Attentional Engagement as Practice: A Study of the Attentional Infrastructure of Healthcare Chief Executive Officers

Abstract

In this paper, we investigate the attentional engagement of chief executive officers (CEOs) of large healthcare organizations in England. We study attention ethnographically as something managers do—at different times, in context, and in relation to others. We find that CEOs match the challenges of volume, fragmentation, and variety of attentional demands with a bundle of practices to activate attention, regulate the quantity and quality of information, stay focused over time, and prioritize attention. We call this bundle of practices the CEO’s attentional infrastructure. The practices that compose the attentional infrastructure work together to ensure that CEOs balance paying too much with paying too little attention, sustain attention on multiple issues over time, and allocate attention to the issues that matter, while avoiding becoming swamped by too many other concerns. The attentional infrastructure and its component practices are constantly revised and adapted to match the changes in the environment and ensure that managers remain on top of the things that matter to them. The idea of a practice-based attentional infrastructure advances theory by expanding and articulating the concept of attentional engagement, a central element in the attention-based view of the firm. We also demonstrate the benefits of studying attention as practice, rather than as an exclusively mental phenomenon. Finally, we contribute to managerial practice by introducing a set of categories that managers can use to interrogate their existing attentional practices and address attentional traps and difficulties.

Social Features of Integration in Health Systems and Their Relationship to Provider Experience, Care Quality and Clinical Integration

“…Identifying the conditions under which strong normative and interpersonal integration are generated across systems will be vital. Such efforts might focus on leadership, as past research has suggested that leaders play a central role in setting norms (Opp, 1982; Taggar & Ellis, 2007), facilitating change when cultures become dysfunctional (Schein, 2010), establishing productive team climates (Nembhard & Edmondson, 2006), and setting the attentional infrastructure of their organizations (Nicolini & Korica, 2021). However, much of this existing scholarship has focused on single organizations and top-level leadership.…”

The attention‐based view: Review and conceptual extension towards situated attention

“…the 'when' of situated attention). This resonates with a recent, pioneering study of Nicolini and Korica (2021) considering attention allocation as a practice. Thus, our arguments give rise to a new perspective on the ABV, which has mainly been considered from an information-processing perspective, highlighting limited attentional capacity (e.g.…”

“…Indeed, practices are enacted in specific circumstances and these circumstances matter. The way practices are enacted is shaped by social dynamics, that is, the relationship among different actors (Feldman & Orlikowski, 2011;Nicolini & Korica, 2021), but also the material conditions under which they are performed; be it the physical environment of a location or the characteristics of a particular tool or piece of software (e.g. Jarzabkowski et al, 2013).…”

“…Thus, attention to issues and answers in strategy-making seems to be continuously negotiated among actors. As a recent study of Nicolini and Korica (2021) indicates, power may play a crucial role in such processes. The authors show that actors in higher hierarchical positions are able to determine or 'subcontract' situated attention of other, lower-level actors and thereby set a firm's (attentional) direction.…”

“…Moreover, it has the potential to connect the ABV to the broad research stream of sociomateriality (e.g. Orlikowski, 2010; Orlikowski & Scott, 2008) and thus give rise to the idea of attention as a (materially mediated) social accomplishment (Nicolini & Korica, 2021; Ocasio et al., 2017). With this review, we hope to move ABV‐based research forward and revive the idea of situated attention.…”