What Do You Mean, "Innovation"?

One of my favorite movies is The Princess Bride.  Among the many great quotes is one from Inigo Montoya, who becomes frustrated when the evil Vizzini keeps using “inconceivable” to describe events that were clearly actually taking place.  “You keep using that word,” Inigo finally says.  “I do not think it means what you think it means.”

Credit: iStock/MicroStockHub

So it is for most of us with the word “innovation” – especially in healthcare.

What started thinking me about this is an opinion piece by Alex Amouyel: Innovation Doesn’t Mean What You Think It Does.   Ms. Amouyel is the Executive Director of Solve, an MIT initiative whose mission is “to drive innovation to solve world challenges.” It sees itself as “a marketplace for social impact innovation.”    

In her article, Ms. Amouyel notes that traditional definitions of innovation focus on the use of novelty to create wealth.  She doesn’t dispute that view, as long as “wealth” includes the less traditional “community wealth,” which includes “broadly shared economic prosperity, racial equity, and ecological sustainability.”  I suspect that innovators like Jeff Bezos or Elon Musk don’t ascribe to that view of innovation.

Alex Amouyel.  Credit: Solve MIT

Ms. Amouyel’s view is: “For me, innovation is about solving problems. And if innovation is about solving problems, what problems you are solving and who is setting about solving them is key.”  She notes the multiplicity and difficulty of both global and community-level problems that we face, and urges: “Most urgently, we should zero in on problems that affect the most underserved among us.”

E.g., in healthcare, which of our many problems do we try to solve, for which populations, with whose help?  Does the innovation increase community wealth, or just some people’s wealth?  Will it improve the health of the most undeserved among us?

She is particularly keen on proximate leadership in solving problems, citing Jackson, Kania, and Montgomery: “Being a proximate leader is about much more than being exposed to or studying a group of people and its struggles to overcome adversity. It’s about actually being a part of that group or being meaningfully guided by that group’s input, ideas, agendas, and assets.”

Therein lies the problem.  Whether it is global warming, poverty, or the dysfunctional U.S. healthcare system:

The issue today is that, too often, we’re not recognizing and thus not investing in proximate innovators working in underserved communities, meaning their innovations may never quite reach the depth and scale needed for systemic change.

Those searching for innovation — investors, corporations, foundations, corporations, or governments — rely on top-down or closed approaches to find innovators. This relies on innovators being part of existing networks in particular geographies, going to the right schools, or being introduced through the right person to an investor or a foundation program officer. We need to fling open both literal and figurative doors to meet proximate innovators where they are, adopting bottom-up and co-creation approaches that allow access to those working in and with the most underserved communities.

I can’t speak to how well that applies to other major problems, but I sure recognize that as a problem in healthcare, particularly in the U.S. We’ve seen a flurry of digital health “innovations,” which, as best I can tell, mostly focus on making things a little easier for middle/upper class people with moderate health issues.  Not exactly getting at the core of the biggest health problems our nation faces, nor the biggest problems in our healthcare system.  Not really flinging open the doors to the thousands, maybe millions, of proximate innovators whose very lives are at stake. 

E.g., if you are a hospital and front-line nurses aren’t helping lead your innovation efforts, you’re probably focusing on the wrong things.  If you are a digital health company, a pharmaceutical company, or a medical device company, and patients play at best an advisory role, admit it – you’re really just in it for the money.   

Solve, for example, puts together Challenges that recruit “social entrepreneurs who are using technology to solve today’s most pressing problems.”  It has supported some 228 Solver teams over the years, including one focused on The Care Economy and another on Equitable Health Systems.  Current open challenges include how to measure performance improvement in primary care and another on improving the quality of lives for people with rare diseases.

Solve just held Solve at MIT 2022.  Two quotes from the summary jumped out at me:

• Azra Akšamija: “When we work with fragile communities we always have the best intentions, but best intentions don't always make the best solutions.”
• Hanna Hala: “Charity asks: what’s wrong, how can I help? Justice asks: why is it happening, how can I change it?”

Look, I’ve long been an advocate of electronic health records. I’m all in favor of more digital health solutions.  I’m thankful for the kind of drug development advances that made finding and producing the COVID-19 vaccines so quick.  I’ve been the beneficiary of improvements on surgical techniques and devices.  I’m fascinated by AI, 3D printing, VR/AR/metaverse, and robotics in healthcare.  All those, and more, count as “innovation” as we typically define it in healthcare, but I have to ask: are they the best solutions for fragile communities?  Do they help bring more justice in our healthcare and in our society? 

I didn’t think so either.

If we’re going to be true innovators in health, we’d need to start by realizing we’re spending our $4 trillion quite stupidly, with much of the innovation going to make the people and organizations who are already rich even richer.  We’d focus on the fact that most of our health issues start from too much poverty, with too many people lacking adequate income, housing, food, and education.  We’d be mad that the people who deliver hands-on care, including nurses, nursing home workers, and home care aids, get paid so little relative to their immense contributions. 

Address those kinds of things, take on those kinds of challenges, then you can call yourself an innovator.  Until then, I’d have to agree with Ms. Amouyel: innovation doesn’t mean what you think it means.