Healthcare systems with limited resources face rising demand pressures. Healthcare decision-makers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system’s ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.

After a decade of efforts to mainstream Responsible Research and Innovation (RRI) across Europe, the policy momentum is now uncertain. We explore how 217 organisations perceive responsibility in relation to their work, what mechanisms they apply to promote responsible practices, and what hindrances to promoting RRI they observe. Most organisations are unfamiliar with RRI but employ diverse perceptions of responsibility and mechanisms to promote it nonetheless. Civil society organisations are primarily outward oriented; collaborating with others and hosting science events. Private companies are more internally focussed and more likely to formalise this effort in strategies and internal guidelines. Universities resemble private companies, while private and public funders use funding-specific tools to incentivise responsible practices. Our results suggest that RRI is still poorly institutionalised and that some areas lack attention among actors in the research and innovation systems. Future policy endeavours might benefit from addressing deficits and tapping into existing perceptions of responsibility.

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Harnessing the role of the public can help build accountability and trust, and also engage with the public about the benefits and risks associated with the science or technology BalancedKey lesson 1: It is important that oversight approaches aim to balance the conflicting benefits and risks associated with the emerging science or technology, as well as the needs of the different stakeholders Diverse and contextualKey lesson 2: There is no 'one-size-fits-all' approach to emerging science and technology oversight -it is vital to take into account the context within which the science or technology is developing Takes the initiativeKey lesson 3: Stakeholders that take the initiative to put in place oversight structures in a timely manner can take advantage of the opportunities provided by the emerging science or technology, and also help identify the risks Anticipatory Key lesson 4: It is helpful to anticipate the different potential paths an emerging science or technology could take as it evolves over time, as well as the ensuing impacts Embraces communication Key lesson 7: Effective communication between the main actors involved in the oversight process facilitates transparency and clarity of roles and responsibilities CollaborativeKey lesson 6: Adopting an inclusive and participatory approach to science and technology oversight helps build accountability and confidence AdaptableKey lesson 5: For an oversight approach to be effective, it helps to build in flexibility so that it can respond to changes and be adjusted over time as the science or technology evolves XIXWe are very grateful to Beth Thompson, Joseph Clift and Gemma Wardle at Wellcome Trust for their helpful guidance and support throughout the project. We would like to thank all of the respondents to our successful crowdsourcing exercise who provided examples of oversight, and the numerous individuals who contributed to the development of the case vignettes through interviews and discussions. We would also like to thank our reviewers, Advait Deshpande and Susan Guthrie, for their critical and constructive comments on earlier versions of this report during the quality assurance process. 10It is worth noting that the Protocol is still being negotiated, modified and used (Convention on Biological Diversity 2015).12 Interviewees are cited throughout the report using the identifier 'INTXX', where XX is a number between 01 and 10. 13These visionaries included the former foreign minister, Toomas Hendrik Ilves, and the former prime minister, Mart Laar (Runnel, Pruulmann and Reinsalu 2009). 14These websites were established to act as democratic forums where legislation could be proposed and discussed. 15Improving ICT-related skills through education has been a long-term oversight activity. The Information Technology Foundation for Education (known as HITSA), a non-profit association established jointly by the Republic of Estonia,