Co-creating a digital platform for smart working in healthcare: reconfiguring social exchange in internal digital transformation

Digital technologies have profoundly transformed healthcare, a phenomenon commonly referred to as Healthcare 4.0. Among these technologies, digital platforms stand out as modular systems that evolve through collaborative and co-creative processes. However, limited attention has been given to how healthcare professionals participate in platform co-creation, how social exchange mechanisms sustain this process, and how tensions emerge from the coexistence of healthcare routines and digital transformation. Drawing on Social Exchange Theory (SET), we examine how trust, commitment, reciprocity, power, and sociotechnical tensions shape internal healthcare platform co-creation. We conducted a qualitative case study in a Brazilian teaching hospital that internalized the development of its primary information system and adopted a co-creative approach in which healthcare professionals assumed Product Owner roles for different platform modules. The empirical investigation combined 25 interviews, participant observation, and document analysis over seven months. The findings show that internal healthcare platform co-creation constitutes a distinct SET configuration in which trust depends on process visibility and responsiveness, reciprocity is associated with professional recognition and shared organizational outcomes, and power is shaped by internal hierarchies and asymmetries in technological expertise. Product Owners emerge as hybrid sociotechnical actors who mediate between healthcare work practices and technical development. Although co-creation enhances smart working by aligning digital solutions with professionals’ needs, it also generates persistent tensions related to technostress, cognitive overload, and competing attention demands between patient care and platform interaction. We argue that these tensions are inherent to healthcare digital transformation and must be continuously managed rather than eliminated.