“Look! this is the future of cardiology": institutional work and the making of telemedicine in healthcare”

This paper seeks to offer a critical perspective on the lack of wide- spread adoption of telemonitoring. The paper proposes a reconstruction of the processes that led from the first experimental adoption to the final codification of the service as a clinical service, showing the complex ecology of actors, knowledge, practices that are necessary to incardinate new services into the in- stitutional fabric. Adopting a qualitative research design, organizational pro- cesses are investigated through the conceptual lens of 'institutional work', defined as the creative and rationally oriented activity of 'culturally competent' actors aimed at adapting to dynamic conditions through which institutions are created, reproduced and destroyed. The work aims to show how different actors, using the resources at their disposal, act to modify healthcare institutions by redefining their role in a scenario characterized by an increasing use of ICT tools in healthcare. The fieldwork confirms how the institutionalization of change re- quires continuous "tuning" and its transformation into everyday operational prac- tices. At the same time, the work makes it possible to show why these processes are difficult to replicate even within the same organization, arguing that in these healthcare contexts in which institutional work is successful, particular practices prevail in connecting discursive frameworks, limited implementation strategies and economic demands.