As most have mentioned like @asmibana and @sanam funding in a major role. I work at MSK in the Office of Technology Development so we constantly have new invention disclosures, but unless the PI has resources/funding available-it is hard to innovate. If an MSK employee comes up with an invention, like a surgeon, and they do not have their own research lab, its hard to move the invention forward. I actually manage an internal fund at MSK called the Technology Development Fund. This fund provides gap funding to add value to MSK inventions. The award is $500,000 over two years; $250k for year 1 and $250k for year 2. The technologies are pitched to an internal review committee comprised of MSK investigators and about half of the applications move forward to another application stage and are reviewed by higher level executives in the biotech field and they ultimately decide which technologies we should fund. This fund is incredibly helpful but I have noticed that that the market places a huge role in what gets funded. For example anything Car-T right now can get funding be licensed at pre-clinical stage, whereas devices are harder to fund. I agree as others have mentioned that it is hard to innovate in a company if the operations/SOPs remain the same and funding/resources aren’t available. I’m currently working at MSK on a Medical Device Initiative to have surgeons/nurses disclose new inventions and to find sources of funding within MSK and potential for collaborations. Overall I think that open-minds to support change/new opportunities and funding are the keys to driving innovation (at least at MSK).