If genius has any common denominator, I would propose breadth of interest and the ability to construct fruitful analogies between fields.
– Stephen Jay Gould, The Panda’s Thumb
Stephen Jay Gould, one of the most influential biologists of the 20th century, was describing in this quote the process by which Charles Darwin formulated his famous theory of evolution.
A common misconception is that Darwin was simply a brilliant biologist. In fact, Darwin read broadly in many emerging fields of his day. He was heavily influenced by Malthus’ sobering theory that the exponentially-growing human population will soon outstrip food supplies, which would lead to the selective survival of the strongest tribes.
He was likewise fascinated by Adam Smith’s key insight in the Wealth of Nations: individual agents, if encouraged to look after their own well-being, can counter-intuitively maximize their potential and increase the welfare of all.
If such a simple rule can produce complexity, what could be said about self-interested biological organisms fighting for survival in any given ecosystem? Darwin came up with a new explanation for how order can arise from disorder, and the rest is history.
Charles Darwin is not alone. The cross-pollination of ideas between different disciplines often results in profound improvements.
Innovations in medicine often borrow from well-understood practices in other industries. Atul Gawande wrote about how the first test pilots who flew the B-27 Bomber crashed because the newly-designed plane simply required the pilots to commit to memory too many tasks.
A simple checklist solved the problem: eventually 1.8 million miles were flown without any further accidents.
Dr. Peter Pronovost at Johns Hopkins University adopted a similar checklist for the ICU to prevent line infections. After implementation, line infections plummeted from 17% to 0% within a year.
Toyota has also done its part to improve medicine. The famous car company’s production line is unique in its maniacal drive to reduce waste and improve quality.
All errors and inefficiencies that occur in the assembly lines are perceived to be learning opportunities, and fixes are sometimes implemented within hours of the initial report.
Iterated over years, the Toyota Production System (TPS) has produced some of the most reliable machines at relatively low costs. The executives at Virginia Mason Medical Center in Seattle recognized the potential for TPS to streamline medicine, and applied the same principles to cancer care. Within months, the preparation time for chemotherapy dropped from three hours to just one, and patients shaved four hours off their average hospital visits. Not only did this increase the quality of life for patients, but it also saved the hospital money by opening up space to treat 50 more patients a week.
At some level, borrowing ideas across disciplines seems intuitive: pilots and surgeons alike perform complicated tasks, so shouldn’t checklist adoption flow naturally from one group to the next? Yet checklists are only becoming commonplace in medicine almost a century after the fateful B-27 crash. What barriers stand in the way of the fluid transfer of ideas between fields?
Different disciplines develop their own culture and vernacular, which are underpinned by assumptions that are shared among its members. A discipline’s language certainly serves many purposes: precise communication, efficient discourse, and cultural cohesiveness among others.
But the exclusivity likewise strengthens tribal sentiments and in-group mentality. Outsiders who are less knowledgeable of the shared set of beliefs are naturally given less credit and sometimes treated with suspicion, especially if they advocate for change.
Recently, a professor told me how Harvard had given its researchers access to professional consultants to review strategies on managing grant money. Historically, according to this professor, principal investigators do not undergo much formal training on allocating research funds, and he thought it would be helpful to hear what the financial experts had to say. He was surprised by how only a handful of his colleagues actually showed up.
Many of his colleagues thought that financial advice was simply ‘below’ them. People on the other side of the fence are equally at fault. Some consultants have complained to me that they found physicians too stubborn to work with, and that they prefer to work with hospital managers instead, thereby bypassing some of the most critical stakeholders in the healthcare system. A wall is erected by one party, and reinforced by the other.
To further exacerbate the problem of multiple cultures, super-specialization has increased dramatically in the past few decades. As the volume of clinical knowledge increases, doctors are becoming further specialized and sub-specialized. Though the depth of knowledge for specialists has increased significantly, their scope has decreased. This trend has made it more challenging for clinicians to address big picture, systemic problems that plague healthcare today.
The demonstrated power of interdisciplinary work has major implications for education.
What is classically considered a ‘well-rounded education’ needs to be reframed.
Future leaders in medicine could benefit from reading The Economist not only because knowledge of the global economic landscape serves their intellectual enrichment, but because they can also gain key insights from the political negotiations that may be analogous to situations they will face in their future careers.
We should keep up to date on how startups like Iora Health or Narayana Health are revolutionizing care delivery not only because entrepreneurship is interesting, but because key lessons could be learned by their failures and successes.
Paying close attention to how leaders in other seemingly irrelevant disciplines innovate can help us do the same in ours.