Saturday, February 3, 2007

clinical innovation - Key Drivers of Health Care Innovation – Compassion, Simplicity, and Persistence

I’m coming off four experiences.

• Delivering a talk on innovation before a group composed largely of nurses serving as hospice directors.

• Reading Mind Set!, the latest book of John Naisbitt, author of Megatrends, which, written in 1982, uncannily predicted what’s happening today.

• Perusing King of Hearts – The True Story of the Maverick Who Pioneered Open Heart Surgery, a saga of heart surgeon, Dr. C. Walton Lillihei, of the University of Minnesota.

• Watching a Public Broadcasting System special, Free to Choose, the story behind a 20 part television series in 1980 featuring Milton and Rose Friedman, conservative husband-wife team who showed economic and political freedom are inextricably joined.


The need for organized compassion for the dying is now self-evident, in the form of hospice care, but it wasn’t always so. The modern movement started in the mid-1960s when British physician Dame Cicely Saunders and Swiss-trained psychiatrist Elizabeth Kubler-Ross brought the subject of dying out in the open. Doctor Saunders founded the first hospice – St. Christopher’s Hospice in London in 1967. A dying patient inspired Saunders. The patient requested words of comfort and acts of kindness and friendship. Dr. Saunders came to believe and to teach, "We do not have to cure to heal." Kubler-Ross wrote Of Death and Dying in 1969. Hospices are a profound innovation, based on compassion, and today are accepted as an essential part of mainstream medicine.

Naisbitt’s take on compassion differs. He says consequential innovations often don’t reside in “hard technologies,” like open heart surgery or miraculous medical cures, but in compassionate “soft technologies” like massage therapy and prayer, hence his term “high tech/high touch.” Naisbitt asserts, “We are moving into a world in which the high touch will become more and more the way to differentiate it from products that are more or less the same technological level.” My favorite example is Emmi Solutions, a company that has developed interactive videos having the right mix of voice, visual, and verbal to educate patients what to expect from health care. Communicating clearly to anxious patients is compassion at work.

C. Walton Lillihei’s story is more complex, but basically it centers around his compulsion to develop techniques, starting with cross-circulation and culminating in the first workable and affordable heart lung machine, to save lives of helpless young children suffering from congenital heart disease. Again and again his story focuses on his compassion for children and their parents. Of Lillihei, one set of parents remarked, “Dr. Lilliehei didn’t act like a star. The Gliddens had found many doctors to be rushed and apparently disinterested, as if anxious to knock off for the day – but not Lillihei. He really listened. He seemed unusually emphatic, as if he himself had once been at the mercy of medicine.”

Milton and Rose Friedman convinced many, including the Nobel Prize committee, that a free market-driven society is more compassionate than centralized command and control economies. The Friedmans noted, “It is natural to assume that someone must give orders to make sure that the ‘right’ products are produced in the ‘right’ amounts and available at the ‘right’ places… But commands must be supplemented by voluntary cooperation – a less obvious and more subtle, but far more fundamental, technique of coordinating the activities of large numbers of people.”

The flip side of the coin, of course, is that social welfare states are more compassionate. Naisbitt calls this mindset as “mutually assured decline,” meaning nations can’t simultaneously be economic powers and a social welfare states and still uplift the economic and health status of their citizens.


Peter F. Drucker in Innovation and Entrepreneurship says,

“Innovation has to be simple and focused. If it does more
than one thing, it confuses. If it isn’t simple, it won’t work. The greatest praise of an innovation is, ‘This is obvious. Why didn’t I think of it?’ “

The need for hospices is simple and understood by all. Dying patients need comfort, friendship, kindness, and understanding. These human needs don’t go away with dying. They become even more important and humanize everyone – caregivers and the care receivers – in the process.

The idea behind Megatrends was simple. Naisbitt noticed one day while passing a newsstand containing scores of local papers that the news differed significantly from one city to the next. He had this epiphany, “I had to find out what was really going on in America…I knew that America is an overwhelmingly bottom-up society and that the pieces of the puzzle would be found in local newspapers from around the country reporting local events.” Of health care innovations, he cites the example of outsourcing of x-ray interpretations to other countries, “Radiologists in India are analyzing the X-rays – sent over the Internet –of American patients. It reduces health care costs, It raises American health care productivity. Who could object to that?” To Naisbitt, it’s as simple as clicks and bytes.

C. Walton Lillihei, the Minnesota heart surgeon, emphasized simplicity in all of his pioneering advances. With his associate, Dr. Richard DeWall, Lillihei built a machine with no moving parts that cost less than 15 dollars. The author of the Lillihei book commented, “What a basic contraption it was, really nothing but a couple of metal stands, some large-diameter beer hose, a cork, a plastic tube, a reservoir, the needles, and two filters. Talk about simple – fifteen bucks and beer hose was simple!” Simplicity led to saving thousands of children with congenital heart disease.

The journey of Milton and Rose Friedman to international recognition and the Nobel Prize in economics for Milton was far from simple. It involved writing eight books – Price Theory, There is No Such Thing as a Free Lunch, An Economist’s Protests, the Optimum Quantity of Money and Other Essays, Dollars and Deficits A Monetary History of the United States, Inflation: Causes and Consequences, and Capitalism and Freedom – and withstanding determined and often demeaning criticism from critics. The simplicity came when the Friedmans’ simple economic theory – the market works – transformed the economies of every nation in which it was seriously tried – the United States, Chile, China, and Estonia.


Everyone I have mentioned -- Dame Cicely Saunders, Elizabeth Kubler-Ross, John Naisbitt, C. Walton Lillihei, and Milton and Rose Friedman – persisted in their innovative beliefs in the face of multiple setbacks and withering criticisms. Often these innovators persisted over a period of two to four decades. They understood, to use Naisbitt’s words, “how powerful it is not to have to be right.” They understood it isn’t worrying about the problems arrayed against you, but exploiting the opportunities that loom before you. Innovators don’t fear being wrong. They fear not exploiting what they know in their hearts to be compassionate, simple, and true.


1. John Naisbitt, Mind Set! Collins, 2006.
2. G. Wayne Miller, King of Hearts: The True Story of the Maverick Who Pioneered, Open Heart Surgery, Crown Publishers, 2000.
3. Peter F. Drucker, Innovation and Entrepreneurship: Practice and Principles, Harper and Row, 1986.
4. Milton and Rose Friedman, Free to Choose, A Personal Statement, Harcourt Brace Jovanovich, 1980.

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