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Imagine your elderly parent is admitted to the intensive care unit (ICU) following a respiratory insufficiency. She is intubated for more than 2 days. As the hours go by, there is an increasing risk that stomach fluids and bacteria from her mouth enter into her lungs as the inflatable cuff that holds her tracheal intubation tube in place leaks.1 As a consequence, she develops ventilator-associated pneumonia (VAP), which is associated with a significantly greater risk of dying in the days to come. The good news is that a technology exists—the Venner-PneuX system—that almost entirely prevents such leaking of fluids into the lungs.2 The bad news is that uptake appears low and slow. Worse, most ICU clinicians, nurses, managers and certainly patients are unlikely to be aware of this technology, despite it having been available since 2007. The story of VAP is one of many that helps us understand why the adoption of innovation in the National Health Service (NHS) remains elusive, despite much policy attention. It illustrates that we should turn our attention to those individuals and organisations we wish to take up innovation—rather than solely the innovators themselves. Our key thesis is that efforts to support and promote the creation of innovation itself will not solve this problem. This argument has not been set out sufficiently before. The real challenge is to create healthcare environments in which the benefits of innovations can readily be seen and understood by those who can use them to improve patient care, and in which healthcare organisations can readily support the procurement and integration of those innovations into their systems and processes of care. In order to do this, we need to create organisational cultures, capabilities, infrastructure, processes and resources that make the uptake of innovation more likely. We need to create this …