Think Bigger. Fail Often.

Alan Kay recently outlined some of the principles that he thought made Xerox's PARC so successful (if you don't know who Alan Kay is or why PARC was so special, you should try to find out).  One was: "'It's baseball,' not 'golf'...Not getting a hit is not failure but the overhead for getting hits."

That doesn't quite square with my impression of golf, but I take the point.  It's about the price of success.

As psychologist Dean Simonton pointed out in Origins of Genius: "The more successes there are, the more failures there are as well."  "Quality," he wrote, "is a probabilistic function of quantity."    

We talk a lot about innovation these days, especially "disruptive innovation."  Why not?  It sounds cool, it allows people to think they're on the cutting edge, and it often excites investors.  But perhaps we've lost sight of what it is supposed to actually be.  

Vuki Vujasinovic recently wrote in Forbes that: "Almost every use of the phrase ‘disruptive innovation’ as we see it today is wrong."  He cited several such examples, including Porsche and even Uber, and reminded us that the phrase doesn't just mean "change" or a new entrant in a market.  

Mr. Vujasinovic urged would-be innovators to be more precise with their claims, reserving "disruption" for true disruption.  Instead, he suggested: "Say you are doing something different, say you are changing the way something is done, but don’t say you’re disrupting something just because it’s a nice word you want people to repeat."

To go back to the baseball analogy, in health care these days we don't have a lot of home run hitters.  We have a lot of companies who are single hitters -- or maybe are just trying to bunt.  There are too few people swinging for the fences.

And even fewer trying to invent a brand-new game, one better suited for the 21st century.

Some examples may help illustrate why.

Wired published an excerpt of Rutger Bregman's new book Utopia for Realists, in which he gives several examples (such as the 2008 financial crisis) where "cognitive dissonance" kept well-educated, intelligent people from seeing what should have been obvious problems.  We're so set in our ways that we keep going down the same track even as it should become increasingly obvious that it is a dead-end.  As a result:

When reality clashes with our deepest convictions, we’d rather recalibrate reality than amend our worldview. Not only that, we become even more rigid in our beliefs than before.

I.e., no one likes our health care system, it's demonstrably not doing a very good job and doing so at a very high cost, but, hey, let's just tinker at the edges.

Professor Bregman does believe that new ideas can change the world, but it may take some sudden shocks and persistent objectors to get people to change their mindsets.  Our trouble, he warns, is that "we inhabit a world of managers and technocrats," who focus on the problems and solutions at hand.

In other words, singles hitters.  Never fear, though, he reminds us: "Ideas, however outrageous, have changed the world, and they will again."

John Nosta similarly warns in Psychology Today that innovation is too often throttled by "the mushy middle," usually in the name of collaboration.  Innovation is not about collaboration and certainly not about consensus, because: "Innovation is not an intellectual average."

He asserts that we need those "high performers" and their sometimes outrageous ideas, instead of "having their fragile voice crushed by generic consensus."

Lastly, in Fast Company, a trio of researchers noted the subtle power of default choices.  How choices are presented -- like opt-in versus opt-out -- has a strong impact on decisions.  Organ donation is a classic example, where the percentage of people agreeing to being an organ donor is significantly higher (like 80% higher) when it is presented as the default choice.

Disclosure about the options doesn't help as much as we'd like to think, because, "Research shows that making an option the default leads people to focus on reasons to accept the default and reject the alternative first and foremost."

We may not always realize the default options we're being given, especially when confronting a highly complex, inter-dependent system like health care.  We think we're changing something, but usually we're only doing so within the default options the existing system gives us.

John Nosta also writes about how Apple and Google's recent forays into health care should be a wake-up call for the life science industry, "which oftentimes has relied on the snooze function of line extensions and extended-release drugs as the source of income and innovation."  Those two companies' "expectedly unexpected" innovation in this area is welcome, but even they may be too entrenched into the existing approaches to have truly disruptive impact.

So, all you would-be health care innovators: are you prepared to fail, lots of times, before you succeed?  Are your ideas truly disruptive, or simply twists on what we've been doing?  Is yours a bold vision of what could be, or is it of just slightly further down the road that we're already on?

For example, when I read about an interesting start-up Better, which seeks to help consumers with their health insurance claims -- fighting with insurers and providers to ensure consumers only pay what they should -- I have two conflicting thoughts:

1. Consumers certainly need help like this;
2. I wish they'd focused instead on making the underlying problem(s) go away.

I love telehealth.  I love digital health.  I love direct primary care.  I love having AI help doctors.  They -- and numerous other examples -- are all important developments that, arguably, will help make our health care system better.

But they are not disruptive innovations.  They are not swinging for the fences.

Our health care system is so inefficient and so wasteful that it's almost too easy for innovators to pick a problem and make it at least less bad.  It certainly needs that.  If that's all they are looking for (and to get their piece of the $3 trillion pie), well, you can't hardly blame them.  

Me, though, I'm rooting for the innovators who are swinging big and are willing to miss a lot.  They're the ones who will eventually get us to the health care system of the future.