Exploring the future of the diagnostic process in primary care: The value of making contradictions explicit using change lab methodology with healthcare professionals and patients

Background
Over the past years many innovations are being developed aiming to improve diagnostic processes in primary care. Limited evidence is available on how those actually involved in those processes, in short-hand end-users (patients, general practitioners, and medical specialists such as radiologists), view innovation of the diagnostic process in primary care. Perspectives from end-users are necessary to ensure the effectiveness of initiatives designed to improve the diagnostic process. Therefore, end-users explored directions and opportunities for the primary care diagnostic process, facilitated by change laboratory methodology in which tensions and differences of insight are used as source of inspiration and learning.

Methods
Directions and opportunities were explored in two study groups comprising nine and ten participants respectively (consisting of patients, general practitioners, and medical specialists) that both had four change lab sessions in a four-month period. In the analysis, the Cultural-Historical Activity Theory was used as theoretical framework. This theory helps to reveal the operation of different healthcare systems in which participants find themselves and associated tensions and contradictions, creating new directions for thinking, learning, and acting from and with one another.

Results
Together with the participants, we identified tensions and contradictions operating within and between different activity systems relevant for diagnostic processes in primary care, like tensions that could arise which arise when more and faster diagnostics are available in primary care or when collaborating parties have other interests and motivations in innovations. By recognizing these tensions and contradictions, participants have formulated innovation directions and opportunities for the diagnostic process in primary care. End-users perceived a need for better exchange of and/or access to test results done in hospital to general practitioners, and they identified certain artificial intelligence imaging techniques as promising to improve the diagnostic process for acute complaints at the point-of-care. Delving into these directions and opportunities for adjusting and advancing the diagnostic process, we formulated criteria to be considered for identifying fruitful innovation projects.

Conclusions
By discussing tensions and contradictions between systems new considerations for successful innovation of the diagnostic process were identified and criteria were formulated which increase the likelihood of delivering promising innovation projects.