MAD statement This annual leading article is making a difference (MAD) through providing an overview of what is design and designerly thinking, and how these constructs may be of interest to organizational change management and leadership theory and practice. In doing so, we are setting out to support a transdisciplinary application of design thinking principles, methods and tools in the continuous development of organizational change and management capabilities, as well as leadership mindsets fit to meet the challenges of the twenty-first century.

This article explores how healthcare consumer collectives integrate self-service technology as part of their everyday lives on a long-term basis. Combining previously published research with data collected from field observations, in-depth interviews and focus groups, the author uncovers distinct adoption styles and then links these to well-being in a chronic healthcare context. Importantly, findings from the research suggest that successful long-term adoption of new technology depends not only on improving a targeted practice (medicating patients in this case), but also other affected everyday practices in the lives of consumers. By drawing on insights from the literature of service-dominant logic and practice theory, the author identifies ‘value-in-context’ and ‘lifestyle fit’ that underlie resource integration in medication adherence. Four adoption styles were uncovered, in which two in particular, ‘door opener’ and ‘transformative change,’ should be emphasized by healthcare managers and developers as they tend to be associated with higher well-being.

Recent developments in digital technologies have challenged the ways in which service firms create, deliver, and capture value. Although research and practice suggest business model innovation as an effective response to digitalization, many firms are not willing to make radical changes in the architecture of the firm’s activities. In this study, we take an in-depth look at which factors influence the firm’s capability for technology-driven business model innovation in the legal industry context. As our empirical context, we have chosen the legal industry, notorious for its risk aversion and for practices that inhibit innovation, but where the focus on digitalization is increasing due to external pressures. We interviewed nine law firms in Norway, representing together the largest share of the country’s legal services market, four of them being traditional law firms and the rest being newly established yet large digital New Law organizations. We find that profitability acts both as an inhibitor of business model innovation for established firms and as a driver for New Law firms. However, the relatively high job satisfaction of Norwegian lawyers in comparison to their US-based counterparts dampens the pull of technological opportunities on business model innovation by making human capital more difficult to acquire by new entrants. Barring an unexpected profitability crisis, digitalization of the Norwegian law sector will not disrupt traditional law firms’ business models. However, New Law firms are accumulating the competences required to compete with the incumbents.

Organizational ambidexterity is widely recognized as necessary for the economic sustainability of firms operating in the financial sector. While the management literature has recognized several forms of ambidexterity, the relationship between them and their relative merits remain unclear. By studying a process of implementation of ambidextrous capabilities within a large Scandinavian financial firm, we explore the role of top-down reforms and bottom-up reactions in determining the development of sector-specific innovative capabilities. We find that blended ambidexterity follows naturally from the attempt to correct the tensions arising from harmonic ambidextrous blueprints. The resulting blended practice appears to be closely related to the reciprocal model of ambidexterity, which appears to be a necessity rather than a choice, for large firms attempting to develop innovative capabilities. Consequently, we suggest to re-interpret current taxonomies of ambidexterity not as alternative blueprints, but rather as stages in a long-term process of transition.

Background: Hospital-at-home (HaH) services are increasingly implemented as digitally supported alternatives to inpatient care. While these models promise efficiency, continuity, and patient-centredness, they also redistribute responsibility from healthcare organisations to patients and family caregivers. This shift introduces health literacy demands related to timing, role clarity, and digitally mediated decision-making, which remain underexplored in digital health research. Methods: This qualitative study draws on ten in-depth interviews with patients, family caregivers, and healthcare professionals involved in hospital-at-home services in Norway. Interviews examined experiences of decision-making, remote monitoring, coordination, and follow-up in digitally supported home-based care. Following inductive thematic analysis, a service blueprint was developed as an analytical synthesis to examine how care demands and responsibilities were distributed across the service trajectory. Results: Caregiver burden was shaped less by individual capability than by service configurations that assumed high levels of availability, confidence, and digital competence. Family caregivers frequently assumed quasi-clinical and coordinative roles without adequate preparation or support. Health literacy demands clustered at key transitions, including decision-making, at-home monitoring, and discharge, where digital tools mediated responsibility and risk. These demands accumulated over time, generating vulnerabilities related to equity and sustainability. Conclusion: Digitally supported HaH services rely on implicit assumptions about patients’ and caregivers’ capacity to manage care at home. Design-informed analysis can reveal transition-located health literacy demands and digitally mediated responsibility shifts, supporting more inclusive and resilient digital health service models.