Anna Essén

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.

Grand challenges such as climate change, global health crises, inequality, and biodiversity loss are persistent societal concerns rather than problems with clear endpoints or definitive solutions. Rather than being “solved,” these challenges must be continually engaged, managed, and navigated over time, as progress unfolds through ongoing efforts to mobilize action and coordinate across organizational and institutional boundaries. This ongoing engagement often proceeds in the absence of shared problem definitions, agreed-upon metrics, or stable criteria for success. This symposium brings together recent research on how organizations and institutions engage grand challenges when authority is limited, evaluations are contested, and expectations shift. The papers highlight that engagement is shaped by the social and institutional processes through which effort is mobilized, legitimacy is constructed, and value is assigned. Across cases spanning corporate pledges, meta-organizations, global evaluation systems, and prosocial certifications, the papers show how actors sustain collective action by recalibrating commitments, coordinating effort, and constructing legitimacy under contestation. Together, the symposium advances a process view of organizing for grand challenges by showing how legitimacy and value are continuously negotiated when formal authority and stable evaluation criteria are absent.


How Social Activism Shapes Corporate Sustainability Pledges

Author: Yeon Woo Cho; The George Washington University

How Western Norms Shape the Recognition of Non-Western Efforts

Author: Ryosuke Yokoya; The George Washington University

Identity Work through Prosocial Certifications in Hybrid Organizations

Author: Hyeonjin Cha; Bucknell University

Meta-organizations Addressing Grand Challenges as Effort Integrating Systems

Author: John-Erik Bergkvist; Stockholm School of Economics

Author: Anna Essén; Stockholm University

Author: Magnus Mahring; Stockholm School of Economics

The proliferation of generative artificial intelligence (GenAI) in the workplace raises critical questions on how to regulate these technologies within organizations. GenAI technologies generate excitement but also present significant ethical and legal issues, compelling organizations to self-regulate in the absence of comprehensive governmental regulations. Although the emerging field of regulation and information technology (IT) provides a foundation for exploring rulemaking in relation to new technologies, the unique trajectories of GenAI remain underexamined. Through a field study of a leading European business school, we trace how an organizational group without technological expertise assumed responsibility in this context. Our preliminary findings reveal how rulemaking around GenAI evolved through the contingent interactions between practices, rules, and technology, where rule-makers transitioned from preventing unwanted uses by “copying” existing regulations to crafting distinct, tailored rules and finally facilitating learning to promote new, wanted uses. Throughout this journey, the rule-makers grappled with the challenge of regulating an emergent technology for which they lacked initial expertise and the envisioned usages and risks were constantly shifting.

Incumbent firms typically face significant risk of losing the relevance of their physical core when facing industry disruption driven by digital technologies. Existing literature emphasizes a digital first approach, whereby firm offerings are fundamentally redeveloped from a digital point of view, from the point of conception. While this prescription can help accelerate innovation, it does not tell us how incumbents might safeguard the relevance of their traditional physical core resources when going digital first. This is important, since major discontinuities in strategic repositioning, while often celebrated in digital innovation and transformation literature, create significant risks to firm survival. To this end, we conduct a grounded analysis of a European automotive firm’s innovation journey over an eight-year period. We contribute to the digital innovation and transformation literature by developing a process model explaining how a digital first approach can be employed in a way that also safeguards the physical core.

Research has explored how algorithmic processes reshape individual tasks in organizations. But less work has explored their implications on the wider service ecosystem. Using data about the “DAS” algorithms in the Swedish rheumatology setting between 1995 and 2019, we examine how the use of algorithms can reconfigure service delivery across the service ecosystem. We identify two algorithmic translation processes that enabled the incorporation of consumer self-evaluations in the multiple service nodes of the studied ecosystem. These processes implied new forms of multilateral surveillance, which had implications on the service delivery and the values that were generated by the ecosystem. By showing how concealed algorithms can make consumers’ voice watch-able and action-able across multiple nodes in the ecosystem, our work challenges traditional conceptualizations of algorithmic black-boxing as reducing human agency. We further theorize algorithmically mediated multi-actor surveillance, in which service nodes are both being watched and watching others, thus also challenging the view of surveillance as involving one “invisible” controlling many visible actors. These results open up new avenues of inquiry about the role of algorithmic processes in enabling new forms of multilateral surveillance that in turn condition value creation in service ecosystems.