Health systems lack a model for operationalizing and scaling innovations, which must be built on a foundation capable of embracing meaningful changes, whether incremental or dramatic.

Health systems are, on balance, very bureaucratic and have fixed structures which are not open to innovation. In fact, innovation is seen to be disruptive and therefore resistance is present.

But to overcome the gaps in the system which have become more apparent in COVID 19, there has to be an acceptance of innovation in clinical management and system wide management.

Four critical elements support development and deployment of innovation in a health system:

(1) workforce capacity to actualize innovation;

(2) an organizational infrastructure that supports integrated, systematic, repeatable pathways for change;

(3) an innovation-nurturing culture; and

(4) strategic external partnerships and collaborations. 

It will be interesting to see if there is motivation over time to innovate by health system designers and health policy analysts.

Raymond Rupert patient advocate and healthcare consultant.


  • Ryan J. Vega, MD, MSHA & 
  • Kenneth W. Kizer, MD, MPH

Vol. 1 No. 6 | November — December 2020
NEJM Catalyst Innovations in Care Delivery 2020; 06DOI: