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The purpose of this study is to contribute to research concerning the role of digital infrastructure in digital government. This is done by answering the research question: how does digital infrastructuring constrain ambidexterity in public sector organizations?

The research is designed as a clinical inquiry in a large Swedish municipality, involving data collection in the form of interviews and internal documents. The method of analysis involves both exploring generative mechanisms in digital infrastructuring and theorizing on the findings based on previous literature.

The findings identify four generative mechanisms through which stability and change in digital infrastructuring constrain ambidexterity in terms of both efficiency (exploitation) and innovation (exploration).

This study’s limitations are related to international and intersectoral transferability and risks associated with its approach to clinical inquiry. The main implications are its contribution to the literature on how stability counteracts not only innovation but also efficiency and how change counteracts not only efficiency but also innovation.

This study identifies clear generative mechanisms that should be avoided by managers striving for digital government, and it offers clear recommendations for said managers regarding how to avoid them.

This study offers implications for national-level digital infrastructure policy and contributes to efforts to increase the capabilities of digital government.

As two of the four identified generative mechanisms are novel contributions, this study offers a concrete addition to existing research. This study has resulted in factual change in the studied organization as well as at the national level through successful dissemination of the findings for both policy and practice in other public sector organizations.

Designing digital artifacts is not a linear, straightforward process. This is particularly true when applying a user-centered design approach, or co-design, with users who are unable to participate in the design process. Although the reduced participation of a particular user group may harm the end result, the literature on solving this issue is sparse. In this article, proxy design is outlined as a method for involving a user group as proxy users to speak on behalf of a group that is difficult to reach. The article investigates the following research question: How can roleplaying be embedded in co-design to engage users as proxies on behalf of those who are unable to represent themselves?

The article presents a design ethnography spanning three years at a cancer rehabilitation clinic, where digital artifacts were designed to be used collaboratively by nurses and patients. The empirical data were analyzed using content analysis and consisted of 20 observation days at the clinic, six proxy design workshops, 21 telephone consultations between patients and nurses, and log data from the digital artifact.

The article shows that simulated consultations, with nurses roleplaying as proxies for patients ignited and initiated the design process and enabled an efficient in-depth understanding of patients. Moreover, the article reveals how proxy design as a method further expanded the design. The study findings illustrate: (1) proxy design as a method for initiating design, (2) proxy design as an embedded element in co-design and (3) six design guidelines that should be considered when engaging in proxy design.

The main contribution is the conceptualization of proxy design as a method that can ignite and initiate the co-design process when important users are unreachable, vulnerable or unable to represent themselves in the co-design process. More specifically, based on the empirical findings from a design ethnography that involved nurses as proxy users speaking on behalf of patients, the article shows that roleplaying in proxy design is a fitting way of initiating the design process, outlining proxy design as an embedded element of co-design.