Innovation is often judged by visibility, speed and scale. But in environments where outcomes have real consequences, those measures don’t hold up. In sectors like healthcare, decisions are not just about growth or engagement. They affect real people, with real risk attached. This changes how innovation works. This panel explores what it means to prioritise impact over optics. How organisations define success when metrics are not enough, what trade-offs are made when impact and growth don’t align, and how teams operate when accountability is higher. It also looks at the reality of working across complex systems, clinicians, academics, industry and regulators, where progress is slower, but the stakes are higher. Because when outcomes actually matter, the way we build, measure and talk about innovation has to change.