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How ignoring data became the norm in Swedish healthcare

In Sweden, patient wait times have long been a critical issue in the healthcare system, with regulations mandating timely access to care. Despite efforts to implement digital technology (DT) to monitor and improve these wait times, the data often went unused. This phenomenon was particularly evident in the Stockholm Region, where a digital registry intended to track wait times was introduced in 2012. The registry was designed to streamline the process of monitoring and reducing wait times by providing real-time data extracted from electronic medical records.

The Swedish national wait time guarantee, introduced in 2005, aimed to ensure that patients received timely care. The digital registry was supposed to enhance compliance with these regulations by allowing healthcare professionals to access, analyze, and act upon the data provided. However, the system's success hinged on active engagement from healthcare providers and administrators, which did not occur as expected.

Why the data was ignored: A closer look

This research aimed to uncover the reasons behind the Swedish healthcare sector's limited use of the digital registry for improving wait times. The study sought to understand how healthcare professionals justified their non-engagement with this technology and the implications of such behavior on organizational learning.

By examining the implementation and reception of the digital registry in Stockholm, the researchers explored the multiple assumptions and expectations that in combination made it seem rational to not engage with the registry, let alone act on its result. They discovered that strategic ignorance, a concept describing the deliberate avoidance of information and knowledge, played a significant role. The study involved analyzing interviews and data collected during an evaluation of the registry to assess its effectiveness and the quality of its data.

"One of the most challenging aspects was navigating the complex web of individual and organizational patterns that made it unattractive to actually use the data provided by the registry.  These patterns were not always obvious or explicit, requiring us to piece together a broader understanding of the systemic issues at play," explained Associate Professor Anna Essén, researcher from the House of Innovation.

Key research findings

• Justifications for ignoring data: Healthcare professionals often justified their non-engagement by emphasizing the futility of trying to address the problems, the incapacity of the system to change ‘anyway’, and questioning the data's reliability or claiming it was irrelevant, thus legitimizing their inaction.
• Strategic ignorance as a barrier: The concept of strategic ignorance emerged as a crucial barrier to organizational learning, where individuals consciously avoided engaging with available data.
• Impact on organizational learning: The study revealed that ignoring justifications hindered knowledge transfer processes, preventing the digital technology from achieving its intended outcomes in improving healthcare efficiency.

The path forward for healthcare data systems

The findings of this study emphasize the importance of addressing strategic ignorance and fostering a culture of active engagement with data in healthcare systems.  This research contributes to the understanding of how organizational learning can be impeded by strategic ignorance and offers a framework for addressing these challenges in the future.

Meet the researchers

• David Ebbevi: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital
• Anna Essén: House of Innovation, Stockholm School of Economics
• Anna Stevenson: Department of Business Administration, Lund University School of Economics and Management