This article explores the role of researchers as innovation drivers in the public healthcare sector. The Triple Helix model is proposed for the analysis of the role of public hospitals in innovation processes. We discuss the role of public hospitals in innovation and in economic and social development, and identify this role as a �fourth mission� of hospitals in addition to their widely recognized threefold function of healthcare provision, education and research. We discuss the evolution of hospital administration from healthcare towards the �entrepreneurial hospital� model. More specifically, we investigate the extent to which the incorporation of full-time researchers can help to foster innovation at research and healthcare centres affiliated with the Spanish National Health System. Data were obtained through a survey of researchers, research group leaders and heads of departments and centres where these researchers worked, as well as through content analysis of researchers� annual reports.
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