From Vision to Practice: How Sociotechnical Imaginaries Influence Municipal Healthcare Control

ABSTRACT Digital technologies influence social and organizational structures, materializing visions of desirable futures that both authorize and constrain how societies and organizations are organized, and how control is exercised. Drawing on Science and Technology Studies (STS), this paper examines how sociotechnical imaginaries of “modern and integrated healthcare” are articulated in national policy, materialized in Electronic Health Record (EHR) systems, and enacted within municipal management control. We investigate how these imaginaries become embedded within the evaluative grammar of new public management (NPM), shaping which forms of control appear visible, comparable, and legitimate while rendering others peripheral. The study employs an interpretive single‐case design of a regional public EHR pilot in Central Norway, based on an analysis of policy documents, observations, and interviews. Empirically, we explore how management control is sustained under conditions of partial vertical fit and the conditions for comparability in decentralized, capacity‐constrained settings. We show how technological imaginaries interact with resource constraints, requiring ongoing managerial mediation and legitimation. The study extends inscription‐based accounts of control by showing how sociotechnical imaginaries operate as upstream legitimizing frameworks that define which forms of control become legitimate and visible. It further describes how control depends on ongoing managerial mediation and legitimation when technical fit is partial. Together, these insights illuminate how digital infrastructures embed normative visions of control, making certain forms of control thinkable and actionable.