Healthcare is not short of people who can see what is not working. A nurse notices a recurring delay. A pharmacist identifies a medication-safety risk. A physiotherapist sees a gap in follow-up. A researcher frames a question that could improve care.
The difficulty often begins with the next question: where should that insight go?
Digital health investment usually focuses on systems that deliver or support care: electronic health records, patient portals, remote monitoring, clinical decision support and artificial intelligence. These investments matter. But health services invest far less in the infrastructure that helps innovation itself move from a frontline observation to governed, evaluated and reusable work.
Published in June, the HSE Framework for Health Innovation provides a timely and constructive reference point. Its emphasis on shared support infrastructure, an innovation repository and a structured lifecycle shows how organisations can connect an initial idea with evaluation, adoption and scale. These building blocks offer useful lessons for health systems internationally.
The missing middle
Most healthcare organisations already have mechanisms at either end of the innovation journey. At the beginning there may be suggestion channels, improvement meetings, competitions or hackathons. At the other end sit research governance, ethics review, information technology, quality and safety, data protection, procurement and operational leadership.
What is often missing is an accessible route connecting the two.
Without that middle layer, staff may not know whether somebody is already working on the same problem. Similar teams can duplicate effort. Progress may depend on knowing the right person rather than following a visible process. A project can lose momentum when its original champion changes role. Even a successful pilot may reach the end of its funding or evaluation period without a defined route into routine practice.
These failures are sometimes described as resistance to innovation. Often, they are failures of pathway design.
What a small clinical research hub taught me
My own lesson came from building a lightweight internal digital hub to support clinical research participation in a hospital environment. The immediate aim was modest: make research opportunities visible, allow staff to filter them by clinical area, save topics relevant to their interests and see where ownership or participation already existed.
The hub did not conduct research, select institutional priorities or replace scientific and ethical review. Its role came earlier: to make the path from curiosity to participation easier to see.
That experience reinforced an important distinction. A digital platform can display projects, but a project list is not yet innovation infrastructure. Without named owners, common status definitions, clear routes for support and an expected next step, it risks becoming a digital noticeboard. The technology is useful only when it makes an organisational process more legible.
What infrastructure must do
Effective innovation infrastructure should provide five connected capabilities.
Make work discoverable. Staff need a shared view of identified problems, proposed initiatives, active projects and completed work. That view should show ownership, current stage, intended value and relevant clinical area, without exposing information that should remain restricted.
Route ideas correctly. Not every frontline idea is a research study. Some are quality-improvement projects, operational changes, clinical-governance matters or digital-development requests. Early triage should direct each idea to the right pathway, evidence standard and decision-makers.
Provide proportionate support. Innovators need access to practical guidance, standard templates and timely input from clinical safety, research, IT, cybersecurity, data protection, finance and procurement. A small local improvement should not face the same burden as a high-risk system-wide technology, but neither should risk be discovered only after development has finished.
Create transparent decisions. A structured lifecycle should contain clear points to proceed, revise, pause, combine with existing work or stop. The purpose is not to approve every idea. It is to make decisions timely, consistent and understandable.
Preserve learning. Completed, paused and unsuccessful projects all generate useful knowledge. Recording decisions, evidence, reusable components and reasons for stopping prevents the next team from starting again with no organisational memory.
Clinician-led does not mean clinician-only
Clinicians are close to workflow, patient risk and the practical consequences of poor system design. That makes their leadership essential when defining the problem and judging clinical value. It does not mean they should be expected to deliver innovation alone.
A clinician may understand the care pathway but not software architecture, cybersecurity, regulatory classification, procurement or change management. A technically excellent team, meanwhile, can build a system that fails because it does not fit clinical work. Clinician-led innovation succeeds when frontline insight is paired early with digital, operational, research, safety and governance expertise.
Leadership therefore has a different task from simply inviting more ideas. It must create a predictable route, assign responsibility, provide protected time and ensure that specialist support is available before avoidable problems become expensive ones.
From repository to organisational capability
The HSE Framework for Health Innovation offers a practical example of how these principles can be translated into day-to-day organisational capability. Its repository, structured lifecycle and proportionate governance are complementary building blocks whose greatest value comes from operating as part of one connected pathway.
When routing and decision points are connected to a repository, it becomes more than a catalogue. Practical support makes governance easier to navigate, while an adoption pathway helps promising pilots progress towards normal practice. In that model, the repository becomes the front door and organisational memory of the pathway, not simply its final destination.
Health systems should also measure more than the number of ideas submitted or pilots launched. Useful indicators include time to initial triage, the proportion of proposals connected to existing work, time spent at each stage, reuse of prior learning, documented reasons for stopping and sustained adoption after evaluation.
Not every idea should scale. A mature innovation system is equally capable of stopping a weak or unsuitable proposal early, explaining why and retaining what was learned.
The goal is not to turn clinical creativity into bureaucracy. It is to stop requiring individual clinicians to carry an entire innovation pathway through personal persistence.
When the infrastructure works, staff know where to take a problem, leaders can see the wider portfolio, relevant experts join at the right time, decisions are traceable and learning survives beyond a single project or person. Clinician-led digital innovation becomes scalable when the right idea can be seen, challenged, supported, evaluated and either carried forward or stopped with its learning preserved.
That is the difference between an organisation that hosts isolated projects and one that has learned how to innovate.
Viewpoint articles are the author’s opinion, produced without payment or sponsorship.
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