Innovation is often regarded as uniformly positive. This paper shows that the role of innovation in quality improvement is more complicated. The authors identify three known paradoxes of innovation in healthcare. First, some innovations diffuse rapidly, yet are of unproven value or limited value, or pose risks, while other innovations that could potentially deliver benefits to patients remain slow to achieve uptake. Second, participatory, cooperative approaches may be the best way of achieving sustainable, positive innovation, yet relying solely on such approaches may disrupt positive innovation. Third, improvement clearly depends upon change, but change always generates new challenges. Quality improvement systems may struggle to keep up with the pace of innovation, yet evaluation of innovation is often too narrowly focused for the system-wide effects of new practices or technologies to be understood. A new recognition of the problems of innovation is proposed and it is argued that new approaches to addressing them are needed.

In today's increasingly competitive market, it is important both to delight and to avoid disappointing the customers. Thus, it is of value to have a systematic process for obtaining feedback from the customers, not only as a basis for corrective action relating to current products, but also as vital input to the new product development process. How can we meet our present and future customers' expectations, if we do not have a feedback process that handles available information? This study investigates how this feedback process functions, and it seeks potential improvement. Three organizations are studied, and data are collected through interviews and personal observation. The case studies are conducted as a collaborative project with three Swedish manufacturing companies and the

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