice nurse practice to ensure the progression of her integration and knowledge acqui- sition.
New nurses as well as older nurses also benefited from the learning strategies created through the learning organization, par- ticularly in the case of videos. The video format used for many projects of the learning organization was considered worthwhile by four participants since it allowed nurses to show the experien- tial knowledge in their daily practice and to describe it visually and audibly, something that could hardly be done before these video projects were carried out. The four DVD videos were distributed in the form of binder so that every installation and unit could have access to these videos. Also, some novice nurses received DVD copies if it was related to their speciality.
Six participants claimed that these strategies made it possible to learn anytime and anywhere since the videos were accessible to them at any time of the day or night on a variety of topics. Seven participants thought that the information acquisition was fast and believed that having the information quickly accessible decreased the time spent for searching it. Additionally, five par- ticipants noted that the information was customizable and eight participants pointed out that these videos represented a great infor- mation reminder for nurses. See Table 2 for a summary of the changes brought to nursing practice by the videos prepared within the learning organization.
Participants also mentioned other changes that took place in relation to their new work environment. All nurses noticed that the practice of care improved with the introduction of the learning organization. Specifically, participants observed improvements in the level of nurse autonomy; three participants noticed time sav- ings and two participants noticed a decline in the level of stress at work. Four participants believed that the learning organization sup- ported the standardization of practices, and four noticed that nurses reflected more on their practice. In terms of work satisfaction, five participants noticed an improvement in general satisfaction at work. Two participants also mentioned that a collective pride among nurses seemed to take hold. Eight participants noted that there was a feeling of recognition often associated with the learning organization’s projects. For example, some nurses noted that more colleagues referred to them after their participation in certain video projects. It is also interesting to note that all of the learning organi- zation’s projects were created by a group of chosen experts on the topic, strengthening collaboration and communication between nurses, and even with other professionals participating in these projects.
Five participants believed that the exposure to the learning organization’s programs and projects would help the process of appropriation of information by their colleagues and, ultimately, develop an intellectual curiosity that could bring them to “learn to learn” by themselves. For four of them, this curiosity could even encourage some to engage more actively to the learning organiza- tion culture through proposing new projects or themes and even participating directly in the creation of learning strategies. Table 3 summarizes the positive effects of the learning organization on nurses’ work environment.
In this CSSS, the distance between the facilities is important, and the use of ICTs was judged critical to achieve the goals of the learning organization across the points of services. According to three participants, the committee chose ICTs that were already available, but that could complete similar tasks at a more reason- able price than more expensive alternatives. The manager gave one particular example of this re-appropriation with respect to the videoconference. Instead of installing expensive videoconfer- ence systems, the organization opted to use equipment that could allow practical communication among nurses from different points
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Table 2 Summary and selected quotes related to the changes brought by the videos to nursing practice.
Changes n Selected quotes
Information reminder 8 After a while, we forget our notions and when we come back with a video that reminds us of the outlines, we can get back to the basics more easily . . . We are more aware that we have forgotten information and need to read up on it again. [. . .] Or we remember teaching that was done in the morning. The nurse can say that we will look at the video again, together. That’s its purpose. (Nurse)
Fast information acquisition 7 Suppose that you don’t know a procedure or a technique. Before, I would take my big notebook of techniques, I would browse through it until I got to. . . Oh, there it is! I would need to read the technique, memorize it, see it with someone or have someone show me. It’s the same thing now. There are cases when nurses do not remember certain procedures or techniques. They need to seek that information somewhere. What the learning organization does is to make the information available right then and there. (Nurse-educator)
Accessible knowledge 6 There are often relatively few nurses on the floor, one or two per shift. If on a Saturday evening at 10:00 PM a young nurse needs an application of the displacement pump, and she doesn’t know how to do it, well, it’s for these reasons that we created the learning videos. (Nurse-educator)
Customizable information 5 There are some people who still like paper. But if you want, I can give you another format. You can listen to it on the iPad, you can watch it at home, and you can see it directly on the computer if you know how it works. [. . .] It’s a new way to present things. It’s interesting for them. (Nurse-educator)
Demonstration of experiential knowledge
4 The nurse will do something automatically sometimes. After that, you ask her to describe the technique that she used. . . She will write it out, but the little thing she did to save time is not written. That’s experiential knowledge. We were not transmitting such knowledge. We were wondering how it was done. We would start videos and nurses noticed: “Hey I do that; I didn’t think that I was doing that. . .” We began writing things down and describing them, and we noticed that there were a lot of unspoken actions. (Chief-nurse)
of services while being economical and mobile. The chosen equip- ment for these tasks was the iPad and iPhone. These devices did not produce the same video quality as dedicated videoconference sys- tems, but they still fulfilled the functions entrusted to them. iPads and iPhones were also used for remote support of novice nurses. The novice nurse had the possibility to call the nurse-educator for a direct consultation when encountering an issue with a patient.
Additionally, these devices allowed access to the videos created by the learning organization, since all of them were integrated into the system by the technical team before giving them to the nurses. For six participants, this access was particularly interesting when it came to the transportability of information, especially in home care. For three participants, these devices were seen as easy to handle
Table 3 Summary and selected quotes related to the positive effects of the learning organization on nurses’ work environment.
Effects n Selected quotes
Improved care 10 [The learning organization] has a ripple effect, we optimize our knowledge, we train the young nurses, we transfer our knowledge and we reinforce our team. [. . .] All these projects share the concern to optimize our care and to offer a better service to our clientele. (Nurse)
Feeling of recognition 8 Since I was part of one of these projects, I helped a nurse who had to work with [the equipment the project was on]. I was also the expert that assisted a nurse for a new project [for another equipment]. New nurses, and even the older ones. . . those who are doing their bachelors, they refer to us a lot more since the project. It was enjoyable. I liked it. (Nurse)
Appropriation of information 5 It is to recognize expert nurses in their fields, the leaders. They’re the key persons to seek out. They’re the one that have credibility and those we want to see in the videos. People will identify to them. The novice that sees [the expert] in the video says: “She is in the TV, she must be quite the expert!” You recognize the person and her personality. It makes the videos enjoyable to watch. You cannot do otherwise than to understand why you need to change your practice. It has an impact. And you want to follow them in these projects. (Nurse)
Increase in work satisfaction 5 Nurses are more satisfied since they have now their say in the projects, can suggest ideas and management is more attentive to what they say. (Technician)
Engagement in the organization 4 I believe that it’s a significant project, it’s a team project. It created a synergy and pride. Because when the product is out, and we receive praises, it falls down on all the team. And it stimulates others to do projects, too. (Nurse)
Reflection on practice 4 I find that nurses will be more alert, they will raise questions on the procedures. “Is it the last version? It is really like that? Is it well like that?” I am more solicited at this level as an educator. (Nurse-educator)
Standardization of practices 4 What the learning organization allows me to do is to ensure a basis. For example, if I take work or work results that the learning organization has done for the maternity unit, it allows me to give a concrete training to young nurses or beginner nurses who will be novices in the maternity specialty. To give them the same functioning basis. (Chief-nurse)
Gains in time 3 We won’t send them [outside the region] for training on leadership. We won’t bring somebody over from outside the region for one or two full days like before. We will take someone from here, that we know she has strengths, and we will organize something short, such as a little clinic. We will film it. We will make a video, and make a tool with it. We will make something so that the nurse will be able to plan and make her daily team meetings more efficient. (Nurse-educator)
Collective pride 2 The learning organization was a process. People like it. They like the organization. It is a source of pride, collective pride. We diminished our medication errors. [. . .] Employees are committed to improve, committed to learn to learn, committed themselves. You don’t need management. It created more autonomy, more pride. We want that people be able to solve problems by themselves, all the time. (Manager)
Diminution of stress 2 It is especially the retention, the increased confidence for novices, to bring them to be expert rather quickly. That’s what we ask from them. It’s really, really stressing for them. I think that an environment where they feel good, where they feel supported by older nurses and where they can enjoy multiple tools to update or improve their competencies is important. (Nurse)
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and not requiring technical support, even though four participants believed that this support was available to the nurses.
According to all participants, the use of ICTs was gaining popularity among nurses. Indeed, they noticed that the nurses increasingly used ICTs as much for communicating than acquir- ing information in the workplace. One nurse even hoped for the complete computerization of the strategies used by the learning organization. Summary of the changes brought to nurses by the ICTs implemented within the context of the learning organization can be seen in Table 4.
As explained in Section 2, the learning organization’s commit- tee pursued three main objectives in the CSSS: better quality and security in health care, support for nurse practice, and knowledge transfer. The comments that were collected suggest that these goals were met. Indeed, all participants emphasized that the learning organization brought about an important improvement in these three fields.
4.3. Variable impact
Despite the positive effects of the implementation of a learn- ing organization on nursing practice, its impact was uneven across the CSSS. According to five participants, the involvement of other health professionals (apart from nurses) was very low. Being a nurses’ initiative, the creation of a learning culture was presented to the other professionals later in the change process and they were not always involved in learning strategies projects, which made it more difficult for these workers to take ownership of the project. Moreover, introducing the learning organization required an important process of culture change. This was not carried out symmetrically among the facilities of the CSSS. For instance, nurses from one local health center reported that they would not take part in conferences at the hospital center that is a 45-min drive away. A nurse at another facility reported that people were not conscious of being part of a learning organization; it was just another project for them.
This situation was caused in part by the role that the hospi- tal center played in the learning organization. According to the comments gathered during four interviews, the majority of the learning organization’s projects were conceived, created, and car- ried out at the hospital center. This situation provided little room for the learning organization to be integrated into the other facili- ties, which hampered its incorporation in their environment. At the hospital center, the learning organization was omnipresent on all floors, especially in the form of posters presenting past and ongo- ing projects. This presence was less noticeable in the other two facilities visited.
It should further be noted that accessibility problems caused by the fact that the organization could not equip all its facilities with new equipment and decent network access, due to a limited budget, were also an important factor explaining the dissymmetry between the hospital center and some of the other facilities. According to six participants, these deficiencies resulted in major accessibility issues when it came to using the learning strategies assisted by ICT in facilities that were not up-to-date on the technological level. Also, two participants noted that there was some resistance over the use of ICTs for communicating and for learning among certain nurses, particularly the older ones. See Table 5 for a summary of the barriers to the adoption of the learning organization in the CSSS.
Lastly, participants perceived that the effect of the learning orga- nization on nurse retention was limited. Even if seven participants highlighted that the implementation of this culture could help the retention of nurses in the CSSS, most believed that other factors were more important. Origins (ten mentions), work environment (eight mentions), and family situation (six mentions) were iden- tified as the most important incentives in the choice of nurses to work in the CSSS. Nevertheless, all the participants believed that the learning organization was important to support nursing practice and knowledge transfer.
5. Discussion
Our study identified many impacts that a learning organization has when it comes to supporting nurses. It also outlined the learning organization’s adoption factors in a CSSS in the province of Que- bec, Canada. Few studies have analyzed the effects of a learning organization in health care settings (Bell et al., 2013). This research sought to help fill this gap by contributing to the understanding of the effects of introducing a learning organization in a Canadian health care institution. This project also aimed to explain how the learning culture influenced nursing practices, the service organi- zation, and knowledge management, as well as how the evolution of the organizational culture resulted from the introduction of the learning organization.
Overall, the interviewed participants seemed to believe that the learning organization addressed the lingering issues of de- professionalization of the nursing profession and challenges related to the transfer of knowledge in this CSSS located in a remote region. One of the learning organization’s preferred learning strategies assisted by ICT for knowledge transfer is video, in the form of DVDs or animated memos. These homemade videos allowed easier transmission, not only of the explicit knowledge associated with nursing practice, but also of the experiential knowledge embedded in nursing practice that would otherwise be hard to formalize. The
Table 4 Summary and selected quotes related to the changes brought by the ICTs to nursing practice.
Changes n Selected quotes
Transportability of the information 6 There are no more nurses who go for nothing to patients’ homes, I don’t have patients who are not treated, there are no more refusals. With [an iPhone or iPad], a nurse can go to a home, see the video section she needs and program a pump. (Manager)
Available support for ICTs 4 I am not really into computers! So, we’re really lucky to have since two, three years, an intern specialist that programmed for us and show us how to work with these technologies. We also have many IT technicians. When we have an issue, or we do not know how to use it, they give us little training or information that allow us to work with them. We are very well supported at the technical level. (Nurse-educator)
Ease of handling 3 I learned [to use iPads] on the fly. I had also the technician who was there. She was very skillful, patient and kind. There were also trials and errors. I brought it at home and I played with it, then I worked with it. At first, I was embarrassed to bring it at home. It is a work instrument; I won’t have fun with it at home, go on the Internet and things like that! The technician told me that it was made for that, and after playing with it, I would master it and do a lot of things with it. . . She was right.
Technologies at reasonable costs 3 A problem we had, and a key to our success, was that we were small and we didn’t have the means. IT did not want to help us, so we went with resources from the community. These resources were: cameras, television, DVDs, iPads, iPhones. We went with the things on the market. We didn’t go with e-learning companies since it was so huge, heavy and practically counter-productive compared to our upcoming needs. (Manager)
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Table 5 Summary and selected quotes related to the unfavorable factors to the adoption of the learning organization.
Factors n Selected quotes
Inappropriate network access 6 At the hospital center, we are lucky; we have a broadband that is pretty strong. The problem is when you look into residential and long-term care centers or some local community services centers, where there are only one or two places in the facility where nurses can go and watch videos. The level of accessibility of the information is not equal everywhere. (Nurse-educator)
Low involvement of other professionals 5 There’re not a lot of multidisciplinary teams [for the projects]. It really needs to be an issue that touches everyone. [. . .] There’s maybe an influence [of the learning organization on other professionals], but I don’t see it. They don’t see which videos we do. They hear about it, but they don’t see any of it. (Nurse-educator)
Centralization around the hospital 4 There are a lot of people [outside the hospital center] who are not aware or don’t know the amplitude of [the learning organization]. They know it is something interesting, they hear about it, they know the outlines, but they’re not that involved in it. (Chief-nurse)
Resistance of nurses 2 Some nurses on the work floor, such as the older nurses, are stuck in a routine and say “[the learning organization] is not for me. I don’t have time for these things. I will go take my break and don’t bother me with it”. [. . .] Saying that they don’t have the time is a lack of interest in disguise. It’s the classic and fatal excuse: I don’t have the time. I don’t believe so. If you want to be up to date, you always have the time for something. (Nurse-educator)
latter statement is consistent with solutions proposed by Nonaka, Toyama, & Konno (2000) and followed by the learning organiza- tion committee, which consist of using observation and imitation to overcome the communication barrier surrounding this particular type of knowledge. By using videos to transfer knowledge, nurses created collective knowledge that preserved both explicit and tacit knowledge of their profession.
Moreover, peers and mentors transmitted to both young and more experienced nurses the ideas behind the learning organiza- tion and the value of “learning how to learn”. This type of transfer, adopted by the learning organization committee, follows the ideas of Marchand and Lauzon (2007) who assert that, ultimately, nurses should learn to learn and internalize the tools available in the orga- nization to improve their practice. This is also consistent with other authors who state that continuous learning in action, as seen with the learning organization, is more likely to influence behavior than other more traditional, passive and non-interactive learning meth- ods (Borbolla et al., 2013; Van Hoof & Meehan, 2011). Moreover, the literature supports the idea that continuing learning environments not only enhance the quality of work for health professionals, but also improve outcomes for clients (Pool, Poell, & ten Cate, 2013), which is in line with the objectives of the studied organization.
Other changes were brought about by the learning organiza- tion as regards nursing practice, such as improved communication among nurses, as well as their collaboration, thanks to the devel- opment of projects and the availability of ICT. Participation in learning organization initiatives also resulted in feelings of recog- nition, pride, and autonomy, as well as time savings, reductions in stress at work, standardization of practices, continuous support to nurses, and reflection. Moreover, the learning strategies assisted by the ICTs used within the context of the learning organization allowed rapid access to flexible information. These effects were also identified in the literature on ICT use in nursing education (Button, Harrington, & Belan, 2014).
Nevertheless, there are still elements that could be improved by the learning organization. At the time of this study, the imple- mentation of the learning organization was still incomplete among nurses, and even more so among other health professionals. The lack of other professionals in the learning organization is an inter- esting point to underscore, since we could easily imagine that a participatory process that promotes collaboration like the process promoted by the learning organization (Harrison-Broninski and Korhonen, 2012; Song, Jeung, & Cho, 2011) would facilitate mul- tidisciplinarity. However, some of these professionals have already participated in the projects, and the learning organization commit- tee expected that this participation would grow over time.
Finally, the learning organization had a limited effect on reten- tion of nurses in this CSSS. While the value of the learning
organization is generally acknowledged, factors such as origins, work environment, and family situation seemed more important as incentives to work in the CSSS.
5.1. Limitations
Even though this exploratory case study is not by its very nature generalizable, it could serve as a basis for comparison when study- ing other cases as well as provide evidence that could be used by others to judge the applicability of a learning organization approach for their situation. For example, this study could be included in a larger research on the influence of learning organizations on health care professionals’ practice. Moreover, we wanted to improve and deepen understanding of the effects of the learning organization using the rich and meaningful experiences and descriptions of par- ticipants, which would have been impossible with other research designs (Collingridge & Gantt, 2008). Nonetheless, this study meets the requirements of valid qualitative research, according to vari- ous quality criteria including triangulation, respondent validation, exposition of methods, reflexivity, attention to negative cases, fair dealing, rich description, and relevance (Mays & Pope, 2000).
6. Conclusion
The organizational culture change process—through a learning organization promoting knowledge transfer in the work envi- ronment and collective learning—instituted in a CSSS of Quebec brought about important and much needed changes in nursing practices and work environment. Research on new and innovative solutions to improve knowledge management and support con- tinuing professional development of health care professionals is still limited. This case study can help clarify the impacts of a learn- ing organization on health care professionals’ practices. According to the participants in this case study, the learning organization seemed to affect daily nursing work in a positive manner, despite its variable impact on other professionals and other sites outside the hospital center. These changes were particularly pronounced with respect to knowledge transfer, support for nursing practices, and quality of health care objectives, which the learning organi- zation had sought to meet since its inception. As a final remark, it would be interesting to study in the future the longer-term effects of the integration of a learning organization on nurses’ professional development, as well as on those of other health care professionals who are part of this new culture.
Conflict of interest
The authors are not aware of any conflict of interests.
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Acknowledgments
Funding for this research project was provided by Canadian Institutes of Health Research (CIHR) (No 200911PHE-217005-PHE- CFBA-11114). The funding source had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the arti- cle for publication. The authors thank Erik Breton who helped with the data collection and analysis and the review of this paper. They would also like to give a special thanks to the participants of this case study.
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Marie-Pierre Gagnon is Associate Professor at the Faculty of Nursing of Université Laval and researcher at the CHU de Québec Research Center. She also holds the Canadian Research Chair in Technology and Practice in Health. Her research interests include telehealth, organization of health services, professional practices and health information systems.
Julie Payne-Gagnon is a research professional at the Public Health and Practice- Changing Research Axis of CHU de Québec Research Center. An anthropologist by training, she currently works on the subject of implementation and use of informa- tion technologies in health care.
Jean-Paul Fortin is a retired Professor at the Department of Social and Preventive Medicine of Université Laval and researcher at the Centre de recherche sur les soins et services de première ligne of Vieille-Capitale Health and Social Services Centre. He developed an extensive expertise on ICTs in health and on the evaluation of health services research.
Guy Paré is Professor at the Department of Information Technology Management and holder of the Chair in Information Technology in the Health Care Sector of HEC Montréal. His research interests include change-related issues to the implementa- tion of new technologies, the effective management of these changes and the use of information technologies in support to emergent organizational forms.
José Côté is holder of the Research Chair in Innovative Nursing Practices and full pro- fessor at the Faculty of Nursing Science of Université de Montréal. She is a regular researcher at the CHUM Research Centre and the recipient of a senior researcher- clinician grant from the Fonds de recherche du Québec en santé (FRQS). Her research focuses on the development, implementation and evaluation of cyberhealth inter- ventions in the treatment of client groups living with a chronic health condition.
François Courcy is Professor at the Department of Psychology of Université de Sherbrooke. He is interested in the prediction of work-related counterproductive behaviors, the promotion of psychological health at work, the assessment and diag- nostic of organizations, as well as staff training and work performance.
- A learning organization in the service of knowledge management among nurses: A case study
- 1 Introduction
- 1.1 Learning organization
- 2 Context of study
- 3 Methods
- 3.1 Study design and participants
- 3.2 Data collection and analysis
- 4 Results
- 4.1 Participants' characteristics
- 4.2 Changes in nursing practice
- 4.3 Variable impact
- 5 Discussion
- 5.1 Limitations
- 6 Conclusion
- Conflict of interest
- Acknowledgments
- References
