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The integration of industry 4.0 has become a priority for many organizations. However, not all organizations are suitable and capable of implementing industry 4.0 because it requires a dynamic and flexible implementation strategy. The implementation of industry 4.0 often involves overcoming several tensions between internal and external stakeholders. This paper aims to explore the paradoxical tensions that arise for health-care organizations when integrating industry 4.0. Moreover, it discusses how a paradox lens can support the conceptualization and proposes techniques for handling tensions during the integration of industry 4.0.

This qualitative and in-depth study draws upon 32 semi-structured interviews. The empirical case concerns how two health-care organizations handle paradoxical tensions during the integration of industry 4.0.

The exploration resulted in six recurring technology tensions: technology invention (modularized design vs. flexible design), technology collaboration (automation vs. human augmentation), technology-driven patient experience (control vs. autonomy), technology uncertainty (short-term experimentation vs. long-term planning), technology invention and diffusion through collaborative efforts among stakeholders (selective vs. intensive collaboration) and technological innovation (market maintenance vs. disruption).

A paradox theory-informed conceptual model is proposed for how to handle tensions during the integration of industry 4.0. To the best of the authors’ knowledge, this is the first paper to introduce paradox theory for quality management, including lean and Six Sigma.

This paper aims to discuss artifacts and how they influence the performative scheme of the routine and human agency. Artifacts emerge from a heterogeneous network of technical and social elements, which implies assuming that they strongly influence the performance of a routine and the organizing.

This essay starts from an established theoretical framework to develop reflections and propose that the artifacts entangle part of organizational knowledge and that the artifact's role is structured by their enactment in performing a routine, which gives them meaning and a sense of purpose.

The propositions contribute to theoretical and empirical advances by offering new insights for analysing the role of artifacts in routine dynamics. The main arguments presented are about (i) the existence of a potential role and a performed role for artifacts, (ii) that the artifacts' role evolves from knowledge and know-how embedded in routines and their actants and (iii) that artifacts are connected through networks of routines, and they embed a vast repertoire of knowledge and expertise.

Also, it proposes a fruitful research agenda based on the main reflections. Finally, the thoughts presented open a pandora's box to reflect on the intertwining between human and artifacts, not just in organizing but also in everyday social life.