Competing institutional logics in healthcare organizations: theorising digitalism

The digitalisation of healthcare services has proven to be difficult, with numerous negative effects. We argue that the reason for the problem is not poor project management, but a clash of different institutional logics. The aim of this article is to explore, define and theorise the concept of digitalism, as a term for a new institutional logic in contrast to other, more known logics in organisations, such as managerialism and professionalism, to better understand processes of digitalisation.

We illustrate our arguments with a case study of a process of organizational development before and after the implementation of centralised large-scale IT systems at a large Norwegian hospital. Data was extracted from documents and observations from January 2015 to January 2016 during an organizational audit. In addition, a follow-up study was conducted in 2019 and 2024 by interviewing eight key personnel who were involved in the implementation process.

The implementation of a new digital health record in a Norwegian hospital is a process of social restructuring that involves new actors, logics and control systems. The process of digitalisation shows us how digitalism create tensions, diverges and merges with other institutional logics.

Understanding digitalism as a sensitising concept offers insights into how large-scale technology and organizations are tied together and can help to reduce organizational dysfunctionalities and improve the implementation of IT systems.

This study contributes to a new understanding of digitalisation processes and links an ongoing theoretical debate on the digitalisation of organizations with empirical findings.