Monday, July 12, 2010

Smart People Adding Too Much Value

The Disease Management Care Blog is happy to host Kit Gorton, MD. Kit is currently a healthcare consultant who is a former VP of Medical Management at HP Enterprise Services, served as President and Chief Medical Officer of APS Health Care and was Chief Medical Officer of Pennsylvania Medicaid. As someone who has developed and presided over a host of good ideas, this is a professional who knows of what he speaks.

In case you’re wondering why your excellent idea isn’t going anywhere, the good news is that you’re smart. Read on and find out about the bad news……

Why do so many good ideas get so little traction? As a guy whose job has often been to support innovative programs, I find myself thinking about this a great deal. The reasons why ideas languish are of course complex: too few resources, too many competing priorities, too little consensus, too much information out there. All are solid explanations for why smart people I’ve worked with accomplish less than everyone would expect.

I was reading Marshall Goldsmith’s book What Got You Here Won’t Get You There (Hyperion, New York, 2007) as I got geared up for my current career transition and I came across another possible explanation that I hadn’t entertained before. Goldsmith posits that smart people impede their organizations and their own careers through what he characterizes as the bad habit of adding too much value. He observes, “It is extremely difficult for successful people to listen to other people tell them something that they already know without communicating somehow that (a) ‘we already knew that’ and (b)’we know a better way.’” He points out that whatever incremental improvement that the smart person provides to an idea is often overshadowed by the loss of enthusiasm and commitment of the other people in the process.

Perhaps smart people’s ideas don’t get more traction because of the smart people’s behavior? In a knowledge economy, adding our two cents is how the idea guys make a contribution, right? Perhaps not. Goldsmith argues that the more powerful or influential we people become (or wish to become…), the more behavior factors into their success. His premise makes a lot of sense: that it is counter-productive to always try to improve on the ideas of others. After all, the obverse of “I’m smarter than you are” is obviously “You are dumber than me.” No one likes to be on the losing side of that conversation.

The typical approach of smart people to care management solution development and academic research is to design incremental improvements or disruptive changes and then demonstrate proof of concept in either a pilot program or through a research protocol. Adoption is then supposed to be driven by the innovators promoting their ideas through publications, seminars and, to a lesser extent, commercial marketing approaches. Their underlying assumption has been is that good ideas sell themselves. They think their job is to simply to build a better mouse-trap and then explain it to the rest of us.

Goldsmith’s perspective suggests to me that innovation processes that focus largely on coming up with and presenting the next best idea are likely to be ineffective in driving improvements in chronic care management, medical homes or wellness and lifestyle programs. Innovators may not have the interpersonal skills and communication behaviors necessary to promote adoption. By “over” delivering on value and underestimating the response of their colleagues around them, innovation can dissipate.

Clearly there is work to be done in translational research and in identifying control points in the diffusion of healthcare innovation. Still Goldsmith’s observations about human behavior raise the question of how much interpersonal relationships and individual communication may impact the success of transformational change. That is a topic I think is worthy of a great deal of silent reflection.

1 comment:

A. Patrick Jonas, MD said...

A good and timely post. Thanks.

One way to interpret Goldsmith is that smart people (whatever that means) needn't bother contributing. Or, "It's hopeless for you smart folks because we dumber ones won't listen." Or,"We will ignore your brilliant ideas because your interpersonal skills are so poor."

Since innovation continues, I think that Goldsmith is dead wrong. Many times the innovation has to come from outside the organization, however, especially if it is radical innovation. The "sludge" in the organizational processes may force the radical innovators to set up shop across the street to sell the innovation to the organization. It sometimes behooves the smart people (again, I wonder what that means) to set up the outside company and cause less acute internal disruption.