Patient-centric digital infrastructure can potentially enhance the efficiency of healthcare systems. However, even in developed nations, evidence suggests low adoption rates for such infrastructure and lack of support from clinicians is considered as one of the most critical hindering factors. In this study, we examine physicians' perceptions of the proposed large-scale information technology initiative in India that aims to transform the health sector and provide universal health coverage to all residents of India. We employed the information ecology lens to understand the broader changes in the healthcare system that could result from the initiative. We use focus group discussion and in-depth interviews to comprehend the perceptions of doctors about the initiative. Drawing upon Foucault’s conceptualization of power, we find that physicians, the key stakeholders in this initiative, are skeptical about the changes in the locus of power in the new ecosystem. Specifically, they perceive that knowledge power has shifted from a historical “expert knowledge power” to power related to “data management.” The physicians believe that changes are expected to manifest through monitoring, controlling, and managing the data rather than providing knowledge-based services. We present recommendations to engage physicians' perspectives in implementing large-scale patient-centric digital infrastructure.


power dynamics, change management, information ecology, India, Aadhaar, large scale health IT project, interpretive research

Author Bio(s)

Dr. Rajesh Chandwani is an Associate Professor in the Human Resource Management area at Indian Institute of Management Ahmedabad (IIMA). He is the “Dr. Lal PathLabs Chair in Healthcare” at IIMA. He has been the Chairperson of the Centre for Management of Health Services (CMHS) at IIM Ahmedabad. He is a Fellow of IIM Bangalore. Previously, after completing his MD (Pediatrics) from Baroda Medical College, he has served as a Pediatrician in public health institutions in rural and urban areas. He has wide ranging interest in the human resource management and technology issues and challenges in the service sector, specifically in the Indian healthcare sector. Particularly, current research interests include the use of Information technology to enhance the effectiveness of healthcare personnel and healthcare delivery. He also has particular interest in mindfulness based strategic decision making. Please direct correspondence to rajeshc@iima.ac.in.

Saneesh Edacherian is an Assistant Professor in Strategy and International Business at the University of Birmingham Dubai, United Arab Emirates. He earned his Ph.D. in Strategic Management from the Indian Institute of Management Ahmedabad, India. His research explores how strategic leadership groups shape strategic outcomes such as innovation and internationalization. His emerging interests lie in extending the scholarly conversation and offering practitioner insights into corporate governance and responsible business practices. Saneesh’s publications include articles in outlets such as International Business Review and the Journal of Business Research. Please direct correspondence to s.edacherian@bham.ac.u.

Prof Mukesh Sud has over three decades of professional experience divided equally between entrepreneurship and academia. After an engineering degree, Prof Sud founded several small-scale industries involved in job work of abrasive blasting and sprayed metal/plasma coatings. In 2000, he exited industry and enrolled in a doctoral program at IIM Bangalore. Prof Sud began his academic career in the US at Augustana College IL in 2006. He was later an Associate Professor with tenure at the Dolan School of Business, Fairfield University, CT. Prof Sud joined the Strategy Area at IIM Ahmedabad in 2015. He is a visiting faculty at Ashoka University, Delhi and at the Naropa Fellowship at Leh, Ladakh. Prof Sud conducts executive education programs on “Design Thinking” and “Creating Entrepreneurial Organizations.” His research is focused on entrepreneurship at the individual, firm and societal levels and includes several publications in FT50 journals. Prof Sud is actively engaged with industry and is currently on FICCI’s National Start- Up & R&D committees. Prof Sud has co-authored a book that has been published by Penguin Random House titled, Leapfrog: Six Practices to Thrive at Work. Please direct correspondence to mukeshs@iima.ac.in.

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