Abstract
Healthcare innovation is often portrayed as beginning with the introduction of new technologies. Yet, in many settings, substantial innovation work occurs well before any technological solution is selected or built. This study examines how early design work, prior to the adoption of digital tools, reconfigures innovation processes in a nurse-led innovation initiative within a large public hospital system. Drawing on an ongoing qualitative case study of a regional nurse-led innovation program in Sweden, the study analyzes how frontline nurses, nurse managers, and innovation leaders collectively articulate problems, stabilize ideas, and translate experiential knowledge into organizationally actionable innovation proposals. Based on interviews, observations of meetings and workshops, and project documents, preliminary data analysis shows that early design activities such as problem framing, storytelling, visualization, and cross-professional dialogue play a critical role in shaping which ideas gain legitimacy, how they travel across organizational levels, and what kinds of technological solutions later become feasible. The findings highlight three key dynamics. First, early design work enables nurses to transform situated workarounds into communicable innovation objects. Second, these practices reconfigure communication between clinical and managerial actors, shifting innovation authority without formal changes in hierarchy. Third, early design decisions constrain downstream technological choices, effectively pre-configuring innovation outcomes before tools are introduced. By foregrounding the communicative and organizational work that precedes technology adoption, this study contributes to research on innovation processes, technology-in-practice, and healthcare organizing. It invites scholars to reconsider where innovation “begins” and to pay closer attention to the pre-technological phases through which ideas are collectively shaped, stabilized, and made organizationally viable.