The One percent – from the desk of Jessica Seddon (the panel for An Emerging Health Innovation Ecosystem)

The 1%

 js“Genius is 1% inspiration, 99% perspiration.”  – Thomas Edison.

The old adage is usually used to remind the eager that it’s a long road from idea to implementation. True, but it’s a long and somewhat ineffective road without the right beginning.

Those starting points can be hard to find. Getting close enough to a complex problem to see, feel, hear, learn enough to have an inspiration that’s worth all of that perspiration is difficult. Building ecosystems so that these kinds of inspirations happen often is even harder.

This is especially true in public health, where the frontiers of care can be geographically remote; many social interactions within the health system are shrouded in fear, misgiving, and hierarchies of expertise; and most of the problems have multiple interlinking causes. Inspiration, in fact, appeared to be more of a missing link than post-idea perspiration in our recent report on emerging social enterprise opportunities in healthcare. [link to http://okapia.co/wp-content/uploads/publications/284/HealthHorizons2021.pdf] Many of the experts interviewed on innovation emphasized the challenges of obtaining the kind of detailed, granular, specific knowledge of problems that inspires scalable solutions.

There are three main challenges for accelerating the 1% inspiration that leverages the other 99% perspiration toward some kind of genius. First, setting the stage for inspiration is hard work.  “Design thinking,” or circling around the problem to examine all angles of the problem with an open mind before jumping to solutions, takes time, money, patience and a kind of social acumen that comes from experience at least as much as formal training. Learning “The Character of Harms,” [Link to http://www.hks.harvard.edu/research-publications/vbt/index/sparrow-character-of-harms] to borrow Malcolm Sparrow’s term for the small factors and interactions that build up to a problem that one wants to eliminate, takes all that plus a strategic mindset to identify ways to disrupt one or more of these contributors. (As an aside – The Character of Harms offers a very useful heuristic framework for tackling the kind of “wicked problems” discussed on this blog. Even if the subtitle, “Operational Challenges in Control,” sounds slightly menacing.) Deep thinking takes effort. Creative ideas often emerge from the subconscious, but turning off our eager, action-oriented conscious minds to mull a bit more and spot unlikely connections or points of leverage is difficult.

Second, the effort is also largely invisible, which means that it’s hard to save time for it in a public health system that’s already overtaxed and under pressure to deliver results. The activities that lead to inspiration also look like so much meandering around and wasted time. Reflection and careful observation can’t be boiled down into the key result areas that human resource directors love or the quarterly activity charts that funders like to see. Outcomes are only visible over the long run and on average across employees. Some of the learning time will pay off immediately with visibly useful innovation, but some of the knowledge may lie dormant for years until it connects with another observation and sparks fly. Other time spent immersed in learning about the problem will lead down blind alleys and failed experiments. Not the kind of thing that makes for good annual reports or answers to questions in Parliament.

Third, it’s hard for large institutions built around established expert, credentialed disciplines to absorb unconventional inspiration and allow the perspiration to happen. Medicine is a regulated profession, where official expertise comes with a certificate and the one with the most letters after her name often reigns supreme. We will have to devise new ways to filter ideas from those with experience on the front lines, and create space to invest in them. Healthcare also has boundaries that are, in most cases, narrower than the roots of ill health. Air pollution and water-borne illnesses, for example, are two of the most significant risk factors that Indians face. They can be treated medically, but they are produced by decisions about infrastructure, regulation, and energy policy. Inspirations may require new kinds of perspiration to succeed in producing genius.

Accelerating the 1% to drive the other 99% toward the kind of genius we need to solve long-standing public health and other social challenges, in short, requires us to rethink much of what we’ve learned about “work.”

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