‘The stupid thing is, it’s all about money’: Clinician-Innovators’ Perspectives on Financial Sustainability of Digital Health Innovations in a Large Dutch Hospital1

Abstract

In the context of increasing healthcare digitalization, hospital-based clinicians are developing and implementing decentralized digital health innovations (DHIs) tailored to their patient and clinical needs. However, achieving financial sustainability remains one of their challenges. We explored clinician innovators' perspectives on these challenges during the implementation and scale-up of their DHIs in a Dutch academic hospital using qualitative methods. Key challenges identified included funding gaps to cover transition costs, misaligned institutional financial incentives and reimbursement structures, short-term logics of funders overshadowing long-term value in DHI financing, and commercialization pressures. Findings provide insights into the financial and operational challenges faced by such context-driven internal innovations, highlighting the need for coordinated project-and institution-level strategies to support sustainable integration into routine care.