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Paper short abstract

“Pilotitis” is a state of being stuck in ceaseless preparation, implying a meantime that is provisional and instrumental. Ethnographic investigation of digital health and care innovation in Scotland reveals the meantime as a teeming space where local realities intercept a national imaginary.

Paper long abstract

Digital health and care innovation in Scotland is characterised by an ecosystem of public, private, and third sector organisations pursuing powerful data imaginaries: Scotland’s Digital Health and Care Strategy envisions seamless interaction across services in a system where citizens have access to and control over their data, where staff can access and share information system-wide, and where data-driven service-design increases efficiency. Those frustrated at the pace of progress towards this future have diagnosed the sector as being in a state of “pilotitis”, where promising smaller-scale initiatives are piloted but not rolled-out and scaled-up nationally.

By setting the present only against this idealised future, the accusation of “pilotitis” consigns much innovation work to a meantime that is deemed partial and provisional because it is not national. Yet ethnographic investigation of that work suggests that it is exactly within this meantime – or, indeed, these meantimes – that there is space and time to attend carefully to Scotland’s multiple local needs and affordances, and to undertake the kinds of participatory design work that fulfil the ‘person-centred’ vision of its Digital Health and Care Strategy.

Thus tensions are exposed between local meantimes and the national meantime, the plural and the singular, meantimes as they unfold and the future as it is imagined; and “pilotitis” (in its assumption that small-scale work is merely preparatory) emerges as a misapprehension. Local projects have value beyond their instrumentality in relation to the national future, and raise questions about what (if anything) is to be rolled-out or scaled-up.