Building the bridge as you cross it – a process evaluation of the implementation of a clinically integrated living lab in Swedish public primary care

BACKGROUND: Ongoing digital transformation is pressuring primary care to adopt new technologies, underscoring the need for clinic-based innovation arenas such as living labs and employee-driven innovation. OBJECTIVE: To evaluate the implementation process of a clinically integrated living lab at a Swedish primary care centre, where employee-driven innovation is utilised to meet healthcare needs. STUDY DESIGN: We conducted a process evaluation of the implementation of a clinically integrated living lab guided by the Medical Research Council guidelines, focusing on context, implementation, impact mechanisms and their interrelations. PARTICIPANTS: Healthcare professionals; primary care managers; executive managers in innovation, research and development; and staff in innovation-supporting roles. DATA COLLECTION AND ANALYSIS: Qualitative data were collected over several years, including focus group interviews, dyadic interviews and various documents. All data were analysed using systematic text condensation. RESULTS: Key findings indicate that the living lab's clinical embeddedness, combined with strategic leadership, facilitated implementation by enabling adaptability, organisational integration and employee engagement. However, it also introduced vulnerability to internal and external influences. Main barriers to implementation included a lack of long-term financial sustainability and challenges navigating complex regulations governing public-private innovation collaborations. CONCLUSIONS: The living lab emerged as a bottom-up initiative deeply rooted in everyday healthcare practice and continuously adapting and evolving in response to its environment, embodying the metaphor of 'building the bridge as you cross it'. The findings can inform decision-makers in building sustainable, clinically embedded innovation structures in primary care and support leaders in fostering sustained employee engagement in innovation.