Defense of Aurore Fierobe

« Strategies for legitimizing innovation. The case of digital health. »

Supervised by Etienne MINVIELLE

Defense scheduled for Monday November, 21 2025 at 2:00 pm to Bibliothèque Sainte-Barbe, 4 rue Valette, 75005 Paris

Abstract: Legitimacy is a crucial resource in the early stages of innovation. Innovative organizations often face a first-mover disadvantage, resulting in higher costs and lower long-term profitability. Healthcare organizations are particularly affected by this phenomenon. Although the healthcare innovation landscape is dominated by non-profit institutions such as hospitals, increasing managerial and budgetary pressures heighten profitability imperatives. 

As a result, innovative projects are influenced by two forces: the shared values of healthcare professionals and the logics of rationalization. This is especially true for information system (IS) projects, which represent a large share of hospital innovations. To innovate effectively, project leaders must gain legitimacy both in medical and economic terms. However, their strategies for achieving this dual legitimacy remain poorly understood. 

This dissertation aims to shed light on the legitimation strategies of health IS innovators, with the following overarching research question: How do actors engaged in health innovation deploy strategies to legitimize their innovation? 

To address this issue, wemobilize four theoretical frameworks. The first two define our research object, while the latter two underpin our analytical approach. 

The first framework examines the adoption of innovative IS in healthcare. Wefocus on adoption resistance, showing that legitimation is a key factor in overcoming implementation barriers. 

The second framework explores the legitimation strategies employed by innovators. 

The third framework brings a practice-based view of innovation, emphasizingactors’ repeated, collective, and normative habits. 

Finally, we draw on a fourth framework: the pragmatist concept of trans action, inspired by Mead (1934) and Dewey & Bentley (1949). Trans-action serves as a theoretical lens to study actors’ practices. 

Our research is based on three case studies of innovative health IS: CanTel, a medical telemonitoring information system, ReMonit, another tele monitoring application, representing the scaling-up of the CanTel project, and a case in Denmark, at Andersen Hospital, focusing on the strategies of a hospital innovation center to legitimize its digital projects among healthcare professionals. 

This dissertation makes two theoretical contributions. 

First, we develop a typology of legitimation strategies, presented as ideal types (Doty & Glick, 1994). We show that legitimation strategies enable innovators to overcome tensions between new and existing practices. 

Second, we extend the use of the trans-action concept as an analytical lens. We demonstrate that it provides a richer understanding of the relationships between innovators, evaluators, their environment, innovative technologies, and non-human,non-technological entities. 

On the empirical side, we encourage healthcare managers to support change and foster reflection on existing norms. We highlight best practices for entrepreneurs and warn institutions about certain risks of digitalization driven by private actors

Keywords: Legitimization strategy, innovation, digital health, case study.

Composition of jury: