OBJECTIVES: To investigate how interventional procedures (IPs) are introduced into the British National Health Services and identify areas for improvement in the current process. METHODS: Qualitative study using one to one semi-structured interviews. Using the framework approach, the data generated from 14 participants were analysed with coding of emergent themes. Data were analysed separately for providers and commissioner organisations. RESULTS: Variations were observed in how IPs are introduced from both the provider and commissioner perspectives. Patterns of approaches allowed the development of models reflecting practice at each type of organisation: very structured in some places to, unstructured or almost non-existent in others. Factors affecting the decision to introduce a procedure include: immediate costs and benefits, numbers of people affected, training requirements, NICE guidance, nature of procedure, support from colleagues, incentives, public or policy-maker pressure, and aims of the institution. Monitoring was seen as a key area for improvement by many. CONCLUSIONS: These variations indicate that the process of introducing new IPs in the NHS can be improved. Factors affecting decision-making and problems have been identified. The results of our study could inform and help shape future processes of managing and the introduction of new procedures into the NHS.