Knowledge and Agency Based Performative Deviations in Practice Transfer Routines: The Case of Evidence-Based Medicine

Abstract

Practice transfer processes in organizations often do not proceed as planned. Prior literature has viewed unplanned deviations as undesirable, emphasizing ways to reduce or overcome them. Performative deviations refers to such unplanned deviations in the actual performance of practice transfer processes from the prescribed intentions of the organization. In this research, we seek to provide a fine-grained analysis of the nature of performative deviation paths through which practice transfer processes unfold by focusing on the role of power differentials. We find that power differentials among transfer participants can cause the unfolding practice transfers to deviate from prescribed processes along one of two alternative paths – the agency-based performative deviation path and the knowledge-based performative deviation path. While the agency-based performative deviation path hinders successful practice transfer, the knowledge-based performative deviation path can actually be helpful to organizations. We draw on the dual nature framework of organizational routines and the pluralist lens of power as our theoretical foundation and evidence-based medicine in healthcare as our empirical context in order to derive a set of propositions about the different performative deviation paths through which practice transfer processes unfold based on the nature of power differentials among work roles involved in practice transfer and the different outcomes that result. The roles of outcome uncertainty and information technology are also presented.

Keywords: practice transfer, organizational routines, knowledge transfer, agency, evidence-based medicine, healthcare, power differential, outcome uncertainty, healthcare information technology, electronic medical records, performative deviations