Managing higher education institutions involves a constant struggle between safeguarding the agency and autonomy of the staff and the stewardship of financial resources for stability, regulatory compliance and job security. Previous research has identified the increased reliance on managerialist academic work allocation models, while also acknowledging the innate de-professionalization these models may infer. We report a longitudinal case study of the implementation of a new approach to academic work allocation in higher education in a Swedish university. This new approach utilized slack resources to enhance the autonomy and performance of the staff in a strive for excellence. We show how the approach resulted in a substantial increase in both the quality of operations as well as working environment, while simultaneously introducing new challenges to management. Based on our findings, we offer recommendations to managers that strive to build and maintain higher education excellence and call for new research.

Public sector organizations struggle with digital transformation to ensure future relevance and efficiency. While the corporatization of public sector organizations offers certain opportunities for digital transformation, it also introduces challenges. In this article, the authors highlight how the existing governance of municipal conglomerates deters digital transformation. By tracing governance-related deterrents, the authors show the presence of a 'vicious circle' where governance mechanisms enforce each other, resulting in sub-par digital transformation and detrimental performance over time. The authors explain that, by understanding the vicious circle, policy-makers and managers in municipality conglomerates can improve existing governance to facilitate digital transformation. Municipalities constitute a core part of the welfare system, with responsibility for everything from the cradle to the grave for the local community's citizens. As municipalities increase their engagement in digital government, shifting over into increasingly digitally intense modes of operations and delivery, they reportedly struggle with achieving digital transformation. This article contributes to the literature on digital transformation in the public sector presenting a study of what deters digital transformation in municipal conglomerates, i.e. legal constructs where the municipality controls a set of corporations tasked with for example housing and utility. The authors identify patterns that deter digital transformation by studying a Swedish municipal conglomerate consisting of a municipality and 16 corporations. Based on this, the authors theorize on the interplay of deterrents, proposing a mid-range process theory of digital transformation deterrence in municipal conglomerates that we call the vicious circle of ambiguity. The findings are discussed in relation to the extant literature, resulting in research, policy, and practice recommendations.

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.

Digital transformation is associated with a fundamental change in the operating models of organizations and industries alike. At the same time, previous research highlights that existing governance practices may act as a deterrent to digital transformation. In this study, we explore how the IT governance of a large university counteracts necessary digital transformation in higher education over time. We show how the adoption of an industry-standard IT governance framework, through a series of generative mechanisms, leads to a vicious cycle that restricts digital transformation into mere computerization, thereby successfully counteracting digital transformation. In other words, the IT governance framework increasingly protects the organization from the organizational change brought on by new digital opportunities. This is discussed in relation to the literature on IT governance and digital transformation with the intent of contributing with a critical perspective on the widespread adoption and use of standard IT governance framework.

Sweden is transitioning from a provider-centric model of healthcare to a person-centric one through a large digital transformation initiative. Leading this transformation are local councils charged with co-creating with patients, citizens, and communities new digital systems. Previous literature has identified the difficulty of both large-scale change and implementing meaningful participatory processes. In this paper, we use Arnstein's model of citizen participation to analyze the degree of delegated decision-making found in managerial discourses and assumptions on this digital transformation. By comparing them with official documents, we find multiple tensions that preemptively undermine the potential active role that patients can play. Building on Arnstein's ladder of participation, we develop a framework that introduces four different modes of engagement for patient involvement in digital transformation initiatives. We suggest that beyond the design of participatory processes, digital transformations that rely on participation should focus on fostering social practices that disrupt established epistemologies.

Digital transformation is associated with a fundamental change in the operating models of organizations and industries alike. At the same time, previous research highlights that existing governance practices may act as a deterrent to digital transformation. In this study, we explore how the IT governance of a large university counteracts necessary digital transformation in higher education over time. We show how the adoption of an industry-standard IT governance framework, through a series of generative mechanisms, leads to a vicious cycle that restricts digital transformation into mere computerization, thereby successfully counteracting digital transformation. In other words, the IT governance framework increasingly protects the organization from the organizational change brought on by new digital opportunities. This is discussed in relation to the literature on IT governance and digital transformation with the intent of contributing with a critical perspective on the widespread adoption and use of standard IT governance framework.

This chapter aims to address the challenges facing Swedish municipal schools in their efforts to embrace digitalization and innovate teaching practices. The study highlights the legacy of traditional governance and New Public Management in Swedish municipalities, which has limited the digital maturity of schools and hampered their adaptive capacity. The authors propose a three-pronged approach to enhancing digital maturity, namely addressing the governance legacy, the digital heritage, and developing digital capabilities. By confronting outdated governance paradigms and investing in a flexible digital infrastructure while simultaneously increasing the capacity for participatory design activities, schools can transition toward a more agile and adaptive governance system. The chapter argues that a shift toward a digital-first mindset is essential for improving digital maturity and promoting innovation in Swedish municipal schools. The findings of this research have implications for instructors, ICT educators, school administrators, and transformational leaders in other countries facing similar governance and digitalization challenges.

PurposeDesigning digital artifacts is not a linear, straightforward process. This is particularly true when applying a user-centered design approach, or co-design, with users who are unable to participate in the design process. Although the reduced participation of a particular user group may harm the end result, the literature on solving this issue is sparse. In this article, proxy design is outlined as a method for involving a user group as proxy users to speak on behalf of a group that is difficult to reach. The article investigates the following research question: How can roleplaying be embedded in co-design to engage users as proxies on behalf of those who are unable to represent themselves?Design/methodology/approachThe article presents a design ethnography spanning three years at a cancer rehabilitation clinic, where digital artifacts were designed to be used collaboratively by nurses and patients. The empirical data were analyzed using content analysis and consisted of 20 observation days at the clinic, six proxy design workshops, 21 telephone consultations between patients and nurses, and log data from the digital artifact.FindingsThe article shows that simulated consultations, with nurses roleplaying as proxies for patients ignited and initiated the design process and enabled an efficient in-depth understanding of patients. Moreover, the article reveals how proxy design as a method further expanded the design. The study findings illustrate: (1) proxy design as a method for initiating design, (2) proxy design as an embedded element in co-design and (3) six design guidelines that should be considered when engaging in proxy design.Originality/valueThe main contribution is the conceptualization of proxy design as a method that can ignite and initiate the co-design process when important users are unreachable, vulnerable or unable to represent themselves in the co-design process. More specifically, based on the empirical findings from a design ethnography that involved nurses as proxy users speaking on behalf of patients, the article shows that roleplaying in proxy design is a fitting way of initiating the design process, outlining proxy design as an embedded element of co-design.

The public sector is currently undergoing significant transformation in striving for digital government. With digital government involving a dilemma between continuous improvements and radical innovation, this places new demands on the manner through which digital initiatives are prioritized and managed. Previous research has called for both increased agility and adaptability in the governing of digital, yet there is to date a dearth of studies into public sector portfolio management. In this study, we address the issue of how digital initiatives are prioritized and managed in organizations, i.e., the practice of portfolio management. Through a clinical inquiry of three public sector organizations (one agency, one healthcare region, and one municipality), we analyze and compare existing portfolio management practices and portfolio compositions using previous findings from the field of organizational ambidexterity. Based on this, we identify pathologies in the current practice, elaborate on the role of balancing in portfolio management, and offer concrete recommendations to practice.

Digital transformation is advocated as a strategic imperative for public sector organizations. With the increased permeability of digital technologies in society, i.e., the digitalization of society, public sector organizations need to find novel ways of utilizing the technology to meet newand fluctuating demands from their citizens. This study approaches the issue of digital transformation strategies through a strategy-as-practice perspective. Through collecting and analyzing all available top-level annual steering documents from Sweden's 290 municipalities in 2021, we employ content analysis to identify the current direction of digital transformation activities. The study finds that the dominant direction of digital transformation in Swedish municipalities is focused on internal efficiency, with only minor impacts from contingency factors such as the political majority and financial stature. This is discussed from a perspective of democracy and equal access to digital welfare, highlighting the empirical phenomenon of digital decoupling as a potential problem within digital government warrant of additional study.

Most organizations today are involved in transformation initiatives; this has led to a burgeoning interest in the phenomenon of digital transformation strategy.Here, we present the findings of a clinical field study of a large Swedish municipality that has been involved in an ambitious digital transformation program since 2017.Despite explicitly not having a formal strategy, the organization utilizes a pseudoformalized and emergent strategy-as-practice for digital transformation that involves a set of key traits that have emerged over the years.We show how these traits have emerged and theorize on how the process can be understood as rhizomatic strategizing.The strategy emerges over time through a series of de-and reterritorializations, expanding through amalgamating new concepts into a strategy-as-practice for digital transformation.

Purpose The purpose of this study is to contribute to research concerning the role of digital infrastructure in digital government. This is done by answering the research question: how does digital infrastructuring constrain ambidexterity in public sector organizations? Design/methodology/approach The research is designed as a clinical inquiry in a large Swedish municipality, involving data collection in the form of interviews and internal documents. The method of analysis involves both exploring generative mechanisms in digital infrastructuring and theorizing on the findings based on previous literature. Findings The findings identify four generative mechanisms through which stability and change in digital infrastructuring constrain ambidexterity in terms of both efficiency (exploitation) and innovation (exploration). Research limitations/implications This study’s limitations are related to international and intersectoral transferability and risks associated with its approach to clinical inquiry. The main implications are its contribution to the literature on how stability counteracts not only innovation but also efficiency and how change counteracts not only efficiency but also innovation. Practical implications This study identifies clear generative mechanisms that should be avoided by managers striving for digital government, and it offers clear recommendations for said managers regarding how to avoid them. Social implications This study offers implications for national-level digital infrastructure policy and contributes to efforts to increase the capabilities of digital government. Originality/value As two of the four identified generative mechanisms are novel contributions, this study offers a concrete addition to existing research. This study has resulted in factual change in the studied organization as well as at the national level through successful dissemination of the findings for both policy and practice in other public sector organizations.

Background The use of online resources has changed how people manage health care processes. Patients seek information about health conditions, guidance in treatment, and support from peers online, complementary to traditional health care trajectories. Online communities have the potential to contribute to the quality of care by increasing patient empowerment; however, there is a gap in research regarding in what way online communities contribute to patient empowerment. Objective We synthesized research regarding how online communities contribute to patient empowerment to address the research question “In what ways can participation in online communities support patient empowerment?” by studying how patient empowerment is operationalized in different studies. The definition of patient empowerment used in this paper is enablement for people to develop mastery over actions and control over decisions that influence their lives. The mastery is both through processes and outcomes of the development. Methods A systematic review was conducted by searching in the following databases: Scopus, ACM Digital Library, EBSCO (CINAHL and MEDLINE), PubMed, and Web of Science. In total, there were 1187 papers after excluding duplicates, and through selection processes using an analytical framework with definitions of patient empowerment and related concepts, 33 peer-reviewed papers were included. Results Findings indicated that online communities support patient empowerment both as a process and as outcomes of these processes. Additionally, it was seen as a complement to traditional health care and encouragement for health care professionals to have a more positive attitude toward patients’ usage. There was a mix between deductive (19/33, 58%), inductive (11/33, 33%), and a mixed approach (3/33, 9%) of studying patient empowerment in various forms. The online communities in most papers (21/33, 64%) were well-established and represented patients’ initiatives. Conclusions There is a need to include professionals' perspectives regarding how health care can embrace patient empowerment through online communities. This systematic review's main contribution is the proposal of a new framework and conceptualization of how patient empowerment in online communities can be understood from different hierarchical levels.

Categorical work in chronic care is increasingly dependent on digital technologies for remote patient care. However, remote care takes many forms and while various types of digital technologies are currently being used, we lack a nuanced understanding of how to design such technologies for specific novel usages. In this paper, we focus on digital technologies for patient-generated health data and how their use changes categorical work in chronic care. Our aim is to understand how categorical work changes, which novel forms of categorical work emerge and what the implications are for the care relation. This paper is based on an ethnographic study of healthcare professionals' work at a pelvic cancer rehabilitation clinic and their interactions with patients. In this setting, supportive talks between patients and nurses are central. To understand the complexities of categorical work in chronic care when patient-generated health data are introduced, we contrast the traditional supportive talks with supportive talks where the nurses had access to the patients' patient-generated health data. We identify and analyze challenges connected to novel forms of categorical work. Specifically, we focus on categorical work and how it can undergo changes. Our empirical findings show how changes occur in the way patients' lived experience of the chronic disease aligns with the categories from chronic care, as well as in the way the nurse works with clinical categories during the talk. These insights help us further understand the implications of patient generated-data use in supportive talks. We contribute to an improved understanding of the use of patient-generated health data in clinical practice and based on this, we identify design implications for how to make categorical work more collaborative.

Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non-clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings.

Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5–17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child’s perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council’s guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registration ClinicalTrials.gov; NCT04433650.