Between Project Enthusiasm and Routine Demands: Conflicting Logics and Unintended Consequences of e-Health Innovation and Diffusion

For a long time, and in most corners of the world, great promises have been maintained from ICT innovations in health care, both in regards to quality and efficiency. A related challenge for social science has been to explain the details of ICT diffusion; what makes some ICT innovations succeed and other disappear. In studying a wide range of such innovations (e-health, telemedicine) and diffusion processes in Norway, we have identified a conflicting logic - between innovation enthusiasm and routine responsibility - as a major explanation of how promising projects only rarely are transformed into normal routine. Understanding the detailed aspects of project organisation and enthusiasm-based driving forces, and how these act as system correction/critique, is necessary to comprehend what comes forward as lack of success, or missing diffusion. In this study we have investigated what innovation projects, in the making, bring with them on a managerial level in health care institutions. We have observed that the heterogeneity between innovation and routine within health-care delivery is handled by separating project management/funding from continuous organisational practice. While this separation eases both normal routines and innovative projects, it also delays expected diffusion. What may be technological successes may therefore be organisational failures. Unintended consequences from innovation projects - including learning and understanding action alternatives - are seldom bases for assessment. The paper suggests that a sociological exploration of logics, including financial, professional, technological, as well as organisational, needs to be tighter connected to innovation.