Syndemic silos: How boundary tensions shape technology-enabled health innovation

Silos have been identified as a key barrier for improvements in the healthcare sector, yet few studies exist on how these obstructive boundaries, individually and in combination, are perceived and acted upon in concrete innovation processes. Based on an action-research methodology, this study examines how actors experienced organisational silos during a six-year (2018–2023) health innovation initiative, which aimed at improving the life of citizens with chronic conditions by applying new digital technologies and establishing a sector-neutral health clinic. The term ‘syndemic’ is introduced to draw special attention to the adverse, synergistic relationship between clusters of organisational silos which constrain the innovation process. The study identifies three interrelated clusters of perceived organisational silos linked to the division of labour between healthcare providers (organisations cluster), professional roles and hierarchies (professions cluster), and the current data infrastructure (systems cluster), all of which worked against the introduction and scaling of new health innovation. The study is based on a qualitative analysis of multiple data sources collected throughout the health innovation initiative, including interview data, workshop transcriptions, meeting minutes, annual reports, blueprints, and research protocols.