"Look! This Is the Future of Cardiology”: Institutional Work and the Making of Telemedicine in Healthcare

This paper offers a critical perspective on the lack of widespread adoption of telemonitoring. By describing the processes that led from the first experimental adoption to the final codification of a clinical service, we show the complex ecology of actors, knowledge, and practices that are necessary to make the new telemonitoring service a part of the institutional fabric. Adopting a qualitative research design, organizational processes are investigated through the conceptual lens of institutional work, defined as the creative and rationally oriented activity of culturally competent actors aimed at adapting to dynamic conditions through which institutions are created, reproduced and destroyed. The work shows how different actors, using the resources at their disposal, act to modify healthcare institutions by redefining their role in a scenario characterized by increasing use of ICT tools in healthcare. Our work confirms how the institutionalization of change requires continuous “tuning” and its transformation into everyday operational practices. At the same time, we investigate why such innovation processes are difficult to replicate even within the same organization, arguing that in these healthcare contexts in which institutional work is successful, practices prevail in connecting discursive frameworks, limited implementation strategies and economic demands.