A Stakeholder-Centric Framework for Blockchain Design and Strategic Integration Alignment: An Application in Healthcare

As digital infrastructures increasingly mediate critical societal functions, the success of emerging technologies such as Distributed Ledger Technologies depends less on their technical sophistication than on their capacity to integrate meaningfully into existing socio-technical systems. In domains such as healthcare, where trust, accountability, and professional responsibility are central, purely technology-centered design approaches have proven insufficient to achieve durable adoption. The resulting proliferation of technically viable yet organizationally fragile solutions highlights the need for principled methods that connect stakeholder values with system design decisions. This motivates research on how stakeholder-oriented values can be identified and operationalized to drive the requirements analysis and design of DLT-based systems in complex socio-technical environments. To address this challenge, the thesis follows a structured research progression that reflects the different facets of the integration problem. First, it investigates the primary domain-independent challenges that hinder the implementation of DLTs in organizational and cyber-physical systems, thereby establishing a general understanding of technical and socio-organizational barriers. Second, it systematically examines the current state of DLT adoption in healthcare through a Systematic Literature Review, analyzing application areas, technological configurations, performance characteristics, and reported outcomes. Building on this foundation, the thesis develops a stakeholderoriented performance and assessment framework that links quality requirements to design decisions, providing methodological support for the systematic engineering of decentralized systems. This framework is then used to derive and structure an architecture for blockchain-based healthcare data management that is explicitly aligned with stakeholder expectations. Finally, the thesis investigates how conceptual modeling can be employed to bridge strategic objectives and technical design, enabling the explicit representation of stakeholder values and their translation into system requirements. The research adopts a Design Science Research methodology in which theoretical insights are iteratively transformed into prescriptive artifacts. The core artifacts include a stakeholder-oriented assessment framework grounded in the dimensions of Security, Efficiency, Resiliency, and Sustainability (SERS), a set of design principles for value-aligned blockchain architectures, and a concrete system architecture instantiated in the healthcare domain. These artifacts are evaluated through analytical reasoning and application in a real-world case study, demonstrating how stakeholder-oriented values can be systematically embedded into the requirements analysis and architectural design of DLT-based systems. Overall, the thesis contributes a coherent, methodologically grounded approach for the socio-technical integration of Distributed LedgerTechnologies, advancing both theoretical understanding and practical guidance for their responsible deployment. The findings of this thesis indicate that the success of DLT-based systems in socio-technical environments depends less on the choice of specific technological configurations than on the explicit alignment between stakeholder-oriented values and architectural design decisions. The study demonstrates that stakeholder values such as Security, Efficiency, Resiliency, and Sustainability can be systematically elicited and structured, and that these values can be operationalized into quality requirements that meaningfully guide system architecture. The proposed SERS framework is shown to support the identification of critical trade-offs between competing stakeholder expectations and technical constraints, enabling more transparent and justifiable design choices. Furthermore, the healthcare case study reveals that architectures derived through valuedriven requirements analysis exhibit improved coherence with organizational processes and regulatory demands compared to technology-driven designs. Collectively, these findings provide empirical and conceptual evidence that stakeholder-oriented, valuebased design constitutes a necessary condition for the sustainable integration of DLTs into complex socio-technical systems.