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Background Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors ( n  = 30). We used a constant comparative approach to develop a framework for guiding implementation. Results We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Conclusions Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.

Purpose This paper aims to address the relevance and impact of the fourth industrial revolution through a theoretical and practical perspective. The authors present both the results of a literature review, highlighting the new competences required in innovative workplaces and a pivotal case, which explores challenges and skill models diffused in industry 4.0, describing the role of proper organizational learning processes in shaping new work cultures. Design/methodology/approach The paper aims to enhance the discussion around the 4.0 industrial revolution addressing both a theoretical framework, valorizing the existing scientific contributes and the situated knowledge, embedded in a concrete organizational context in which the fourth industrial revolution is experienced and practiced. Findings The findings acquired through the case study endorse what the scientific literature highlights about the impact, the new competences and the organizational learning paths. The conclusions address the agile approach to work as the more suitable way to place humans at the center of technological progress. Research limitations/implications The paper explores a specific organizational context, related to a high-tech multinational company, whose results illustrate the empirical evidence sustaining transformations in the working, professional and organizational cultures necessary to face the challenges of the fourth industrial revolution. The research was conducted with the managers of an international company and this a specific and limited target, even though relevant and interesting. Practical implications The paper connects the case with the general scenario, this study currently faces, to suggest hints and coordinates for crossing the unfolding situation and finding suitable matching between technological evolution and the development of new work and professional cultures and competences. Social implications Due to the acceleration that the COVID-19 has impressed to the use of digital technologies and remote connexion, the paper highlights some ambivalences that the quick evolution of the new technologies entails in relation to work and social conditions. Originality/value The opportunity to match both a literature analysis and an in-depth situated case study enhances the possibility to achieve a more articulated and complex view of the viral changes generated in the current context by the digitalization process.

PurposeBuilding on the existing literature and on a series of interviews conducted in very diverse coworking spaces, this article attempts at analyzing coworking by focusing on the historical evolution and heterogeneity of its interpretations, as well as the plurality of its realization in practice and prospective developments.Design/methodology/approachThe theoretical framework adopted is Cultural Historical Activity Theory – a dialectical approach which allows the study of human activities as historically evolving and complex systems which change under the impulse of their inner contradictions. The analysis presented here starts with an overview of the history of the theoretical elaborations and discussions of coworking. The authors then focus on the experiences and interpretations of this phenomenon as conveyed by coworkers and coworking managers in the north of Italy – one of the most active coworking areas in Europe.FindingsCoworking first emerged as a way of promoting forms of work and organization that require simultaneous, multidirectional, and reciprocal work, as understood in contrast to forms that incorporate an established division of labor, demarcated communities, and formal and informal sets of rules. However, with time, coworking has evolved toward novel directions, giving rise to heterogeneous interpretations of it. Inquiry constitutes a deeper investigation of the heterogeneity of coworking. The take-away message here is that the prefix co- in coworking can be interpreted, through a play of words, to evoke multiple positions and views conveying internal contradictions.Originality/valueThe historical overview of coworking shows a strong differentiation and multisided interpretation of this phenomenon along two dimensions of historical development, namely, social and business, and outward and inward. The qualitative analysis of the interviews traces the different lived interpretations and conceptions of coworking. The analysis confirms, on the one hand, the complexity and heterogeneity described in the literature, and on the other hand, it enriches the literature by depicting the contradictory nature of the phenomenon, including how the historical and inner tensions of coworking are dynamically evolving in the concrete experiences reported by the managers and users in the coworking spaces.

Purpose The study refers to a health-care organization engaged in adopting “home health care” as a new object of activity. This study aims to explore how the reconfiguration of the object influences the transformative perspective, affecting not just a service but a broader approach and meaning behind patient care. It also investigates the main contradictions at play and the levers to support inter-organizational learning while facing the new challenges and change processes. Design/methodology/approach The work is based on a qualitative and ethnographic methodology directed to examine cultural, practical and socio-material aspects. The activity theory is assumed as a powerful approach to understand collective learning and distributed agency processes. Findings The renewal of the new object of work is analyzed as a trigger for shifts in representations, cultural processes and collective support implemented by the organization. Three agentic trajectories – technical, dialogical and collaborative agency – were cultivated by the management to deliver home health care through joint exercises of coordination and control, dialogical spaces and collaborative process. Research limitations/implications The data collection was disrupted by the pandemic. A follow-up study would be beneficial to inquire how the learning processes shifted or were influenced by the contextual changes. Practical implications This contribution provides a practical framework for health-care organizations aiming to navigate and explore the physiological tensions and contradictions emerging when the object of work is changed. Originality/value The paper develops the field of intra- and inter-organizational learning by presenting an intertwined and structural connection between these processes and the renewing of the object of work. It advises that processes of transformation must be handled with attention to the critical and collective dynamics that accompany sustainable and situated changes.

Purpose The aim of the paper is to analyze the process of “germ cell” formation by framing it as an opportunity for promoting organizational learning and transformation. The paper aims to specifically answer two research questions: Why does the “germ cell” have a pivotal role in organization’s transformation? and Which conditions facilitate the formation of the “germ cell” in the management of complex and uncertain problems? Design/methodology/approach The paper answers the research questions first by presenting the literature related to knowing and learning inside organizations, and second by introducing the concept of “germ cell” and connecting it with the metaphors of “waiting experiment” and “anchoring forward”. Finally, the paper analyzes the steps by which the “germ cell” is shaped, thus owing to the exploration of problematic situations, underpinning the “germ cell’s ” role to open perspectives for multiple applications and development. Two research interventions are presented by focusing on the construction of the “germ cell” moving from the problematic situations to promote organizational learning and change. Findings The paper describes the formation of the “germ cell” as a process that opens possibilities for subjects to recognize and reflect on the recurrent and taken-for-granted practices and concepts and give sense to them by making the inner contradiction and the ways for managing it visible. Originality/value The unfolding and challenging inceptive configuration of the germ cell sheds light on the discursive/conversational/language processes and the activities entangled in socio-material instrumentalities and environments in which people are involved.

Purpose The paper aims to analyse a specific configuration of coworking space that emphasises the production of social value in the territory (resilient/welfare-oriented coworking). This kind of space represents the current evolution of coworking that recovers the original meaning of coworking space to promote social changes, questions the role of the physical space and brings to the fore its connections between the internal (space) and the external (territory). Design/methodology/approach The paper presents an action research on a rising network of coworking spaces. The action research was based on qualitative interviews of the founders and main stakeholders of the network and monthly meetings discussions with the steering committee of the coworking spaces. Findings The paper provides some key elements that highlight different meanings related to the value produced by the coworking spaces and related interpretations of the material and immaterial characteristics of the spaces. The results also highlight different managerial challenges connected with these interpretations. Originality/value The main results of the study shed light on the fact that it is not enough to focus on material aspects of the coworking space, such as the design and the dispositions of furniture and the curatorship of the relationships among coworkers, if the desired outcome is a reinterpretation of work against the consolidated individualistic paradigm. Rather, the boundary work is the condition that permits to sustain and maintain the evolutionary trajectory of coworking in the most innovative direction. Inside a network of different stakeholders, aimed at integrating individual and collective needs, the constant crossing of boundaries between people, relationships and contexts is the process that permits to generate new meanings and possibilities of action (affordance), holding a transformative potential.

PurposeModern intra- and inter-organizational arrangements require firms to cross boundaries, but this process represents a crucial and complex challenge, especially for organizations that face pluralistic tensions. Scholars still lack sufficient knowledge of how boundaries can be crossed and what kind of boundary management is necessary within pluralistic contexts. This paper aims to enrich the understanding of these issues by exploring how strategy maps can be mobilized and used as boundary objects to elicit boundary-spanning practices that foster cross-boundary collaboration in pluralistic organizations.Design/methodology/approachThis paper employs the case study methodology to capture the dynamics of cross-boundary management elicited by the use of a strategy map within a pluralistic social/healthcare organizational context.FindingsThis study identifies four practices of boundary spanning (i.e. identifying and crossing problem boundaries, orchestrating collective responsibilities, acknowledging a common understanding of convergent values and goals, and evolving into action) in the analysed pluralistic context and investigates the conditions under which cross-boundary interactions can mobilize a shared zone of knowing via strategy maps.Originality/valueThis paper suggests a complex (and not linear) processual model of boundary management in pluralistic contexts in which the use of the strategy map mobilizes a dynamic of centrifugal and centripetal movements which engage plural actors in a shared site of collaborative knowing. The study contributes to a conceptualization of boundary management in pluralistic contexts as a progressive social accomplishment.

In recent years, the number of new organizations aiming to accomplish principles of sustainability has rapidly grown, leading analysts and scholars to announce almost a new industrial revolution. An example of this is the proliferation of the so-called fabrication laboratories (FabLabs) that nowadays are perceived as being forerunners in innovative and sustainable high-tech production through peer-to-peer collaborative practices and sharing. However, the challenges managers face in translating these promotional aims into organizational action is vastly understudied. To address this research gap, we have studied the management of two FabLabs, in Italy and Finland. In this study, we draw from a psycho-sociological framework applying cultural-historical activity theory, and especially from the concepts of activity system and contradiction. According to this perspective, a sustainable organization is based on promotion, enrichment, regeneration, and flexible change efforts, and it is related to the managerial and ability to bring internal and external stakeholders together to recognize and solve tensions and contradictions collectively. Through our case studies, we have provided new research knowledge on how managers make an effort to translate sustainability into action in the complex context of FabLabs, involving multiple, often competing stakeholders and activity systems. Our analysis reveals multiple tensions in the collective activity, stemming from system level contradictions, which represent a challenge for the daily work of the FabLab managers. In the paper we also suggest how an engaged management orientation towards sustainably can be promoted, and we discuss future research topics.