Information and Organization 31 (2021) 100377

Contents lists available at ScienceDirect

Information and Organization

journal homepage: www.elsevier.com/locate/infoandorg

The (re-)configuration of digital work in the wake of profound

technological innovation: Constellations and hidden work
Stefan Klein a, *, 1, Mary Beth Watson-Manheim b, 1
a
School of Business and Economics, University of Muenster, Leonardo Campus 11, 48149 Münster, Germany
b
University of Illinois Chicago, Department of Managerial Studies, 601 S. Morgan Street (MC 294), Chicago, IL 60607, USA

A R T I C L E I N F O A B S T R A C T

Keywords: This paper explores the technology-induced transformation of work by examining two fields,
Digital work robotic surgery and teaching from home via Zoom. We begin by examining the perspectives of
Hidden work individual surgeons and lecturers and the relational, organizational, and institutional settings in
Configuration
which they are embedded. Recognizing and emphasizing the idiosyncrasies of these cases, we
Liminal innovation
Robotic surgery
develop theoretical lenses that allow us to identify the dynamics of the transformation and pat­
Zoom teaching terns in reconfiguration work.
To investigate these illustrative cases of digital work and their implications, we employ two
conceptual frames, 1) configuration work (Suchman, 2012), specifically emergent configurations
of digital-human work, and 2) orders of change (Bartunek & Moch, 1987), emphasizing the role
and development of frameworks in making sense of organizational change.
We thus combine multi-faceted accounts of individuals’ experiences of “figuring out” how to
make digital work feasible with reflections on how the transformation of work affects the iden­
tities of individuals, organizations, and institutions. We propose that this transformation affects
the ways in which we think about ourselves, our colleagues and employers, and the institutions
that shape our work.

1. Introduction

We are witnessing, and often experiencing, rapid changes in the nature of work as we adjust to the COVID-19 era. In particular, the
swift uptake in remote work across many occupations, as well as in remote teaching and learning, has altered our assumptions of how
work can and “should” be performed. While in many instances this is a new and abrupt change, the onset of new and technologically
intensive work practices is in fact a continuation (albeit abruptly forced on some employees) of profound technological changes that
have been emerging for some time. More broadly, the transformation of work in response to the introduction of new tools and
technologies is a key part of human history.
This study focuses on technologies—e.g., social media platforms, communication and collaboration platforms, and robotics—that
are more open and contingent than previous generations of technology (e.g., applications such as enterprise resource planning [ERP]
systems and workflow systems). This class of technologies has been designed to offer a myriad of action possibilities and, increasingly,
to utilize advanced algorithmic capabilities to create opportunities for profound technological innovation. Furthermore, as these

* Corresponding author.
E-mail addresses: stefan.klein@uni-muenster.de (S. Klein), mbwm@uic.edu (M.B. Watson-Manheim).
1
The authors contributed equally to this work.

https://doi.org/10.1016/j.infoandorg.2021.100377
Received 1 November 2021; Accepted 2 November 2021
Available online 19 November 2021
1471-7727/© 2021 Elsevier Ltd. All rights reserved.
S. Klein and M.B. Watson-Manheim Information and Organization 31 (2021) 100377

technologies are increasingly intertwined with human activities and dependent on human actions to achieve the expected results, the
role of the human actor and the nature of the work being performed are changing profoundly. The occupational use of these tech­
nologies requires relational, organizational, and institutional embedding and scaffolding: relational, as the technologies cannot be
used in isolation; organizational, as they are used in complex and purposefully designed “workshops” and work settings; and insti­
tutional, as their use typically requires some kind of policy or regulation. Individual expertise, talent, and imagination play significant
roles in the application of technology to a particular context (Riemer & Johnston, 2012). For example, unlike employees who receive
training to use ERP systems, educators using Zoom to teach classes have had to figure out how to use the software on their own,
including various features and functions such as creating assignments and activities and taking attendance.
We can contrast this transition with that taking place in a different occupation, surgery, where robotic technology has become
deeply embedded into the performance of an increasing number of surgical procedures. While robots are often depicted in popular
media productions as autonomous agents, in reality, this is rarely the case (and when it is, the task is extremely well-understood and
automated). More often, robots exist in a “master-slave” relationship wherein a human directs the actions of the robot (Aleksander,
2017). The symbiotic relationship between human and computer in this class of contingent technologies requires practices to be
shaped (i.e., configured by users) to produce beneficial outcomes.
While the notion of digital work design (Richter, Heinrich, Stocker, & Schwabe, 2018) conceptualizes the transformation of work as
an engineering task, we aim to identify and describe the types and extent of transformation and configuration work required from
individuals to make innovation feasible.
Identifying such factors requires not necessarily performing the task, but rather situating the task in the context of what can be
described as meta-work: preparations for the task and reflections on how its performance can be improved, how technology can be
utilized, and how arrangements of collaboration and delegation can be reconfigured. Our aims include analyzing how to craft work and
how to measure its effect on others. This approach requires care and attentiveness as core values.
In this paper, we aim to understand the implications of this deep technological shift for human work, akin to the notion of liminal
innovation, “a process entailing iterative experimentation and implementation that explores novel or alternative materializations of
established work practices” (Orlikowski & Scott, 2021). This study examines complex organizational environments in which novel
technologies are being used and new practices developed in a process that requires not only open-ended and dynamic exploration,
experimentation, tinkering, sensing, reflecting, and sense-making but, equally importantly, strategizing, planning, and preparation. To
illustrate the (re)configuration of human work, we examine how two fields—education (both teaching and learning) and surger­
y—were reconfigured in response to technology-augmented work. These cases occurred in different timeframes and contexts but have
led to the significant alteration of surgeons’ and educators’ work practices as well as the emergence of deep organizational changes.

2. Theoretical lenses

To investigate these cases of the transformation of work and their implications, we employed two separate but related conceptual
frames: configuration work (Suchman, 2012), specifically the emergent configurations of digital-human work, and orders of change
(Baptista et al., 2020; Bartunek & Moch, 1987). We introduce four vantage points to orientate this empirical inquiry into the two
examples of robotic surgery and teaching from home via Zoom.

2.1. Configuration work

Our examination of digital configuration work is prompted by a general lack of understanding of how users’ actions and in­
teractions shape how technology is used. We draw on Suchman’s notion of configuration (2007, 2012) to investigate more deeply the
phenomenon of emergent configuration work. Suchman (2012) argued that configuration is necessary due to the “contingency and
incompleteness of the artifacts.” Configuration work is conceptualized as “how humans and machines are figured together—or con­
figured—in contemporary technological discourses and practices and how they might be reconfigured, or figured together, differently”
(Suchman, 2012, p. 49). Configuration work involves both analyzing the materiality of the technology in its specific setting and
configuring and reconfiguring the practices in that context. The notion of digital-human configuration work designates design-in-use
practices as critical human work. The human worker puts the technology in place, makes sense of it in the context of their practices,
and in doing so, their work and identity are shaped by the use of technology. Configuration thus denotes both the dynamics of ar­
ranging human-technology work and the mutual shaping of humans and technology. Digital configuration work requires human
agency, innovation, and imagination in making sense of technologies and configuring (and reconfiguring) knowledge, discourses, and
practices. Configuration work is fundamentally embodied and cognitive; its analysis involves human intuition, perception, and
expertise. With the introduction of technology, it is to be expected that practices will be altered. Significant preparation work is
necessary and requires cognitive labor. Individuals must be attentive to possibilities, anticipating potential paths and options for
practices in relation to the specific technology that is enabling new configurations between humans and technology (Suchman, 2007,
Suchman, 2012).
Configuration work is material, social, political, economic, and psychological. It involves shaping, adjusting, and redesigning the
contexts within which technology is becoming embedded. The configuration and reconfiguration of work leads to new and expanded
competencies, skills, and expertise, which all rely on human agency (Neff & Nagy, 2018; Suchman, 2012). However, despite its
constitutive role, this work is often unrecognized and invisible to stakeholders, including even the human actors (Watson-Manheim &
Klein, 2019).

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2.2. Orders of change

Configuration and reconfiguration involve the mutual shaping of human-machine interactions and discourses that occur over time
in specific settings. This is the process through which transformation emerges. To further investigate the resulting effects on the work
system and organizations, we turn to Baptista et al. (2020), who utilized the three orders of change framework posited by Bartunek and
Moch (1987). This framework establishes a multi-level process for the digital transformation of work, taking into account individuals’
understanding and interpretations of their work and organizations. It focuses on the notion of individual and organizational schemata,
or organizational frameworks for understanding events. The framework articulates a systemic view of complex societal trans­
formations and the dynamics of change, highlighting the inherent limitations of intended, convergent change, which inevitably leads
to second-order and third-order effects. It reminds us, on the one hand, of the limitations of human foresight and control and en­
courages us, on the other hand, to engage in analysis of how such changes unfold, how we can make sense of them, what to do about
them, and how they affect us.
In this framework, the use of technology in knowledge work is usually envisioned as a first-order, convergent change—that is,
technology is used to enhance the effectiveness of an established aspect of the job. However, certain questions remain: what con­
figurations are possible, how are they possible, what do the configurations look like? There are also questions of agency: who decides,
whose intent matters? Individuals may initially frame technology use through the lens of existing practices, but doing so is not suf­
ficient or sustainable.
Over time, amid fundamental shifts in patterns of work and workplace interactions, the effects of previous changes, known as
second-order effects, are emerging. As unforeseen opportunities for technologies become visible, new fault lines and digital divides
may occur. As technology is increasingly versatile and generative (Zittrain, 2006), it may be appropriated in unforeseen ways. New
configurations may break old boundaries and establish new paths forward. Moreover, most forms and instances of automation do not
fully substitute human work but rather lead to a reconfiguration of work, creating new tasks, types, and divisions of work while
substituting or transforming other tasks. As workplace technologies become deeply embedded in work practices and, consequently, in
organizational structures and processes, new organizational structures and capabilities emerge. Third-order effects are deep structural
transformations that include rethinking the nature of work, changing the identities of individuals, groups, and institutions, and
problematizing epistemic cultures (Knorr Cetina, 2007). Third-order effects are revelatory in that they enable us to see our work in a
different light by revealing our underlying goals, how we may achieve them, and measures of quality and values, as well as how
technology shapes our roles, relationships, and identities.
We extend this framework to look more closely at how technology and human practices come together in the mangle of the
reciprocal production, and shaping of technology, the individuals, and their work (Pickering, 1995). This framework also allows us to
study how novel human-technology constellations emerge in the liminal spaces between intent, unintended effects, and deep structural
changes, where intent is complemented by experimentation, improvisation, sensing, sense-making, and identity work.
In transformations of such scope, the individual is both agent and participant observer, acting, shaping, and analyzing, trying to
make sense of unfolding changes, which only gradually become visible and sometimes are intentionally hidden, e.g., under the pre­
tense that technological innovation needs to be disruptive and transparency might cause resistance.
First-order effects mainly involve enacting intentional change or transformation work (preparing, familiarizing, grasping the
changes). Second-order effects require trying to imagine and anticipate the effects of effects, which only gradually become visible. This
phase also involves making sense of direct and indirect effects, e.g., how do others respond to changes and unforeseen side effects or
figure out when and why the technology malfunctions (Jussupow, Spohrer, Heinzl, & Gawlitza, 2021)? Third-order effects require
individuals, societies, and institutions to perform identity work, involving reflection and the actualization of deep structural effects.
Moreover, this process can trigger another cycle of change that requires further reconfiguring human-technology arrangements.
Second- and third-order effects might not always become visible, which oftentimes necessitates additional work: attention, antici­
pation (Lucivero, Swierstra, & Boenink, 2011, p. 129; Reijers et al., 2018, p. 1439), scrutiny, articulation, compensation for short­
comings, and tackling issues caused by second- and third-order effects.
We use the three orders of effects as an analytical device and take particular interest in transformative processes between and across
the different orders of effects: how individuals and organizations move in unforeseen directions, manage tensions between the
intended and the unexpected in a liminal space (“a realm of pure possibility whence novel configurations of ideas and relations may
arise” [Turner, 1967, p. 97]), put their (professional) identities on the line, reinvent roles and relations, and identify the directions of
deep structural changes.

2.3. Four vantage points

Investigating the transformation of work requires recognizing that configuration work is embedded in a setting-specific system of
production. We suggest that examining configuration work from four different perspectives can help shed light on this hidden work: 1)
the adaption of physical settings for work; 2) the transition to life on the screen; 3) establishing and re-establishing common ground in
the face of technological intermediation; and 4) changing actor constellations and institutional arrangements.
The adaptation of the physical setting for work: While human-technology configuration work is primarily cognitive, it is also crucially
material as it takes place in a physical setting. The adaptation of the workplace is critical to the performance of the work—preparation,
setting the stage, preparing the “workshop” (Sennett, 2008, pp. 53–80)—in line with the idea of mise en place, the setup of the kitchen
required before the actual cooking begins (Charnas, 2016; Weisberg, Hirsh-Pasek, Golinkoff, & McCandliss, 2014). In other words, the
physical space where digital work will be performed needs to be reconfigured as the transformation unfolds. This involves

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infrastructure work: designing, setting up, and crafting the workshop (e.g. the operating theatre or home office), reevaluating the
material and spatial structures that shape the flow of work, and developing new routines and practices.
The transition to life on the screen: While human actors continue to be present and perform work in physical settings, the machinery
and objects of work are shifting, at least partially, from the physical and material to the representational (Østerlie & Monteiro, 2020).
Teachers and surgeons were once required to be physically near to students and to patients, respectively, but these latter have been
transformed into virtual presences, and the identities of the lecturers and surgeons have been transformed as well. Thus, adjusting to
“life on the screen” (Turkle, 1997) is a critical aspect of configuration work. How we engage with computer-mediated representations
of a task environment is a key aspect of human-digital configuration. Through observation and planning, as well as experimentation
and reflection, individuals shape and reshape practices; in other words, they identify what becomes backgrounded or foregrounded,
visible or invisible, tacit or explicit, as they imagine alternatives and reflect their identities in newly representational environments.
This implies additional cognitive and emotional work is required to work “on the screen,” including learning, monitoring, reflecting,
making continuous adjustments, anticipating, imagining, exploring, experimenting, (contingency) planning, sense-making, and doing
relationship work.
Establishing and re-establishing common ground in the face of technology intermediation: As human work becomes increasingly
entangled with technology, technology mediates interactions with other aspects of the machinery of work. In Zoom teaching, in­
teractions with students are mediated by technology, meaning that the instructor and student are no longer in the same classroom but
are each in different physical settings with different features, qualities, and constraints. How is common ground created in the face of
double contingency? Jarvenpaa and Keating (2021) have explored communication failures and breakdowns in dispersed virtual teams.
Their lessons about dealing with communication obstacles can easily be applied to communication challenges that occur while
teaching over Zoom. Commonly understood social practices and routines (“what is seen as appropriate”) provide scaffoldings of sense-
making, signal expectations and cues, and stabilize reciprocal expectations. When new practices need to be developed or acquired,
common ground needs to be (re-)established, negotiated, and enacted (Gherardi & Nicolini, 2002). Establishing common ground in
robotic surgery refers to the process of aligning the surgeon’s view on the console and the surgery team’s view of the patient.
Actor constellations and institutional transformation: We have focused on the transformation of the work of individual actors;
however, the transformation of knowledge work is dispersed across constellations of multiple actors in which the individual worker is
embedded. Such transformations affect the roles and relations of those involved in the work. Most work happens within an institutional
framework that governs roles, rules, incentives, and sanctions that, most of the time, become inappropriate for the new work
configuration and will require adjustments in recognition of a new reality.
The performance of knowledge-intensive work is dependent on a setting-specific system of production (Knorr Cetina, 2007). Knorr
Cetina (2007) referred to “epistemic culture” as “those sets of practices, arrangements and mechanisms bound together by necessity,
affinity and historical coincidence which, in a given area of professional expertise, make up how we know what we know” (p. 363).
Thus, the machinery of the work system, the group of people or system of experts and their collective achievements, as well as essential
objects and infrastructures, must be examined to understand the effects of work transformations. In this conceptualization, configu­
ration and reconfiguration mean identifying practices and systems in relation to others and identifying and shaping boundaries of
knowledge and meaning across a multi-actor constellation. Doing so requires developing and fine-tuning organizational models of
collaboration in the operating room or classroom and establishing structures, guidelines, rules, and expectations to provide orientation
and assurance, in which process information or issues may be discovered that were previously missed or misunderstood.
These four vantage points provide distinctive lenses on the transformation of work, shed light on the settings in which analysis takes
place, and thus illuminate the versatility and ambidexterity of configuration work, which includes inventing new routines and sta­
bilizing them. Thus, these vantage points cut across the three orders of change, moving from the intended and well-understood facets of
convergent change toward the surprising and unanticipated effects of effects to the deep structural changes of epistemic cultures and
identities.

3. Research design

Digitalization facilitates increased computer-mediation in work, which in turn requires organizational and institutional in­
frastructures including institutional scaffolding, regulation, training, career path refinement, funding and incentives, and legitimi­
zation for the new way of working. We provide two narratives of groups of professionals gradually redesigning their respective
workplaces. Not only have surgery and teaching become new tasks—performing work on the screen, engaging with the affordances
and controls provided by technology—but they have also fundamentally transformed the constellation of actors in an organization and
the relations between them. We analyze these two contrasting cases in order to study and articulate the extent, types, and scope of
configuration work, which often is hidden work.
We use the three orders of effects as lenses to analyze how these cases unfolded over time and how deep-seated structures and new
possibilities gradually become visible. These lenses allowed us to identify the initial visions for the transformation of work (intended or
first-order change), how the transition was enacted, and the changes that became visible only after certain technologies had been
appropriated and adopted. While our analysis focuses on individuals’ configuration work, work happens in constellations of actors and
is sensitive to institutional settings. Changing configurations of work often have ripple effects across actor constellations and in­
stitutions: relations and interactions change, new divisions of labor between humans and technology are instituted, new tasks and roles
emerge. In effect, individuals and organizations undergo transformations and develop new identities.

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4. Empirical illustration: The case narratives

4.1. Robotic surgery

The practice of medicine, and specifically the practice of surgery, have continually adopted new methods and techniques to
enhance the treatment of patients. Advances in technology and a culture of continuous innovation are currently driving new de­
velopments in surgical practice. The concept of robotic tele-surgery began to take shape about 30 years ago with George H.W. Bush’s
announcement of a goal to put a man on Mars, which would require the performance of remote surgery on astronauts (Ghezzi &
Corletta, 2016). Around the same time, interest emerged in new methods of performing surgery on wounded soldiers in war zones with
the surgeon located in a safe, remote location (Leal et al., 2016). Significant strides were made in the development of tele-surgery,
though it was ultimately deemed unfeasible. However, in the 1990s, the first “master-slave” robot system was developed: a robot
with manipulators controlled remotely by a surgeon at a workstation (Ghezzi & Corletta, 2016). Some aspects of the tele-surgery
project, in particular the development of small monitors and “data gloves” (electronically wired gloves that would track hand mo­
tions and manipulate instruments remotely), could be used by a surgeon at a console via a robotic system (Satava, 2003).
The development of laparoscopic or “minimally invasive” surgical procedures was a major innovation in the 1980s (Francis &
Winfield, 2006). Laparoscopy had significant benefits for patients, including shorter hospital stays, smaller incisions, decreased pain,
fewer complications, and lower costs. Laparoscopy, however, had consequential disadvantages for the surgeon, including fatigue, two-
dimensional vision, reduced dexterity, and increased tremors (Lanfranco, Castellanos, Desai, & Meyers, 2004). Surgeons soon realized
the potential of tele-surgery advancements to enhance laparoscopic procedures and expand the benefits of minimally invasive surgery
(Ghezzi & Corletta, 2016). “From their inception, surgical robots have been envisioned to extend the capabilities of human surgeons
beyond the limits of conventional laparoscopy” (Lanfranco et al., 2004).
Recognition of these potential benefits led to the commercial development of robotic surgical systems: first, the DaVinci Surgical
System, followed quickly by the Zeus Robotic Surgical System (Lanfranco et al., 2004). The robotic systems provided surgeons a three-
dimensional view of the surgical site that included depth perception and resulted in enhanced ergonomics, less fatigue, and enhanced
dexterity of motion (Lanfranco et al., 2004). Robotic surgery also produced improvements in patient care, including smaller incisions,
fewer complications, faster recovery, and shorter hospital stays (Tsuda et al., 2015).

4.1.1. Adaptation of the physical setting for work: transitions in the operating room
The operating room, or operating theatre, is the physical space where surgery takes place. The room must be sterile, with carefully
controlled temperature and humidity and constant measures being taken to prevent contamination. The practice of surgery is highly
collaborative (Pelikan, Cheatle, Jung, & Jackson, 2018) and involves a surgical team, with the surgeon considered the leader of the
team. The team usually consists of at least five members, including the surgeon, an assistant (often a highly-skilled nurse or possibly a
second surgeon), an anesthesiologist, a scrub technician, and a circulator (who records what happens during the procedure and make
sure that the environment and instruments remain clean and sterile). Complicated surgeries may be staffed with additional scrub
technicians and circulators. In teaching hospitals, the teams are larger, including residents, interns, and students (Pelikan et al., 2018).

4.1.2. How the operating room setup changed with robotic surgery
In conventional surgery, either open or laparoscopic, the surgical team gathers in close proximity around the patient and performs
highly interdependent activities. An open incision at the surgical site allows direct access to the patient’s organs. In conventional open
surgery, the tools commonly used include scalpels, forceps, scissors, and clamps (Beane, 2019). Laparoscopic surgery is a minimally
invasive procedure in which organs are accessed through a small incision using specialized instruments and a miniature camera.

Fig. 1. Robotic Surgical System. From https://www.franciscanhealth.org/health-care-services/robotic-assisted-surgery-334, CC BY-SA 4.0, https://

commons.wikimedia.org/w/index.php?curid=70874369

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The layout of the operating room changes dramatically for the performance of robotic surgery. Robotic surgery is technically
considered a type of minimally invasive surgery but the actual procedure differs dramatically. The robotic system is extremely large
with multiple components. A four-armed robot is located at the operating table while the surgeon is seated at a distant console
directing the robot’s actions (Sergeeva, Faraj, & Huysman, 2020). The Da Vinci Robotic Surgical System, the most commonly used
system (Sergeeva et al., 2020), is described by Pelikan et al. (2018) as follows. The system consists of three components. The patient cart
is about the size of a large refrigerator and has four extendable arms that operate inside the patient. The surgeon (or a team of surgeons)
controls the movements of the patient cart’s arms through consoles, which also provide a 3D video feed from inside the patient. The
vision cart contains all computing equipment and a microphone system as well as a screen that displays the video feed in 2D for the
team.
In preparation for surgery, the team works together in close proximity to dock the robot on the patient, setting the arms in the
correct positions. The patient is immobilized and the robotic arms are fixed on the patient prior to the beginning of the surgery. Once
the docking of the robot is complete, the surgeon takes a seat at a computer console removed from the patient. During the procedure,
the surgeon watches a computer screen with a wide view of the surgical site and monitors a constant stream of information being
transmitted. A surgical assistant and the scrub technician stand at the operating table next to the patient’s body (Sergeeva et al., 2020).
The robotic system is large and its multiple components introduce physical space between formerly collocated team members, as
shown in Fig. 1.

4.1.3. The transition to life on the screen

When performing robotic surgery, the surgeon is seated at a console removed from the patient. The robotic surgical system is
dependent on human direction. The console interface allows the surgeon to control the movements of the robotic arm or other
functions of the robot, usually using a set of joysticks or a computer mouse to click buttons on the interface. These systems are designed
to be an “extension of a surgeon’s hands and fingers” (Francis & Winfield, 2006).
The work of surgeons is increasingly abstract and cognitive (Sergeeva et al., 2020). Specifically, surgeons now monitor information
via computer console instead of directly observing the human body in a conventional open surgery. During the robotic surgical
procedure, the surgeon’s attention is focused on the console screen, and they can only see the operating room if their attention is turned
away from the screen. Moreover, operating the controller and directing the movement of the robot to perform the surgery require a
new, abstract “bodily grammar” (Beane, 2019). Beane recounts a resident describing tying a knot when an artery has been nicked in
open surgery vs. robotic surgery: “The actual process is different … It’s not your own hand, wrist or fingers [tying the knot] … You have
to think how to tie the knot when you’re doing it robotically” (p. 98).
However, the transformation of knowledge production required for surgical work is more complex than simply the abstraction of
the performance of physical activities. The following quotation describes the transition from direct manipulation of the human body to
the direction of robotic actions based on the surgeon’s interpretation of a representation of the human body:
“… when operating with the robot, surgeons still lack the integration between visual and manual control of the tissue. In other
words, is not just the lack of haptic feedback that matters, but the condition of operating without the simultaneous info coming
from visual and tactile senses, conveying data to the brain that are translated into a more complex interpretation of the tissues’
characteristics” (Di Benedetto, Tarantino, & Magistri, 2019, p. 512).
The surgeon has less access to “tactile and visual” information during robotic surgical procedures; they are provided various
streams of digital information at the console to mirror the surgical site. The following is a description of the information received
during liver surgery:
“The Tile-Pro function on the robotic console is one of the most important resources of the platform and displays at the same
time the classical endoscopic view and imaging sources such as the US [ultrasound], CT [computed tomography] scan, MR
[magnetic resonance] images or 3D reconstructed models (9). Up to three different images can be viewed at the same time by
the console surgeon and the operating room personnel” (Di Benedetto et al., 2019, p. 512).
The transformation of the surgeon’s work is a complex shift from a process that was assumed to be embodied to an intricate, multi-
layered knowledge construction effort integrating different types of information from multiple sources. As previously described, even
the most basic of skills, such as tying a knot, require advanced skill to perform robotically, necessitating significant training and
fundamental changes in the nature of surgical practice.

4.1.4. Establishing and re-establishing common ground in the face of technological intermediation
During conventional surgery, members of the surgical team are co-located with a common and direct view of the surgical pro­
cedure, including incisions or alterations to the patient’s tissues, internal organs, or other body parts. This physical arrangement
naturally produces a common ground for understanding the actions being taken and their consequences. In particular, the importance
of such common ground is evident when unexpected situations arise and quick action must be taken. For example, if all team members
become aware of an unexpected nick creating bleeding that must be stopped, necessary group actions to stop the bleeding can be
quickly executed and synchronized using non-verbal cues (Pelikan et al., 2018).
By contrast, the common understanding and non-verbal communication relied upon in conventional surgery have almost no place
in robotic surgical procedures. In robotic surgery, team members are physically separated and monitor different information streams,
much of it displayed on monitors. The surgeon cannot see the operating room or other members of the surgical team unless they turn
their head away from the computer. Moreover, the surgeon has a wider and more extensive three-dimensional view of the patient and
the surgical site than other members of the surgical team, as well as access to a continuous flow of information. Two-dimensional

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monitors (three-dimensional displays are emerging) are placed throughout the operating room and display more limited information
to other surgical team members, allowing team members to follow the surgical procedure.
While the team members (not including the surgeon) have a common view of the monitors placed throughout the operating room
during robotic surgeries, the interpretation of the information on the screen requires significant communication and explanation to
coordinate actions and increase mutual understanding (Pelikan et al., 2018; Sergeeva et al., 2020), a shift from conventional surgery,
in which team members took for granted that they all had the same access to information. Not surprisingly, multiple studies have found
verbal communication increases significantly in operating rooms where robotic surgery is performed as compared to traditional open
surgery (Pelikan et al., 2018; Sergeeva et al., 2020).

4.1.5. Actor constellations and institutional transformation

The surgeon is considered the surgical team leader. Clearly, the shift from conventional to robotic surgery transforms the surgeon’s
work, but there are also significant changes in the role and work practices of other surgical team members, including nurses and skilled
support technicians. Francis and Winfield (2006) documented changes at all points of the surgical cycle, including pre-operative, intra-
operative, and post-operative surgical procedures. In particular, all surgical healthcare professionals on the robotic surgery team must
become proficient in working with the robotic system. As Francis and Winfield wrote,
“Every health care professional involved in the utilization of a robotic surgical system has the potential, through human error, to
cause an unwanted outcome. The chance of this happening can be greatly reduced by providing education and training to all
personnel involved in operating, setting up, and maintaining a robotic surgical system” (2006, p. 103).
During pre-operative surgical procedures, the nursing personnel must know how to properly connect, calibrate, and set up the
equipment of the surgical robotic system. During the intra-operative phase, the nurses’ role changes considerably (Francis & Winfield,
2006; Sergeeva et al., 2020). As the surgeon is seated at a console removed from the operating table, the nurse (or a group of nurses)
becomes the primary skilled professional located close to the patient and must be familiar with emergency procedures for removing the
robotic system in case of an aborted procedure or unexpected conditions that necessitate other changes. Moreover, during the pro­
cedure, nurses must interpret and react to information displayed on the two-dimensional monitors to ensure the proper physical
procedure is followed and allow the surgeon to focus on the procedures at the console (Francis & Winfield, 2006; Sergeeva et al., 2020).
The tasks of other members of the team seem less affected, but all team members must be proficient in the setup and maintenance of
the robotic system as well as how to interpret the representation of the patient on the monitor. In addition, coordination with members
such as the circulator and scrub nurses is critical to maintaining sterility throughout the procedure.
During the post-operative phase of the procedure, the role of the nurse expands to include a larger focus on the education of the
patient as shorter hospital stays become shorter (Francis & Winfield, 2006).
In teaching hospitals, significant changes to surgical training have been documented (Beane, 2019). Specifically, residents were
previously part of the team physically surrounding the patient, observing the process and taking over from the surgeon or acting as the
chief surgeon as appropriate. In this setting, the senior surgeon is physically co-located with and closely monitors the work of the
resident. This allows the senior surgeon to immediately react to any unexpected conditions encountered by the resident but also allows
the surgical resident to hone their surgical skills through performance under the oversight of a senior surgeon (Beane, 2019).
The surgical training process has been significantly transformed by the adoption of robotic surgery. Beane (2019) carefully
documented how the well-known and widely approved methods of surgical training were initially applied to robotic surgical training
but were modified over time as their drawbacks were exposed. The chief surgeon, directing and monitoring the surgery from the
console, has a more extensive view of the patient’s surgical site than in conventional surgery and more access to information, which
leads to a higher level of awareness of potential problems (Beane, 2019). In this setting, Beane (2019) found that the chief surgeon is
often reluctant to let the attending get involved. Specifically, the chief surgeon is hesitant to take risks when potential problems are
known. In the robotic surgical setting, major errors are much harder to correct quickly if problems are encountered than in traditional
surgery (Beane, 2019) as indicated by the following example (p. 101):
“In open [surgery], if you put a hole in the iliac vein, yeah, it’s a big problem, but you can put your finger there, compose
yourself and get control. If you cause that in a robotic procedure, the patient could hemorrhage before you regain visualization.
If they [surgeons] think they can do it by themselves safely, they’re not going to want to take that risk [letting the resident
operate]. (Resident)”.
Thus, the surgeon tends to “micro-manage” the resident, not allowing the resident as much actual time performing surgical pro­
cedures and honing surgical techniques. Robotic surgical training is consequently comprised of more time with simulations and even
videos than traditional surgical training (Beane, 2019). This is also true when surgeons experienced in conventional surgery receive the
necessary training to transition to robotic surgery.

4.2. Teaching from home via zoom

In the spring of 2020, many universities across the globe had to go into lockdown and switch from classroom teaching to online
teaching. While the move to online-only teaching was the result of the COVID-19 pandemic, it also accelerated the implementation and
extension of widespread plans for the digitalization of higher education.
Our analysis examines how individuals—in various constellations of actors—figured out how to transform and organize their work
in novel human-technology configurations, an ongoing process that has created a vibrant and dynamic atmosphere. Most actors are
engaged in collective experimentation (Whillans, Perlow, & Turek, 2021), sense-making, and adjusting their practices. Radical change

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and the inevitable uncertainties require a commitment to figure things out, to explore, to experiment, to tinker with the options: “To do
good work means to be curious about, to investigate, and to learn from ambiguity” (Sennett, 2008, p. 48). We identify and distinguish
different types of work, many of them hidden (Sostrin, 2016), unrecognized, or unaccounted for, which are nevertheless necessary and
an essential part of the identities of those who accomplish the work.
The experiential accounts and reflections on teaching from home via Zoom echo many of the authors’ conversations with col­
leagues around the globe, conversations with students, and the data systematically collected from three surveys distributed to faculty
during the summer of 2020 as well as structured feedback and comments provided by students in their course and examination
evaluations, which included specific questions and items about the impact of COVID-19.

4.2.1. The home office and the design of the “workshop”

Swapping the classroom for one’s home office provides a rich setting in which to explore the technology-induced and -enabled
transformation of work. Teaching from home involves turning a confined, private space into a virtually public space (Chaves, 2021).
Traditionally, the home office was a space into which only colleagues or collaborators would be invited. Even then, video feeds were
often be turned off, leaving one’s surroundings invisible. When the home office becomes one’s only workspace for months, it requires
organizing and preparing the technical, spatial, and temporal infrastructure, i.e., extensive “infrastructure work” (Watson-Manheim &
Klein, 2019). The temporal structuring involves being mindful of the local time of the participants in a meeting (or course, exami­
nation, etc.) and balancing the program schedule with individual requirements. The spatial setting requires selecting a suitable spot in
the apartment or house, one that does not interfere with the other household members (or does so minimally). Often the space has
multiple purposes and has to be set up for computer work. This space is turned into a kind of broadcasting studio, where commu­
nication bandwidth, AV equipment and setup, lighting, possibly several computer screens, and a repertoire of software tools together
become an assemblage for work. From an organizational point of view (and this applies to home offices and mobile work), this shift
may result in a sense of the organization fragmenting or raise concerns about individuals’ performance and contributions. Most
universities and their management teams had little experience with remote work before the COVID-19 pandemic and thus struggled
with the lack of visibility of colleagues and their team (Hafermalz, 2020).
An assemblage simultaneously creates an intellectual challenge (cognitive work) for the individual, namely to figure out—with little
or no support—how to make things work, how to make them work better, and what can be done if they don’t work as expected. To do
so, employees are dependent on the technical infrastructure, which yields a feeling of vulnerability (emotional work). In order to cope
with this dependency, employees draft contingency plans mentally or even in writing, e.g., for the first session of a class or for an online
examination. Communication and articulation work (Corbin & Strauss, 1993; Suchman, 1996), also referred to as outer-action, has
been vastly extended to (re-)establish expectations (Nardi, Whittaker, & Bradner, 2000) or to provide (re-)assurance (e.g., “I can see
and hear you; the screen you are sharing is the correct one …”). This seems necessary to compensate for students’ lack of casual contact
and conversations among peers and with faculty.
Trying to figure out the new configuration involves managing technical settings in Zoom, coordinating presentations to and
conversations with students, monitoring the participant list and the chat box, and establishing whether the students see what they are
supposed to see, e.g. a shared window containing a presentation. What used to be two tasks—setting up the classroom (computer,
projector, etc.) and delivering the lesson—have become a matter of constant juggling, (re-)arrangement, monitoring, and analysis of
whether and how the session works.

4.2.2. Life on the screen

Online teaching turns the classroom into work and life on the screen.2 While a physical classroom is the same space for all who enter
it, the virtual classroom is a collection of individual spaces, large or small, comfortable or not, quiet or noisy. The virtual classroom is
flat, a rectangular grid the size of the screen, composed of a maximum of 25 squares at a time, which show the videos of those in
attendance, either their pictures or just their initials, depending on the setting and their willingness to be visible. The classroom thus
turns into a collection of individual squares. It is thus simultaneously homogeneous and heterogeneous. The screen becomes the
environment within which work is being performed. In their phenomenological analysis, Introna and Ilharco characterized screens as
“screens in-the-world … a framing of relevance, a call for attention, a making apparent of a way of living. Thus, the reduced phe­
nomenon of a screen is something devised to attract—or rather, that already has—our attention and locate our action as acting beings
in the world of ongoing activity” (2004, p. 227).
The act of entering the classroom and walking to the podium or the lecturer’s corner has been replaced by a click that starts a Zoom
session. However, there remains a sense of getting ready, of preparing mentally and emotionally to enter the virtual classroom through
small symbolic acts like putting on one’s headset, arranging one’s desk and screens, and turning off one’s own mirror image.
Individuals’ visibility in the virtual classroom has become a software setting: users select a profile image, turn the camera on, and
customize the background, which can be blurred or replaced by an artificial background. The latter comes at a price for one’s
communication partners as the face of the speaker is blurred at the edges and conveys a Zombie-like appearance.
As everything is digital, there are several options for recording the session or reviewing analytics (such as the speaking time and
participation of each user), yet privacy concerns may deter some users from enabling these functions. Software like Zoom provides a
collection of choices—from how participants are displayed to screen sharing, the list of participants and related controls, chats,

2
Turkle’s book “Life on the Screen” (1997) reflects on the online way of life and its impact on individuals’ identities.

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breakout rooms, polls, etc.—that can be used to facilitate teaching. However, this requires quite a bit of experimenting with teaching
formats as well as, typically, scripting in order to manage the complexity of running one’s own studio with all the controls, delivering a
course, and combining various setup options in a didactic manner. Yet this also provides a repertoire of options that are easy to set up
and some of which are specific to the online environment, e.g. chats with selected or all participants. The typical example of Zoom is a
meeting, which can be scheduled and to which participants can be invited. It typically requires some planning (sending invitations,
negotiating availabilities, etc.) and is thus distinct from a call. Having to monitor technical settings, channels, controls, and alerts in
Zoom, while at the same time orchestrating the flow of an interactive teaching session and monitoring the participants, constitutes an
increased cognitive load.
The virtual classroom provides an ambivalent sense of control of oneself and others: the lecturer (the “host”) has control over a
number of issues, such as who is admitted, whether there is a waiting room, whether participants’ video feeds are shown, whether they
are muted, etc. The user shares agency with the software (Neff & Nagy, 2018): Zoom can be configured to send out invitations,
translate meeting times into the local time of the invitees, remind attendees of the imminent start of the meeting, or produce noti­
fications about the arrival of participants in a waiting room or poor connectivity.
Participants have control over whether and when they log on, the name they use, and whether they turn their video feeds and
microphones on. While there is a clear distinction in the roles and levels of control between the host (or co-hosts) and participants, the
overall setup can be more symmetric and offer more shared agency than a traditional classroom. During proctored online examinations
via Zoom, the examination room is turned into a panopticon (Foucault, 1995): the students are visible to the proctor, who remains
present in case of problems or questions, yet the proctor is mostly invisible to the students.3
Sitting in one’s home “studio” and running a course can make the instructor feel quite a bit like they are in a control center removed
from the immediate action. Still, they are expected (and expect themselves) to read the class, to imagine and sense what is going on, to
respond, to orchestrate participants’ learning in the call, and facilitate a dialog. Some lecturers have consequently (re-)discovered a
conversational style of teaching.
As faculty figure out how to use Zoom for a broad range of communication and work scenarios (one-on-one or small group sessions,
seminars, conferences, social events, etc.), despite this wide repertoire of options and communication partners to engage with, there is
a prevailing and distinctive sense of monotony. Work that used to take place in a variety of physical settings as the instructor moved
from one room to another, from one building to another, and even across the city, has been centralized in the home office, with
employees sometimes moving from one meeting to the next with the only break being the few seconds it takes to leave one meeting and
start another.
The university has provided Zoom licenses for every member, academic, student, and technical and administrative staffer. It thus
has provided a more level playing field than existed traditionally: students and faculty have the same tool and students are encouraged
and empowered to figure out how life on the screen works. When all students have a common tool, it becomes easier for peers to engage
with each other. However, students and faculty alike lack the mundane distractions, casual encounters, and respite provided by brief
breaks and physical relocations between one meeting and the next.

4.2.3. Double contingency and attempts to create common ground

Students have been deprived of their physical and social university habitats, which typically provide a rich set of opportunities to
observe others, to ask, to listen in to conversations, to approach the lecturer casually, etc. The reduction to virtual encounters has left
students and faculty more uncertain about mutual expectations, roles, and rules and has revealed the limitations of their mutual
understandings. It is not always obvious or even clear what is appropriate behavior in the new environment of a Zoom classroom. The
notion of double contingency thus applies to faculty and students but also to the relations among students: “Luhmann argues that the
complexity of social systems rules out the participants’ (Luhmann, 1995, p. 109) reciprocally fully understanding each other … The
participants are opaque and incalculable to one another. Hence, one can also talk of ego and alter ego as black boxes. ‘The basic
situation of double contingency is then simple: two black boxes, by whatever accident, come to have dealings with one another’”
(Luhmann, 1995, 109; Vanderstraeten, 2002, p. 85).
A possible response is to (re-)establish a basic set of structures, mutual role expectations, and basic rules, a scaffolding we call
‘Zoomiquette’. In order to do so, it was necessary to figure out what kind of structure and orientation the students needed and how to
communicate the new structure. In one teacher’s case, even though the school had not changed learning management systems, it was
found that new students were not familiar with the system (Moodle), and even for the continuing students, the role of Moodle to
organize their study schedules—in combination with Zoom links—was unclear. Equally unclear were the questions of whom students
could ask about such technical issues when no one was “around” and how the faculty could provide assurance and structure when they
did not fully understand what was amiss.
While double contingencies are part of the human experience, it remains challenging to figure out what communications, orien­
tations, assurances, or structures students need in an online-only environment. In many ways, both faculty and students have to rebuild
their relationships with and assumptions about one another. As students traditionally provide limited feedback, distance learning
makes it even harder for instructors to get a sense of whether what they say is received, understood, recognized, and remembered.

3
See the controversy about the remote-proctoring software Proctorio: https://www.theverge.com/2021/1/28/22254631/university-of-illinois-
urbana-champaign-proctorio-online-test-proctoring-privacy

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4.2.4. Actor constellation

In the above-mentioned distance classroom case, the instructor would call on an assistant during online examinations who func­
tioned as a sidekick, an additional set of eyes and ears, and backup capable of taking over if needed or pointing it out if the instructor
missed a chat message or a raised hand.
The instructor noted that, while they were alone in their home office, they were at the same time part of a large constellation of
actors. This constellation included the COVID-19 task force (in charge of crafting basic responses to the crisis), the IT staff (who
maintained and configured infrastructures, including a distinct iteration of Moodle just for examinations), the examinations office staff
(who set rules for examinations), and others. The constellation built on established roles and institutions, which, however, were
difficult to adjust to the new challenges. While rules and regulations to address the pandemic are emerging, the scope of actions open to
an individual remains considerable. The positive effect of such ambiguity is that individuals have the space to experiment, improvise,
and ultimately do what they feel is best.
As the expectations for interactions between faculty and students, which are normally taken for granted, become problematized
and foregrounded, new opportunities arise to understand such interactions, shape them in new ways, and establish new routines and
practices. Both the ostensive and the performative aspects of teaching and learning need to be reconfigured (Feldman & Pentland,
2003).

5. Discussion

This study has examined two extreme cases of the technology-induced transformation of human work to make sense of the dy­
namics of change and to document them in order to avoid social amnesia as such changes swiftly become routinized and
backgrounded.
The surgical robot is a highly complex, brittle piece of technology around which the operating theatre and the team of surgeons and
nurses are organized. The robotic system requires a highly controlled environment and setting, which includes the patient, in order to
be safe and effective. In contrast, Zoom is quite a robust platform and problems typically result from limited bandwidth or network
outages. It has quickly become part of the infrastructure and background of teaching environments and daily routines. Its distinct but
limited set of options results in a versatile platform that can be used to organize all kinds of meetings, virtual classes, seminars, ex­
aminations, and more.
This study has shed light on out how emerging human-machine constellations unfold (including the first, second, and third orders
of effects) and become visible from four distinct vantage points: 1) the physical setting for work; 2) life on the screen; 3) establishing
common ground, and 4) changing actor constellations and institutional arrangements (see Fig. 2). We explore patterns of trans­
formation as continuous reflexive processes.

5.1. Configurations

This analysis focuses on configuration work (including how to craft and shape work and the work environment or “workshop”) and

Divergent Framing
Altered Instuonal
of Acons
Framing
Importance of
Convergent Mindful
Individual and Transformaon
Framing of Acons Adaptaon*
Collecve Acons (Configuraons stabilize)
Ante- Individual and
cedent:
Collecve • Changes in Nature of
Profound Adjusng to Life Work
Acons Figuring out Figuring out
Techno-
on the Screen • Changes in
logical
Trans- Adapng the Professional Identy
formaon Workspace • Changes in
Organizaonal Identy
1st order effects Repairing
Communicaon 3rd order effects
Fractures
*Divergent framing
suggests/requires innovaon
and experimentaon,
important to be
2nd order effects mindful/vigilant? as acons
at this stage produce
transformaon

Fig. 2. The dynamics of “figuring out” and orders of effects.

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S. Klein and M.B. Watson-Manheim Information and Organization 31 (2021) 100377

relationships among colleagues and employers. Both cases require cognitive work to envisage types and modes of usage, their concrete
enactment in the social settings of the operating theatre and virtual classroom, and the embedding of technology into the institutional
settings of hospitals, teaching programs, research collaborations, and the organizational units of the school or healthcare system. As
improvisation is a crucial part of skilled work (Orlikowski & Hofman, 1997), we reflect on whether and how technology enables,
facilitates, or hinders improvisation and whether and how we can use technology to accomplish our goals.
Figuration, as Suchman stated succinctly, is critical to the transformation process as it “requires ‘unpacking’ to recover constituent
elements” (2012, p. 49). Certain essential elements of work are frequently taken for granted (Sostrin, 2016), perceived as routine
behaviors, and often unaccounted for even by the actor. Only when conditions change do some aspects of the work come to the
foreground and become obvious. For example, while instructors expected that teaching over Zoom would make it more difficult to read
student body language (a first-order effect), only by actually experiencing this loss of body language did we begin to clearly understand
its critical role in our teaching practices (a second-order effect). Only through experimentation and tinkering could they begin to frame
practices that might offer compensatory value. This has become an ongoing process as students also shift their practices in response.
Configuring and reconfiguring essential elements of work, and the mutual shaping of technology and practices evolves over time
and in practice. Only through experiencing the unanticipated effects and adjusting technology uses and work practices accordingly can
lead to new understandings. A surgeon performing a robotic surgical procedure can no longer rely on touching tissue to gain
knowledge about the surgical site, thereby losing an essential information source. This loss was expected (a first-order change), and to
compensate, streaming video of the site was provided in the surgical console. While effective, this information stream does not fully
replace the loss of information through touch. On the other hand, the video stream provides a wider, more comprehensive view of the
surgical site than is available in conventional surgery. Over time, representation methods have evolved to provide the surgeon with
multiple digital information streams during the procedure, allowing them to view the site from different angles with different levels of
granularity and scopes (Wu et al., 2021). The interpretation of these multi-layered information streams requires skills other than the
sensing and interpretation of direct tactile and visual information required by conventional surgery. This transformation has direct
implications for professional training and preparation (Beane, 2019), leading to deep changes in professional identity (a third-order
effect).
We argue that human-digital configuration is essential in order to utilize the profound technological innovations we are high­
lighting. Previous technologies moderated human capabilities, enabling humans to improve or extend some aspect of an activity. For
example, technologies in the traditional classroom allowed real-time access to the internet and online polling via cell phone with
immediate results. In contrast, online teaching via Zoom (or other platforms) mediates the teaching experience. Online teaching
cannot exist without the relationship between the human and technology. Learning how to teach in an online environment requires
learning how technology can be used to accomplish goals, even to create assignments and activities, adding a layer of complexity to the
task.
We take particular interest in how the process of adapting to and “figuring out” these changes has unfolded over time, how the
initial plans or intents shifted or drifted (first-order change), how unintended and unanticipated effects became visible (second-order
change), and how the emerging human-technology configurations challenged assumptions about what matters in the work and the
identities of workers and their institutions (third-order change).

5.2. Pattern of transformation: Applying and rethinking orders of effects

The three orders of effects describe three categories of systemic effects. Change at each level is revealing, albeit in different ways.
The sequential logic of the three orders of effects initially provides a useful structure to articulate the dynamics of different scopes of
effects. However, the order of effects should not be thought of as deterministic but rather as contingent on technology as well as actors
and their institutions, whether and how they embrace or resent change, and whether they engage in foresight and mindful experi­
mentation. Some effects are as profound as they are unexpected and result in work that has neither been planned nor budgeted.
In our two cases, surgery and teaching, the changes have not been limited to the different tasks involved in performing work on the
screen with the affordances and controls provided by technology but rather have fundamentally transformed the constellation of
institutional actors and relations among them.
The four vantage points utilized convey a sense of the scale and scope of the configuration work that individuals in our study
encountered in addition to having to navigate new work routines. The distinct order of effects allows a given change to be assigned an
initial position, which could change as a result of ongoing analysis.

5.2.1. First-order effects: Convergent framing of actions

First-order effects capture the active acceptance of new human-technology constellations, the attempts to make them feasible,
whether in designing, crafting, or performing the work. Computer mediation (including digitization and datafication) triggers the first
order of change: it creates a space (and necessity) for change, partly orientated around the designers’ intent, reflected in an organi­
zationally enriched view of change, and adjusted by individuals and teams based on their understanding of the task. It implies
infrastructure work: designing, setting up, and crafting the “workshop” (i.e., the operating theatre or the home office), including the
material and the spatial structures that shape the flow of work. In this sense, configuration work is aimed at accommodating first-order
effects, even while second-order effects may be already foreshadowed or anticipated (for example, how will the new workshop design
affect the work?).
Both cases reveal new constellations of work in rearranged workplaces with transformed constellations of actors and relations
between them.

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5.2.2. Second-order effects: Divergent framing of actions

Second-order effects highlight the growing awareness and reflection of unforeseen consequences of the recent transformation, from
spiraling workloads to the shift from embodied work to cognitive work and the need to (re-)create common ground. Affordance, the
human ability to foresee an action possibility in a given technology and its environment and to enact some of these envisaged pos­
sibilities, helps explain second-order effects. Affordance is an effect of the technological innovation embedded into socio-material
environments and provides openings for new possibilities, adjustments, and future developments. It calls for ongoing appropriation
and the crafting of work.
As configurations are actualized in practice, discrepancies between the designers’ and institutions’ intent and the users’ needs,
framing, and appropriation become visible (Rossi, Nandhakumar, & Mattila, 2020). Established patterns of work and interactions are
disrupted in unanticipated and unexpected ways. However, for some, the ensuing uncertainty (Griffin & Grote, 2020) may create a
welcome opening for innovation and change that otherwise might have remained inaccessible. Workarounds are constructed through
sense-making, improvisation, and innovation in order to enable the methods and routines the workers find appropriate, useful, etc.
Organizational schemata remain intact even while individuals reframe their ways of thinking and understanding.
Adjusting to life on the screen, and engaging with digital representations of work and coworkers, both extend and constrain ways of
working; identities and relations are reshaped in this process.
Repairing breakdowns in communication calls for articulation work, i.e., crafting logical explanations, creating common ground,
and learning how to read others even on the screen.

5.2.3. Third-order effects: Altered institutional framing

Third-order effects reveal the deep structural changes related to the identities of actors and their institutions: what does it mean to
be reduced to an image on a screen? What is the identity of one who controls a robotic arm or manages settings on Zoom? While
surface-level job descriptions may remain consistent (surgeons perform surgery, instructors deliver lectures or seminars), the deep
structures of these tasks have been changed so much that even experienced surgeons and lecturers require training in the new ways of
performing their tasks. We don’t have a good sense yet of which changes are transient and will eventually be backgrounded as people
learn, make adjustments, and develop new routines and which effects will be lasting.
Third-order effects typically amount to a change in worldview or an interpretive discontinuity (Riemer & Johnston, 2019). As­
sumptions that were once taken for granted and stabilized by institutional identities—assumptions about the essence and quality of
work (Hagel, Schwartz, & Wooll, 2019; Riemer & Peter, 2020), about required competencies and the degree of specialization (Malone,
Laubacher, & Johns, 2011), and about professional and organizational identity—have become open to challenges, thus creating space
for transformation and reconfiguration. Eventually, third-order effects may yield a normative stabilization of the new way of working
in which the new methods are not only legitimated but increasingly portrayed as inevitable and diffused into good practice documents
and curricula (i.e., they trickle down into the educational system).

5.2.4. A continuous reflexive process

The three orders of effects provide an analytical framework for investigating the digital transformation of work. As represented in
our model, this is not a linear transformation but a dynamic process unfolding over time, with actions at each level having reflexive
effects on other levels. In the case of robotic surgery, conventional surgical training consists of residents shadowing master surgeons,
observing procedures being performed, and then actually performing the procedure while being monitored by the master surgeon. In
contrast, robotic surgical equipment is bulky, with multiple components that introduce physical space between formerly collocated
team members. Moreover, becoming proficient at robotic surgery requires vastly different professional training, e.g., extensive time
honing skills through simulation vs. working directly with a chief surgeon during actual surgery. Beane (2019) argues that while
surgical residencies ostensibly produce surgeons who should be trained in both areas; in practice, this is not feasible.
Mindful adaptation is of critical importance in the liminal space between second- and third-order effects. We have stressed that the
process of “figuring out” human-digital configurations is improvisational and adaptive. Configurations will emerge in practice that
may or may not be institutionalized, depending on many factors. However, some configurations will become systematized. The im­
plications of these configurations should be considered as they are the foundation of the transformation and may have significant (but
unintended) consequences. For example, we found nothing in the literature to indicate that robotic surgery was expected to branch off
and become a surgical subspecialty outside of traditional surgery.
Our model shows an arrow pointing from third-order effects back to first-order effects. As configurations become stabilized and the
effects are systematized, institutional changes reach a state of stasis. Institutional members share established expectations and un­
derstanding of their work, their professional identities, and organizational norms and beliefs. Cognitive frameworks converge in a
common understanding of “who we are” and “how things are done.” However, when profound new technological interventions appear
or environmental changes take place, the cycle can begin again.

5.3. Boundary conditions

The analyses of these cases suggests that the effects of installing robotic surgical systems and of using Zoom for teaching are highly
contingent on institutional settings, technical infrastructure, organizational framing, and individual modes of appropriation.
We suggest that the two illustrative cases represent a middle ground in the continuum of technologically induced transformations
in cognitive work: workplaces and work environments have been reconfigured, work relationships have become digitally inter­
mediated, and significant parts of employees’ work now take place on screens, requiring engagement with digital representations.

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Conversely, we have not examined the automation and replacement of human work, nor are we looking at systems like ERP, which
invoke and enforce a strict process logic, leaving little leeway for the individual.
Following periods of heightened fluidity and malleability in work configurations, certain designs will become dominant and
successfully vanish into the background as the configurations are routinized and taken for granted (becoming “the new normal”)
before a new cycle of transformation commences. Robotic surgery seems to have reached a mature stage of adoption among patients
and surgeons and institutionalization in hospitals and health insurance providers, even though the effectiveness of robotic surgery is
still contested (Muaddi et al., 2021). By comparison, the responses to online teaching via Zoom remain divided, ranging from those
advocating for the adoption of online teaching as a crucial part of universities’ offerings to those who expect that classroom conditions
will return to pre-pandemic norms. The assessment of Zoom classrooms is still skewed by the constraints of the pandemic.

6. Conclusions and future research

In this paper, we analyze transformative change. We use the experiences of individuals (the surgeon, the lecturer) to explore the
reconfiguration of work and the workplace as well as configuration as a method for studying the emergence of assemblages. In doing
so, we recognize the contingency and inevitable incompleteness of artifacts.
Examining human-machine constellations through four perspectives (the workplace, the screen, establishing common ground, and
institutional settings) revealed how technology changes work and how it shapes those who do the work. The three orders of effects
disclose indeterminacy as both a condition of work transformation and an opportunity for “agentic proaction … a projection of her/his
self into the situation” (Spender, 2011, p. 197). They provide prompts for those doing the work to reflect on the essence of their work,
what affordances of the human-machine constellation they perceive, and what they make of it.
Configuration work is not a collection of different tasks, though we do recognize different categories of work; rather, it is a
distinctive stance that calls for attentiveness to the transformation and emergence of practices. “Figuring it out” is a mode of exper­
imenting and exploring, of sensing and sense-making, of anticipating and imagining, of performing work and reflecting about its
essence. This method does not assume technological determinacy or human voluntarism but rather highlights the malleability and
versatility of technology, which needs to be “tamed,” put in place, so that it becomes more predictable and so that humanity and
technology can find their respective places.
The first order of convergent change foregrounds human intent as the driving force for change, while the second order of un­
foreseen effects reminds us of the mutual influence of humanity and technology and the indeterminacy of the transformation, which
enables and requires appropriation (Dourish, 2003) and place-making (Riemer & Johnston, 2012) but is also subject to social, eco­
nomic, and political forces. Deep structural (third-order) changes reflect the transformations of practices and related epistemic as well
as institutional stabilizations of change and can serve as the launchpad for further cycles of change.
Deep structural changes provide an opening to recognize (infra)structures and institutional arrangements that are typically taken
for granted and backgrounded. They raise profound questions about the nature of work, what constitutes good work, and whether the
changes are furthering the pursuit of values we recognize as important.
The vantage points used in our analysis point toward profound considerations, including the questions of what constitutes good
work (Sennett, 2008, p. 48), how life on the screen shapes our identities, how we can (re-)establish common ground and mutual
understanding, and how we can shape humane work systems that foster values such as fairness, accountability, and transparency.
The three orders of effects make the technology-induced transformation of work intelligible. However, the second and third orders
of effects need to be articulated and identified or they may remain unnoticed. Worse, those who are propagating first-order changes
may not even have an interest in recognizing second- and third-order effects.
Reflecting on settings (e.g., the workshop, the screen) and their phenomenology anchors the work in material or immaterial space.
Settings are the places where effects become visible or are experienced.
By recognizing that a great deal of the process of “figuring out” the transformation of work remains hidden, we highlight the
amount of work that is required and put novel arrangements into practice. It falls to the collective (individual, social, economic)
responsibility to recognize and adequately deal with it, as hidden work will otherwise become shadow work. Without attention and
vigilance, the hidden work of navigating systemic changes will become unremarkable and normative, setting off a (likely unplanned)
transformation.
Discussing hidden work then becomes part of a third-order effect (in discourse form): it reveals profound structures of work that
people might wish to suppress rather than recognize to their full extents.
Further research remains necessary to establish whether this analysis hold true across different types of work and organizations.
Additional implications that should be explored include:

• New configurations may pose novel risks to individuals, organizations, or society.

• Technological transformations call for exploring hybrid human-computer agency; what does it mean for human agency if computer
agency is extended (second- and third-order effects)?
• When so much work is cognitive, invisible, and individualized, how are norms created and managed?
• The transformation of work has implications for management, raising the questions of, e.g.,
o how to engage with second- and third-order effects;
o how to complement a performance culture based on workplace analytics with a learning culture (Grant, 2021);
o how to recognize and account for hidden work.
• Finally, we need to continue our reflection on the nature and quality of work.

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