Coping with complex environments: the case of digital healthcare technology producers

Abstract

The aim of this thesis is to enrich the understanding of institutional complexity. To that end, my research focuses on an emergent field, as the most acute instantiation of institutional complexity, in addition to being an understudied phenomenon. Theoretically, the approach is anchored in the institutional logics perspective and the concept of institutional work. My research design is an inductive multi-level, multi-case study, found adequate to investigate a poorly understood and complex phenomenon. The research setting is the emerging field of digital health, at the intersection of healthcare and consumer digital technologies fields. By means of the theoretical framework and the operational methodology, the research offers a robust understanding of the field emergence and of the institutional work undertaken by organisations in the midst of high institutional complexity. At field level, findings reveal the logics at play: the state, medical profession, market, science and citizen logics, as well as how the emerging role of the empowered patient mediates institutionalisation. A significant contribution of my research is a new theoretical model for field emergence. This research provides insights on the understudied phenomenon of bottom up institutionalisation through the organisational level analysis. The study reveals the institutional work new organisations undertake in an emergent field, depending on their position, plurality and ambiguity and their own identity. It shows how organisations hybridise logics, often by co-creating digital solutions with stakeholders and by acting as institutionalisation agents. This research makes significant contributions towards the role trust and leadership play in organisation’s success and the field institutionalisation itself. In addition, it reveals how new organisations contribute towards field emergence by adhering to distinctive categories and the promulgation of the new role of the empowered patient. Not last, my research contributes to the understanding of how digital technologies, by the virtue of their unfinished character, play a significant part in institutionalisation