Terje Aksel Sanner

Sanner, Terje Aksel; Kempton, Alexander Moltubakk; Russpatrick, Scott McKee & Sæbø, Johan Ivar (2024). Governing digital platform ecosystems for social options. Information Systems Journal. ISSN 1350-1917.  https://doi.org/10.1111/isj.12546

Sanner, Terje Aksel, and Egil Øvrelid. “Informating Hospital Workflow Coordination.” Computer Supported Cooperative Work (CSCW), May 28, 2019. https://doi.org/10.1007/s10606-019-09362-z.

Roland, Lars Kristian; Sanner, Terje Aksel; Sæbø, Johan Ivar & Monteiro, Eric (2017). P for Platform. Architectures of large-scale participatory design. Scandinavian Journal of Information Systems.  ISSN 0905-0167.  29(2)

Sanner, Terje Aksel; Manda, Tiwonge Davis; Nielsen, Petter. 
Grafting: Balancing Control and Cultivation in Information Infrastructure Innovation. Journal of the AIS 2014 ;Volume 15.(4) p. 220-243

Sanner, Terje Aksel; Sæbø, Johan Ivar. 
Paying Per Diems for ICT4D Project Participation: A Sustainability Challenge. Information Technologies and International Development 2014 ;Volume 10.(2) p. 33-47

Sanner, Terje Aksel; Roland, Lars Kristian & Braa, Kristin (2012). From pilot to scale: Towards and mHealth typology for low-resource contexts. Health Policy and Technology.  ISSN 2211-8837. 1(1), s 155- 164 . doi: https://doi.org/10.1016/j.hlpt.2012.07.009

• Sanner, Terje Aksel; Kempton, Alexander Moltubakk; Russpatrick, Scott McKee & Sæbø, Johan Ivar (2024). Governing digital platform ecosystems for social options. Information Systems Journal. ISSN 1350-1917. doi: 10.1111/isj.12546. Full text in Research Archive Show summary

  To date, there is little insight into how digital platforms might be governed towards the creation of social value. We argue that digital platforms can contribute to the creation of social value by enabling social options. Thus, we are concerned about how digital platform ecosystems may be governed towards the enablement of social options. We report on the results from our longitudinal qualitative case study of a digital platform employed by ministries of health in more than 70 low- and middle-income countries. We trace the formation and subsequent shaping of governance mechanisms employed to enable social options across national borders and domains. We develop a model of platform governance that shows how such mechanisms are shaped over time through resourcing, capacitating and purposing processes. These three processes play distinct yet complementary roles in governing for social options.

• Amuha, Monica Grace; Masiero, Silvia & Sanner, Terje Aksel (2023). Taking a Leaf from Health: Implementation of a Decentralized Education Management Information System in Uganda. In Jones, Matthew (Eds.), After Latour: Globalisation, Inequity and Climate Change. Springer Nature. ISSN 9783031501531. p. 156–174. doi: 10.1007/978-3-031-50154-8_13. Full text in Research Archive Show summary

  Education management information systems (EMIS) play a critical role in providing quality data for effective decision making and design of appropriate interventions. Over the last two decades, the health sector in low and middle-income countries (LMICs) has seen the emergence of robust and responsive health management information systems (HMIS). On the contrary, the education sector lacks comprehensive and flexible information systems for reporting and management of key education data, resulting in fragmentation and limited education data use above the school level. Against this backdrop, this paper presents key lessons from the implementation of a standardized HMIS in the health sector in Uganda, which has informed the implementation of a decentralized EMIS. Drawing from an action research approach to EMIS strengthening in Uganda, we provide guidance to education managers and policy makers in LMICs seeking to enhance education data standardization, management and use.

• Valbø, Bjørnar & Sanner, Terje Aksel (2023). Informing sustainable development in education: Identification and actualization of layered is affordances. Electronic Journal of Information Systems in Developing Countries. doi: 10.1002/isd2.12302. Full text in Research Archive Show summary

  Abstract This paper reports from a qualitative case study in the Gambian education sector. The study applies an affordance perspective to the ongoing strengthening of the national education management information system. Our analysis distinguishes between micro‐level technology‐use affordances (e.g., civil servants using IT for data capture and reporting), meso‐level information system (IS) affordances (e.g., data‐driven decision making at the organizational level), and macro‐level affordances, which include policy interventions to ensure the attainment of education sector goals. The contribution of the paper is twofold. First, the paper introduces a stepwise framework for IS affordance identification in terms of granularity levels (micro, meso and macro). Second, the paper outlines how use of IT at the micro‐level allows for the actualization of meso‐level IS affordances, which in turn serve as a foundation for the articulation of higher‐level interventions. Far too often, ICT for development (ICT4D) projects focus on putting technology in the hands of users with the assumption that “better data” will drive development. The significant work involved in identifying and actualizing meso‐level IS affordances is often not explicated and recognized in related plans and budgets. By highlighting meso‐level IS affordance actualizations, the paper explicates the link between public sector IT adoption and use and intended societal‐level impact, which remains a key policy and research concern.

• Øvrelid, Egil & Sanner, Terje Aksel (2020). Sense-able process innovation in digital health infrastructures. Scandinavian Journal of Information Systems (SJIS). ISSN 0905-0167. 32(1), p. 81–116. Full text in Research Archive
• Sanner, Terje Aksel & Øvrelid, Egil (2019). Informating Hospital Workflow Coordination. Computer Supported Cooperative Work (CSCW). ISSN 0925-9724. doi: 10.1007/s10606-019-09362-z. Full text in Research Archive
• Sanner, Terje Aksel & Nielsen, Petter (2019). Software Platforms for Inclusive Innovation. In Nielsen, Petter & Kimaro, Honest C. (Ed.), Information and Communication Technologies for Development: Strengthening Southern-Driven Cooperation as a Catalyst for ICT4D. 15th IFIP WG 9.4 International Conference on Social Implications of Computers in Developing Countries, ICT4D 2019, Dar es Salaam, Tanzania, May 1–3, 2019, Proceedings, Part I. Springer Nature. ISSN 9783030183998. p. 218–230. doi: 10.1007/978-3-030-18400-1_18. Full text in Research Archive
• Øvrelid, Egil; Sanner, Terje Aksel & Siebenherz, Anette (2018). Creating Coordinative Paths from admission to discharge: The role of lightweight IT in hospital digital process innovation. In Bui, Tung (Eds.), Proceedings of the 51st Hawaii International Conference on System Sciences 2018 (HICSS-51). Association for Information Systems (AIS). ISSN 9780998133119. p. 3160–3169. doi: 10.24251/hicss.2018.399. Full text in Research Archive Show summary

  In this paper, we examine the role of IT in process innovations related to patient flow from emergency care admission, through subsequent patient transfers, and discharge. In particular, we explore how digital technology helps create and improve coordinative paths. We find that the interplay between traditional "heavyweight IT" (resilient, secure and stable) and "lightweight IT" (mobile, context-aware and flexible) enable process innovation in complex health care settings. Drawing on Zuboffs "informate" perspective, we highlight the strength of digital information technology as a process innovation enabler. We provide two contributions. First, we shed light on the innovative capacity of lightweight IT as a flexible, dynamic and distributed technology for process innovation. Second, using Garud and Kumaraswamys framework of vicious and virtuous circles, we identify and discuss potential positive and negative outcomes of process innovation. URL for til publications is: http://hdl.handle.net/10125/50287

• Sanner, Terje Aksel & Øvrelid, Egil (2018). Enabling responsive hospital housekeeping with workflow IT. NOKOBIT: Norsk konferanse for organisasjoners bruk av informasjonsteknologi. ISSN 1892-0748. Full text in Research Archive Show summary

  Workflow oriented use of IT in hospitals can increase resource utilization, patient satisfaction and patient throughput, by integrating and aligning work processes. However, the role of hospital support staff, such as porters and housekeepers in interdepartmental workflow coordination has received scant attention. With digitally integrated workflows, the influence of support services on patient flow becomes visible and open to scrutiny and explication. Empirically, we follow efforts to leverage IT to improve workflow coordination at Kalnes general hospital in Norway. Specifically, we employ the Theory of Swift and Even Flow to examine the influence workflow oriented use of IT has on housekeeping responsiveness to patient flow variability and temporary patient flow bottlenecks. We find that efforts to improve workflow coordination introduces novel ramifications for hospital housekeeping and that IT serves both as a real time coordinative tool and as a source for post hoc data analysis and process streamlining. In particular, we identify and discuss three maturity levels of IT mediated workflow coordination, which we refer to as workflow transparency, synchronization and responsiveness. We find that workflow oriented use of IT can raise the responsiveness of hospital support services through a combination of interdepartmental transparency and improved synchronization. Importantly, workflow integration can reveal interdependencies that impinge on the productivity of support staff but are beyond their immediate influence. Consequently, it is important to involve often-overlooked hospital support services directly in the planning and evaluation of workflow-oriented use of IT.

• Sanner, Terje Aksel (2017). ICT4D sustainability as generativity. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 504, p. 498–509. doi: 10.1007/978-3-319-59111-7_41. Full text in Research Archive
• Roland, Lars Kristian; Sanner, Terje Aksel; Sæbø, Johan Ivar & Monteiro, Eric (2017). P for platform: Architectures of large-scale participatory design. Scandinavian Journal of Information Systems (SJIS). ISSN 0905-0167. 29(2), p. 3–34. Full text in Research Archive Show summary

  Participatory Design (PD) has traditionally been committed to extensive interaction between developers and situated users to mitigate the disempowering consequences of computerization, such as the deskilling of labour workers. However, the widespread adoption of off-the-shelf software and the emergence of complex information system architectures with interdependencies across user groups and organizations challenge the applicability of traditional custom PD. Pressure is put on PD to scale with initiatives that span an increasing number and distribution of heterogeneous settings, developers, users and uses over time. In this article, we follow a PD project that started out in post-apartheid South Africa more than two decades ago. The project, which centres on the development of a software product for decentralised public health care management, has since grown into a venture with a significant footprint in the Global South. In order to problematise the scaling of key aspects of PD, such as the politics of design, the nature of participation and participatory design techniques, we first review extant literature and develop a classification of four different types of PD with respect to scale. We then apply the typology to our empirical case to discuss PD in relation to architectural traits at different stages of project scale. We contribute to PD literature by addressing the exploratory research question: What role does architecture play in large scale PD? Specifically, the study highlights how an emergent platform architecture and its surrounding ecosystem co-constitute a platform for participation in design.

• Poppe, Olav; Sæbø, Johan Ivar; Nielsen, Petter & Sanner, Terje Aksel (2017). Standardising Through Software. IRIS Selected Papers of the Information Systems Research Seminar in Scandinavia. ISSN 1891-9863. 8, p. 111–119. Full text in Research Archive
• Roland, Lars Kristian; Sanner, Terje Aksel & Aanestad, Margunn (2017). Flexibility in EHR ecosystems: five integration strategies and their trade-offs. NOKOBIT: Norsk konferanse for organisasjoners bruk av informasjonsteknologi. ISSN 1892-0748. 25(1). Full text in Research Archive
• Øvrelid, Egil; Sanner, Terje Aksel & Siebenherz, Anette (2017). From admission to discharge: Informating patient flow with lightweight IT. NOKOBIT: Norsk konferanse for organisasjoners bruk av informasjonsteknologi. ISSN 1892-0748. Full text in Research Archive
• Manda, Tiwonge Davis & Sanner, Terje Aksel (2015). The Mobile is Part of a Whole: Implementing and Evaluating mHealth from an Information Infrastructure Perspective. International Journal of User-Driven Healthcare. ISSN 2156-1818. doi: 10.4018/ijudh.2014010101. Full text in Research Archive
• Sanner, Terje Aksel & Sæbø, Johan Ivar (2014). Paying Per Diems for ICT4D Project Participation: A Sustainability Challenge. Information Technologies & International Development. ISSN 1544-7529. 10(2), p. 33–47. Full text in Research Archive
• Sanner, Terje Aksel; Manda, Tiwonge Davis & Nielsen, Petter (2014). Grafting: Balancing Control and Cultivation in Information Infrastructure Innovation. Journal of the AIS. 15(4), p. 220–243. doi: 10.17705/1jais.00356. Full text in Research Archive
• Purkayastha, Saptarshi; Manda, Tiwonge Davis & Sanner, Terje Aksel (2013). A Post-development Perspective on mHealth - An Implementation Initiative in Malawi. Proceedings of the Annual Hawaii International Conference on System Sciences (HICSS). ISSN 1530-1605. p. 4217–4225. doi: 10.1109/HICSS.2013.53. Full text in Research Archive Show summary

  While the sheer number of mHealth implementations around the world have been increasing dramatically, authoritative voices on global health have tried to put the focus on quantifiable evaluations and comparisons of these projects (e.g. health outcomes, cost savings, efficiency) in order to channel donor funds and investments into proven and scalable solutions. Drawing on empirical data from an mHealth implementation in Malawi we argue that quantitative evaluation of health interventions often assumes a top-down and limited view on the developmental impact of mHealth. Through our action-research involvement with facility-based reporting of routine health data through mobile phones, we conclude that developmental impacts of mHealth are local and each locale experience a different developmental impact depending on the context of use and available resources. The paper contrasts global concerns for quantifiable development with local priorities with respect to mHealth projects and information system (IS) interventions in health more broadly.

• Sanner, Terje Aksel; Roland, Lars Kristian & Braa, Kristin (2012). From pilot to scale: Towards and mHealth typology for low-resource contexts. Health Policy and Technology. ISSN 2211-8837. 1(1), p. 155–164. doi: 10.1016/j.hlpt.2012.07.009. Full text in Research Archive

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• Sjøvoll, Espen; Utvik, Vetle Alvenes; Kempton, Alexander Moltubakk & Sanner, Terje Aksel (2026). Mindre avhengighet av tek-gigantene krever mer enn å bytte ut Office-pakken. Full text in Research Archive Show summary

  En politikk for åpen kildekode må være basert på åpne økosystemer.

• Valbø, Bjørnar & Sanner, Terje Aksel (2022). Investigating Mid-level IT Affordances as Drivers for Societal Change: Addressing the Education Data Challenge in The Gambia. Full text in Research Archive Show summary

  Affordance perspectives have gained traction among information systems (IS) scholars and have seen recent adoption in ICT4D research. Although scholars recognize the need to differentiate between mere technology use and higher-level organizational and societal IT affordances, no clear terminology for the representation of affordance granularity exists. This paper introduces “mid-level IT affordances”, which, we argue, emerge from technology use and serve as prerequisites for the actualization of higher-level affordances. To illustrate, we draw on a case study of education management information systems in The Gambia. International development agendas encourage public sector actors to produce increasingly granular data. Yet, the capacity to utilize the data is not strengthened correspondingly. This introduces a disconnect between policy and practice, whereby investments in technology use affordances fail to translate into IT affordances for monitoring progress towards complex policy goals. A mid-level IT affordance perspective allows for the identification and potential mitigation of such gaps.

• Jallow, Seedy Ahmed & Sanner, Terje Aksel (2022). Education Information System Decentralization: The Introduction of Digital Learner Records in the Gambia. Full text in Research Archive
• Russpatrick, Scott McKee; Sæbø, Johan Ivar; Monteiro, Eric; Nicholson, Brian & Sanner, Terje Aksel (2021). Digital Resilience to Covid-19: A Model for National Digital Health Systems to Bounce Forward From the Shock of a Global Pandemic. Full text in Research Archive
• Fossum, Kristoffer; Fossum, Selamawit Molla; Hanseth, Ole & Sanner, Terje Aksel (2019). Adaptive networked governance of e-health standards: The case of a regional health information infrastructure in Norway. Full text in Research Archive
• Nielsen, Petter & Sanner, Terje Aksel (2018). Digital Innovation and the Dynamics of ICT4D Projects. Full text in Research Archive
• Sæbø, Johan Ivar; Sanner, Terje Aksel & Muhire, Andrew (2014). Better Information, Better Decisions, Better Health. Full text in Research Archive
• Sanner, Terje Aksel; Sæbø, Johan Ivar & Moyo, Christon M. (2013). Interdependent Institutional Logics: The Case Of Health Information System Restructuring In Malawi. Full text in Research Archive Show summary

  The paper aims to identify, through an institutionalist analysis, the interplay between institutional logics pertaining to a prolonged and ongoing HMIS restructuring process in Malawi. In doing so the paper highlights important contestations between interpretations of the HMIS function, efforts aimed at its restructuring, and the meaning of the health data it evolves around. The paper contributes theoretically to the institutionalist perspective by conceptualizing a pair of mutually legitimizing institutional logics, of development (impact) and aid (opportunism), as interdependent institutional logics.

• Roland, Lars Kristian & Sanner, Terje Aksel (2013). Accommodating Multiple Rationalities in Patient Oriented Health Information System Design. Full text in Research Archive
• Sanner, Terje Aksel & Manda, Davis Tiwonge (2012). Bootstrapping Information Technology Innovations Across Organisational and Geographical Boundaries: Lessons from an mHealth Implementation in Malawi. Full text in Research Archive
• Sanner, Terje Aksel; Braa, Kristin & Roland, Lars Kristian (2012). From Pilot to Scale: Towards a mHealth Typology for Low Resource Contexts. Full text in Research Archive
• Sanner, Terje Aksel & Braa, Kristin (2011). Making mHealth happen for Health Information systems in low resource settings. Full text in Research Archive
• Amuha, Monica Grace; Masiero, Silvia; Braa, Kristin & Sanner, Terje Aksel (2026). Empowerment of District Managers with Data: An Institutional Logics Analysis of Education Management Information System Decentralization in Uganda. Universitetet i Oslo. Full text in Research Archive Show summary

  Within decentralized education systems, district education managers serve as critical intermediaries that translate national education policies into implementation realities at the lower levels. Despite being responsible for planning, monitoring, and supporting service delivery, they face challenges responding to diverse local needs due to limited decision-making authority, constrained resources, and insufficient access to timely data for decision-making. This thesis examines how the decentralization of Education Management Information Systems (EMIS) relates to the empowerment of district managers within Uganda’s education sector. While EMIS reforms are often framed as technical interventions aimed at improving data quality and efficiency, this study positions EMIS decentralization as a sociotechnical and institutional process embedded within a complex governance environment with non-linear empowerment outcomes. The study uses an institutional logics perspective to explore how multiple, sometimes competing, logics such as development project impact, political influence, and professionalism interact to influence the empowerment of district managers with data for decision-making at the sub-national level. Based on an action research project, the research investigates how these multiple logics shape EMIS decentralization and how district actors negotiate these logics as they adopt new data practices, assume greater responsibility for data management, and seek autonomy in decision-making. Using an interpretive qualitative research design—including interviews, observations, and document analysis—the study examines how EMIS decentralization can either enable or constrain empowerment, depending on the alignment or tensions between institutional logics. The findings show that while digital tools can expand access to information and strengthen local agency, empowerment emerges with alignment between institutional logics, organizational structures and routines, and the distribution of decision-making authority. The thesis contributes to the literature by offering an empirically grounded account of how institutional logics mediate the empowerment potential of digital information systems in public sector governance. By highlighting the conditions under which EMIS decentralization can strengthen local decision-making, the study provides theoretical insights and practical implications for policymakers and development partners seeking to design digital initiatives for strengthening decentralized governance of education systems.

• Sanner, Terje Aksel (2015). Grafting Information Infrastructure: Mobile Phone‐based Health Information System Implementations in India and Malawi. Universitetet i Oslo. Full text in Research Archive Show summary

  In the wake of ‘the mobile revolution’ there has been an immense upsurge in mobile phone based health innovations, or mHealth for short. Expected efficiency gains and health benefits with such innovations, however, have been notoriously difficult to realize in the resource sparse settings of less developed economies. Scholars and industry specialists have found the implementation of a large portion of mobile phone-based innovations unsustainable beyond short term pilot projects. This dissertation is positioned within the information systems (IS) research tradition and develops a nuanced understanding of so called mHealth sustainability challenges through two qualitative and exploratory interpretive case studies, one in India and one in Malawi. Both mobile phonebased implementations under study were commissioned by health authorities to strengthen routine reporting of public health data. A ‘big-bang’ roll-out to 5000 community-based health workers was initiated in India while incremental ‘baby-steps’ were favored in Malawi. The two empirical cases highlight different technical, infrastructural, socio-political, and institutional hurdles. The dissertation draws theoretical inferences from both cases through the proposition of information infrastructure grafting, whereby complex and fragile multi-stakeholder ICT implementation processes are conceptualized analogously with horticultural grafting (read: gardening). There is one simple maxim to plant grafting – the grafted branch or shoot has to take hold before it can grow. The merge between congenial plant parts can be assisted, but not asserted, by a gardener’s careful application of appropriate grafting techniques. The grafting metaphor foregrounds the need for care and tenderness in information infrastructure development, particularly in resource sparse settings. Information infrastructure grafting, then, is a fragile process whereby innovative ICT capabilities merge and coevolve with extant technologies, work practices, physical and digital infrastructure, and social institutions. This dissertation explores how congeniality between innovative ICT capabilities and extant socio-technical arrangements, and not merely ‘technology fit’ or ‘organizational readiness’, paves the road towards more sustainable implementations. This has practical implications for health information system policy makers and strategists, international funding agencies, ICT project managers and mHealth practitioners. Based on empirical investigations and an ecological conceptualization of socio digital change, this dissertation engages constructively with the discourse on sustainable development as it pertains to ICT based implementations in general and mHealth research and practice in particular.

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