How digitalization (un)changes performance management and operations in healthcare organizations: implementation experience in a surgical theatre

Purpose – Healthcare information systems (HISs) can support both clinical and managerial decisions, enhancing performance and creating value for patients and healthcare professionals. The study aims to explore how digital HISs influence managerial decision-making by transforming performance management (PM) systems and, in turn, operational activities. Design/methodology/approach – Action research was conducted to assess the change process undertaken by an Italian public healthcare organization that implemented a digital HIS to replace paper registries and improve the operating theatre's performance. The action research lasted approximately 15 months. Data were collected in close collaboration with clinical and administrative staff. A digital performance dashboard was developed to support performance monitoring. The study builds on Lapsley and Pettigrew's (1994) organizational change model to analyse how PM and operational activities evolved and to identify key influencing factors. Findings – Despite initial enthusiasm, the hospital PM system remained focused on volume-based metrics, without integrating the dashboard indicators. Operational activities showed limited change, reflecting a decline in healthcare professionals' perceived usefulness of the digital tool. Contributing factors to this stagnation were discontinuity in leadership commitment, an unclear change agenda, lack of alignment between strategic and operational levels and an unsupportive organizational culture. Originality/value – The study highlights that digital HISs hold significant informational potential to transform managerial decision-making. However, their realization depends on critical factors that, when effectively addressed, can enable the transformation of PM systems and operational activities. These factors are essential in creating value for all stakeholders involved, including patients.