This licentiate thesis aims to understand how infection preventionists (IPs) continuously find problems and implement solutions related to health care-associated infections (HAIs) in hospital settings.

HAIs are infections acquired by patients during the process of care and are among the main causes of deaths worldwide. Recently, practices for HAIs prevention and control have challenged IPs due to pandemics (e.g. COVID-19), antimicrobial resistance, population aging and limited resources in health care facilities. Such challenges demand actions to find, solve problems and implement solutions. However, IPs often fail to address these problems. The reasons stem from their inability to timely identify valuable problems and implement new solutions. Although the literature on infection prevention and control is well developed, previous studies have largely investigated how IPs implement preconceived practices to solve given problems as a single event, rather than on how to continuously find problems and implement solutions. 

This licentiate thesis comprises two empirical papers. Paper I investigates how infection prevention and control teams find problems with HAIs, and is based on a multiple case study of three infection prevention and control teams from one Swedish and two Brazilian hospitals. Paper II investigates how IPs continuously implement changes in infection prevention and control practices during pandemics, and is based on a qualitative descriptive study. The data in both papers were collected from 44 semi-structured interviews with health care professionals enrolled as IPs in Brazilian and Swedish hospitals. The key theories and literatures covered include Problem-Finding and Problem-Solving Perspective and Implementation research.

This licentiate thesis contains three main contributions. First, it advances the Problem-Finding and Problem-Solving Perspective literature by providing empirical evidence on how to create valuable knowledge from ill-structured and complex problems. Second, this licentiate thesis suggests a distinction between HAI prevention and HAI control based on two modes of decision-making for finding valuable problems with HAIs. Third, the licentiate thesis describes and categorizes sets of practices that allow to continuously implement changes of infection prevention and control practices during pandemics. 

Background: Healthcare is undergoing a digital transformation as advanced analytics, artificial intelligence (AI), and connected devices revolutionize clinical decision-making, care delivery, and patient outcomes. Digital technologies, particularly AI, have created unprecedented opportunities for value creation through improved diagnostics, automated workflows, and data-driven care. Despite this potential, the adoption of digital technologies in healthcare remains slower than in other industries. Multiple factors contribute to this gap, with value creation emerging as central to adoption decisions. While individual factors - such as healthcare professionals' responses to new technologies - significantly influence adoption, medical technology (MedTech) firms play an essential role in facilitating value creation through digitalization. Previous research has largely overlooked this complexity, particularly the interplay between healthcare professionals' adoption decisions and MedTech firms' capabilities. 

Purpose: The purpose of this doctoral thesis is to explore how healthcare professionals adopt digital technologies and how MedTech firms acquire capabilities to facilitate digitalization and value creation in healthcare. 

Method: To fulfill the overall purpose of this thesis, five independent papers were developed. The papers comprise one qualitative descriptive study, one sys- tematic literature review, one exploratory qualitative study, one embedded case study, and one survey. The data collection is based on exploratory and semi-structured interviews, workshops, observation, and questionnaires. The data analysis follows a thematic analysis technique and linear regression analysis. 

Findings: The findings of this thesis indicate that digitalization and value creation in healthcare emerge through dynamic interactions between healthcare professionals and MedTech firms. Healthcare professionals, as technology adopters, evaluate multiple value dimensions (cost-sacrifice, instrumental, hedonic, and symbolic) that shape their attitudes toward digital technologies. They engage in facilitation activities to manage resistance to change and develop paradoxical mindsets to navigate tensions arising from technological transitions. MedTech firms acquire the necessary capabilities through formal, vii semi-formal, and informal mechanisms to facilitate digitalization. These capabilities - health-related, data-driven, and social capabilities - are primarily accessed through external actors. Value co-creation occurs through structured encounters between healthcare professionals and MedTech firms, where they share resources and knowledge, align expectations, and collaborate to enhance technology adoption and value realization. This interplay creates a foundation for successful healthcare digitalization while ensuring technologies meet clinical needs and create sustainable value.