Non-negotiables in digital health innovation: leadership perspectives from the C-suite

OBJECTIVES: This study investigates the non-negotiable criteria employed by C-suite information leaders when evaluating digital health innovation projects. METHODS: We conducted a qualitative interview study with 17 executives serving in C-suite information leadership roles. Participants represented not-for-profit US health systems that varied in size, geographic location and mission. Semistructured interviews were conducted using a topic guide developed by the research team. Transcripts were analysed deductively with iterative refinement to identify recurrent themes. RESULTS: Three non-negotiables consistently emerged across interviews: (1) strategic alignment with organisational mission, (2) clinician buy-in and workflow integration and (3) regulatory, privacy and security compliance. These criteria functioned as baseline requirements and organisational safeguards, determining whether innovations advanced to further consideration. DISCUSSION: Findings suggest that C-suite information leaders operationalise digital innovation decisions through implicit filters that extend beyond financial considerations. In particular, leaders emphasised 'return on benefit' as an evaluative lens that accounts for time savings, workforce sustainability, patient outcomes and community benefit in addition to financial return. This framing reflects the non-profit identity of many health systems and aligns with calls for multidimensional evaluation of digital health initiatives. CONCLUSION: Strategic alignment, clinician buy-in and compliance represent non-negotiables in digital health innovation decision-making. The addition of return on benefit highlights the need to broaden evaluative frameworks to capture patient-centred and workforce-oriented outcomes.