Unraveling Tensions and Paradoxes: Middle Managers in the Hospital Digital Transformation towards Remote Monitoring

The healthcare system in the Netherlands faces significant challenges due to demographic changes, rising complex care needs, and chronic illnesses, with projected shortages of 155,000 healthcare personnel by 2032, necessitating alternative care delivery methods through digitalization and hybrid care models. Remote monitoring (RM) facilities this way of alternative care delivery. This study examines the digital transformation (DT) towards RM from the viewpoints of hospital middle managers. Focus lies on identifying tensions and paradoxes they encounter within the DT to RM. For this research, a case study was conducted in a top-clinical hospital in the Netherlands, in which sixteen semi-structured, qualitative interviews were held with primarily team- and department managers. The collected data was coded and analyzed with an inductive, grounded theory approach, following the Gioia method. This resulted in the identification of three tensions that middle managers encounter in the DT to RM, namely: aligning with doctors; balancing between quality and quantity; and temporal tensions. These three tensions are interwoven and visualized in a ‘tensional knot’, which highlights the complex position that the middle managers find themselves in during the DT to RM. The study's findings contribute to understanding the challenges of implementing RM in hospital settings. It shows that RM cannot be seen separately from the socio-technical system it is brought into, underscoring how DTs impact different relationships and balances, causing tensions and paradoxes. Moreover, the study offers insights for policymakers and healthcare leaders to better attune their approach of the DT to RM to the complexity of reality.