Complexities in securing sustainable IT infrastructures in hospitals: the many faces of local technical support

This paper contributes to an understanding of the complexity of support work and stress the need for local technical support in hospitals in order to maintain a sustainable infrastructure of information systems (IS) and information technology (IT). Given this complexity it is pointed out that a naïve trust in formal stylized models of support organization is problematic. With an increasing number of critical systems in the hospitals technical support is becoming an essential service needed for maintenance, acute failure of systems and help with the everyday use of hardware and software. In order for the health informatics technologies and systems to work, the healthcare institutions need strong IT organizations to support and maintain the IS/IT infrastructure on which these technologies and systems rely. Through a qualitative study of IS/IT support at hospitals I have examined the work and competencies of the service level in the IT organization. On this basis I recommend a nuanced understanding of the complexity of the work of these local technical supporters. I contrast this to the understanding of the organization of IT support through rationalized, formal 'best practice' models that emphasize centralization and cost-effectiveness through single point of contact. It is argued that there is a need for local technical supporters in hospitals with organizational and local knowledge because a) the local circumstances are key to supplying effective support and b) the supporter supply pro-active support that aid to secure the sustainability of the IT infrastructure.