This commentary from Nature Medicine, published online 13 February 2026, discusses the role of strategic units in navigating research institutions in the complex landscape of health research and innovation. The article highlights how best to navigate the increasingly complex and dynamic environment of health research. Strategic units help guide institutions through this complexity. The DOI of the article is 10.1038/s41591-026-04218-8. The commentary focuses on the challenges associated with the dynamics of innovation in medicine.