This doctoral thesis aims to advance theoretical and practical understanding of how individuals––both insiders involved in healthcare delivery and outsiders––proactively leverage information and digital assets to build more sustainable healthcare systems amid unique sectoral sociotechnical constraints. Given the context, the operational process and the outcomes, the thesis’s aim includes grasping the mechanisms behind how individuals represent related ill-defined and complex problems, both independently and collectively, and how their actions and interactions unfold and impact multiple levels. The topic choice is driven by a fundamental contradiction facing regulated healthcare organizations (HCOs): while delivering care more effectively than ever, they do so at unsustainable economic, social, and environmental costs. Complementarily, the choice of topic and problematization is also motivated by the consideration that, as an information-intensive sector reliant on intangible, knowledge-based assets, digital innovation is recognized as an enabler of more anticipatory, universally accessible, data-centric, and sustainability-oriented healthcare ecosystems. Yet, despite growing scholarly and practitioner interest, limited microlevel understanding remains of how individuals emergently and voluntarily collaborate on the ground toward this change, representing problems, and envisioning alternative futures while considering both contextual facilitators and inhibitors, separately and jointly. The thesis is organized as a collection of three papers, synthesizing the multi-method qualitative research process undertaken. The emergent design of the research followed a sequential yet iterative progression through various stages of analytical approaches, both within each empirical article—grounded in the empirical phenomenon—and across the articles. Addressing interconnected objectives in light of the thesis’s aim, the methodological process facilitated the transition from raw data to more abstract representational constructs. To understand the role of digital innovation toward the leverage of information in HCOs for service delivering, the first article, a standalone literature review, sets the stage. Two phenomenon-driven investigations build on and expand, contributing toward a novel context-based and multilevel theoretical standpoint. The second article is a longitudinal process study addressing the perspective of a category of outsiders—early-stage entrepreneurs in digital healthcare—aiming to deploy technology and a new approach to health data to positively impact patient experiences and the long-term sustainability of healthcare providers' outcomes. The third article, instead, is a configurational and longitudinal process study addressing the perspective of a category of insiders—hospital leaders (HL), managers, and connected top management teams (TMTs) from the frontline—aiming to advance new data governance initiatives to enhance the sustainability of a large public hospital. While each article offers distinct contributions to existing theory and debate, the findings from the two empirical articles also offer––cumulatively––a contextually grounded methodological standpoint, thus an opportunity for sector studies in healthcare to create dialogical multilevel spaces linking actors––both humans and non-humans––and individual actions and interactions at the microlevel to emergent, collective organizational, and macrolevel sustainability outcomes and performance.
Questa tesi di dottorato si propone lo scopo di avanzare la comprensione teorica e pratica di come gli individui—sia insiders coinvolti nell’erogazione dei servizi sanitari che outsiders—possano sfruttare le informazioni e gli asset digitali per costruire sistemi sanitari più sostenibili, affrontando condizioni contestuali sociotecniche uniche del settore. Collegando quindi il contesto al processo e agli esiti, lo scopo della tesi include la comprensione dei meccanismi attraverso cui questi individui sviluppano la rappresentazione dei problemi verso questi cambiamenti, sia in modo individuale che collettivo. La scelta del tema è motivata da una contraddizione fondamentale che caratterizza le organizzazioni sanitarie regolamentate (OSR): pur erogando cure in modo più efficace che in passato, ciò avviene a costi economici, sociali e ambientali sempre più insostenibili. In modo complementare, la scelta del tema e la problematizzazione sono motivate anche dalla considerazione che, essendo il settore sanitario un ambito ad alta intensità informativa e fortemente dipendente da asset immateriali e conoscenza, l’innovazione digitale è riconosciuta come un fattore abilitante per costruire ecosistemi sanitari maggiormente predittivi, accessibili, orientati ai dati e alla sostenibilità. Tuttavia, nonostante il crescente interesse accademico e pratico, resta ancora limitata la comprensione a livello micro di come gli individui, in modo emergente e volontario, collaborino sul campo per promuovere questo cambiamento, rappresentando i problemi legati allo sfruttamento delle informazioni e della innovazione digitale per la sostenibilità, quindi immaginando futuri alternativi, ma condizionati da fattori contestuali facilitanti e ostacolanti unici derivanti dal settore. La tesi è organizzata come una raccolta di tre articoli, che sintetizzano il processo di ricerca qualitativa e multi-metodo adottato. Il design emergente della ricerca ha seguito una progressione sequenziale ma iterativa attraverso diverse fasi di approcci analitici, sia all’interno di ciascun articolo empirico—guidato dal fenomeno osservato—sia tra gli articoli. Affrontando obiettivi interconnessi alla luce dello scopo della tesi, il processo metodologico ha facilitato la transizione dai dati grezzi a costrutti rappresentazionali più astratti. Per comprendere il potenziale dell’innovazione digitale nell’uso strategico delle informazioni nelle OSR, il primo articolo, una revisione della letteratura, fornisce il quadro di riferimento. Due successivi studi empirici, muovono da questa base e la ampliano, contribuendo a una diversa prospettiva teorica, contestualizzata e multilivello. Il secondo articolo è uno studio longitudinale di processo che esamina la prospettiva di una categoria di outsiders—imprenditori nelle prime fasi di sviluppo nel settore della sanità digitale—che mirano a implementare tecnologie e nuovi approcci ai dati sanitari per migliorare l’esperienza dei pazienti e la sostenibilità a lungo termine del sistema. Il terzo articolo, invece, è uno studio configurazionale e longitudinale di processo che affronta la prospettiva di una categoria di insiders—leader ospedalieri, manager e top management team connessi alla prima linea—che mirano a sviluppare nuove iniziative di governance dei dati per migliorare la sostenibilità di un grande ospedale pubblico. Sebbene ciascun articolo offra contributi distinti alla teoria e al dibattito esistenti, i risultati dei due studi empirici forniscono—cumulativamente—un nuovo punto di vista metodologico ancorato al contesto. Ciò apre un’opportunità per gli studi di settore sulla sanità di creare spazi dialogici multilivello, collegando attori—umani e non umani—e le azioni e interazioni a livello micro con esiti organizzativi emergenti e incrementi di performance riguardo la sostenibilità a livello macro.
Digital Futures in Healthcare: Essays on Strategy, Information and Sustainability
TRINCANATO, Edoardo
2025
Abstract
This doctoral thesis aims to advance theoretical and practical understanding of how individuals––both insiders involved in healthcare delivery and outsiders––proactively leverage information and digital assets to build more sustainable healthcare systems amid unique sectoral sociotechnical constraints. Given the context, the operational process and the outcomes, the thesis’s aim includes grasping the mechanisms behind how individuals represent related ill-defined and complex problems, both independently and collectively, and how their actions and interactions unfold and impact multiple levels. The topic choice is driven by a fundamental contradiction facing regulated healthcare organizations (HCOs): while delivering care more effectively than ever, they do so at unsustainable economic, social, and environmental costs. Complementarily, the choice of topic and problematization is also motivated by the consideration that, as an information-intensive sector reliant on intangible, knowledge-based assets, digital innovation is recognized as an enabler of more anticipatory, universally accessible, data-centric, and sustainability-oriented healthcare ecosystems. Yet, despite growing scholarly and practitioner interest, limited microlevel understanding remains of how individuals emergently and voluntarily collaborate on the ground toward this change, representing problems, and envisioning alternative futures while considering both contextual facilitators and inhibitors, separately and jointly. The thesis is organized as a collection of three papers, synthesizing the multi-method qualitative research process undertaken. The emergent design of the research followed a sequential yet iterative progression through various stages of analytical approaches, both within each empirical article—grounded in the empirical phenomenon—and across the articles. Addressing interconnected objectives in light of the thesis’s aim, the methodological process facilitated the transition from raw data to more abstract representational constructs. To understand the role of digital innovation toward the leverage of information in HCOs for service delivering, the first article, a standalone literature review, sets the stage. Two phenomenon-driven investigations build on and expand, contributing toward a novel context-based and multilevel theoretical standpoint. The second article is a longitudinal process study addressing the perspective of a category of outsiders—early-stage entrepreneurs in digital healthcare—aiming to deploy technology and a new approach to health data to positively impact patient experiences and the long-term sustainability of healthcare providers' outcomes. The third article, instead, is a configurational and longitudinal process study addressing the perspective of a category of insiders—hospital leaders (HL), managers, and connected top management teams (TMTs) from the frontline—aiming to advance new data governance initiatives to enhance the sustainability of a large public hospital. While each article offers distinct contributions to existing theory and debate, the findings from the two empirical articles also offer––cumulatively––a contextually grounded methodological standpoint, thus an opportunity for sector studies in healthcare to create dialogical multilevel spaces linking actors––both humans and non-humans––and individual actions and interactions at the microlevel to emergent, collective organizational, and macrolevel sustainability outcomes and performance.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/218684
URN:NBN:IT:UNIFE-218684