Health care systems developers should adopt a strategy of “user led” innovation, according to a recent Viewpoint article published in The Journal of the American Medical Association. The practice is widely accepted in other US industries, and the authors point out that it would rapidly address frontline health care delivery problems and improve patient health. User-led innovation is predicated on the idea that important enhancements to products and services are often made by users to best suit their needs. Many new surgical procedures originate with surgeons modifying tools and processes for better results, the authors wrote. Traditional clinical academic research may not be appropriate for testing new approaches because it is difficult to adequately assess in randomized control trials the independent impact of an innovation when it is part of a complex system. The authors propose a clinician-innovator model in which the user/clinician identifies the problem, develops a solution, and tests it on a small scale using a quality improvement approach. Feedback is generated to help determine effectiveness and, if judged to have merit, will be implemented on a larger scale. Patient feedback is key to the innovation process. The authors – Dr. Barry Zuckerman of Boston University School of Medicine and Boston Medical Center; Dr. Peter A. Margolis of the University of Cincinnati, the James M. Anderson Center for Health Systems Excellence and Cincinnati Children’s Hospital; and Dr. Kedar Mate of Weill Cornell Medical College in New York – call upon hospitals and medical schools to promote and reward new approaches and tools to make health systems more effective.