Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 1, 2025
Date Accepted: Feb 10, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Facilitating Digital Transformation at Scale: A Qualitative Analysis of Multi-Level Factors Mobilizing the Spectrum of Inter-Organizational Knowledge Sharing
ABSTRACT
Background:
Inter-organizational knowledge sharing is vital for scaling digital transformation efforts that span multiple organizations and system-wide change, yet its optimal coordination remains debated.
Objective:
This paper examines how knowledge is orchestrated across organizations in healthcare’s digital transformation, identifying key factors and mechanisms that foster inter-organizational learning ecosystems.
Methods:
examine visions and experiences across individual, organizational, inter-organizational, and sector levels. Drawing on a formative evaluation (2018–2023) of England’s Global Digital Exemplar (GDE) Programme, we use multiple case studies and conduct interviews with experts both within and beyond organizational settings for data collection, and a grounded theory approach to analyse the data.
Results:
The study identifies a range of interconnected factors at the macro-environmental, inter-organizational, organizational, and individual levels that influence how inter-organizational relationships and partnerships are formed, structured, and sustained. Key drivers include policy shifts, technology supplier strategies, and intermediary roles (macro level); relational recognition, governance mechanisms, and proximity (inter-organizational level); external search strategies, absorptive capacity, and prior collaboration experience (organizational level); and both intrinsic and extrinsic motivations, as well as individual-level inhibitors. These factors collectively shape a diversity of partnership types.
Conclusions:
Our study highlights how an orchestrated approach by policymakers and practitioners can help healthcare organizations build effective learning ecosystems. We offer a framework that examines key mechanisms and factors driving this process, alongside guiding questions to help policymakers and practitioners establish learning ecosystems by making visible the structures, processes, and influences on knowledge sharing.
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