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While digital transformation holds immense promise, organizations often fail to realize its benefits. This study aims to address how policies for digital transformation benefits realization are translated into practice.

The authors apply a qualitative, comparative case study of two large, public-sector health care organizations in Sweden. Through document and interview data, the authors analyze the process of translation.

The study finds that practice variation is primarily caused by two types of decoupling: policy-practice and means-ends. Contrary to previous studies, coercion in policy compliance is not found to decrease practice variation.

The limitations primarily stem from the empirical selection of two large public health-care organizations in Sweden, affecting the study’s generalizability. Reducing practice variation is more effectively achieved through goal alignment than coercion, leading to implications for the design of governance and control.

Policymakers should, instead of focusing on control-related compliance, work to align organizational objectives and policies to decrease practice variation for successful benefits realization.

The study contributes to better benefits realization of digital transformation initiatives in health care. As such, the authors contribute to a better functioning and more transformative health care in times of increased demand and decreased supply of health-care services.

The study challenges conventional wisdom by identifying that coercion is less effective than goal alignment in reducing practice variation, thereby enhancing the understanding of policy implementation dynamics in health-care settings.

The purpose of this study is to explore and theorize on balancing practices (BP) for digital ambidexterity in the public sector.

The research is designed as an interpretative case study of a large Swedish authority, involving data collection in the form of interviews and internal documents. The method of analysis involves both theorizing on the findings from a previous framework for digital innovation and deriving design implications for ambidextrous governance.

The findings show that all identified BP except one (shadow innovation) is directed toward an increased emphasis on efficiency (exploitation) rather than innovation (exploration). With the increased demand for innovation capabilities in the public sector, this is identified as a problem.

The limitations identified are related to the choice in the method of an interpretative case study, with issues of transferability and empirical generalizability as the main concerns. The implications for research are related to a need for additional studies into the enactment of digital ambidexterity, where the findings offer insight and inspiration for continued research.

The study shows that managers and executives involved in the design and imposition of governance within the public sector need to take the design recommendations for digital ambidexterity into consideration.

The study offers two main implications for practice. First, policymakers need to take the conceptual distinction of efficiency and innovation into account when designing policies for the digital government. Second, existing funding practices need to be re-designed to better facilitate innovation.

This is the first study directed toward enhancing the insight into BP for digital ambidexterity in the public sector. The study has so far resulted in both a localized shift in policy and new directions for research. With the public sector facing needs for increased innovation capabilities, the study offers a first step toward understanding how this is currently counteracted through governance design.