My PhD Research Project: Digital Transformation Paradoxes in Healthcare

My research is about digital transformation in healthcare, what is that?

Digital transformation (DT) refers to how digital technologies (for example AI, robotics, digital platforms, and cloud computing) change the way we work, deliver services, and interact in society. In healthcare, DT has introduced innovations like telemedicine, robots that facilitate therapies, smart technologies for remote care, electronic medical records that streamline data management, wearable technology that tracks vital signs, and AI-based diagnosis tools among others.

Given that DT is too broad, I focused on one type of technology: mobile telepresence robots. In simple terms, these robots are robotic systems that allow people to interact remotely while moving around a space. Think of them as a Zoom call, but instead of being stuck on a screen, the person on the other end can 'walk' around using the robot. In healthcare, these robots are used for telemedicine, letting doctors consult with patients remotely, but also for social connection, like enabling a nursing home resident to take a virtual stroll with their family member who lives abroad. That is the type of robot that I studied. In collaboration with a robotics company (details are omitted to protect their anonymity), I collected data in a nursing home and two hospitals where the mobile telepresence robots were going to be tested.

My initial interest: meaningful work

When I started my PhD, I was interested in meaningful work: how employees experience their jobs as significant and worthwhile. I was particularly drawn to this topic within DT because we’re living in a time where robotics and AI are automating jobs in new ways. If certain tasks (or entire jobs) are automated, what happens to work meaningfulness? Work is a key source of meaning in people’s lives, so tech-driven job automation could have profound societal impact. This is especially relevant in healthcare, where staff face demanding, high-stress environments (think clinicians working non-stop, dealing with life and death). Remembering why their work matters helps them keep going.

I started to study mobile telepresence robots in a nursing home with that perspective, trying to understand how these technologies could affect the meaningfulness of their work. Initially, I thought that these robots would either promote or inhibit meaningful work, being either a threat or an opportunity. That’s how we (humans) often think: black or white, good or bad. But my research revealed something more complex. These robots do both: they enhance meaningful work in some ways while undermining it in others. This tension creates paradoxes: digital technologies solve some problems while simultaneously creating new ones.

What is a paradox?

A paradox is a situation or proposition where two opposing elements exist simultaneously, creating tension but also interdependence. A common example of everyday life is the paradox between autonomy and belonging in relationships. People seek connection and intimacy but also value independence. Prioritizing one over the other entirely can lead to loneliness or dependency, respectively. Therefore, the point is not to choose one over the other but to have both in a balanced way.

Paradox theory is about understanding how to navigate between opposing elements to enjoy the benefits of each one more than the downsides. The key is to dynamically balance both, adapting to different situations. The same logic applies to organizations, which need to balance opposing forces like control and flexibility, stability and change, or short-term and long-term goals. You can take a look at what Wendy Smith and Marianne Lewis have written about this theory if you want to learn more.

The paradox of digital disconnect (proximity vs. distance)

In my PhD, I explored paradoxes in DT in healthcare. One paradox I found was between distance and proximity, which could affect meaningful work for healthcare staff. Mobile telepresence robots enable remote interactions, allowing doctors, patients, and families to connect across physical distances. These robots create a feeling that the remote person is physically there, creating proximity. But at the same time, they can create distance. Using these robots can result in weaker in-person relationships due to the lack of physical touch, making healthcare feel more impersonal and risking trust that patients have on healthcare staff. Most healthcare workers find meaning in personal interactions and therefore struggle with this paradox.

Digital tools are designed to improve communication and efficiency, yet they can unintentionally weaken human connection and, thus, affect meaningful work. Other examples are email consultations that provide flexibility but can reduce empathy in patient interactions, making clinicians feel like chatbots rather than caregivers. Or smart technologies for remote care, which allow elderly people to feel like they are being taken care of by a remote caregiver, but the lack of in-person visits can make them feel lonely.

How can we navigate paradoxes?

I wanted to understand how people actually navigate between two opposing demands in practice, especially the digital disconnect paradox in healthcare DT.

I noticed that existing research tends to take one of two approaches. Some studies focus on how individuals think about and respond to paradoxes, emphasizing individual agency. Others focus on factors like rules, regulations, and technology but overlook how people adapt and work around these constraints.

A few scholars acknowledge that both perspectives matter, but they don’t fully explain how they interact. My research aimed to bridge this gap by exploring both the role of individuals and the structures that shape their actions.

To do this, I combined paradox theory (which explains how tensions emerge and can be managed) with structuration theory (which can help to study the interplay between human agency and organizational structures in management).

The main idea of my PhD is that by recognizing and shaping the interplay of agency and structure, we can develop better strategies for managing paradoxes. For example, in the digital disconnect paradox, healthcare staff found creative ways to use mobile telepresence robots without fully replacing physical interactions. Some limited remote consultations to specific treatment stages where physical presence was less critical, while others proposed to use the robots for therapy sessions with pre-recorded videos instead of live communication or for collecting data through their touch screen while moving around the nursing home. However, their ability to navigate this paradox depended on supporting organizational structures like training programs, proper infrastructure, collaboration with robot providers, and technical support systems. Without these, their agency to innovate and adapt the technology in unintended ways can be limited.

The paradox of professionalization (consistency vs. responsiveness)

But my research didn’t stop there. I realized that many of the structures healthcare employees rely on to balance distance and proximity, and ultimately find meaningful work, depend on robot providers. These companies play a key role in offering training, facilitating collaboration, providing technical support, and enabling innovation. So, I became curious: What might prevent robot providers from building and maintaining these support structures? That question led me to study the robotics company I was collaborating with.

Early on, the company operated like a typical startup, fast, flexible, and highly responsive. But as it expanded into the highly regulated healthcare market and experienced growth, senior management introduced strict processes and quality control measures to ensure consistency and meet industry standards. The informal, entrepreneurial ways of working were no longer allowed. This transition, known as professionalization, involves shifting from a purely entrepreneurial firm to a more structured, professionally managed organization.

Here, I encountered the paradox of professionalization: consistency vs. responsiveness. While new structures improved consistency, compliance and ensured quality, they also slowed decision-making and restricted employees' ability to communicate, solve problems, innovate, and meet customer needs. The heavy focus on consistency over flexibility led to frustration. Employees felt stuck, unable to move forward. To navigate this paradox, employees often found workarounds, informally bending rules and relying on past ways of working to maintain agility while still operating within the new formal structures.

This over-emphasis on consistency could limit the company’s ability to co-create and collaborate with healthcare employees at the nursing home. In other words, one paradox (consistency vs. responsiveness) was making it harder to navigate another (distance vs. proximity), showing how interconnected these tensions can be in digital transformation.

The bigger picture: rethinking how we manage digital transformation

The key takeaway from my PhD is that navigating paradoxes in digital transformation isn’t about eliminating tensions but understanding how the interplay of agency and structure can help to navigate them. Instead of treating paradoxes as problems to fix, organizations could see them as spaces for innovation where employees can navigate opposing demands with the right structural support.

Of course, some constraints, like healthcare regulations, are fixed. But many paradoxes can be managed by giving employees both the freedom to adopt technology in unintended ways and innovate and the structures that enable them to do so (and constrain them in other ways).

Digital transformation in healthcare doesn’t have to be a source of frustration. Instead, it can become a process of continuous adaptation where new technologies are integrated without losing the human touch that makes healthcare meaningful.