Atul Gawande, an Indian-America surgeon and author of “The Checklist Manifesto,” has written a fascinating article in The New Yorker entitled “Slow Ideas.” This article explores why some innovations spread quickly, while others spread slowly. The article also tries to explain how to speed up innovations that don’t spread quickly.
The author begins the article by comparing the trajectories of two innovations that were discovered in the nineteenth century: surgical anesthesia and antiseptics. The practice of using surgical anesthesia spread quite quickly while the adoption of using antiseptics was much slower.
Mr. Gawande writes in “Slow Ideas”:
“So what were the key differences? First, one combated a visible and immediate problem (pain); the other combated an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism [the principles and practices of antiseptic techniques], by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands. You can imagine why Lister’s [antiseptic] crusade might have been a tough sell.”
“This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.”
The question that Mr. Gawande then tries to address is how do we champion and speed up important innovations that just can’t seem to get any traction? His answer is to create new norms through one-on-one training (i.e., mentoring).
Mr. Gawande writes on that topic:
“… technology and incentive programs are not enough. ‘Diffusion is essentially a social process through which people talking to people spread an innovation,’ wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”
“This is something that salespeople understand well. I once asked a pharmaceutical rep how he persuaded doctors—who are notoriously stubborn—to adopt a new medicine. Evidence is not remotely enough, he said, however strong a case you may have. You must also apply ‘the rule of seven touches.’ Personally ‘touch’ the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change. That’s why he stocked doctors’ closets with free drug samples in person. Then he could poke his head around the corner and ask, ‘So how did your daughter Debbie’s soccer game go?’ Eventually, this can become ‘Have you seen this study on our new drug? How about giving it a try?’ As the rep had recognized, human interaction is the key force in overcoming resistance and speeding change.”
Gawande then spends some time in this article describing a simple, effective treatment of diarrheal illness (i.e. “basically a solution of sugar, salt and water that you could make in your kitchen”), and how this oral rehydration therapy was communicated to the rural Indian population starting in 1980. This door-to-door public health campaign (which started small but eventually “hired, trained, and deployed thousands of workers region by region”) was stunningly successful. “Use of oral rehydration therapy skyrocketed. The knowledge became self-propagating. The program had changed the norms… Three decades later, national surveys have founds that almost ninety per cent of children with severe diarrhea were given the solution. Child deaths from diarrhea plummeted by more than eighty per cent between 1980 and 2005.”
I highly recommend that you read the full text of this article. While Gawande chiefly uses medical examples of how innovation spreads, his ideas are applicable to many other fields (e.g. sales and marketing, technology, etc.). These ideas on the spread of innovation should be part of any investor's latticework of mental models.
The author begins the article by comparing the trajectories of two innovations that were discovered in the nineteenth century: surgical anesthesia and antiseptics. The practice of using surgical anesthesia spread quite quickly while the adoption of using antiseptics was much slower.
Mr. Gawande writes in “Slow Ideas”:
“So what were the key differences? First, one combated a visible and immediate problem (pain); the other combated an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism [the principles and practices of antiseptic techniques], by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands. You can imagine why Lister’s [antiseptic] crusade might have been a tough sell.”
“This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.”
The question that Mr. Gawande then tries to address is how do we champion and speed up important innovations that just can’t seem to get any traction? His answer is to create new norms through one-on-one training (i.e., mentoring).
Mr. Gawande writes on that topic:
“… technology and incentive programs are not enough. ‘Diffusion is essentially a social process through which people talking to people spread an innovation,’ wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”
“This is something that salespeople understand well. I once asked a pharmaceutical rep how he persuaded doctors—who are notoriously stubborn—to adopt a new medicine. Evidence is not remotely enough, he said, however strong a case you may have. You must also apply ‘the rule of seven touches.’ Personally ‘touch’ the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change. That’s why he stocked doctors’ closets with free drug samples in person. Then he could poke his head around the corner and ask, ‘So how did your daughter Debbie’s soccer game go?’ Eventually, this can become ‘Have you seen this study on our new drug? How about giving it a try?’ As the rep had recognized, human interaction is the key force in overcoming resistance and speeding change.”
Gawande then spends some time in this article describing a simple, effective treatment of diarrheal illness (i.e. “basically a solution of sugar, salt and water that you could make in your kitchen”), and how this oral rehydration therapy was communicated to the rural Indian population starting in 1980. This door-to-door public health campaign (which started small but eventually “hired, trained, and deployed thousands of workers region by region”) was stunningly successful. “Use of oral rehydration therapy skyrocketed. The knowledge became self-propagating. The program had changed the norms… Three decades later, national surveys have founds that almost ninety per cent of children with severe diarrhea were given the solution. Child deaths from diarrhea plummeted by more than eighty per cent between 1980 and 2005.”
I highly recommend that you read the full text of this article. While Gawande chiefly uses medical examples of how innovation spreads, his ideas are applicable to many other fields (e.g. sales and marketing, technology, etc.). These ideas on the spread of innovation should be part of any investor's latticework of mental models.
