Christina Keller

Polycentric governance has often been theorized as a desirable model for digital ecosystems due to its potential to spur innovation and enhance adaptability. However, in decentralised healthcare systems like Sweden's, low innovation rates and interoperability issues persist. This paper examines Sweden's efforts to achieve national digital health goals within its decentralised model. Analysing qualitative data from interviews and archival documents, we utilised the COOF framework (Context, Operations, Outcomes, Feedbacks) to assess the outcomes of the ecosystem's operational arrangements and its feedback pathways. We identified governance outcomes such as vendor lock-ins and inadequate digital adaptation structures. Furthermore, the presence of suboptimal feedback pathways and adjustment mechanisms explain the persistent governance challenges, which we refer to as governance opacity and over-reliance on regulation. By exploring the implications of polycentric governance, this study provides recommendations for enhancing collective action and enabling successful digital transformation in decentralised healthcare ecosystems.