A spatial structuring approach to IT use and workplace change : what's space got to do with it?

Abstract

This dissertation uses the disparate spatial practices of radiologists and outpatient physicians to frame a study of the relationship between space, information technology use and workplace change, with a particular focus on relationships of control. Drawing from diverse urban, organization and economic literatures, I propose a spatial structuring approach to examining issues of space and work practices. From this perspective, spatial practices are seen as both shaping and being shaped by information technology use. The spatial practices of outpatient physicians prior to adopting Electronic Medical Records (EMRs) shaped the implementations of the EMRs in that they led to a series of problems in coordinating outpatient work, problems that EMRs were adopted in part to solve. The EMRs, in turn, were successfully used to further extend physician work in time and space, as well as to better coordinate and control their work. For radiologists, their historic spatial practices shaped the way they used teleradiology applications to respond to a recent, and overwhelming, scarcity of radiologists. Radiologists were able to successfully exert control over the offshoring of their work, in part due to their long history of working at a distance from their patients and other physicians.

(cont.) Radiology work has been done remotely since the inception of their profession, so the fact that it can now be done from thousands of miles away, rather than a hundred yards away, did not appreciably lessen their ability to exert professional control. This research also links spatial practices at work to temporal practices at work. I use a comparison of the ways in which outpatient physicians and radiologists work in space and time to highlight the importance of these practices in shaping and being shaped by the use of information technologies. In both cases, information technologies that enabled physicians to extend their work in space were used to extend their work in time, as well. Once again I link these complex dynamics to issues of control, both of the information technologies in question, and of medical work more generally.