With Lives on the Line : How Users Respond to a Highly Mandated Information System Implementation - A Longitudinal Study

Some people are forced to use a specific technology in their work. Should they resist, people die. This thesis examines the implementation of a Patient Data Management System for the critical care departments at two Swedish hospitals. The degree of mandate to use a technology varies along a spectrum anchored between none and absolute. This thesis focuses on the context of absolute mandated use, an area unexplored by Information System (IS) research. Use of technology is a well-established indicator of the success of IS implementation. Nonetheless, when IS is required, use is not a suitable indicator of success. Instead, affectual responses, such as attitudes regarding use and satisfaction, are appropriate indicators of success. This thesis recognizes the process nature of implementation and develops a longitudinal four-stage research model to predict the attitude of individual end-users during the implementation of an IS. The model’s first part considers the stage where users do not yet have first-hand experiences of using the system. The following parts of the model relate to different stages of the implementation process and the final part addresses the stage of the implementation process where IS use has become routine. To test the research model, this research used data collected through field surveys. Non-parametric covariance based (CB) structural equation modelling (SEM) analyses revealed that the users’ perceptions of IS use changed over time and kept changing for months. The results further indicate that both the set of variables and the degree of their influence on a users’ perceptions vary during the implementation process. Furthermore, the users’ trust in the adequate functioning of the system is a persistent predictor of the users’ attitudes. In contrast to many reported findings in the literature, users’ resistance to change is not an influential factor at any stage of the implementation process. Finally, the influence of communication through the organisational channels only affects the users’ perceptions before they have first-hand experience with the IS. This research contributes to the IS literature by uncovering mechanisms of the increasingly ubiquitous although un-investigated phenomenon of highly mandated use. This research reports on causal drivers of users’ attitude towards highly mandated use and how the influence of these drivers develops throughout an implementation process