Implementing and scaling complex innovation in public healthcare

Licentiate thesis, 2026

With an ageing population, healthcare systems are facing increasing numbers of patients and shrinking resources. Hospital at Home – a service delivery model moving hospital-level care to patients’ homes – is suggested to help address these issues by increasing hospital capacity while maintaining or increasing quality of care. However, the model is a complex innovation which is notoriously challenging to implement and scale in public healthcare. It has been suggested that different logics of change – mechanical, ecological, and social – can be combined to address these challenges. Mechanical logic denotes a focus on standardisation, linearity, and replicability, ecological logic emphasises emergence, interdependence, and adaptiveness, and social logic focuses on identifying and explaining social mechanisms such as people’s behaviour and interpretations.

This thesis uses an action research approach to longitudinally study the implementation and scaling of Hospital at Home in a large hospital in Sweden, including interview data from 59 clinicians, patients, and managers, and a systematic literature review. It confirms that the aforementioned logics can be used in combination in order to support innovation processes. Multiple ways in which this can be achieved are described, for example by maintaining tensions conducive to continued innovation or by avoiding Catch-22 situations. The thesis confirms and extends views in extant innovation literature as well as suggests a convergence point between service ecosystem literature and learning-based approaches to innovation in organisations, enabling integration and cross-fertilisation of insights. Additionally, it provides a developed version of an analytical framework for practitioners who seek to support ongoing innovation processes.