You've got a great idea. Now how do you get it adopted?

Original post:  Nov 13, 2013

I like to think that the world is logical. In this idealized version of reality, simply making the case for a good idea is enough. Everyone agrees that this new method is the right thing to do and it gains adoption. Unfortunately, that is rarely the case. Most of the time, the good idea itself is only the first step. Then comes the long slog of convincing those who are vested in the status quo that the change will be worth all of the disruption it takes to get there.

If you've ever sat in a monster traffic jam as they work to expand a freeway, you will know exactly what I am talking about.

Atul Gawande has another great article on this very subject in the New Yorker. "Slow Ideas" discusses how some (medical) innovations spread more rapidly than others. He opens with two clear-cut examples of revolutionary innovations in medicine:  anesthesia and infection control in surgery.

Anesthesia spread more quickly. Prior to its invention, surgeons were judged for their speed. Even minor procedures like tooth removal still required restraints and struggle. Once William Morton demonstrated the idea and Henry Jacob Bigelow published an account in a medical journal, the idea spread like wildfire. Within two months, the idea had already spread to London and Paris.

Despite this rapid uptake, there were still skeptics:

There were forces of resistance, to be sure. Some people criticized anesthesia as a “needless luxury”; clergymen deplored its use to reduce pain during childbirth as a frustration of the Almighty’s designs. James Miller, a nineteenth-century Scottish surgeon who chronicled the advent of anesthesia, observed the opposition of elderly surgeons: “They closed their ears, shut their eyes, and folded their hands. . . . They had quite made up their minds that pain was a necessary evil, and must be endured.” Yet soon even the obstructors, “with a run, mounted behind—hurrahing and shouting with the best.” Within seven years, virtually every hospital in America and Britain had adopted the new discovery.

Infection control took a more torturous path. It was the leading killer of surgical patients. It was so common that oozing pus was considered a sign of healing! Dr. Joseph Lister read a paper by Louis Pasteur about how microorganisms could cause fermentation and spoilage. He had an idea to use small amounts of carbolic acid to improve surgical infection rates. By 1867, he published the results of years of study showing that the common use of his method dramatically reduced the rates of sepsis and death. Despite these findings, his ideas faced a much colder reception than anesthesia. Gawande reports:

....The surgeon J. M. T. Finney recalled that, when he was a trainee at Massachusetts General Hospital two decades later, hand washing was still perfunctory. Surgeons soaked their instruments in carbolic acid, but they continued to operate in black frock coats stiffened with the blood and viscera of previous operations—the badge of a busy practice. Instead of using fresh gauze as sponges, they reused sea sponges without sterilizing them. It was a generation before Lister’s recommendations became routine and the next steps were taken toward the modern standard of asepsis—that is, entirely excluding germs from the surgical field, using heat-sterilized instruments and surgical teams clad in sterile gowns and gloves.

Why did one innovation have such an immediate impact while the other took decades to take root?

We'll discuss Gawande's insight into the answer tomorrow.
Here is a link to part two.

The link to the full article is in the title above and here:  http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_gawande