The main conclusion of this text is that the development of systemic innovation in Metropolitan Bilbao is hampered by a fragmented effort. This conclusion is reached by a study of OTRI, Euskoiker, Cluster Conocimiento and BEAZ - four public-private initiatives that are set up to support innovative performance. The aims and efforts made by each initiative are positive, but they lack the necessary resources for making a real impact. Because of the complex context of government and administration in Metropolitan Bilbao, significant results from such initiatives are also hindered by lack of communication and co-ordination. The initiatives come from various directions and are small.Public-private relations are seen as important in the process of achieving systemic innovation, and future policies in Metropolitan Bilbao will need to systemise and co-ordinate the various efforts. This is particularly important in relation to the innovative performance of the Small- to Medium Sized Enterprises (SMEs) in the area.The first part of the paper sums up existing literature explaining the importance of systemic innovation in relation to economical development. How public-private relations can support innovative performance in SMEs will also be important in this part. Some particular problems that are important to be aware of in the context of Metropolitan Bilbao will also be presented.Later, the activities of the four public-private initiatives will be described and discussed, in relation to theory and how they are performing.