Digitalization as institutional work: a case of designing a tool for changing diabetes care

E-health tools for patients aim to change current care practices. However the role of IT in transforming health care is not straightforward. The purpose of this paper is to understand how this change process unfolds and what characterizes the process by which visions of new care practices become inscribed into digital tools.

The study adopted a qualitative research design and it is based on an interpretive case study on the digitalization of a tool for diabetes care used in a hospital in Norway. Data have been collected via interviews and observations. Digitalization activities are understood as institutional work in order to examine the relation between the decisions taken in the design process and the intended change of the practices of diabetes care.

The study identifies three types of activities of institutional work: inscription of self-reflection, inscription of legitimation and inscription of new usage. The analysis of these activities shows how the vision of patients’ more active, learning and reflection-oriented role is inscribed into digital technology; how institutional work strives both for change and for legitimation thus smoothing the transition to a new institutional arrangement; and how institutional work relates to digital materiality.

The study contributes to the institutional theory literature by conceptualizing digitalization as institutional work toward changing institutions. It also contributes to the IS literature on digitalization by providing an analysis of how the affordances of digital materials support the work toward new institutions.