Medical education has traditionally focused on mastering biomedical knowledge, clinical skills, and professionalism. Yet it remains poorly equipped to prepare doctors for the complex, rapidly changing health systems they will work in. Despite repeated calls for transformative learning, progress in teaching system innovation has been limited. Current curricula produce clinicians adept at treating disease but often underprepared to address system failures or contribute to organizational change. Embedding patient-centered innovation within training may help address this gap. This approach integrates design thinking, value-based health care, and co-design with patients to cultivate the metacompetence required to engage with system change. Emerging examples suggest that innovation education is most effective when integrated within existing activities such as quality improvement initiatives, multidisciplinary collaboration, and protected time for improvement work. Teaching these principles early may help normalize innovation as an integral component of clinical practice rather than a peripheral activity. Lessons from the successful integration of communication skills and ethics into medical curricula demonstrate that such cultural shifts are possible. Practical approaches may include incorporating design-thinking exercises, patient co-creation activities, and innovation projects alongside existing quality improvement and leadership programs. Reframing innovation as part of professional responsibility may empower clinicians to act as catalysts for system improvement. From anatomy to innovation, medical education must continue to evolve, preparing doctors not only to treat patients but also to engage with the systems that shape health care delivery.

We are at a pivotal moment. The future of healthcare innovation can no longer be defined solely by technological advancement or institutional efficiency. While digital tools, therapies and platforms continue to evolve, they must be embedded within a broader transformation, one that places the human experience at the centre of how we design, deliver and evaluate care. This patient-centred renaissance calls for the integration of both horizontal and vertical forms of knowledge: connecting services across the care continuum. From the literature and our experience, an unexpected byproduct of co-production with patients in health innovation and care delivery is a reduction in complaints, litigation and a significant increase in treatment compliance.¹⁹ This results in a reduction in misdiagnosis,²⁰ over investigation and treatment, giving a reduction in costs in the overall healthcare economy. Empowering patients as innovators is not a symbolic gesture. It is a practical imperative if we are to create pathways that are not only clinically effective but also meaningful and responsive. Fragmented systems that overwhelm or disorient must give way to cohesive and compassionate journeys, designed with and for the people they are meant to serve. This is a call to rethink not only what we innovate, but how and with whom. Let us commit to building systems that honour not just the science of healing, but the individuals we treat. In doing so, we move closer to a future where innovation and empathy are no longer treated as separate domains, but as interdependent pillars of truly transformative care.

Transformative research is a broad and loosely connected family of research disciplines and approaches, with the explicit normative ambition to fundamentally question the status quo, change the dominant structures, and support just sustainability transitions by working collaboratively with society. When engaging in such science-practice collaborations for transformative change in society, researchers experience ethical dilemmas. Amongst others, they must decide, what is worthwhile to be researched, whose reality is privileged, and whose knowledge is included. Yet, current institutionalised ethical standards, which largely follow the tradition of medical ethics, are insufficient to guide transformative researchers in navigating such dilemmas. In addressing this vacuum, the research community has started to develop peer guidance on what constitutes morally good behaviour. These formal and informal guidelines offer a repertoire to explain and justify positions and decisions. However, they are only helpful when they have become a part of researchers’ practical knowledge ‘in situ’. By focusing on situated research practices, the article addresses the need to develop an attitude of leaning into the uncertainty around what morally good behaviour constitutes. It also highlights the significance of combining this attitude with a critical reflexive practice both individually and collaboratively for answering questions around ‘how to’ as well as ‘what is the right thing to do’. Using a collaborative autoethnographic approach, the authors of this paper share their own ethical dilemmas in doing transformative research, discuss those, and relate them to a practical heuristic encompassing axiological, ontological, and epistemological considerations. The aim is to support building practical wisdom for the broader research community about how to navigate ethical questions arising in transformative research practice.

Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer. Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer. Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to ‘‘dream’’ together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study. Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.