Modes of Engagement: Problematizing Managerial Assumptions of Participation in Public Sector Digital Transformation: Problematizing Managerial Assumptions of Participation in Public Sector Digital Transformation.

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.