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Only Some Good Ideas Take Off. Here's Why

In the 19th century, anesthesia spread much faster than antisepsis. A replicable lesson in innovation from the history of medicine.
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Why do some ideas spread so swiftly and others so slowly?

This is the question Atul Gawande, a surgeon and journalist, asks in this week's New Yorker.

To answer it, he looks at the history of two crucial 19th century medical innovations: anesthesia and antisepsis.

In 1846, a dentist named William Morton convinced a Boston surgeon to try his new invention, which he promised would make surgery painless--and easier for doctors, who would no longer have to deal with screaming, thrashing patients. Anesthesia was an instant hit. Within seven years, it was the standard in the U.S. and Britain.

Meanwhile, in 1867, surgeon Joseph Lister published reports on his new techniques for cleaning hands, wounds, and equipment, which he found lowered rates of sepsis and death an enormous degree. Yet, Gawande points out, "two decades later, hand washing was still perfunctory."

These two new ideas both changed the field of surgery entirely, but only one caught on quickly. The other took decades. Why was that?

Gawande argues that while both improved care and saved money for doctors (living patients pay better, after all), only one solved a visible and immediate problem. "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," he says.

In the end, what helped spread the use of antisepsis was a slow sea change in surgical norms, explains Gawande. It wasn't until surgeons began to think of themselves as scientists and, more importantly, convinced others to do the same, that lab sterility began to become the standard.

According to innovation strategist Debra Kaye, author of Red Thread Thinking, understanding the culture is the key to making innovations stick. "The reason products fail is because we think people are going to change their habits to buy what we've created, and that is never ever, ever going to happen," she says. "The question is: How do you make it fit in to the culture and people's underlying habits?"

Michael Schrage, an innovation advisor and the author of Who Do You Want Your Customers to Become?, agrees, noting that a good idea is never enough. "For completely understandable reasons, really smart people who love ideas prefer to think of innovation as the 'reduction to practice' of ideas. That's reasonable, rational, and wrong. Creating valuable experience, not transmitting brilliant ideas, is what changes both minds and behaviors."

In any field, some ideas act like anesthesia, spreading like wildfire. Others are like antisepsis, needing to slowly, person by person, overcome social norms. For entrepreneurs, the question from medical history is clear: is your idea an anesthesia or an antisepsis? And if the latter, what are the experiences that can convince others to adopt your innovation?




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