Health care organizations wishing to harness innovation to improve performance or address critical problems face a series of important decisions. The first decision involves selecting specific areas of performance where improvement is needed. Identifying target areas for improvement, in turn, requires simultaneous consideration of three factors.
Factor #1: Organizational Priorities
Identifying the organization's key strategic goals and mission-critical activities represents the first step in selecting priorities for innovation. Innovation is likely to prove most useful if it addresses one of the following:
Identifying organizational priorities is often straightforward, particularly in organizations with well-established strategic planning processes. Even if not specified in a recent strategic plan or other document, the organization's core, mission-critical areas that need improvement are typically well-known to organizational leaders and key stakeholders, although consensus regarding their relative importance may be low. Formal procedures for identifying and ranking areas for improvement can be helpful in facilitating consensus regarding priorities. 
Factor #2: Likely Impact of Innovative Solutions
A second consideration in selecting areas for innovation requires assessment of available innovations and their likely impacts. Although organizations with a successful track record of innovation can be bolder in their future initiatives, organizations lacking experience should select target areas and innovations to minimize risk and cost and maximize the likelihood of rapid success. Risk and uncertainty are lower for innovations that:
- Have been in existence for longer periods of time,
- Have been implemented and evaluated in multiple organizations under a range of conditions,
- Have high-quality evaluation data on costs and benefits available, and
- Have undergone small scale testing to determine their feasibility and potential for success.
Because innovation is disruptive and success depends on the commitment and support of key internal and external stakeholders, early innovation attempts should clearly demonstrate the value and benefits of innovation's costs and disruption. Adoption costs arise from planning and preparation for initial implementation (i.e. staff training, purchasing new equipment or supplies, changes to physical space), ongoing monitoring and refinement of the innovative practices, and effort required to stabilize, institutionalize, and sustain the innovation.
Successful innovation and stakeholder support can become a self-reinforcing cycle when early results are positive; in contrast, a negative, damaging cycle is likely to result from early failures. High-risk, high-cost innovations that trigger predictions of failure by key stakeholders may fail in practice if lack of confidence prevents stakeholder commitment and support.
The strong interdependency between expectations and success suggests that organizations in the early phases of a planned series of innovations should start with low-cost, low-risk, "sure thing" innovations—even if the potential benefits are modest—to help demonstrate the value of innovative activity, develop experience and a culture of innovation, and build support and appreciation for its value and benefits.
Factor #3: Capacity to Innovate
A third factor affecting the selection of priorities for innovation is the organization's capacity. To fully implement an innovation and its benefits, an organization should possess the requisite capital, technology, staffing, skills, experience and culture. The greater the degree of mismatch between the innovation’s requirements and current organizational characteristics (and the organization’s ability to develop required attributes), the higher the likelihood of implementation failure.
Innovation is time- and resource-intensive and requires focused leadership attention for an extended period of time. Limiting the number of innovations in progress at any given time will ensure adequate attention to each.
When determining how many innovation initiatives can be underway simultaneously, keep in mind that implementation and the need for leadership involvement do not end when the innovative practice has been introduced and key activities (such as staff training and the introduction of new organizational policies) are completed. An extended period of monitoring, refinement, and support is needed to permit the organization to fully adjust to the new practices and vice versa.
This adjustment includes refinement of operational details of the innovation, as staff progress up the "learning curve" and develop new ways of working to accommodate the innovation, and as key external stakeholders, such as customers and others, become accustomed to the changes.
Leadership involvement is required throughout this process, which may require several months or longer.
Extensive documentation of innovation use and impacts is critical to guide future adopters and reduce uncertainty and errors in implementation. Documentation is especially important for innovations that are:
- Complex and difficult to understand or replicate,
- Sensitive to fine details of implementation and context, and
- Diverse and variable in their implementation with significant variations in their effectiveness across different settings and situations.
Balancing the Three Factors
Although the three sets of decision considerations presented above may appear to be sequential, they must be considered in parallel. For example, if the available innovations targeting the organization's greatest priorities are too complex or costly for a newly-innovative organization to adopt, it may prefer to adopt simpler, more certain innovations addressing secondary priorities. Similarly, the number of innovations an organization can adopt simultaneously depends on their complexity and target area. A large organization, even if not highly experienced in innovation adoption, might pursue multiple innovations if each is simple and low-risk and involves a very different part of the organization.
 Rubenstein LV, Fink A, Yano EM, et al. Increasing the impact of quality improvement on health: an expert panel method for setting institutional priorities. Jt Comm J Qual Improv. 1995 Aug;21(8):420-32. [PubMed]