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. 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. 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. 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.

Managers today increasingly find themselves facing unexpected problems, needing to learn how to cope with complex environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive writing practice. We first present methodological reflections related to the challenges of sustaining management practice through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts. This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss the specific conditions and limits of such an approach.

Purpose: – The aim of the paper is to investigate social sustainability by focussing on the stakeholder theory and by presenting specific levers and capabilities for building more socially sustainable organizations.Design/methodology/approach: – The paper is based on the analysis of recent academic and managerial literature. Through comparing theoretical and methodological perspectives from multiple authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is proposed.Findings: – The paper discusses the idea that building socially sustainable organisations requires the management of multi-stakeholder processes that are physiologically conflicting and that often create paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and “paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes towards a more socially sustainable organizing.Research limitations/implications: – This paper raises reflections focussed on the “social pillar” of sustainability and does not consider different types of organizations in different multi-stakeholders processes. Such a perspective does not exhaust the variety of cases and research studies that could be considered in the field and further developed.Originality/value: – The value of the paper is in its construction of a framework for both research and practical purposes in the domain of management and sustainability. The work also attempts to link the concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey towards social sustainability.

The pandemic has forced organizations to find new ways of working. In fact, we are seeing an increase in remote working and this has inevitably impacted onboarding processes. In this respect, the aim of this study was to understand how young graduates under 30 experienced digital onboarding (in terms of emotions and cognitions) when joining organizations with structured Human Resources processes. An exploratory qualitative study was conducted in which participants were asked to fill in ethnographic sheets in order to understand the barriers and facilitators that organizations can implement to improve the digital onboarding experience. We used thematic analysis. What emerged from our study is that newcomers struggled, in digital contexts, to find the right information, to be proactive and to receive immediate feedback in order to understand the context and to understand their fit with the company: it is important not to lose sight of the importance of socialization, but rather to find effective and structured practices that facilitate it and make it last over time. In our study, we argue that a structured digital onboarding program could be a relevant step in order to implement an effective transition towards remote working cultures and an attention to socialization processes.

Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation. We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews. CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake.