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Malcolm Gladwell on disruptive innovation: The importance of urgency and disagreeableness


Being impatient and disagreeable generally are not considered admirable qualities. But Malcolm Gladwell suggests they may be exactly the characteristics needed to drive innovation forward. He points to Apple founder Steve Jobs as Exhibit A. 

After Xerox developers showed Jobs their next big idea—a “mouse” that would allow consumers to interact with a computer without having to type in code—he thought it was the most magical thing he’d seen in his life. He ran back to Apple’s software engineers who were toiling away on a personal computer known as Lisa and said, “That’s the past, I’ve seen the future.”

Xerox engineers also knew it was the future of computing. The difference? They didn’t feel the sense of urgency that the famously impatient and disagreeable Jobs felt. While Xerox was taking its sweet time perfecting the product, Jobs told his engineers, “We’re going to do this, and we’re going to do this tomorrow.” The reason we all use Apple and not Xerox computers today has nothing to do with the quality of Jobs' ideas or insights, asserts Gladwell. He basically stole the idea from Xerox, after all. “His success had to do with the fact that he was in a hurry.” 

Where is the sense of urgency to transform health care? Who are the creative, impatient and disagreeable people whose ideas and persistence have the potential to change the future? And have we created environments in which those visionaries can survive? Those were the questions that the best-selling author of The Tipping Point, Outliers, Blink, and most recently David and Goliath posed today in his keynote speech to health care leaders at the American Hospital Association’s 2014 Leadership Summit.

Gladwell pointed out that history is replete with David and Goliath match-ups where the little guy — powered by urgency and disagreeableness—prevails. By way of example, he tells the story of one temperamental physician who in the 1950s was determined to fight a different Goliath—the horrific and inescapably fatal disease of childhood leukemia. “One day you’d have a healthy child and the next, your child would come down with a fever…and then start hemorrhaging from all points of the body,” Gladwell said. Often physicians wouldn’t even round in the leukemia ward. It was too depressing—there was nothing they could do. Nurses would finish their shifts with uniforms covered in blood. The chemotherapy drugs had such horrific side affects and such low efficacy that not treating these children seemed to be the most humane option to the medical establishment.

That was unacceptable, however, to Emil Freireich, M.D., who worked in the leukemia ward at the National Cancer Institute. He hypothesized that administering a combination of chemotherapy drugs might be the solution. At the time it was a “heretical” idea, unsubstantiated by science. Freireich had no animal models or dosing studies to back up his hypothesis. But he also didn’t have the patience to watch thousands of children die waiting for the studies. “He had a sense of urgency,” said Gladwell. He also had the “rare and precious” personality trait of “disagreeableness.” By that, Gladwell means, he didn’t require the approval of others to pursue what he beliveved was right.

Freireich would bring his patients “to the brink of death to kill as many of their cancer cells as possible, nurse them back to health and then do it again and again until the cancer was in remission. “People thought he was running some kind of grisly torture chamber,” said Gladwell. His colleagues responded with horror, heckling him at scientific conferences at which he described the results of his experiments. The government-sponsored NCI pressured him to slow down."

Freireich persisted, however, and in 1965 published the results of a trial of a cocktail of four chemo drugs–“the beginning of the cure for childhood leukemia,” said Gladwell. Today, “combination chemotherapy” is the standard, and cure rates for childhood leukemia are somewhere north of 94 percent.”

True innovators, like Jobs and Freireich, are creative, conscientious and disagreeable. They persist and are “willing to go forward in spite of the fact that people around them are calling them crazy,” Gladwell said. What they need to succeed, however, is a safe environment.  “There are lots of places to do incremental work, but have we created the safe havens for lunatics to do revolutionary work?” Gladwell asked the audience. “Or have we put up so many barriers and bottlenecks that we’ve extinguished the very spirit that makes it possible to innovate?”

And do we have enough of a sense of urgency? “The easiest thing in the world is to slow things down,” said Gladwell. “The easiest thing to do is go home at 6 and not have your world turned upside down.” And finally, are we conscientious enough to bring about the transformational changes that our health care system so desperately needs? Gladwell suggests we might measure our responses in comparison to Freireich’s. When asked why he persisted in the face of so much resistance, his answer was simple. “I had no choice.”

By: Kirsten Stewart

Kirsten Stewart is a senior writer for University of Utah Health Sciences