Innovation is essential to ongoing improvements in quality healthcare, yet healthcare institutions continue to struggle with the challenge of how best to operationalize the multiple commitments to risk minimization, accountability, the defensible use of resources and quality innovative practices. An ideal pathway would be one that adheres to both the ethical values of the institution in which the innovation is being introduced and relevant legal standards in a way that preserves the innovators' imagination and enthusiasm while ensuring scientific rigour and accountability. An interdisciplinary team at the Hospital for Sick Children in Toronto, Ontario, developed a policy-entrenched pathway f or managing the introduction of innovative procedures in surgery. This article describes the innovation pathway and the steps; taken in its development.