Table A1

Cross-cutting trigger-tension analysis

TriggerTension activatedEmpirical manifestationIllustrative evidenceSection
Regulatory reform (MDR/IVDR implementation)Protection and safety ↔ Innovation and access (primary)Expanded documentation, stricter audit regimes and procedural accountability redirected attention towards compliance and defensibility, narrowing perceived space for innovation within NB work“The auditing role focuses on compliance, not fostering innovation. Even though that is why I took this job in the first place, to bring innovation to market” (n2)4.5
Exploration ↔ Exploitation (secondary)Expanded regulatory scope increased procedural rigidity, reducing capacity for exploratory learning within established assessment routinesInformal AI experimentation occurred alongside formal prohibition, indicating constrained exploration under expanded compliance requirements4.5, 4.6
Autonomy ↔ Control (secondary)New procedural layers introduced by regulatory reform added approval requirements that reduced scope for discretionary professional judgementWithdrawal of accreditation and loss of employment described as persistent threats reinforcing compliance orientation over professional discretion4.5, 4.9
Workload and resource pressureExploration ↔ Exploitation (primary)Increased assessment volumes and complexity under constrained staffing narrowed space for exploratory learning and experimentation with new technologies“We should use AI, but that would mean getting everyone on board, and it’s just too much … We don’t have time for that right now” (n10)4.6
Efficiency ↔ Quality (secondary)Rising volumes intensified pressure to maintain throughput, exposing gaps between formally defined quality standards and the conditions required to sustain them“We are putting the buckets out for the leaky roof without fixing the hole” (n17)4.6, 4.8
Autonomy ↔ Control (secondary)Time scarcity reduced opportunities for discretionary judgement, as professionals defaulted to standardised routines under pressureCapacity constraints described as forcing reliance on existing SOPs, even when professional judgement suggested alternative approaches4.6, 4.9
Heightened institutional scrutinyCollaboration ↔ Isolation (primary)Intensified oversight from designating authorities reframed collaboration with manufacturers as a professional risk rather than a procedural norm“We’re not allowed to speak to our clients. As a former R&D engineer, this is frustrating because I know I could help” (n1)4.7
Efficiency ↔ Quality (secondary)Heightened defensibility demands increased justification work, adding to documentation burden without corresponding efficiency gainsCautious language and partial disclosures observed at industry events reflected scrutiny-induced constraints on open professional exchange4.7, 4.8
Autonomy ↔ Control (secondary)External oversight intensified internal formalisation, as organisations sought to demonstrate compliance through expanded approval layersScrutiny from designating authorities described as reinforcing internal control mechanisms that further constrained professional discretion4.7, 4.9
Procedural and organisational demandsEfficiency ↔ Quality (primary)Increasing documentation and reporting obligations transformed previously compatible goals into a persistent source of moral strain“There’s a constant moral dilemma in balancing quality with deadlines” (n9)4.8
Autonomy ↔ Control (primary)Expanded approval layers and performance monitoring reduced professional discretion, transforming autonomy from taken-for-granted to an explicit object of concern“We used to rely on professional judgement; now every deviation needs formal approval” (n4)4.9
Protection ↔ Innovation (secondary)Compliance-oriented procedural demands reinforced safety and traceability logics, further narrowing perceived space for innovationProcedural definitions of quality constrained AI use even when recognised as a potential means of improving consistency4.8, 4.5

Note(s): This table maps each trigger to the paradoxical tensions it activates, distinguishing primary from secondary activation, and provides empirical manifestations, illustrative evidence and corresponding findings sections. This complements Table 2 (which documents how tensions are embedded in legal texts) by showing how and where they become salient in regulatory practice

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