Beyond cost and outcomes: how clinicians understand the value of medical technologies

Healthcare systems around the world are suffering from constrained resources while demand for medical care is growing (Thokala et al., 2025). Solutions to this paradox are often presented in the form of medical technologies – broadly understood as innovative procedures (e.g. Watson and Wozniak-O’Connor, 2025), diagnostics (e.g. Madu and Lu, 2010; Yang et al., 2021), medical devices (e.g. Boccato et al., 2022; Schutte et al., 2022) and treatments (e.g. Liu et al., 2022; Lahiri et al., 2023). These technologies promise improved diagnostic and treatment outcomes, as well as more efficient utilization of resources (Grutters et al., 2019). Recent medical technology innovations have helped improve health outcomes, extend life expectancy and enhance quality of life across a number of conditions (Wamble et al., 2019). Technological advancements are now enhancing existing treatments and also enabling completely new forms of targeted and precision medicine; this, in conjunction with the digitization of healthcare, can profoundly reshape the clinician–patient relationship (Yeganeh, 2019).

Despite these potential benefits, the proliferation of medical technologies has also become a factor in rising healthcare costs, which has added financial strain to health systems that are already overstretched (Mansilla et al., 2022). Consequently, the successful integration of such technologies into healthcare settings becomes more than just a matter of improving care – it is also a governance challenge that requires strategic decision-making regarding allocation of resources, cost-effectiveness and the broader impact of adopting technology within a healthcare system. There is an inherent link between these governance decisions (as well as, perhaps more importantly, how they are materialized in everyday healthcare practice) and the way in which value is understood and prioritized within a healthcare system. Within the field of medical technology, “value” can have various meanings depending on perspective (Zhang et al., 2022). For example, while a policy-maker might frame value in terms of its system-wide impact, a clinician – who is ultimately responsible for the technology's implementation in practice – might give higher priority to more immediate clinical concerns (cf. Glouberman and Mintzberg, 2001). These divergent perspectives regarding value show that this is a contested concept, not a fixed one, that is molded by the interests and priorities of various stakeholders.

Although value in healthcare is multidimensional in nature, it is often framed simply as a measured improvement in health outcomes against the cost of achieving that improvement (e.g. Porter and Teisberg, 2006; Porter, 2010; Owens et al., 2011; Teisberg et al., 2020). The problem with such a perspective is that it fails to fully appreciate the complex way in which value is understood, defined and applied in practice (Zonneveld et al., 2018). It is true that improved health outcomes are central; however, there is a close link between conceptions of value and notions of high-quality care, and these ideas can differ significantly among stakeholders, such as clinicians, managers and patients (Gadolin, 2017). Relatedly, the value of a medical technology is not a fixed entity confined to economic efficiency and patient outcomes; rather, it is influenced by professional judgment, organizational priorities and other contextual factors. It has been recognized that, in order to achieve quality improvements in healthcare, a multidimensional perspective of value is central (Thusini et al., 2024). However, based on extant research, there is a need to further explore how these dimensions influence the evaluation, adoption and integration of medical technology within healthcare systems (e.g. Hofmann, 2005; Sorenson et al., 2013; Miller et al., 2019).

In particular, it is essential to appreciate conceptualizations of value in order to understand barriers to the acceptance and implementation of a medical technology. In this regard, healthcare clinicians, particularly physicians, face numerous barriers, which are often linked to competing values, between stakeholder groups, within professional groups and even at the individual level (van der Zijpp et al., 2018). Consequently, clinicians' assessments of medical technologies have a direct influence on the adoption and utilization of such technologies. If clinicians do not consider a technology to be valuable in relation to their professional role, or if the clinicians lack a holistic understanding of value, the technology may not be utilized to its full potential, despite its availability (Al-Hadban et al., 2017).

Examining the structural and contextual factors that shape clinicians' perceptions of value will provide a better understanding of these challenges. One such challenge is that physicians are frequently organizationally separated from other professional groups, which reinforces their autonomy and restricts the direct influence of healthcare managers on the physicians' work (von Knorring et al., 2010, 2016). This could mean that the physicians' understanding of the value of a medical technology remains relatively unaffected by perspectives outside their own profession, which shapes the ultimate utilization of the technology. Meanwhile, professional values influence clinicians' engagement with new medical technologies because their perceived value is quite often measured against established norms and expectations within the profession (Nieboer et al., 2014). As a result, governance strategies alone are insufficient to drive adoption because clinicians' acceptance of technology is also affected by perceived usefulness, ease of use and trust in the technology, among other factors (AlQudah et al., 2021). In the end, a technology's integration into clinical practice will depend on how clinicians perceive its value.

In these circumstances, the present study explores how clinicians conceptualize the value of medical technologies. Extant research has highlighted the need to understand various stakeholders' perceptions of value in technology adoption. However, less is known about how clinicians construct and negotiate the value of medical technologies within their professional practice. This knowledge gap is especially relevant because it is unclear whether clinicians are changing their attitudes toward technology. While some studies (e.g. Özdemir-Güngör and Camgöz-Akdağ, 2018; Nigatu et al., 2024) have indicated increasing willingness to adopt new innovations, others (e.g. Golz et al., 2022; Lambert et al., 2023) have argued that concerns regarding trust, professional autonomy and usability may hinder such integration. The present study seeks to address this gap by exploring how clinicians conceptualize the value of medical technologies and offers insights into how these perceptions could relate to the adoption and use of the technologies in clinical practice, and the conditions under which medical technologies are integrated into healthcare systems.

The present study was conducted at one of Sweden's largest university hospitals, which integrates a range of advanced medical technologies into clinical practice. To investigate the ways in which clinicians conceptualize the value of medical technologies, data were collected from two distinct clinical settings that involve different medical technologies: thrombectomy and osseointegrated prostheses. Thrombectomy is an advanced endovascular procedure for removing blood clots from arteries in patients who have suffered acute ischemic stroke. This technique has made significant improvements to stroke care, with outcomes that are superior to traditional thrombolysis (Yoo and Andersson, 2017; Munich et al., 2019). Thrombectomy has been shown to decrease disability and enhance long-term recovery, especially when it is performed within a limited therapeutic window (Albers et al., 2018). Osseointegration, which provides an alternative to conventional socket-based prostheses, is a surgical technique in which prosthetic limbs are directly anchored to the skeleton. Osseointegration was pioneered by Per-Ingvar Brånemark (Brånemark et al., 2001) and has been refined for patients for whom traditional prostheses involve discomfort or functional limitations (Overmann and Forsberg, 2020). The technology is especially beneficial for patients with lower limb amputations because the stability, mobility and long-term comfort it provides are superior to conventional methods (Hebert et al., 2017). These two technologies represent contrasting healthcare environments – acute and planned care – which gives more comprehensive insights into value construction in varying clinical contexts.

The qualitative research approach utilized semi-structured interviews (Ruslin et al., 2022) with a wide range of healthcare professionals and other key stakeholders concerned with the adoption, implementation and clinical use of thrombectomy and osseointegrated prostheses. Thirty-two interviews were conducted. The primary focus was on clinicians, such as physicians (neurologists, orthopedic surgeons, neuroradiologists, etc.) and nurses, who directly engage with these technologies in practice; however, the study also included other professionals who contribute to the implementation and integration of these technologies within the healthcare system. The interviews covered the adoption, implementation and perceived impact of thrombectomy and osseointegrated prostheses in order to explore how these professionals assessed the technologies' value. Instead of framing value as a fixed concept, the questions covered clinical comparisons, organizational integration, professional collaboration and patient outcomes, which made it possible to assess how value is constructed in practice through the perspectives of those involved in its application.

For the thrombectomy dataset, 16 interviews were conducted with professionals involved in the clinical implementation and broader system integration of the procedure. Eleven of the interviewees were clinicians with direct experience in thrombectomy: three neurointerventionists, four stroke nurses, one neurologist, one retired neuroradiologist who played a key role in the early development of thrombectomy, one physician training to become a neurointerventionist and one radiology nurse who had been involved in establishing thrombectomy services at the hospital. Interviews were also conducted with three healthcare managers who oversee stroke and neurointervention services, and two prehospital care professionals involved in patient transport and triage, to gain insights into the organizational and system-level factors that influence the adoption and implementation of thrombectomy.

For the osseointegration dataset, 16 interviews were conducted with professionals involved in the clinical implementation and broader development of the technology. Nine of the interviewees were clinicians. These were comprised of two trauma surgeons, two physiotherapists, two retired orthopedic surgeons who were pivotal in the early adoption of osseointegration, one current and one former coordinator for the osseointegration team (both of whom had nursing backgrounds and direct involvement in patient care) and one retired professor in disability research who had extensive experience in the clinical application of osseointegration and was also a trained physician. The dataset also included an orthopedic engineer specializing in prosthetic design, whose work directly impacts clinical decision-making and patient rehabilitation. Further interviews were conducted with one senior manager in orthopedic care, two international patient coordinators and two patients who had undergone osseointegration. A professor of medical engineering and signal processing was also interviewed due to that person's role in advancing and contextualizing the development of the technology. Given its longer trajectory of development and broader application, osseointegration has engaged a wider range of stakeholders over time than thrombectomy.

The study's primary focus was clinicians' perceptions of value; however, including other key stakeholders allowed for a richer contextual understanding of how these medical technologies have been integrated into clinical practice. The interviews with these stakeholders provided insights into the operational and structural conditions that shape clinicians' assessments of medical technologies, which gave us a broader perspective on the factors influencing their adoption and use. In addition, this input helped inform the interviews with clinicians by providing contextual knowledge that enabled more targeted follow-up questions and supported the interpretation of clinicians' accounts in relation to the broader organizational and technical settings, consistent with methodological insights that key informants, though not part of the focal participants, may provide crucial insider perspectives and contextual understanding that enrich interpretation and analysis (Lanfer et al., 2024). Because we had a limited number of participants from each professional category and needed to safeguard participants' confidentiality within a relatively identifiable research context, the illustrative quotes in the findings section do not specify the interviewees' professional backgrounds (for example, nurse or physician). The analytical focus of this study was explicitly at the aggregated level of clinicians as a professional group, rather than on examining differences between individual professional roles. This approach helps maintain participants' integrity and aligns analytically with the study's aim of understanding clinicians' conceptualizations of value more broadly.

Thematic analysis was used to analyze the data, following an iterative coding process (Terry et al., 2017). Transcript excerpts were initially grouped separately for each technology in order to identify emerging patterns related to clinicians' conceptualizations of value, both in terms of who the value is created for (perspective) and what this value consists of (benefits). These two dimensions are essential for understanding value beyond mere cost-effectiveness or measurable outcomes (cf. Landon et al., 2021). Coding of the data was conducted by the first author (CG), who also carried out the data collection. To enhance analytic rigor through investigator triangulation (Archibald, 2016), co-authors read interview transcripts and regular discussions among the authors supported reflexivity by questioning interpretations and promoting consistency in the analysis.

Once these initial groupings had been established, they were compared across the two settings. The analysis revealed that clinicians in both settings shared similar perspectives regarding the beneficiaries of the value. However, the specific medical technologies influenced not only what this value entailed but also which stakeholder perspectives became particularly salient. Thus, combining the datasets underscored both commonalities and technology-specific nuances in clinicians' conceptualizations of value, providing the foundation for the subsequent thematic categorization. At this stage, it also became clear that the dataset was analytically saturated, as no new stakeholder perspectives or dimensions of value emerged during the later stages of analysis.

The insights were then consolidated into four overarching thematic categories that were in line with identified stakeholder perspectives: value for society, value for the hospital organization, value for clinicians and value for patients. The specific benefits associated with each perspective were delineated within each category in order to identify the shared conceptualizations across clinical contexts and also the differences created by the specific medical technologies under study. These themes were systematically reviewed against the original data to make sure they were coherent and accurate. The final thematic structure encapsulates the similarities and the context-specific variations identified in the clinicians' conceptualizations of medical technology value. This structure is presented in the findings section.

Clinicians conceptualized the value for society through two distinct but interrelated benefits: economic savings and improved population health outcomes.

For thrombectomy, clinicians strongly emphasized both of these dimensions. Economic value was consistently highlighted, particularly in terms of societal cost savings associated with reduced dependency on healthcare services and increased workforce participation. As one clinician noted, “Thrombectomy is very economically beneficial for society – we save money – but it is very expensive for the hospital.” Another clinician reinforced this perspective, stating, “Every thrombectomy saves society several hundred thousand [SEK].” These economic considerations were explicitly connected to patients' ability to return to employment or, in the case of elderly or chronically ill patients, reduced dependence on long-term care services. Clinicians also highlighted significant societal health benefits, framing successful thrombectomy outcomes as profoundly impactful for the patient collective and for public health more broadly, emphasizing that “If these patients weren't treated, they would remain on sick leave for the rest of their lives” and that “At the group level, the health effects are incredibly clear.”

Clinicians, by contrast, were more inclined to discuss the societal value of osseointegrated prostheses, primarily through patients' enhanced quality of life and productivity. One clinician highlighted the broader societal contribution that osseointegration enabled, noting the active lifestyle and occupational participation common within this patient group, including achievements in sporting competitions, such as the Paralympics. However, economic considerations were also mentioned. For instance, another clinician remarked on the economic implications of this relatively small patient group: “From a health economics perspective, 200 patients may not sound like a lot. But if it's 200 people who can live a life with high quality, remain active and productive, it has significant societal implications.”

Hence, while clinicians associated both economic and health-related benefits with each technology, thrombectomy was distinctly linked to explicit discussions of economic benefits, whereas clinicians discussing osseointegration tended to focus more on patients' activity, life quality and indirect economic implications. Thus, societal value encompassed both economic and public health dimensions, but their relative emphasis varied depending on the medical technology in question.

Clinicians conceptualized organizational value through two distinct overarching benefits: prestige and economic benefits.

In the context of thrombectomy, clinicians frequently emphasized the value of prestige and the associated pride among hospital management. This was expressed explicitly by clinicians describing thrombectomy as a “flagship service,” “flashy,” “sexy” and “something people can brag about.” As one clinician elaborated, “We are at the forefront on all measurable parts. Our hospital is very proud of this. They often highlight our work because it supports their goal to be the best.” Such comments reveal how clinicians recognized prestige and hospital status as central organizational values.

Clinicians engaged with osseointegrated prostheses did not recognize prestige as an organizational value. Instead, they described the organizational value of osseointegrated prostheses in explicitly economic terms, emphasizing the financial benefits derived from attracting patients from other regions and countries. Clinicians described this economic advantage clearly, as illustrated by statements such as, “This operation is very lucrative for the hospital. Patients coming here from other regions specifically for this care bring significant revenue.” Similarly, another clinician emphasized the economic interest from hospital management: “When patients from other countries started coming, especially from Norway, the hospital viewed it positively because it brought revenue.”

Hence, clinicians engaged with the different technologies both acknowledged an organizational value, but it took distinctly different expressions, prestige or economic benefits depending on the specific medical technology.

Clinicians articulated a multifaceted conceptualization of value derived from working with thrombectomy and osseointegrated prostheses, encompassing three benefits: career development, multiprofessional collaboration and patient feedback.

Clinicians identified career development as a central benefit, highlighting opportunities for research, international networking and specialization. For clinicians involved in osseointegrated prostheses, these opportunities were particularly pronounced during early phases of technology implementation, which provided significant avenues for career advancement and international exposure. One clinician described these opportunities as follows: “It was fantastic being involved from the start. The early years offered significant possibilities for research and innovation, allowing many of us to achieve prominent positions within our respective fields.” Others emphasized the extensive international collaborations facilitated by early-stage involvement, noting, for example, that “It has enabled me to travel and build new collaborations” and “I have been to so many international conferences.” In the thrombectomy context, ongoing career development was supported primarily through structured registries and systematic follow-ups, which sustained research activities over time. As one clinician explained, “We have a national registry in Sweden, capturing every treatment performed over the past 10 years. It allows us to continuously extract data and publish research.”

Multiprofessional collaboration represented another significant benefit, characterized by effective teamwork and integration of diverse professional perspectives. In thrombectomy settings, interdisciplinary interactions notably enhanced teamwork, as one clinician expressed: “Sometimes we stand and wait a bit for the patient to arrive from the ambulance. In these moments, even small talk significantly improves our collaboration. We have developed a fantastic teamwork environment where we truly benefit from each other's competencies.” In a similar manner, clinicians who were involved with osseointegrated prostheses underlined the importance of teamwork and reliance on multidisciplinary expertise for successful patient outcomes. One clinician said, “We have come to depend on each other's competencies for patient outcomes.”

The third benefit, patient feedback, reflected the fact that individual professional fulfillment was directly derived from interactions with patients and observable clinical outcomes. Clinicians often highlighted the immediate rewards that were obtained through patient interactions, as illustrated by the following reflection from a thrombectomy clinician: “It's incredibly rewarding when someone arrives half-paralyzed and unable to speak, and after we extract the clot, they're able to talk again and express their gratitude before leaving. It's something that sustains us professionally, especially when things are challenging.” Similarly, clinicians involved with osseointegrated prostheses stressed ongoing fulfillment from building lasting patient relationships: “It's very rewarding seeing how satisfied patients become over time.”

Thus, all three identified benefits – career development, multiprofessional collaboration and patient feedback – were present across both medical technologies, albeit with notable differences. Career development opportunities linked to technological specialization and multiprofessional collaboration were similarly emphasized in both contexts. However, clinicians involved with osseointegrated prostheses particularly highlighted career advancement and international exposure during early phases of technology implementation. Additionally, patient feedback differed distinctly between technologies: clinicians involved in thrombectomy described patient feedback as immediate and directly rewarding, whereas clinicians working with osseointegrated prostheses experienced patient-related fulfillment gradually over time.

Clinicians conceptualized patient value through three benefits: functional recovery and independence, quality of life and normalcy and patient agency in care decisions.

Functional recovery and independence was a primary aspect clinicians associated with patient value, particularly in the case of thrombectomy, where the speed and clinical impact of recovery were striking. Clinicians described how thrombectomy could rapidly reverse severe impairments, restoring patients' independence within hours. As one clinician noted, “Patients come in half-paralyzed and unable to speak, and after we extract the clot, they're suddenly talking and wondering what just happened. It's an astonishing transformation.” Another clinician framed this recovery in terms of the broader shift in stroke care: “We've gone from being passive to actually being able to act and make an enormous difference. A patient who would have been bedridden and completely dependent for the rest of their life can now walk out of the hospital.” With regard to osseointegrated prostheses, functional recovery was discussed mainly in terms of improved mobility, autonomy and reduced physical limitations compared to traditional socket prostheses. One clinician stated, “It was an enormous functional leap for these patients. Before, they struggled with socket prostheses, but now they just click their leg on and go – it's a completely different way of living.”

Clinicians also identified quality of life and normalcy as vital aspects of patient value, emphasizing the role of thrombectomy and osseointegrated prostheses in helping patients regain their identities, routines and sense of normal life. With regard to thrombectomy, clinicians highlighted the importance of rapidly preserving patients' pre-stroke identities and enabling them to return to their previous social roles and interests in a timely manner. One clinician stated, “I've seen patients come in critically ill and, 15 min later, talk about their upcoming dance competition – it's difficult to overstate how much this [technology] changes their lives.” In reference to osseointegrated prostheses, clinicians emphasized the long-term quality-of-life improvements whereby patients could comfortably engage in everyday activities that had previously been restricted by conventional prosthetics. As one clinician described, “These are people who could have spent their lives without a leg. If they can now get a prosthesis that actually works, that's a massive difference in quality of life.” Thus, clinicians framed quality of life primarily in terms of subjective experiences and emotional benefits linked to patients' everyday social lives and sense of normalcy.

A third benefit that clinicians of osseointegrated prostheses highlighted was patient agency, including extended involvement in the care process. Clinicians emphasized that patients' active engagement was central, particularly because patients themselves were enthusiastic and motivated. One clinician expressed: “The enthusiasm of patients has been crucial. This kind of technology wouldn't work if there wasn't such a strong response from them.” Furthermore, the inherently prolonged, and often lifelong, nature of the treatment follow-ups created unique opportunities for deeper patient participation and influence, allowing patients to become increasingly involved in their own care and even, in exceptional cases, contribute directly to technological innovation. One clinician said, “One of our patients, who was an engineer, actually helped develop a key prosthetic component.” Although such direct contributions were uncommon, clinicians described patients' sustained involvement and active participation as important drivers behind the continued evolution of the technology.

Overall, clinicians conceptualized patient value through functional recovery and independence, quality of life and normalcy, and patient agency in care decisions, albeit with notable differences between technologies. Whereas clinicians primarily associated thrombectomy with immediate restoration of function, independence and normalcy, those working with osseointegrated prostheses emphasized long-term autonomy and quality-of-life improvements, and uniquely highlighted extended patient agency driven by ongoing treatment engagement.

The findings indicate that clinicians' conceptualizations of the value of medical technologies are holistic and incorporate a number of perspectives. However, these perspectives vary regarding the concrete benefits that the clinicians felt constituted value. At the societal level, value was often articulated in economic terms, particularly for thrombectomy, where clinicians emphasized financial benefits for society derived from reduced dependency on healthcare services and increased workforce participation. Clinicians working with osseointegrated prostheses did not frame the technology's societal value quite so explicitly in economic terms, although they did refer to improved population health outcomes. At the organizational level, clinicians' conceptualizations of value were straightforward. For thrombectomy, clinicians emphasized benefits for the hospital in terms of prestige and the competitive advantage of being seen as a leading institution. For osseointegrated prostheses, organizational value was expressed in monetary terms, particularly regarding revenue from patients outside the region. The value of medical technologies for clinicians themselves was the most explicitly and multifacetedly articulated perspective. Clinicians underlined the individual professional benefits related to career development and patient feedback, as well as the prospect of collaborating across professional boundaries by taking advantage of a range of competencies. Furthermore, the patient perspective was clearly visible, as it encompassed benefits related to functional recovery and quality of life and patient agency, in the case of osseointegrated prostheses.

Clinicians engaged with these different perspectives on value in distinct ways, particularly in terms of how they positioned economic considerations relative to societal, professional and patient-centered values. Organizational value, especially in financial terms, was consistently positioned as external to clinicians' professional considerations. This was evident among thrombectomy clinicians, who described the procedure as “very expensive for the hospital,” thereby framing economic burden as the hospital's concern. Similarly, clinicians working with osseointegration described economic benefits as matters of hospital revenue – noting, for instance, that “this operation is very lucrative for the hospital” – and conceptualized such considerations as managerial rather than of clinical concern. This distancing from the hospital's economic considerations was further reflected in clinicians' language. When discussing value for society, clinicians or patients, the interviewees used broader and more inclusive terms, such as “we save money”. In contrast, organizational value was framed in more detached terms, clearly delineating the perspective. Such distancing aligns with established patterns in healthcare, where professional autonomy and clinical priorities are often positioned in opposition to economic rationales (Gadolin, 2017).

On the whole, it appeared as though the clinicians primarily oriented themselves toward professional and patient-related value perspectives. This reflects the complex nature of these domains compared to the more narrowly defined societal and organizational perspectives. However, clinicians also considered organizational and societal value, which implies a potential broadening of how they understand medical technologies and their wider implications. This is particularly relevant for governance and policy, as it may reflect evolving professional orientations in response to structural transformations in healthcare (cf. Numerato et al., 2012; Croft et al., 2015; Cornett et al., 2023). By illustrating how clinicians differentiate between societal, organizational, professional, patient-centered perspectives on value, the present study contributes not only to understanding how clinicians conceptualize value in relation to medical technologies but also to how these conceptualizations help shape implicit value hierarchies in clinical practice.

The findings further show that while the same overarching value perspectives were present in both cases, the concrete benefits associated with each perspective took distinct forms shaped by the specific nature of the technologies. The contrasting contexts of the two technologies – acute care vs planned care – clearly influenced how clinicians understood and articulated value. This finding supports, but also extends, previous research suggesting that value is shaped not only by the perspective from which it is considered (cf. Zhang et al., 2022) but also by the contextual conditions in which a technology is embedded. Additionally, the study reveals a temporal dimension in how clinicians conceptualize value, in this case in relation to professional benefits. In the early phases of osseointegrated prostheses, clinicians emphasized career development and networking opportunities. In later stages, value was more strongly associated with patient feedback and multiprofessional collaboration. While this finding aligns with existing literature on technology life cycles, which examines how innovations evolve from emerging technologies to established practices, the present study adds a novel perspective by showing that such transitions not only concern technological maturity (Smith et al., 2013), its evaluation (Kirwin et al., 2022), or that clinicians' perceived value of a technology may increase with accumulated experience of use (Butz et al., 2022). This study therefore contributes a further dimension by demonstrating that it is not only perceptions of value that may shift with time but also the underlying benefits from which value is derived.

These findings point to several tensions in how medical technologies are assessed, integrated and utilized, and these tensions are directly relevant for health governance. A key concern is that when clinicians externalize the organizational value of medical technologies, particularly in economic terms, this may contribute to misalignment in decision-making. If financial sustainability becomes the dominant frame in governance, while clinicians remain oriented toward professional and patient-centered values, this disconnect could generate resistance and undermine long-term integration. At the same time, greater attention to what clinicians truly prioritize in medical technologies could support hospitals in making more informed choices about which technologies to adopt and integrate into practice. As Groenewoud et al. (2019) suggested, a more pluralistic, values-based approach may be needed to balance economic imperatives with professional judgment and patient needs. Achieving such a pluralistic approach requires training for both clinicians and healthcare managers to raise awareness of the multiple value dimensions at play.

Perceived prestige can also influence adoption, but if it outweighs evidence-based considerations, there is a risk that managerial decisions prioritize status over effectiveness. Addressing these tensions requires governance approaches that balance professional judgment with transparent evaluation criteria. Previous research has underscored the need for governance models that not only balance managerial oversight with professional autonomy (Eeckloo et al., 2004) but also incorporate participatory mechanisms to enhance system responsiveness (Barbazza et al., 2015). Furthermore, medical leadership has been found to play a key role in navigating tensions between professional and managerial logics, ensuring that governance structures remain adaptive to both clinical priorities and institutional constraints (Jones and Fulop, 2021). The findings of the present study reinforce these insights but also point to a further requirement: governance models should include structures that allow for phased evaluations, ensuring that assessments of value remain responsive to shifts in clinical engagement and technological maturity. This finding also aligns with previous research that highlights the importance of fostering continuous learning between managers and clinicians (Poddar, 2013).

Finally, given the increasing positioning of medical technologies as solutions to both resource constraints and rising healthcare demands (Grutters et al., 2019), the present study's findings are relevant beyond the specific cases examined. Future studies should examine whether emerging innovations, such as remote monitoring, AI-based diagnostics and precision medicine, reveal similar patterns of clinical hierarchies of value and comparable tendency to externalize organizational value. As part of the evolution of the healthcare ecosystem, governance structures must continue to adapt to clinicians' divergent conceptualizations of value – which may be shifting and sometimes conflicting – in order to support the integration and long-term sustainability of new medical technologies.

This research was reviewed and approved by the Swedish Ethical Review Authority [2023-01646-01].