Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Abhijit Gopal


The Canadian public healthcare system appears to currently be under considerable strain. Escalating costs, dwindling budgets and growing patient dissatisfaction are just a few of the systemic pressures that have called into question our current ways of delivering healthcare. As a consequence, there is a growing recognition that renewal is needed, and that this renewal, to be successful, should meet the needs of a wide array of stakeholders, hence calling for unprecedented levels of collaboration among increasingly fragmented interests. In order to bring about this renewal, the federal government seems to be intent on implementing a pan-Canadian electronic health record (EHR) system. To that end, in 2001, Canada Health Infoway was born out of a novel collaboration between federal and jurisdictional health ministries with the specific mandate to accelerate the implementation of EHRs across Canada. In this thesis, I use material-semiotic and dialogic approaches to gain a more nuanced understanding of how the pan-Canadian EHR system is unfolding and in what ways Infoway is trying to accelerate that unfolding. I conclude by suggesting that a more dialogic approach to innovating, in which the innovator focuses on finding various ways to occasion dialogic spaces, may better foster the creation of new meanings of the innovation and therefore result in a more, and not less, harmonious change process. Furthermore, through these dialogic spaces, it is not just multiple meanings of the innovation that are being occasioned, but the innovation itself seems to become more meaningful.