Testing organizations must often weigh operational efficiency against content validity and stakeholder expectations. This session explores a real-world case study involving a proposed OSCE improvement, keeping examinees stationary while standardized patients rotate, and why it was ultimately rejected despite successful pilot data. Using this example, we will examine how organizations can evaluate innovation through a structured decision-making framework that considers psychometrics, exam realism, logistics, and diverse stakeholder needs. Attendees will leave with practical tools for navigating complex decisions, addressing resistance to change, and aligning improvements with mission and impact.