A Matter of Time: Participation and Digital Infrastructures in Public Healthcare

Abstract

Participation is widely positioned as foundational for shaping the digital infrastructures that increasingly underpin public healthcare, both in research and in policy. Despite this, healthcare digitalization remains marked by frustration, resistance, and participatory efforts that rarely translate into meaningful influence. This thesis argues that the problem is not primarily one of method or commitment, but of temporality: the temporal conditions through which participation unfold shape what it can accomplish, and these conditions have received insufficient analytical attention. As digital technologies have become increasingly infrastructural, participation now unfolds through long-lived sociotechnical arrangements rather than bounded projects. Through two interpretive case studies in Swedish public healthcare conducted between 2021 and 2025, the thesis develops a processual and temporal account of the shape that participation and digital infrastructures take together. Drawing on process ontology and a flow-oriented perspective, it treats both participation and digital infrastructures as ongoing accomplishments rather than stable entities. The analysis develops two interrelated processual dynamics: infrastructural thickening (accumulated decisions, dependencies, and omissions sediment into conditions that narrow what future action can set in motion) and responsiveness (the degree to which situated doings can redirect infrastructural trajectories). The thesis contributes a processual vocabulary that makes temporality analytically operative in research on participation and digital infrastructures, bridging the two fields through their shared temporal conditions and reframing participation as immanent in infrastructural becoming rather than as an activity that begins with invitation. In practical terms, it redirects attention away from how participation is organized toward whether the temporal conditions for participation to have effect, as shaped through architectural, governance, and procurement practices, are present and briefly aligned.