RT Journal Article SR Electronic T1 Improvisation during a crisis: hidden innovation in healthcare systems JF BMJ Leader JO BMJ Leader FD BMJ Publishing Group Ltd SP 185 OP 188 DO 10.1136/leader-2020-000259 VO 4 IS 4 A1 Rene Wiedner A1 Charlotte Croft A1 Gerry McGivern YR 2020 UL http://bmjleader.bmj.com/content/4/4/185.abstract AB Background Crises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed.Findings This paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect.Conclusion Health managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potential crisis: a global economic recession.