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Title of the thesis: Overcoming the complexity of healthcare renewal

Thesis defender: Annika Bengts
Opponent: Associate Professor Tuomas Huikkola, University of Vaasa
Custos: Professor Risto Rajala, Aalto University School of Science

Healthcare systems are facing growing challenges as populations age and chronic diseases become more prevalent. In particular, the management of chronic conditions requires collaboration among multiple actors, yet in practice services are often fragmented and responsibilities unclear. This doctoral dissertation examines how care coordination can be improved in such a complex environment. The aim was to understand how different healthcare actors can work effectively together in situations where they are guided by differing goals, practices, and institutional logics. This phenomenon is described by the concept of institutional complexity.

The study contributes new knowledge by demonstrating that complexity is not merely an obstacle to collaboration; when properly managed, it can enable better and more innovative solutions for care coordination. A key finding is the concept of shared operating principles: collectively developed and maintained understandings of how the system functions and how actors should operate within it. These principles help different actors coordinate their activities without top-down control.

The results complement prior research, which has largely focused on technological solutions or single-actor perspectives. This study highlights the importance of collaboration between actors and the development of shared understanding. The findings can be utilized in the development of healthcare systems, particularly in the coordination of chronic care. They are also applicable to other complex service systems where multiple actors collaborate without a clear hierarchy. Successful and sustainable reforms require that actors have shared operating principles that guide their actions.

Contact information: annika.bengts@aalto.fi 

Thesis available for public display 7 days prior to the defence at .