Professional Responses to Digital Projects and Systems in Norwegian Hospitals: Retaining Autonomy Through Negotiation, Strategic Adaptation and Opposition

Digitalization and algorithmic control have become central features in the governance of professional work in hospitals. The way digitalization and the prominence of managerialism have impacted professional autonomy has received considerable attention in later years. In this chapter we delve into professional responses to digital developments in Norwegian hospitals. By utilizing and expanding upon Numerato et al.’s (2012) framework for analysing professional responses to managerialism to also include issues of formal representation, co-determination and collective participation, we show responses ranging from the acceptance of managerial hegemony, via negotiation and strategic adaptation to outright opposition. Three qualitative case studies inform the analysis. In the first case, we examine how medical doctors respond to electronic patient record systems (EPRs) by strategically adapting to them in one way and evading them in another. In the second case study, we investigate the development of an algorithmic monitoring system of professionals’ log activity in EPRs that is designed to ensure compliance with patient privacy laws. In this case study, professionals negotiated the algorithmic design through formal representation. The third case explores the implementation of a smartphone-based communication tool in a local hospital ward. Here, professionals responded by not using the technology, illustrating the dilemmas between standardized digital solutions and local, professional problem-solving needs. The case studies demonstrate that professionals retain autonomy and power by responding to digital choices and systems. However, while some choices and systems are open to formal co-determination, others depend on individual and collective action in the form of pragmatic workarounds, invisible work and resistance.