Struggles for Meaning and Struggles for Control: The Diffusion of Bandwagon Technology in Two Institutional Environments

Abstract

Using comparative case studies, this paper shows how institutional contexts influence the process of diffusion of a complex technology by determining the pattern of material resources and authority available to actors in their struggles to control the technology, and by constituting the discursive resources that may be mobilized in their struggles to shape its meaning in preferred ways. The paper also reveals how governance structures may be contested and realigned when they conflict with interests legitimized by dominant institutional logics. This form of contestation and adjustment constitutes one mechanism by which institutional frameworks are tested, stretched and reproduced or redefined. 1 We thank Jean-Philippe Bonardi, Peer Fiss, Robin Gustafson, Mariann Jelinek, John Meyer, Tammar Zilber and participants in the 2008 Academy of Management symposium on the "Travel of Health Care Ideas: International Perspectives" as well as participants in the 2007 EGOS subtheme on Innovation and Institutions for their helpful comments on earlier renderings of the data and ideas in this paper. The authors are also grateful to the "Fondation du 450 e anniversaire" of the University of Lausanne, to the Social Sciences and Humanities Research Council of Canada and to the Fonds québécois pour la recherche sur la société et la culture for their financial support of this research. 4/47How does the nature of the institutional environment influence decisions about the adoption of advanced technology within an institutional field? Reciprocally, how might organizational decisions about technology contribute to the maintenance or adaptation of institutional frames? Although there is a vast literature on the diffusion of technological innovations (Ferlie, Fitzgerald, Wood, & Hawkins, 2005;Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidou, 2005;Rogers, 2003;Ryan and Gross, 1943), and although institutional theory has frequently been mobilized to explain the diffusion of managerial innovations and ideas (Abrahamson, 1991;DiMaggio and Powell, 1983;Meyer and Rowan, 1977;Tolbert and Zucker, 1983), there is surprisingly little work that has examined the specific role that institutionalized structures and meaning systems may play in the process of diffusion of technological artifacts, or on how these decisions might eventually challenge institutional frames.In this paper, we address these issues by examining the diffusion process for a complex medical technology -positron emission tomography, or the PET scanner -in two institutional contexts, one of which is more market-oriented (Switzerland) and the other more centrally managed by a public agency (Quebec). The comparison allows us to untangle the role of the institutional environment in the diffusion process by holding the object of diffusion constant.The PET scanner is a particularly interesting technology for this study because it is complex, extremely expensive, and was initially at least, quite controversial, creating excitement in the medical community while engaging health c...