Clinicians as health technology designers: Two contrasting tales about user involvement in innovation development

• Little attention has been paid to clinically-driven technology development processes.
• The impact of clinical expertise on design and user involvement strategies varies.
• The needs and issues prioritized by technology spin-offs deserve policy attention.

ObjectiveBecause the way clinicians contribute to the design of a new technology remains poorly understood, our study describes how two academic spin-offs developed a labor decision support software and a home monitoring system.MethodsOur analyses triangulate different sources of data; interviews elicited how the team gathered the input of clinical and/or end users, the challenges it faced and how it addressed them; and documents either provided a chronological portrait of the design priorities set by each spin-off or factual information describing technological functionalities.ResultsBy characterizing the design strategies the two teams put forward (solution- or problem-driven) and the user feedback they gathered, our analyses clarify why certain priorities were set among clinical, organizational and health system needs. While both teams relied significantly on the clinical expertise of their members, how and when they gathered user feedback differed greatly.ConclusionA solution-driven design process, e.g., focused on further developing a technological solution, is not conducive to a broad appraisal of healthcare system issues and restricts the scope of feedback that may be gathered regarding clinical and end users' needs. From a policy perspective, including clinical expertise in technology development is thus not enough; what matters is the scope of the issues that developers address.