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Quantifying the performance level of surgeons with digital virtual reality (VR) simulators can help ensure that quality requirements in healthcare are met. In order to better understand integration amongst quality principles, practices and technologies in the adoption and diffusion of VR simulators, the authors applied a technological innovation system (TIS) framework. The purpose of this study is to understand how the adoption and diffusion of VR surgical simulators in a Swedish healthcare context is influenced by various system factors.

In this study, single-case holistic design based on innovation system theory was used to analyse the adoption of digital quality technologies related to surgical performance in Swedish hospitals. The case employs a mixed methods approach triangulating data longitudinally from published documents and expert interviews.

Adoption of digital technologies regarding surgical performance is restricted by system factors relating to inconsistent normative and regulatory requirements for quantified performance criteria to judge surgical expertise. Addressing these systems' weaknesses with evidence-based training programmes can have a significant impact on the further development of the innovation system and can ultimately affect healthcare reliability and quality.

This paper explores quality management (QM) challenges in the context of digital transformation in healthcare. The paper attempts to fill the gap for TIS studies in a healthcare context and highlight the role of innovation function strength along the value chain and in relation to technology cycles to increase the understanding of adoption of digital technologies relating to surgical performance.

The aim of this paper is to open a debate about the relevance of American pragmatism for the philosophy of the social sciences. The agenda for a pragmatist philosophy of social science is introduced by contrasting it with ‘sociological hermeneutics’. Sociological hermeneutics refers to a common research agenda that attempts to implement insights from the philosophical project of hermeneutics into the social sciences. According to this view, the interpretative method is a sine qua non for any faithful representation of the external world. In contrast, a pragmatist philosophy of social sciences shows affinities with Nietzsche's genealogical method and the reflexive turn in cultural anthropology. Its aim is not to represent something out-there, but to use the encounter with different forms of life to reassess our selves and our own culture.