In recent years, clinical innovation has been strongly promoted as a pathway to a better health service. The adoption of new technologies, use of data analytics and the redesign of processes have been seen as promising mechanisms to reduce delays, improve patient experience and to increase diagnostic accuracy and therapeutic efficacy. Clinical engineers are uniquely well placed to contribute to this wave of innovation, having technical expertise, exposure to real world clinical issues and a systems based approach. This presentation is a reflection of the role on clinical engineering in innovation and how it may develop, and on the general direction of in-hospital innovation. In particular, the presentation draws on the experiences of the Design Innovation Lab at St. James’s Hospital, an innovation space developed by the hospital’s Medical Physics and Bioengineering Department.