Table 2.

Thematic analysis of challenges identified along with corresponding enabling conditions.

Quadruple Aim Domain *	Challenge/Theme Identified	Key Informant Quote	Potential Solution/Condition(s) to Help Address
Work life of care providers	Care interruptions and wait times	“It is a challenge to connect different streams of planning. A nimble lab service is highly dependent on integrated lab systems and capital planning. Workforce planning and education is also critical”   “There is a need to triage the urgency based on the test application and clarity about the prerequisite level of evidence to apply”	• Resource planning • Financing approach • Education and training • Informatics • Evaluative function • Entry/exit point for innovation
Patient and caregiver experiences	Inappropriate identification of patients and family members	“There is a need for standards around governance, security and patient consent, what we can use the data for etc. Rule around commercial interests in data need to be in place [as well as] some consideration of investing in the laboratory function independently of therapeutic application”	• Service models • Awareness and care navigation
	Inequitable care delivery	“Legislation plays an important role as well. The Acts give different provinces different levels of influence over care coordination”	• Regulation
Health of populations	Uncoordinated, inconsistent, inappropriate or duplicative care	“There is a need to have clear understanding of what the care pathway is and an aligned community of practice”	• Integration of innovation and healthcare delivery • Creating communities of practice and healthcare system networks
Per capita costs of healthcare	Inefficient, low-value care	“So then we invest in standards, outcome measures, quality measures etc. along with a process. You can’t be too prescriptive because of the wide utility of testing”   “Information is also valuable and must be valued. Currently information is generated for medico-legal purposes and yet it could be generated to generate revenue and lower care costs”	• Integration of innovation and healthcare delivery

* Challenges and themes span across some quadruple aim domains, so rows are deliberately misaligned.