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

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 effects 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, organizational learning, and organizational knowledge to explore how rule network characteristics affect different types of knowledge uptake revisions of rules. Our analysis is quantitative and longitudinal 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 knowledge uptake of rules. Rules are dynamic, and their elaboration is path dependent and network dependent.