Innovation is often celebrated as the key to solving pressing societal challenges. Yet in the health and care sector, in whitch I work as Chief Business Development Officer for a private company within social entrepreneurship, the distance between a successful pilot project and full-scale implementation is considerable.
Ideas alone are not enough—what determines whether innovations take root and deliver value is leadership.
Municipal leaders in particular are at the heart of this challenge. They are asked to balance limited budgets with growing service demands, improve quality while ensuring efficiency, and address today’s needs while preparing for the demographic and economic pressures of tomorrow. In this environment, leadership becomes the decisive pathway from innovation to implementation.
The leadership challenge in public innovation
Municipal leaders operate under tight financial and organizational constraints. Decisions must often be made within the framework of annual budgets, with little room for risk-taking or long-term investment. This structure can unintentionally discourage leaders from pursuing innovative solutions, even when the potential benefits are significant.
Research and reports underline this point: One has no shortage of promising innovations, but one lags in implementing them.
Leadership capacity—not only in terms of vision, but also in terms of organizational mandate and systemic support—is the bridge that must be strengthened.
Principles for market interaction and leadership’s role
The Directorate of e-Health (Norway) has outlined a set of promising principles for public-market interaction, including:
- Sourcing strategies that balance quality, sustainability, and cost
- Contract models that support innovation
- Business development to strengthen health-sector markets
- Norms of cooperation between public and private actors
- Predictability for suppliers and users alike
These principles are important drivers of innovation. Yet they must be matched by leadership systems that enable—and reward—implementation. Without that alignment, even well-designed principles risk remaining abstract rather than transformative.
Rethinking incentives for leaders
Current evaluation systems often assess municipal leaders primarily on their ability to deliver against annual budgets. While fiscal responsibility is vital, this narrow measure creates a structural disincentive to innovation. Leaders may hesitate to adopt solutions that generate benefits only after several years or in another organizational “silo.”
For example, a digital health intervention may reduce hospital admissions, but the financial benefit may accrue to a different part of the healthcare system than the one that invests in the technology. Without mechanisms to recognize and redistribute such value, leaders face an uphill battle when advocating for change.
To address this, leadership frameworks should:
- Broaden evaluation criteria to include innovation and implementation outcomes, not just budget adherence.
- Introduce benefit realization models that track value across organizational silos and time horizons.
- Allow reinvestment of savings so that part of the value created—whether through cost reduction or improved quality—can flow back to the unit or municipality that initiated the innovation.
These adjustments would make it safer and more attractive for leaders to take calculated risks on innovation, and they would help align local decision-making with national policy goals.
Creating conditions for courageous leadership
Leaders need more than incentives; they need a supportive environment in which innovation is not only possible but expected. This requires:
- Training and capacity building to strengthen leaders’ understanding of digital health, innovation processes, and change management.
- Cross-sector collaboration so that leaders can draw on expertise from private companies, non-profits, and academia, rather than shouldering the burden of innovation alone.
- Clear national strategies that connect policy ambitions with practical tools for leaders at the municipal level.
When leaders feel equipped, supported, and recognized for their role in innovation, they are more likely to move from cautious guardians of the status quo to active agents of change.
Mind the gap – Bridge the gap
Innovation in health and care services does not fail because of a lack of ideas. It fails when ideas cannot make the transition from pilot projects to everyday practice. Leadership is the decisive factor in closing this gap.
To succeed, we must ensure that leadership evaluation frameworks are aligned with innovation goals.
This means broadening performance criteria, recognizing long-term value creation, and rewarding leaders who take steps to implement solutions that improve care and sustainability.
By creating the right conditions and incentives, municipalities can empower their leaders to act as catalysts for innovation—ensuring that promising ideas do not remain pilots but become part of a resilient, people-centered health system.
DREIESKIVA|Roald Kvam 
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