The policy-practice divide: How assumptions undermine authentic participation in digital public healthcare

Assumptions influence decision-making and guide behavior within organizations, and unexamined or unaligned assumptions can lead to flawed strategies. This is especially true in complex and rapidly changing environments, such as those encountered in digital transformation initiatives. Despite this, assumptions are not a common object of empirical study. In this article, we explore the role of assumptions in reshaping organizational practices regarding participation in a public digital transformation initiative in Swedish healthcare. We find a critical disconnect between assumptions in policy and practice, showing how prevailing assumptions uphold legacy approaches to participation and, consequently, impede the potential to utilize digital technology for new, more innovative ways to personalize care. We contribute a framework that illustrates the consequences of assumptions on participation. Drawing on Aronstein's ladder of citizen participation and the Scandinavian tradition of participatory design, we advocate for authentic participation that takes into account the contextual nature of patients' lives and work practices leveraging digital technology. • Assumptions often reproduce and uphold legacy approaches to participation. • Policy-practice disconnect hampers innovative digital personalization. • Participation should not be done in separation but integrated into everyday work. • Participation is crucial for personalized care through recombinational work. • Healthcare challenges demand re-configurated assumptions on participation.