The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure.

BACKGROUND: Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a "burning platform" for scaling up such services. As health care organizations look to expand and maintain the use of video in the "new normal," it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. OBJECTIVE: This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. METHODS: A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al's 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). RESULTS: Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an "organizing vision" for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. CONCLUSIONS: For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.

Responding to organizational identity change: ethnographic insights from multinational hotel subsidiaries

Purpose>This paper aims to use an organizational ethnography perspective to explore how subsidiary hotel properties of a multinational hotel corporation experience planned organizational identity (OI) change instituted by headquarters.Design/methodology/approach>This study uses a multi-site approach to collect ethnographic data on organizational change from six hotel subsidiaries in California, USA. Over three years, multiple sources of data were collected including: 31 interviews with hotel subsidiary leaders;more than 100 participant observation hours including job shadows, conferences and meetings;and photographs and internal communication materials.Findings>Multinational hospitality companies face struggles between corporate standardization and subsidiary localization. This paper reveals that when headquarters plan changes focused on employees at their subsidiaries, the ways the latter initially accept and resist change are significantly impacted by the organizational memory and history of subsidiary leaders. However, as time progressed, properties with strong financial performance continued to operationalize new identity initiatives while properties with poorer profit margins played a balancing act between headquarters’ visionary identity and subsidiary ownership’s revenue expectations. Additionally, the situational realities caused by the COVID-19 pandemic put a halt to all properties which amplified practical and emotional challenges of organizational ethnography in hospitality research.Originality/value>This paper contributes to hospitality literature by introducing an under-researched concept, OI change and advances understanding of the struggles in managing multinational company change. More importantly, this paper is a stepping stone for future hospitality management to embark on organizational ethnography.