The CML framework is an iterative approach that breaks down the innovation process into 3 interdependent domains :

The Needs: consideration of usability and clinical aspects in a user-centered approach (patients, healthcare professionals) from the “upstream” phases

The Technique: axis related to the choice and implementation of technologies, covering the levels of the TRL scale

Programmatic: aspects related to project management, regulatory constraints, and project financing


The notion of maturity

Born in the 1980s, the concept of maturity has long been associated with research on continuous improvement stemming from Total Quality Management (TQM), for example in the Capability Maturity Models (CMM), where it is a question of evaluating “the extent to which a specific process is explicitly defined, managed, measured, controlled, and effective” (Paulk et al. 1993). According to Mettler (2011), “the concept of maturity assessment models is increasingly being applied within the field of information systems (IS) and management science.” In contrast, the use of the concept of maturity in the field of innovation is much more recent and still in the process of being structured.

The maturity concept 

The Concept Maturity Levels (CMLs) were developed in the early 2010s by the Jet Propulsion Laboratory (PL- Caltech / NASA) to address the early formulation phases of innovation processes in space missions (Ziemer et al., 2013). The CMLs aim to extend the technology view of Technology Readiness Levels (TRLs) to incorporate the maturity of a concept in the needs (targets, uses, markets) and programmatic (organization, skills, viability) domains of an innovation project.

Fundamental principle of CMLs

The basic idea of the CMLs is to share a universal language for describing and communicating the actions, resources, and tools needed to develop a concept according to its “maturity level”: “The CML vocabulary provides a standardized mechanism for describing and communicating the products / accomplishments required for achieving a given CML and for identifying work remaining to proceed to the next level.” (Wessen, 2013). In other words, just as a seed initially needs humus and fertilizer, and then, as it grows, water, sunlight, and mulching, a concept requires a different action strategy according to its level of maturity.


Contributions and opportunities for health activities

The CMLs are a maturity metric for innovation projects that allow to:

– Diagnose where the project stands in terms of understanding the needs, the adequacy of the response provided, and the preparation of the public for the new solution.

– Identify what needs to be done, the skills required for the project at a given time, for example to be able to anticipate the impact of the project on organizations, on professional activities, to test a technology…

– Propose services to project leaders based on the network of available skills and by referring to best practices

– Share a common language between project leaders and support structures

Limitations and risks for health activities

There are a number of limitations: (1) many of the “maturity” models do not describe the concrete actions to be taken to structure maturation; (2) a “falsified certainty” is given to decision-makers, with the emphasis on processes masking the real competencies needed for professionals to commit and act; (3) an overly strong focus on the formalization of the metric and improvement efforts leads to bureaucratization. In the case of health activities, which are already subject to strong regulatory requirements, a metric could increase these limits and create risks for the actors’ ability to act.

Philosophy and general organization of the CML Health scale

The idea is to share a generic measurement scale for healthcare activities (see diagram below), while allowing for specific variations according to the field (e.g., healthcare technologies, technical aids for the disabled, population responsibility in the territories, support methods, etc.). To date, the “generic” formalization distinguishes 9 levels of maturity from the formulation of the initial idea (CML1) to the post-industrialization follow-up of the solution (CML9), passing through various intermediate evaluation stages



This process provides a methodological framework that integrates (i) the definition of 9 levels of maturity, (ii) concrete actions to structure the maturation activities for each level; (iii) a mapping of the tools and skills needed to carry them out.

The whole was integrated into a collaborative platform developed by the start-up Agile Solutions.