Caring by sharing: A single case study on the implications of horizontal information systems for public sector accountability

Abstract: This paper aims to examine how accountability forms and conceptions are affected by the implementation of a horizontal information system in a public healthcare organization. Drawing on a qualitative case study of the healthcare organization of a mid-sized Swedish local government region, in which the analysis is framed by Adler and Borys' (1996) framework of enabling and coercive control, we contribute to the rather scarce literature on public sector digitalization and accountability in three main ways. First, we empirically demonstrate that the implementation of a new horizontal information system can enhance horizontal forms and conceptions of accountability. Second, our findings suggest that it does so by fostering an environment in which multiple interests and perspectives are considered - the system's design features and the process of designing it perceived as enablers for horizontal accountability given the related changes in data production and consumption. Third, we shed light on how the implementation context of hierarchal forms of accountability to some extent can discourage digitalization's enabling orientation. In some instances, increased horizontal accountability is thus rather expressed as an informal sense of shared accountability that does not necessarily translate into actions.