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Coordinating digital transformation in healthcare : Governance, platforms, and generative interdependencies

Saenyi, Betty Nekesa LU (2026)
Abstract
Digital transformation of healthcare has largely been conceptualised through
adoption-centric lenses, relying on “barriers and facilitators” frameworks that
focus primarily on individual technology adoption or organisational factors.
Yet transformation in practice depends on sustained coordination among
multiple autonomous actors who must align their actions across organisational,
professional, and technological boundaries. This thesis examines healthcare’s
digital transformation through a coordination lens, conceptualising it as a
multistakeholder collective action grounded in voluntary contributions and
ongoing cross-boundary work.

The thesis addresses three research questions: how collective... (More)
Digital transformation of healthcare has largely been conceptualised through
adoption-centric lenses, relying on “barriers and facilitators” frameworks that
focus primarily on individual technology adoption or organisational factors.
Yet transformation in practice depends on sustained coordination among
multiple autonomous actors who must align their actions across organisational,
professional, and technological boundaries. This thesis examines healthcare’s
digital transformation through a coordination lens, conceptualising it as a
multistakeholder collective action grounded in voluntary contributions and
ongoing cross-boundary work.

The thesis addresses three research questions: how collective action is
coordinated and sustained (1) through governance arrangements in
decentralised healthcare ecosystems, (2) through digital platforms in timecritical
settings, and (3) how recurring challenges identified across these
settings can be explained. The dissertation is presented as a compilation thesis
comprising four interrelated papers: an empirical study of governance
arrangements in Sweden, an in-depth study of a health emergency response
platform, and two systematic literature reviews that theorise coordination and
standardisation work in digital health ecosystems.

Across the papers, the findings show that coordination failures persist not
primarily because actors lack shared goals, but because digital initiatives
continuously generate interdependencies that outpace the ecosystem’s capacity
to align governance, standards, and everyday practice. At the governance level,
coordination is weakened by opaque governance, limited feedback
mechanisms, and an over-reliance on regulation as a stabilising response to
emerging cross-boundary dependencies. At the practice level, digital platforms
coordinate emergency response through soft algorithmic coordination, while
also shifting substantial responsibility for preparedness and continuity onto
volunteers, with implications for accountability and support.

Synthesising these findings, the thesis explains recurring coordination
challenges as outcomes of generative interdependencies in digital health
transformation and outlines implications for building adaptive governance
capacity as interdependencies evolve. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Aanestad, Margunn, University of Oslo
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Digital health transformation, Digital transformation, Coordination, Generative interdependencies, collective action, Digital platforms, Polycentric governance
pages
134 pages
publisher
Lund University (Media-Tryck)
defense location
EC2:101
defense date
2026-03-13 13:15:00
ISBN
978-91-8104-817-9
978-91-8104-816-2
language
English
LU publication?
yes
id
96acd95a-96c2-4178-93b3-cf318cb1903e
date added to LUP
2026-02-16 14:35:18
date last changed
2026-02-23 09:11:55
@phdthesis{96acd95a-96c2-4178-93b3-cf318cb1903e,
  abstract     = {{Digital transformation of healthcare has largely been conceptualised through<br/>adoption-centric lenses, relying on “barriers and facilitators” frameworks that<br/>focus primarily on individual technology adoption or organisational factors.<br/>Yet transformation in practice depends on sustained coordination among<br/>multiple autonomous actors who must align their actions across organisational,<br/>professional, and technological boundaries. This thesis examines healthcare’s<br/>digital transformation through a coordination lens, conceptualising it as a<br/>multistakeholder collective action grounded in voluntary contributions and<br/>ongoing cross-boundary work.<br/><br/>The thesis addresses three research questions: how collective action is<br/>coordinated and sustained (1) through governance arrangements in<br/>decentralised healthcare ecosystems, (2) through digital platforms in timecritical<br/>settings, and (3) how recurring challenges identified across these<br/>settings can be explained. The dissertation is presented as a compilation thesis<br/>comprising four interrelated papers: an empirical study of governance<br/>arrangements in Sweden, an in-depth study of a health emergency response<br/>platform, and two systematic literature reviews that theorise coordination and<br/>standardisation work in digital health ecosystems.<br/><br/>Across the papers, the findings show that coordination failures persist not<br/>primarily because actors lack shared goals, but because digital initiatives<br/>continuously generate interdependencies that outpace the ecosystem’s capacity<br/>to align governance, standards, and everyday practice. At the governance level,<br/>coordination is weakened by opaque governance, limited feedback<br/>mechanisms, and an over-reliance on regulation as a stabilising response to<br/>emerging cross-boundary dependencies. At the practice level, digital platforms<br/>coordinate emergency response through soft algorithmic coordination, while<br/>also shifting substantial responsibility for preparedness and continuity onto<br/>volunteers, with implications for accountability and support.<br/><br/>Synthesising these findings, the thesis explains recurring coordination<br/>challenges as outcomes of generative interdependencies in digital health<br/>transformation and outlines implications for building adaptive governance<br/>capacity as interdependencies evolve.}},
  author       = {{Saenyi, Betty Nekesa}},
  isbn         = {{978-91-8104-817-9}},
  keywords     = {{Digital health transformation; Digital transformation; Coordination; Generative interdependencies; collective action; Digital platforms; Polycentric governance}},
  language     = {{eng}},
  month        = {{02}},
  publisher    = {{Lund University (Media-Tryck)}},
  school       = {{Lund University}},
  title        = {{Coordinating digital transformation in healthcare : Governance, platforms, and generative interdependencies}},
  url          = {{https://lup.lub.lu.se/search/files/242446829/Thesis_Betty_Saenyi_LUCRIS.pdf}},
  year         = {{2026}},
}