From Accelerator to Exchange: Scaling Clinician Innovation Training Beyond the Academic Health Science Centre

In 2020, we reported outcomes from Hexcite, a 16-week entrepreneurship training programme for clinicians at Johns Hopkins, using the Kirkpatrick training evaluation model. That evaluation called for further research into professional identity and institutional support as determinants of sustained clinician innovation engagement. This paper reports on the programme's evolution into the Chesapeake Digital Health Exchange (CDHX), a federally funded regional digital health innovation hub (2019-2022), and examines what happened when the grant ended. Over the grant period, CDHX tracked 47 startups, delivered 445 mentoring sessions, and supported portfolio companies that raised over $137 million in venture capital and sustained 891 jobs. However, none of the five proposed sustainability mechanisms were operationalised by closeout. We argue that conventional programme evaluation frameworks, including those used in health informatics programme assessment, capture skills acquisition and economic outputs but do not account for the relational knowledge infrastructure or professional identity work that may determine whether innovation engagement is sustained. Further theoretical development is needed to explain how health professionals construct authority across traditionally separate clinical, technical, and entrepreneurial domains.