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

Digital transformation of healthcare has largely been conceptualised throughadoption-centric lenses, relying on “barriers and facilitators” frameworks thatfocus primarily on individual technology adoption or organisational factors.Yet transformation in practice depends on sustained coordination amongmultiple autonomous actors who must align their actions across organisational,professional, and technological boundaries. This thesis examines healthcare’sdigital transformation through a coordination lens, conceptualising it as amultistakeholder collective action grounded in voluntary contributions andongoing cross-boundary work.The thesis addresses three research questions: how collective action iscoordinated and sustained (1) through governance arrangements indecentralised healthcare ecosystems, (2) through digital platforms in timecriticalsettings, and (3) how recurring challenges identified across thesesettings can be explained. The dissertation is presented as a compilation thesiscomprising four interrelated papers: an empirical study of governancearrangements in Sweden, an in-depth study of a health emergency responseplatform, and two systematic literature reviews that theorise coordination andstandardisation work in digital health ecosystems.Across the papers, the findings show that coordination failures persist notprimarily because actors lack shared goals, but because digital initiativescontinuously generate interdependencies that outpace the ecosystem’s capacityto align governance, standards, and everyday practice. At the governance level,coordination is weakened by opaque governance, limited feedbackmechanisms, and an over-reliance on regulation as a stabilising response toemerging cross-boundary dependencies. At the practice level, digital platformscoordinate emergency response through soft algorithmic coordination, whilealso shifting substantial responsibility for preparedness and continuity ontovolunteers, with implications for accountability and support.Synthesising these findings, the thesis explains recurring coordinationchallenges as outcomes of generative interdependencies in digital healthtransformation and outlines implications for building adaptive governancecapacity as interdependencies evolve.