Page 64 - Journal of Management Inquiry, July 2018

278 Journal of Management Inquiry 27(3)

picture about ongoing operations as they paint an inaccurate smuggling is possible because the fasting guidelines are less
picture and direct attention in a potentially misleading way if strict in more urgent cases, and surgeons who like to conduct
actors base their decisions on what is displayed by the OTAP. a surgery earlier because it would better fit their personal
The tool failed to inscribe existing common knowledge or schedule could achieve this through a category “upgrade.”
even change past—wrong—inscriptions easily, and it seems As the different departments compete for the scarce time
not to be flexible enough to represent temporal changes. To slots and additional elective patients earn individual (high-
assess the actual progress and anticipate the duration of sur- ranked) doctors extra income, changes in the priority of
geries, surgeons and the manager of the operations theater had patients had some potential for being subject to political
to go into the operation theaters by themselves and assess the gaming. In a later interview, the manager of the operation
situation based on their expertise. This does not only take up theaters stressed that the screenshots served as decisive evi-
their time but also create additional effort for the team in the dence in several disputes with surgeons about who made the
operation theater that now has to explain about rather than decision about the category, why there was a change, and
conduct the surgery. who would be hold accountable in case of false categoriza-
On the other hand, it is probably the most intriguing find- tions. In addition, changes in the order of patients might,
ing in our case study that some limitations of the tool actually owing to various technical, economical, and organizational
triggered actors to improve their attempts to organize mind- reasons, influence the amount of time in an operation theater
fully. As the tool’s misrepresentations were widely known, allocated to a department by the top management. Thus, the
actors were preoccupied with possible failures that result agreed and legitimized allocations should be safeguarded
from the frequent inaccuracies. The tools’ shortcomings of against politically motivated changes by making screenshots
not accurately representing what is actually happening trig- that could proof that changes had been made. Ironically,
ger reflexive interaction (e.g., discussions about deviations) safeguarding is itself a micropolitical practice.
and improvisation to cope with the unexpected course of
events. Thus, the practices of anticipating and predicting Behaving defensively. With our focus on the tool’s materiality,
deviations, which are conducive of a preoccupation with fail- we also found evidence of the creation of accountability
ure (Sutcliffe, 2011), can be seen as being triggered by the trails (see Power, 1997). As common in many IT systems,
tool’s shortcomings. During these practices, the tool is users of the OTAP have to log in to enter or change data.
pushed to the back or is supplemented with expert assess- Only certain users are allowed to make crucial changes; for
ments, which are quite precise. In a sense, the shortcomings example, changing the emergency categorization of a patient,
of the tool prompted a deference to expertise, especially say from C to B. As mentioned, the manager of the operation
when actors engaged in practices of inscribing the big picture theaters insisted that he does not do that. Even if he is logged
and tried to represent operations accurately. Once the sched- in and is asked by a surgeon to change the emergency catego-
ule and progress of surgeries had been updated in the OTAP, rization, he would never change the categorization himself,
the process of inscribing temporality via the OTAP stopped. but log out, have the surgeon log in, make the change, log
out, and then the manager would log in again. Indeed, we
Inscribing Accountability witnessed this procedure. The operation manager employed
strong rhetoric to justify the rather complicated procedure: “I
A final major aspect of the OTAP that had an impact on won’t go to prison for this job!” Clearly, defensive behavior
mindfulness is “inscribing accountability,” which we infer reduced to speed of action for the sake of leaving a trail of
from “practicing micropolitics” and “behaving defensively.” evidence.
Through the material and immaterial inscriptions it created The way the OTAP creates accountability is through the
and left behind (e.g., printouts, logfile), the OTAP functioned traces its inscriptions create and leave behind. Surgeons,
as and was used as a producer of accountability. anesthetists, and the manager of the operation theaters
alluded to questions of accountability in case of medical mal-
Practicing micropolitics. The already mentioned activity of practice resulting from a wrong categorization of a patient.
making screenshots and saving and/or printing them is also This could lead to severe consequences if a patient was insuf-
about safeguarding against unwanted or self-interest-seeking ficiently cared for owing to a too low categorization, or that
behavior by other organizational members. The manager of an unjustifiably high categorization of a patient prevents the
the operation theaters not only made a screenshot of the appropriate treatment of another patient. During our job
OTAP in the morning but on average 4 times per day. When shadowing, we observed that a surgeon wanted to upgrade a
asked for the purpose of this routine, the manager of the patient from D to C to be able to perform the surgery sooner.
operation theaters responded that he checked whether sur- This attempt led to a dispute about the patient’s state of unin-
geons had added elective patients (lowest urgency) and toxication and safety. The manager of the operation theaters
smuggled them into the schedule by changing the category to considers upgrading patients to more urgent categories detri-
a higher urgency level. Several interviewees mentioned that mental to high reliability because insufficient fasting and