Digital transformations in healthcare professionals’ work: Dynamics of autonomy, control and accountability

Digital technologies and the standards underlying them are omnipresent in healthcare. Despite a wealth of knowledge about the relation between standards and issues of autonomy, control and accountability in professional work, we know much less about how digital technologies alter these relations. To address this gap, we present the findings of an in-depth qualitative case study in a medium-sized German hospital and its hospital information system (HIS) with a particular focus on the operating room (OR)-module used in the operating rooms. Conceptually, we draw on the notion of digital objects which allows studying information entities as well as visualizations that represent information entities and their relations in a visual gestalt (e. g. coloured boxes that represent surgeries on a timetable). We found that during ‘normal’ situations, digital objects influenced professional work towards conforming with professional standards. During ‘hot’ situations such as emergencies, however, professionals took over and worked around the system. In unexpected situations, control by professional norms effectively overruled control by the standards and guidelines encoded in digital objects. Relatedly, we found that digital objects produce a specific kind of accountability that is mainly rooted in ‘visibility management’, which determines what becomes represented – i. e. available and accessible – to whom and what not.