JMIR Publications

ABSTRACT

Background:

Health care organizations increasingly invest in digital technologies, yet digital transformation remains difficult to organize and embed in everyday care. Existing research has generated important knowledge about barriers, facilitators, and implementation conditions, but less is known about the strategic logics through which frontline clinical units pursue digital transformation.

Objective:

This study aims to examine how digitally advanced clinical microsystems pursue digital transformation within the everyday organization of care. It seeks to identify recurring strategic digitalization logics and to develop an ideal-typical framework for understanding how clinical microsystems define the role of digital technologies in relation to their care goals and everyday work.

Methods:

We conducted a qualitative multiple-case study of 25 digital health pioneers in North Rhine-Westphalia, Germany. The cases covered diverse clinical microsystems, including ambulatory practices, hospital departments, rehabilitation clinics, long-term care facilities, emergency medical services, diagnostic laboratories, regional care networks, and digital health platforms. Data were collected through 87 semi-structured interviews and on-site observations. Building on the clinical microsystems perspective, we analyzed the cases along six dimensions: purpose, patients, professionals, processes, patterns, and partners. A combined deductive and inductive cross-case analysis was used to identify recurring strategic digitalization logics.

Results:

We identified four archetypes of strategic digitalization logics. Clinical Optimizers use digital technologies to strengthen clinical practice, particularly diagnosis, treatment, intervention, and professional judgment. Clinical Explorers use digital technologies to enter less established domains of clinical practice through experimentation, learning, and collaboration with innovation partners. Operational Standardizers use digitalization to make care delivery more reproducible and scalable by stabilizing recurring workflows and process architectures. Care Integrators use digitalization to extend and connect care across encounters, actors, and settings. These archetypes can be positioned along two dimensions: whether digitalization is primarily oriented toward clinical practice or toward the organization of care delivery, and whether it involves lower or higher digital transformation risk. The archetypes are ideal-typical reference points; empirical cases may approximate, combine, or shift between them over time.

Conclusions:

Digital transformation in clinical microsystems is a strategic process through which frontline units define what digitalization should contribute and how it should support what the microsystem aims to achieve. By distinguishing four archetypes along the dimensions of strategic orientation and digital transformation risk, this study provides a framework for understanding, comparing, and reflecting on digital transformation at the frontline of care. The findings suggest that successful digitalization depends on the alignment between digital tools and the microsystem’s purpose, patient role, professional work, processes, patterns of practice, and partner environment.