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Navigating Governance Challenges in a Decentralised Healthcare Ecosystem

Saenyi, Betty LU ; Mansour, Osama LU and Keller, Christina LU (2025) In Proceedings of the Annual Hawaii International Conference on System Sciences p.3499-3499
Abstract
Polycentric governance has often been theorized as a desirable model for digital ecosystems due to its potential to spur innovation and enhance adaptability. However, in decentralised healthcare systems like Sweden's, low innovation rates and interoperability issues persist. This paper examines Sweden's efforts to achieve national digital health goals within its decentralised model. Analysing qualitative data from interviews and archival documents, we utilised the COOF framework (Context, Operations, Outcomes, Feedbacks) to assess the outcomes of the ecosystem's operational arrangements and its feedback pathways. We identified governance outcomes such as vendor lock-ins and inadequate digital adaptation structures. Furthermore, the... (More)
Polycentric governance has often been theorized as a desirable model for digital ecosystems due to its potential to spur innovation and enhance adaptability. However, in decentralised healthcare systems like Sweden's, low innovation rates and interoperability issues persist. This paper examines Sweden's efforts to achieve national digital health goals within its decentralised model. Analysing qualitative data from interviews and archival documents, we utilised the COOF framework (Context, Operations, Outcomes, Feedbacks) to assess the outcomes of the ecosystem's operational arrangements and its feedback pathways. We identified governance outcomes such as vendor lock-ins and inadequate digital adaptation structures. Furthermore, the presence of suboptimal feedback pathways and adjustment mechanisms explain the persistent governance challenges, which we refer to as governance opacity and over-reliance on regulation. By exploring the implications of polycentric governance, this study provides recommendations for enhancing collective action and enabling successful digital transformation in decentralised healthcare ecosystems. (Less)
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Chapter in Book/Report/Conference proceeding
publication status
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host publication
Proceedings of the 58th Hawaii International Conference on System Sciences
series title
Proceedings of the Annual Hawaii International Conference on System Sciences
pages
3499 - 3499
ISSN
2572-6862
language
English
LU publication?
yes
id
34333f1f-96df-4863-b5ae-1c608008203a
alternative location
https://scholarspace.manoa.hawaii.edu/items/0114354d-ee85-49f4-a370-0d9bfe353d33
date added to LUP
2025-01-23 10:20:11
date last changed
2025-04-04 14:25:36
@inproceedings{34333f1f-96df-4863-b5ae-1c608008203a,
  abstract     = {{Polycentric governance has often been theorized as a desirable model for digital ecosystems due to its potential to spur innovation and enhance adaptability. However, in decentralised healthcare systems like Sweden's, low innovation rates and interoperability issues persist. This paper examines Sweden's efforts to achieve national digital health goals within its decentralised model. Analysing qualitative data from interviews and archival documents, we utilised the COOF framework (Context, Operations, Outcomes, Feedbacks) to assess the outcomes of the ecosystem's operational arrangements and its feedback pathways. We identified governance outcomes such as vendor lock-ins and inadequate digital adaptation structures. Furthermore, the presence of suboptimal feedback pathways and adjustment mechanisms explain the persistent governance challenges, which we refer to as governance opacity and over-reliance on regulation. By exploring the implications of polycentric governance, this study provides recommendations for enhancing collective action and enabling successful digital transformation in decentralised healthcare ecosystems.}},
  author       = {{Saenyi, Betty and Mansour, Osama and Keller, Christina}},
  booktitle    = {{Proceedings of the 58th Hawaii International Conference on System Sciences}},
  issn         = {{2572-6862}},
  language     = {{eng}},
  pages        = {{3499--3499}},
  series       = {{Proceedings of the Annual Hawaii International Conference on System Sciences}},
  title        = {{Navigating Governance Challenges in a Decentralised Healthcare Ecosystem}},
  url          = {{https://scholarspace.manoa.hawaii.edu/items/0114354d-ee85-49f4-a370-0d9bfe353d33}},
  year         = {{2025}},
}