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Estonia is leading digital transformation because it’s a small country, while Finland has an innovation culture—is this true? Evidence-free beliefs offer simplified explanations of complex processes. They give an illusion that we fully control socio-technological shifts. But what if digitalization is also a matter of luck?
Digital transformation reminds me of surfing. While some countries effortlessly chase the waves and perform impressive maneuvers—like Instagrammable tube rides or tail slides—others are trying to catch balance on quiet waters. Is it a talent stronger than any unfavorable wind, a skill to make the best of even the worst conditions or a mix of both?
Are some countries fortunate to have digital capabilities, or do they work harder than others to lead in digital transformation?
A library could be filled with articles, papers, and reports on the determinants of digital transformation in healthcare. While some recommend guidelines such as building digital infrastructure, introducing change management, or strengthening leadership, the granularity of health systems, cultures, and countries’ histories makes it impossible to develop one-size-fits-all change protocols.
It’s more wishful thinking than evidence-based principles
Even the most popular recommendations are questionable since they can’t be evaluated objectively, for example, in randomized control studies. There is no non-digitalized twin of Estonia or Denmark.
Thus, the quest to find a golden mathematical formula for digital transformation goes through the shadowy waters of quotes repeated again and again:
- “Digital transformation is not about technology, it’s about people,”
- “Digital transformation is more about mindset than technology,”
- “Digital transformation is a journey, not a destination,” and so on.
Some are even more philosophical, like “Instead of doing more, just stop resisting.” Stop resisting the digital wave instead of pushing for change—I must admit there is much truth in this: More “going with the tech flow” (or determinism) and less expensive protectionism.
What is still missing are mugs with slogans like “Dream Big and Dare to Fail,” with an image of a rocket shot to the moon to motivate doctors and nurses to curb more enthusiasm. Or some fortune cookie with messages inside like “Innovate your tomorrow, one click at a time!”
Tales of IT
After the last three decades of digitalization—with outstanding achievements and iconic failures—every country has written its own story about what digital health means. Sometimes, it’s a story about the tyranny of clicking; sometimes, it’s about a technological hero saving healthcare from an upcoming system collapse. And every story has invisible power, even if some new rationale undermines the credibility of their old heroes.
Digital transformation is always the result of multiple factors, and no one fix exists.
Still, people like to think in “cause-effect” categories. Estonia adopted early digital infrastructure; Denmark has a culture of collaboration between stakeholders; Finland has a DNA of innovativeness; Sweden stakes on interoperability, while the Netherlands prioritizes patient-centricity. I spot a lot of speculation in these simplified reasonings. It’s like saying that life on Earth is possible due to its blueness—true, but granularity is missing to understand the causality behind it.
Social psychologists also claim that organizations tend to cherry-pick the underlying reasons for success to demonstrate their unique competencies, choosing those they can control.
“To explain how we came to be who we are, we recognize pivot points that so often were out of control. But what we ignore are the invisible pivots, the moments that we will never realize were consequential,” writes Brian Klass, Professor of Global Politics at University College London, in his recent book “Fluke.” This is hindsight bias, a tendency to perceive events as more predictable than they actually were before they happened.
Digital transformation is less controllable than we think—or, to control it, we must consider many more factors than we used to.
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