Digital technologies, economization and professional practice in hospitals: How socio-technical systems shape...

Economization and digitalization are central transformation processes in contemporary healthcare systems, with critical implications for hospitals operating as high reliability organizations (HRO) under uncertainty, risk and time pressure. While digital technologies are expected to enhance efficiency and safety, research on socio-technical systems shows that their implementation may formalize work processes, intensify control and create coordination problems, particularly when systems are fragmented or poorly aligned with everyday clinical practice. Yet, little is known about how digital technologies mediate the interplay between economization and professional practice, and how this shapes coordination and reliability in hospitals. Against this background, this paper analyzes how digital technologies mediate economic and professional logics in professional practice, drawing on 57 semi-structured interviews and five participant observations in German public hospitals. Considering HRO principles as sensitizing concepts, we use the term digitally mediated configurations to capture socio-technical systems in which digital technologies, institutional logics and professional practices are intertwined. Within these configurations, we distinguish between economically-oriented digital configurations that operationalize performance-based steering, profession-oriented digital configurations that support clinical decision-making and coordination, and hybrid digital configurations in which economic and professional logics are embedded, translated and enacted. The findings show that digitalization does not uniformly reinforce economization. Cost pressures constrain digitalization through underinvestment and fragmented infrastructures, producing underperforming systems that hinder professional practice. Economically oriented digital configurations intensify temporal pressure, accountability and coordination problems, while profession-oriented digital configurations can support professional discretion and reliability. Reliability and resilience are maintained less through digital technologies than through professional practices compensating for socio-technical misalignments. The same digital technologies can have different effects on reliability.