2.5 – Anticipation - Anticipating Organizational Change A Study of the Pre-implementation Phase

No such studies appear to have been conducted since the calls made by Greenhalgh et al (2009) and Llulch (2011) and Ben-Zion et al (2014) whom yet again reviews the literature on adoption of EHR.

Part II

In part 2 of this review, attention turns to the concept of anticipation and the

development of the analytical / conceptual framework of the dissertation. Early analysis of interview data indicated patterns in the ways clinicians prepared for the pending organizational changes. Further data collection, more in-depth theoretical studies and ongoing structuring and analysis of data e.g. using Nvivo strengthened the proposition and confirmed the presence of patterns to the point where it was possible to establish the theoretical /conceptual framework presented below. The analytical framework consists of anticipation as the overarching concept. Following the initial introduction and discussion of the concept of anticipation, each anticipatory element (Sensemaking, Positioning and Scripting of the future) is introduced and discussed. Particular attention is offered to Positioning Theory because this is the main source of untapped explanatory power in relation to anticipation.

workloads, changing procedures etc. They in a sense feel entitled to this by virtue of the importance of their work. These are specific beliefs that something is going to happen, and they may get disappointed or not. The primary interest of this dissertation is however the pre-implementation preparation of clinicians and the more vague and internal feelings prior to the change. Focus is on the mental preparation and mental action in anticipation of Sundhedsplatformen and relating more generally to how it may or may not transform everyday life in the clinic. The question is what are the

anticipatory action clinicians engage in relation to the pending organizational change induced by Sundhedsplatformen?

The concept of anticipatory action is drawn from the work of Anderson (2010). He writes that “anticipatory action is a seemingly paradoxical process whereby a future becomes cause and justification for some form of action in the here and now” (p.778). The

proposition of this dissertation is that clinicians of Sundhedsplatformen engage in three distinct types of anticipatory action; Sensemaking, Positioning and Scripting of the future. In order to assemble a coherent conceptual and theoretical framework each of the three anticipatory elements is presented in this section, but first attention is turned to the notion of ‘anticipatory action’.

“Anticipatory action perplexes us, or at least it should, because it invites us to think about how human geography engages with the taken-for-granted category of ‘the future’” (p.777-778). As is evident in this quote Anderson’s focus is the social science branch of human geography, and even though this particular dissertation is focused on the narrow setting of organizations, the perspective of anticipatory action is well suited because it allows to engage in a systematic way with what Anderson strikingly calls the taken for granted category of the future.

According to Anderson (2010) this taken-for-grantedness is a mistake caused by an assumption of a linear temporality. Anderson argues that we are misled by the idea

“that the future is a blank separate from the present or that the future is telos towards which the present is heading” (p.778). The keyword here is ‘blank’ – the future is not a blank canvas, but already ‘colored’ by the present. As such the future is already in the present, and “to understand how anticipatory action functions we must understand the presence of the future, that is the ontological and epistemological status of ‘what has not and may never happen” (Anderson, 2010, p. 778).

Anticipatory action consists of or is assembled by Styles, Practices and Logics;

 Styles are defined as, “a series of statements through which ‘the future’ as an abstract category is disclosed and related to. Statements about the future condition and limit how ‘the future’ can be intervened on.” (p.779). Styles can as such been seen as discursive frames applied by individuals in an effort to gain or maintain some kind of control of an otherwise uncontrollable future.

 Practices in term are defined as what gives “content to specific futures, including acts of performing, calculating and imagining. It is through these acts that futures are made present in affects, epistemic objects and materialities.” (p.779)

 Logics, finally, are defined as “a programmatic way of formalizing, justifying and deploying action in the here and now. Logics involve action that aims to prevent, mitigate, adapt to, prepare for or preempt specific futures.” (p.779)

Combining these three elements, Styles, Practices and Logics, provides a vocabulary allowing to inquire or articulate the presence of the future in the now, through statements, materialities and policies and programs. Of particular interest in this connection are ways in which possible futures are made present through various

practices, including calculation, imagination and performance (Anderson, 2010, p. 784).

Calculations represents bets on possible futures made present through numbers. It is e.g. charts, tables and diagrams used to present anything from the forecast of the business plan to the climate models of future weather. The second way of making the future present in the now is essentially by making it up, through what Anderson calls acts of creative fabulation in which future events e.g and states of affairs or persons are imagined as if they were actual and real (p.785). With this rather loose approach the aim is not to present the most accurate picture but rather to present a future that moves and mobilizes (p. 785) which bares striking similarities to what Weick (1989) referred to as ‘disciplined imagination’. Following Andersen (2010) the scenarios can be thought of as tools to think with and subsequently be used to make interventions. The final practice suggested by Anderson to make the future present is through performance, which includes forms of acting, role playing, gaming or pretending (p.786). The idea is that by feeling the stress of a situation (simulated or real) on your own body is very different from reading about it in a report. Feeling the ‘heat’ if a system fails and having to make crucial decision based on the available information is very different from reading statistics about possible future situations or simply imagining it. Anyone who has been

exposed to communication training in front of spotlights and a rolling camera can testify that it is anything but a normal conversation. Sitting in the hot chair of a crisis is very different from talking about it.

The concepts presented by Anderson (2010) are useful for the description and aid in the analysis of Sundhedsplatformen. One of the characteristics of the practices described above are the closeness to existing theories. Imagination as described above bares striking similarities to the notion of (prospective) sensemaking of Weick and when talking performance, the similarities to the theatrical Goffmanian concepts are noticeable. “Practices based on performance include a series of techniques that have their origins in the realms of theatre, drama and play, most notably exercises (Anderson, 2010), war games (Der Derian, 2001) and simulations” (Anderson, 2010, p. 786). The missing link in terms of theoretical grounding, I suggest has to do with the effect on institutionalized rights and responsibilities of the actors. Positioning theory fills this gap.