From disrupted routines to sustainable practice: integrating management sciences to navigate the innovation journey of precision imaging.
Authors
Affiliations (3)
Affiliations (3)
- Scintidoc, Montpellier, France.
- Département Interdisciplinaire de Sciences Sociales (DI2S) d'IMT Atlantique, Laboratoire D'économie et de Management de Nantes Atlantique (LEMNA), Nantes, France.
- Institut Interdisciplinaire de l'innovation (i3 CNRS), Telecom Paris, Institut Polytechnique de Paris, Palaiseau, France.
Abstract
Precision medicine is reshaping medical imaging through artificial intelligence, quantitative biomarkers or hybrid modalities such as PET-CT. Yet these tools reach patients unevenly, and that unevenness is usually blamed on technical problems: interoperability, validation, trust. Drawing on management science and the sociology of professions, we propose a different explanation. What decides whether an innovation reaches patients equitably is not the technology, but the way it travels. We distinguish three ways of travelling. Diffusion is spontaneous spread through professional networks (letting it happen). Dissemination is spread deliberately directed towards a defined population (helping it happen). Implementation is the work of turning an adopted innovation into everyday routine (making it happen). Imaging innovations have travelled mainly by diffusion, which follows existing specialist density, funding rules and like-with-like professional networks; diffusion therefore reproduces the inequalities of access it inherits instead of correcting them. Three consequences follow. First, adoption hides three separate decisions taken by different people: acquiring the equipment, deciding what the examination actually contains, and deciding whether it is requested at all. Routine statistics count the first and the third; the second is never measured. Second, professional boundaries are held in place at once by regulation, by specialty jurisdiction and by everyday working relationships, so reforms acting on only one of them fail. Third, the medical report is where those boundaries meet: when it does not carry an integrated answer, the innovation stalls. A fourth point runs through all three: an innovation's value is not fixed before it travels; its construction is predicated on the expectations that precede it, and the practices through which it is utilised. Using a three-study programme on PET-CT in France as illustration, we argue that equitable and sustainable precision imaging is achieved not by buying equipment but by governing how innovations spread-including by actively retiring the low-value practices they were meant to replace, what management science calls exnovation.