Architectural alignment of process innovation and digital infrastructure in a high-tech hospital

Two central approaches to IT-enabled organisational change are process innovation and digital infrastructure research. In this study, we investigate the alignment between them, both from a theoretical and a practical perspective. They have quite different basic assumptions on evolution; process innovation is a top-down approach, while digital infrastructures evolve bottom-up and are partly outside direct managerial control. Our research question is, how can a process innovation initiative successfully align with an underlying digital infrastructure? Our empirical evidence is an in-depth case study at a new high-tech hospital in Norway. Building on a proposed framework of alignment between process innovation and digital infrastructure, we identify, analyse three architectural alignment mechanisms. We found that (i) the careful deployment of lightweight IT in onsite configuration, loosely coupled from the infrastructure activities, allows for fast process innovation while leveraging the slow and nonlinear evolution of infrastructure (ii) the interaction between lightweight IT and large clinical systems by a set of boundary resources resolves the tension between innovation and infrastructure. For practitioners, we show that lightweight IT can serve as a mediating technology in the configuration.