surgery

Innovation and Pain

surgeryI was reading an article in the New Yorker comparing the adoption of surgical anesthesia versus antiseptics–two very important medical innovations. Some background is essential.

Anesthesia

In 1846, surgery was both painful and brutal. For most procedures, even a tooth extraction, patients were pinned down by assistants as they screamed and writhed in pain. Surgeons were trained to work with lightening speed to minimize the duration of the pain. Clearly, there was an emotional toll for both the patient and the surgeon. In October 1856, a gas was discovered by William Morton (a dentist) that could completely render a patient motionless and quiet. He demonstrated the gas to a surgeon, who was awe-struck by its effects, and who quickly published a paper in November 1846 in the Boston Medical and Surgical Journal. By the middle of December of the same year, surgeons were using the gas in London and Paris, by February 1847, anesthesia had been used in almost all of the major capitals in Europe, and in June 1847 by almost all regions in the world—mind you that this is before the internet–all of this communication was by letters, meetings, and other “slow methods.”  So, in took on 8 months from discovery to wide spread use! By 1852, anesthesia for surgery was a standard procedure everywhere.

Infection

Now consider infections. During this same time period, infections were the major cause of death for surgical patients, with as many as 50% of patients falling victim to post-surgical infection, sepsis, and death. Clearly, this is a big problem. In the 1860s, a surgeon named Joseph Lister came to the conclusion that infections were caused by microorganisms after reading a paper by Louis Pasteur.   Lister perfected his sterilization techniques and eventually published a paper in The Lancet in 1867 that documented spectacular reductions in death following surgery. His process consisted of many steps, such as washing hands, sterilizing instruments, and using sterile gowns and gloves.  Unfortunately, in wasn’t until nearly 40 years later that this practice became universal.

Why?

So we have two techniques that revolutionized medicine, yet one was adopted in 7 years and another in 40 years. Arguably, more lives could have been saved if surgeons had adopted the sterile techniques that were presented, but they didn’t. Both techniques required scientific/technical discoveries, i.e., the composition of the gas for anesthesia, and the realization that germs are present and need to be eliminated for infections. There are two main differences. With anesthesia, the doctor’s problem was solved, i.e., screaming, writhing patients (not to mention the emotional toll) making their job easier and less stressful. Also, the solution solved a very visible problem–screaming patients, something that was readily understood to be a problem. With sterile techniques, the problem was solved for the patient (they didn’t die!), but the doctor had little to gain. The patient was quiet during surgery, and would die several days or weeks later. Also, the problem was invisible–the killing of germs. It was hard to see that washing your hands or using sterile instruments was really solving the problem.

How does this apply to Innovation?

There are lots of good ideas that come up in organizations, but it’s the implementation that is the problem. It becomes hard to implement something when you are not directly solving your own problem and when the problem you are solving is invisible (to you). Organization’s are typically relying on “customer feedback” about a problem. In many cases, the people solving the problem don’t encounter the problem on a day-to-day basis like their customers—they may know and understand the solution better, but are not forced to “make it work” in order to get their job done like their customers are.   Consider just the simple example of a headache. If a co-worker of friend is having a terrible headache, you’ll probably lean back in your chair and recommend they find an aspirin, but if you are having the headache, you’ll knock over walls and doors to find a bottle of Advil.  The other aspect is the visibility of the problem.  Consider that you’re car stops working and you pull to the side of the road–you have no idea what is wrong. You open the hood and everything appears to be in order. In this instance, the problem is invisible, and you will probably just wait for your car to be towed to a service station.  Now imagine when you open the hood, you see that the battery connection is completely off–you immediately re-attach it and solve your problem. It was a problem that was visible and you fixed it right away.

These are the several major issues you must resolve when implementing new innovation:

  1. You must clearly articulate the pain/problem that is solved into something that everyone understands.  (If I don’t think I have a headache, then I am not going to be interested in your solution)
  2. You must make it visible. I think it is just a fact of life that it is easier to solve something where the solution is tangible. In business, it’s harder to sell services than products primarily because it is hard to see the results of services.
  3. Timing.  I believe that the time between the problem and the resolution must be short, or you’ll have to explain more.

In the case of infections, surgeons realize that having patient’s that live increases their collections (and they make more money), experimentation and microscope improvements make the problem visible, and it the benefit was immediate (the patient stopped squirming right in front on you).  Simply said, we need “sales” techniques to convince others of the value and benefit to themselves.

One way to do this is through innovation challenges. Challenges are problems proposed by organizational leaders.  The problem has value because solving it could result in a promotion, financial rewards, or other recognition.   Challenges force the problem to be explained in concrete terms and in simplified language so that everyone understands the issue, value, and benefits.  Challenges are also time-limited in order to force the timing between problem and solution.