From Breakdown to Breakthrough: An Integrated Framework for Analysing Activity Contradictions in Digital Health Ecosystems

Abstract

Health Information Systems (HIS) governance literature has struggled to explain how coordination is achieved in complex ecosystems marked by institutional voids and technological scarcity. This study addresses this challenge by developing an integrated analytical framework that systematically links process-level bottlenecks, identified through Business Process Model and Notation (BPMN), to their underlying systemic contradictions, analysed through Cultural-Historical Activity Theory (CHAT). Drawing on an in-depth case study of community mental healthcare in remote Indonesia, our analysis offers a counterintuitive theoretical argument: coordination breakdowns are not simply process failures, but catalysts for expansive learning and transformation. We demonstrate how stakeholders’ improvisations in response to these contradictions constitute a form of emergent, bottom-up governance. Our study contributes a new perspective on IS governance as a learning-oriented process.