The Dynamics of Embedded Rules: How Do Rule Networks Affect Knowledge Uptake of Rules in Healthcare?

• Published date: 01 December 2019
• Author: Martin Schulz,Kejia Zhu
• Date: 01 December 2019
• DOI: http://doi.org/10.1111/joms.12529

© 2019 Society for the Advancement of Management Studies and John Wiley & Sons, Ltd.

The Dynamics of Embedded Rules: How Do Rule

Networks Affect Knowledge Uptake of Rules in

Healthcare?

Kejia Zhua and Martin Schulzb

aUniversity of Waterloo; bUniversity of British Columbia

ABSTRACT Rules – in organizations and elsewhere – often become connected to other rules

pertinent to similar or related action, and often they form rule networks that structure entire

organizations and jurisdictions. Although rule networks are a common phenomenon, their ef-

fects on rule change have found little attention so far. How do rules change when they become

embedded in rule networks? We build on prior conceptions of performance programs, organiza-

tional learning, and organizational knowledge to explore how rule network characteristics affect

different types of knowledge uptake revisions of rules. Our analysis is quantitative and longitudi-

nal and draws on archival data of clinical practice guidelines in a Canadian regional healthcare

organization. Our findings indicate that the inbound networks of guidelines significantly affect

their revisions. Our study suggests that rule networks shape the speed and direction of knowl-

edge uptake of rules. Rules are dynamic, and their elaboration is path dependent and network

dependent.

Keywords: Carnegie school, clinical practice guidelines, organizational knowledge,

organizational learning, organizational rules, rule networks

INTRODUCTION

Written rules play an important role in many contexts. In organizations, rules are

pervasive. Organizational rules are often structured as a division of labour in which

specialized rules serve different purposes. For example, the collection of clinical practice

guidelines (CPGs) of a healthcare organization – the empirical focus of this study –

contains formal rules that provide written instructions for health care practitioners for a wide

range of clinical practice situations, such as ‘lifting and transferring patients’, ‘caring and

Journal of Man agement Studi es 56:8 December 2019

doi:10. 1111/jo ms. 1252 9

Address for reprints: Martin Schulz, Organizational Behaviour and Human Resources Division, Sauder School

of Business, University of British Columbia, 2053 Main Mall, Vancouver, BC, Canada, V6T 1Z2.

Tel: +1 604-822-8381 (martin.schulz@sauder.ubc.ca).

1684 K. Zhu and M. Schulz

© 2019 Society for the Advancement of Management Studies and John Wiley & Sons, Ltd.

managing the patients with continuous bladder irritation’, or ‘inserting or removing a

chest tube’.

A collection of organizational rules that are specialized to serve different purposes

allows organizations to respond in a pre-programmed way to a broad range of condi-

tions. At the same time, rules can contribute to organizational adaptation. As new expe-

riences and understandings arise and new knowledge becomes available, organizations

tend to update their rules. Organizations can essentially ‘learn’ by adjusting their rules

(e.g., Levitt and March, 1988; March et al., 2000; Schulz, 2002). Rules, in that learning

perspective, are repositories of lessons drawn from own (individual or collective actor) or

other’s experiences. In practice, updated rules can guide decision makers on paths that

are consistent with current understandings and knowledge. For example, rules in the

form of CPGs contribute to ‘knowledge translation’ into clinical practice when they are

revised to include evidence-based instructions (e.g., Gaddis et al., 2007; Irvin et al., 2007;

Straus et al., 2013). In this perspective, rule-based learning processes shape the change

of each rule.

However, organizational rules are usually not independent. Often rules become con-

nected to one another – rules incorporate instructions that reference other rules – and

form rule networks which guide action on complex paths that reliably and recurrently

produce extraordinary outcomes such as a successful heart surgery or a corporate merger.

Rule networks facilitate integrated organizational responses to multifaceted situations

(e.g., taking care of a patient with bladder irritation might require a CPG related to con-

tinuous bladder irrigation, which references other CPGs related to insertion of catheters

and transporting patients with catheters, which, in turn, reference other relevant CPGs).

Rule networks can be found in many domains (including healthcare, tax law, and air

traffic). As organizations expand, rules become embedded in a web of complex rela-

tionships with other rules. But what happens to rule-based organizational learning pro-

cesses when rules become embedded in rule networks? How do rule networks affect rule

adaptation?

There is no prior literature on rule networks nor on the effect of rule networks on

rule adaptation. However, relationships between rules have been discussed, and their

importance is well recognized, particularly in work related to the Carnegie School and its

extensions. For example, organizational learning that proceeds through the adjustment of

routines includes ‘cases in which each routine is itself a collection of routines, and learn-

ing takes place at several nested levels’ (Levitt and March, 1988, p. 322). Likewise, routines

in political institutions stabilize ‘by being embedded in a structure of routines’ (March

and Olsen, 1989, p. 55). Empirical studies on rule-based learning (e.g., March et al.,

2000; Schulz, 1998a) highlight ecological relationships between rules (such as competi-

tion for attention), but they did not explore direct ties between rules.

In the perspective of March and Simon, interrelations of rules can arise from a divi-

sion of work in which rules play roles for other rules. They developed their argument

with respect to ‘performance programs’ (a concept that is similar to our notion of rules)

in several subsections of their 1958 book ‘Organizations’ (March and Simon, 1958, here-

after, M&S), in particular under the headlines of the ‘interrelation of programs’ and the

‘division of work’ (M&S, pp. 142, 149, 159, 190). They conceived a performance pro-

gram as a routinized, ‘highly complex and organized set of responses’ to defined stimuli