Discussion Summary

In the introduction, I argued that IS research lacks an effective understanding of how the materiality of information technology enables and constrains the people who interact with that technology. I then proposed that affordance theory could provide an effective theoretical lens for studying the material aspects of IT. Robey et al. (2011) suggest that the need to define the theory‟s conceptual building blocks is of primary importance for theorizing the materiality of information technology, and this dissertation represents an effort to address that need. I began this process by taking the perspective that affordances are a relational concept (Chemero 2003), and more specifically, that an IS affordance is a relationship between the features of an

information system and the abilities of an individual with the context of an environment. This conceptualization, I argued, maintains the balance between human agency and material

properties of technology while preserving the unique characteristics of both. In this chapter I have defined and described several affordance concepts and positioned them within the

nomological network of affordances. I have provided evidence from my research data for their salient characteristics and distinguished them from other concepts in the literature in order to more precisely theorize the ontology of affordances.

Critical realism was the guiding philosophical perspective in this research. Critical realism takes the ontological position that there is an objective reality with intransitive objects which exist independent of humans. The production of knowledge (i.e. science) is a human endeavor which seeks to improve our understanding of this objective reality through the use of transitive objects (e.g. theories, concepts, models). Mingers suggests that this is accomplished

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when, “we take some unexplained phenomenon and propose hypothetical mechanisms that, if they existed, would generate or cause that which is to be explained” (2004, p. 94-95). The affordance threshold represents one of these hypothetical mechanisms. I started by defining the affordance range as a continuum of difficulty to act on an affordance which includes Warren‟s (1984) critical and optimal points at either end of that continuum. All affordances exist somewhere within this range and I argued that an increase in difficulty along the affordance range results in a decrease in likelihood of action on the affordance, but that the correspondence of difficulty to act is not consistent across the entire affordance range. I then proposed the affordance threshold as a point within the affordance range at which important behavioral changes regarding an individual‟s use of the affordance are expected to occur. These behavioral changes are theorized to differ based on whether the use of the affordance is optional or

mandated from a work practice perspective. Specifically, when the difficulty of acting on an optional affordance increases beyond the affordance threshold, the likelihood of the individual acting on that affordance should decrease significantly. This conceptualization is illustrated in Figure 14. In contrast, when the difficulty of acting on a mandated affordance increases beyond the affordance threshold, the likelihood of action may not change significantly. Instead, other behaviors related to that affordance will be manifested.

The concept of constraints has been closely linked to the concept of affordances throughout the literature. Most recently, Leonardi (2011) proposes that when people evaluate technology they see either affordances or constraints based on how the technology fits with their current goals. I have argued that, ontologically, constraints are not a product of affordances as suggested by Stoffregen (2003). Instead, constraints are a product of the component parts of an affordance and other properties of the environment. In other words, system features and

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individual abilities along with environmental characteristics, not the affordance relationship, constrain behavior. I suggested that another way to conceptualize the relationship between affordances and constraints is through the affordance range. Specifically, shifts within the affordance range are primarily a function of constraints and therefore the use of technology is shaped by this interrelationship of affordances and constraints. The study of affordances offers an understanding of possible behaviors in relation to a particular information system, while the study of constraints offers an understanding of how those potential behaviors are likely to be inhibited. Together they are expected to provide a more complete understanding of technology use.

These conceptualizations of affordances and constraints have potential value for IS research. However, the complexity of information technology presents a challenge to their application. My proposal to focus on user perspectives of affordances, as a solution to the

problem of repeated decomposition, stands in contrast to the reductionist approach to affordances taken in much of the HCI literature. Critical realism supports a user perspective of affordances in that social structures are considered to be as real as natural phenomena, and yet those social structures do not exist independent of the activities they govern or the conceptions of the individuals engaging in those activities. To be sure, individual perspectives are incomplete views of reality, but when combined with the perceptions of others and the researcher‟s own knowledge of the study context, a more complete picture of the phenomena being investigated is produced. In this study that picture was comprised of both in situ and retrospective accounts, which enabled a longitudinal contrast between present and past work processes and the influence of the material characteristics of information technology on those work processes. The inclusion of accounts from multiple patient care units within the hospital also allowed distinctions to be

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drawn between work practices and technology configurations that varied from unit to unit. My own experience with healthcare and inpatient hospital care was described and I believe that knowledge enhanced the data gathering and analysis processes.

Nurse‟s work practices in the context of inpatient care include multiple relationships which information technology can both enable and constrain. The caregiver relationship

between nurses and their patients, the relationship between nurses for the continuity of care, and the hierarchical relationship between physicians and nurses are three of the more important relationships in that environment. Various aspects of each relationship were described and supported with data. I argued that information technology supported these relationships through affordances for sociality, which are contrasted with social affordances that are behavioral

opportunities provided directly by other people. Affordances for sociality offer additional opportunities for conceptualizing the influences of information technology on the work practices users while at the same time adding to the complexity of studying materiality.

These insights into the ontology of affordances of health information technology comprise the core contribution of this research. Conceptual clarification about the nature of affordances in healthcare can provide groundwork for future studies on clinical work practice and potentially inform the design and implementation of systems that work effectively within the context of clinical practice. In the following chapter, I develop the implications of the present research and look ahead to possible future research opportunities.

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Chapter 6