MSF OCG’s Initiative for Medical Innovation (2IM) has successfully introduced the beginnings of a change in organisational culture through a number of innovation projects. Every department has now adopted the notion of innovation and risk taking and a mindset of challenging the status quo. We have found evidence that the 2IM Initiative has, with a degree of success, started to address an identified latent risk aversion in OCG. Any form of organisational change must be expected to lead to tensions within the status quo, and to some extend this was even intended and deemed necessary. However, a lack of clarity on terminology, roles, responsibilities, functionalities and business processes incorporated risks which were not always well understood or managed, particularly during the design stage of the 2IM Initiative and in some cases exacerbated during implementation.