Innovation can be defined as invention + adoption + diffusion. In healthcare, it may be a novel idea, product, service or care pathway that has clear benefits when compared to what is currently done. Successful innovations often possess two key qualities: they are both usable and desirable. How can proven innovations be quickly and effectively adopted as best practice and taken up across the whole healthcare system? How can the commercial success of our ideas be realised at home rather than abroad, as has too often been the case? This review explores important issues of funding, information governance, interoperability, medical device regulation, procurement, clinical prototyping and the systemic challenge of encouraging and scaling innovation.