Disruptive Innovation - Christensen at the OHA

Christensen talked about the tendency for products (or services) to start off simple, cheap, and convenient.  Over time as technological change proceeds, the products become more sophisticated.  Only a few skilled people can use the product; it’s used in a centralized place.    Finally,  innovation comes full circle, making the product simpler and more accessible again.

Christensen recounted a history of computation to illustrate the concept and used concentric circles to indicate the number of people served by each innovation.  We started with the slide rule.  Because it was easy to use, cheap, and convenient, virtually everyone in the sciences at university had one.  Early computers – although a huge advance in capability - lived in centralized ‘glass houses’ tended by highly trained acolytes and accessible only to those few people.  Early computers were not easy to use, they were not cheap, and they were not convenient[1].  Eventually, mini-computers and PCs punched through the glass walls and brought computers to less skilled people, and a much broader audience.   And now, the iPad, iPhone and other mobile devices have completed the decentralization cycle – they’re easy to use, cheap and convenient, and they’re accessible to virtually everyone.  In fact, even more people use these devices than ever used slide rules.

Maybe some readers of this post will remember the days of doctors’ house calls.  This was highly convenient for patients and very accessible[2] – call a doctor in the morning and he’d drop by in the afternoon!  With advances in medical knowledge, the practice of medicine withdrew to specialized places, like the big research and teaching hospitals, where patients are treated by highly skilled doctors working in ever narrower specialities.  So, healthcare is now at the stage of the ‘glass house’ – it’s not easy to access, it’s not cheap, and it’s not convenient.  The next big improvement must be to decentralize the practice of medicine.

In other work, Christensen has described corners of the healthcare industry have already undergone such decentralization. Minute Clinics is an example of this decentralization process.  In Minute Clinics, situated in drug stores or grocery stores, nurse practitioners treat a limited number of conditions.  Thus the service is being carried out by nurse practitioners, with lower skill levels than doctors.  The service is accessible, cheap and convenient. 

There's a more extreme example in diabestes treatment.  In the ‘old days’, back in the 70’s, diabetes patients had to trek to a doctor’s office to have blood drawn and sent to a  lab for analysis.  Results were outdated by the time they got back to the patient.  Thus the testing process was expensive, required specialized doctors and lab technicians, and was certainly not convenient.  In contrast, the advent of self-monitoring kits has decentralized diabetes treatment, rendering  it accessible, cheap and convenient, as well as better quality.  And it represents the ultimate in low skill use - patients themselves.

Christensen argues that this migration of medical treatment to lesser skilled people (ultimately self-treatment like the case of diabetes), in more convenient locations will deliver better healthcare at a lower cost.  This was a challenging proposition, when you consider that he was speaking to the Ontario Hospital Association!

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[1] I remember that period well.   I worked at a timesharing company called I.P. Sharp Associates and one of our main attractions was providing users with an end-run around the impenetrable barrier of the computer centre. 

[2] Admittedly, cost barriers made this kind of convenient, accessible service unavailable to some.

Arianna Huffington

I was invited to dinner honouring the Top 100 Powerful Women in Canada this week.  The guest speaker was Arianna Huffington, founder of the Huffington Post.  She is an engaging speaker, without a doubt.  I had been hoping she might provide her opinion on the recent Wikileaks, but for this occasion, she was providing advice to women to help them be more powerful.  She surprised me by placing 'get more sleep' at the very top of her list of advice.  She said most of the world, and particularly those scratching for advancement, were trying to survive on minimal sleep.  Her advice was to balance up your life by getting more sleep, so that you could be a much more effective person.

Arianna, rightly or wrongly, posited that men think the one getting the least sleep has bragging rights.  She exhorted women not to follow their lead.  She described a recent dinner where one of the guests had boasted that he had only got four hours sleep the night before.  She resisted the impulse to riposte that he would have been a much more interesting dinner companion if he had got five.

Clayton Christensen

For many years I've admired the groundbreaking work of Clayton Christensen on innovation.  I first met Christensen back in 1998.  I was working at the Globe and Mail and Thomson Newspapers (the owner of the Globe at the time), invited me to an all-day session in Boston where Christensen was presenting his theory of disruptive innovation.  We were given a copy of The Innovator’s Dilemma (judged by The Economist as one of the six best business books of all time), and treated - and I do mean treated -  to Christensen’s eloquent explanations.   It was an epiphany.  So much of what I had observed in the world of business suddenly clicked into a framework.  And so much of what I’ve done with my professional life since then has hinged on that original exposure to his ideas. 

The big ideas that I took away with me from that day, and subsequent exposures to his theories are:

• Technology improves faster than users’ ability to absorb, or willingness to pay, for those improvements
• Incumbent companies, seeking to maximize profits and margins and cater to their biggest and best customers, focus their attention on the possibilities at the top end of that technological curve, overshooting the majority of the market
• Disruptive innovations offer just good enough quality on traditional attributes, but provide exceptional cost effectiveness, convenience or accessibility that appeal to the least demanding consumers or non-consumers
• Technology improvements make these products good enough to take over the core markets of the incumbents (see first point above), while incumbents are loath to compete because to do so would attack their own business models

As this little summary suggests, it’s all about the business model and doing things in a radically different way – usually starting by offering less than what’s already there.

Give me 5 minutes and a cocktail napkin, and I will draw the above diagram to explain disruptive innovation to anyone who'd like to hear  - and many who would not!

Fast forward to my taking a job as Corporate Advisor to Michael Sabia, the CEO of BCE.  The  first thing I did was recommend that he should read The Innovator’s Solution, Christensen’s second book.  BCE, as Canada’s largest telephone company, was the prime victim in an industry which was being totally disrupted.  Could understanding the process of disruption help us on the path to seizing opportunities in this new world instead of being victimized?  I thought that getting the boss to read Christensen would be a good start.  I arranged a copy of the book for Michael.  He said he’d try to read it on the weekend.  On Monday, I eagerly called to see whether he'd found time in his frenetic schedule to read it.  “No”, he said.  There was a big pause while I swallowed my disappointment.  He went on to say, “I read it twice”.

And so began my fantastic journey in getting to know Christensen better and in working with him and learning from him.  We did several projects with him at BCE, involving him speaking to groups of executives, from which sprang various workshops to discuss specific implications of disruption theory for the communications business.  He would start such talks and workshops by expressing his honour to be there, learning from a great company.  (Over the years, I came to see this humility was not assumed but real).  He would then present his ideas with crystal clarity.  Questions were welcomed with remarks such as “You know, that’s a great question.  It really gets to the heart of the matter.  Thanks for asking”, after which he would deliver a succinct and lucid answer to the question.   He was always generous with praise for his students and  anyone who had contributed to his thinking.  When he invited my comments on his upcoming book, he took my modest input and criticisms seriously and, to my surprise and delight, I was mentioned in the acknowledgements.    You always walk away from a conversation with Clay impressed by his wide-ranging intellect (not to mention his 6'8" height!), but, remarkably, you also say to yourself “Gee, I never knew I was that smart”.  He just has that effect of making you feel good about yourself.

So, what prompted me to suddenly write this paean?  It was Clay’s recent address to the Ontario Hospital Association.    Clay was invited to speak because of his recent book The Innovator’s Prescription.  He’s been tussling with the ideas of disruption and how they apply to healthcare for several years now.  So he was a logical speaker for the OHA’s annual conference.   

However there was a little glitch in the plan.  After fighting off cancer last year, a heart attack before that, and diabetes since he was 30, he suffered a stroke in July which left him with expressive aphasia, the loss of the ability to produce language (spoken or written).   Wow, what a crime to have this happen to this most eloquent of men. 

As you might expect from what you’ve read so far, Christensen did not cancel the engagement, but pushed himself to deliver the talk.  He started by expressing his gratitude to the organizers for their patience with him.  Then he explained that for his whole life, he’d been learning words by writing them on little file cards and storing them away in a file cabinet in his brain.  They all had bar codes on them and a little gatekeeper in his head would pull out the words as he needed them.  However, since his stroke, the gatekeeper had been on holiday.  Would we the audience please excuse him if he sometimes used the wrong word, and shout it out if we could see him struggling to access a particular word without his gatekeeper helper.

Despite the caveats, Christensen delivered to the audience of 2,500 a clearly organized, highly relevant, spectacularly cogent and highly fluent account of disruptive innovation and what it could mean to healthcare.  Indeed, there were a handful of instances when he searched for a word.  You could almost sense the audience leaning forward to help him.  It was a masterful presentation – for someone who hadn’t had a stroke.  It was a stunning triumph for someone who had.  It met with a heartfelt standing ovation and thunderous applause that just didn’t stop.   How well deserved.

In a future post, I'll tell you what he actually said.

TEDxIBYork

TEDxIBYork was a consuming project for me over many months.  It was wonderful to have it all come off without a hitch.  The speakers put intense energy and commitment into their talks and it showed up on the stage.  The host, David Newland, did a superb job of holding the whole day together.  The AV team and filming team were on their toes all day.  The whole committee came together to tie up all the details that make something like this feel smooth and enjoyable to all the attendees.

There was a full house of 500 attendees in person.  The students were coming off a magnificent Speak Out Day at the York School the day before and brought their energy into the room.   The attendees often hooted and hollered in response to a speaker, led on by the enthusiastic teens – imagine, a bunch of jaded teens getting excited about ideas.  It was wonderful to witness. 

Despite being very quiet about the availability of the live web cast (we wanted to make sure that IB schools planning to watch online had a solid feed, with no overload problems), over 1,600 sites watched during the day, from over 40 countries.  We had unexpectedly high participation from Argentina; then we remembered that the devoted mother of one of our speakers was there and apparently single-handedly raised awareness in the whole country!  What a great lady.

We also discouraged the use of electronic devices during the day, instead exhorting people to talk to other attendees – the most valuable part of a TEDx experience.  However, there was a steady stream of positive feedback on Twitter during the conference and blog postings about it afterwards.

I keep hearing about people who’ve made connections – during the break and the wonderful party afterwards.    One teacher said that virtually all her students had managed to talk to all the speakers.  Several people have asked for follow-up introductions with people they met.  This is a huge value of a conference like this: get a lot of people in one room who are all interested in ideas, and the sparks fly.

I’ll be blogging soon about some of the great talks we heard.

Signs of Age

There are moments that in life when the realization suddenly hits you that you may be aging.  I was talking to a 20-something recently about plans for the upcoming TEDxIBYork conference.  Should we have a stash of markers available for people to identify their gift bags?  I pointed out that this might create a traffic jam, and why not let people use their own pens?  He seemed rather stunned that I would think anyone was likely to carry a pen with them.  "It's probably an age thing", he gently pointed out.

The Wave: In the Pursuit of the Rogues, Freaks and Giants of the Ocean

Big waves.  Really, really big waves.  Surfers yearn for them.  Ships run from them.  Scientists study them.  Not that long ago such big waves were thought to be exaggerations or hallucinations, the 'big fish' stories of deluded mariners.  Of course, most of the sailors who saw such waves didn't live to tell the story.  Even Shackleton, who encountered such a wave when exploring the Northwest Passage, was not believed when he described the size of wave which hit his boat - a wave whose foam he originally thought was a cloud because it was so high in the sky. 

But today we know such waves exist.  Science has recorded many such rogues waves - waves that are two to four times higher than the surrounding swell - but the physics still can't completely explain them.  The largest wave ever recorded was in Lituya Bay in Alaska, a stupendous 1,079 feet.  The current theory is that waves behave, in part, like light waves, part energy part wave.  And somehow energy concentrates into certain waves which then end up much higher than the waves around them. 

The Wave takes us to visit the scientists who study these waves, and the sailors and captains who sail through them, and to Lloyd's of London who insure these ships.  Almost two ships a week are lost at sea.  Some disappear without a trace, without even time to send an SOS.  The book posits that the most likely cause of such mysterious losses is a huge unexpected rogue wave.  Picture yourself as a captain of a ship valiantly struggling against 50-foot seas.  All of a sudden, out of the blue, comes a huge 150-foot wave.  It hardly seems fair!  Understanding of these waves gets even more important as we build more offshore oil platforms and wind farms.

Although there's lots in this book about shipping, and the science of big waves, the heart revolves around surfers.  This is a breed of person I had not been familiar with, and they're drawn in fascinating detail by Susan Casey, particularly Laird Hamilton, the greatest surfer of them all.  These men aspire to surf a 100-foot wave.  Think of it - that's ten stories high!

They've invented a new method of surfing to challenge these big waves.  It's called tow-surfing, where a jet ski tows the surfer into position for a big wave, because you can't possibly paddle fast enough for these big waves.  It's also handy to have the jet ski there to rescue you if you fall in such a monstrous wave.

There are companies which develop sophisticated algorithms to predict where the biggest waves are coming.  When they broadcast news of super waves, the surfers jump onto planes to head off to Jaws or Hookipa or Egypt in Maui, or Ghost Tree or Mavericks in California, or even to be dropped by helicopter at Cortes Bank, a spot in the ocean far off California.  You see, these waves have names, a sort of 'family name' for all the waves that roll in at that particular place.  These surfers know the individual characteristics of these waves, and they're all different.  They want to catch them at their biggest.

And there are photographers who specialize in photographing these magnificent and beautiful feats and rush to those same airports.  When the forecast predicts especially big waves, these surfers all hop on a plane, in a frenzy to be there when the big waves break.  They often head out to the waves after exhausting travel, little sleep - but lots of adrenalin.  The area is crowded with would-be heroes, many of whom are ill-equipped to be out there.  And none of whom can resist the allure.  A picture develops of men who only feel truly alive when they're on that wave.  And they're not young men - they're in their 40s and have wives and families.  With battered bodies.  Very battered bodies.

Susan Casey, the author of The Wave, is a Canadian who's pursued a publishing career,and  is currently the editor of O, The Oprah Magazine.  But she's worked in the past on the publishing side on the book Into Thin Air.  This doesn't surprise me because that book had some of the same riveting elements as the wave.

Casey herself is a surfer.  Her travels for this book involved some pretty hair-raising encounters with dangerous situations, just watching these surfers.  I saw her speak at a Literary Breakfast in Toronto and she was a captivating speaker.  I had dreams of enticing her to speak at TEDxIBYork, but alas she felt she was too busy to make the trip.

The Wave is definitely a book worth reading.

A Vintage Affair

Sometimes you pick up a book for pure escapist nonsense.  I can't remember what recommendation made me pick up this book to read.  All I can say is this.  If this temptation hits you, resist.

The Man from Beijing

The latest mystery book I've read in my 'world tour' is The Man from Beijing, whose locales range over four continents.  The novel starts with a horrific, unprecedented mass murder of 19 people in a Swedish hamlet, all named Andrens or related to Andrens.  Intrigued and shocked when she reads the newspaper reports about the crime, Judge Birgitta Roslin’s recognizes Andren as the name as her mother’s foster parents.  She heads off to the village to learn more and reads a family diary which leads her to form a contrarian view of the cause of the murders.

The diary reveals a brutal and racist ancestor who was a foreman of Chinese work crews during the construction of the American transcontinental railway.  The link to China is reinforced when Roslin discovers that a red ribbon found near the scene is from a lamp in a Chinese restaurant in a nearby town.  Further, she nails down that the ribbon was cut away on exactly the night before the massacre, and that a Chinese stranger happened to eat there that night, never to be seen again.  Except in a fuzzy picture from the security camera of a nearby hotel.  

Roslin, off work due to a medical condition, joins a friend  going to China for a conference.  She and Roslin were student radicals and believers in Mao’s Little Red Book.  Walks around Beijing arouse musings on the China she supported in her youth compared with the bustling capitalistic society she finds in the 21^st Century.   Showing the security-camera photo of the unidentified Chinese man brings her to the attention of the authorities, and links the story to a wealthy Chinese industrialist Yu Ra.  

Yu Ra believes that the solution to China’s overcrowding is to trade investment and infrastructure for the right to resettle Chinese peasants.  Mankell lives in Mozambique, and believes the scenario of Chinese colonialism is very real.   Mankell says that a deal to rent land in Kenya for one million Chinese peasants has already been consummated.  Ya Ru is resisted intensely by his sister who believes in China’s hard-fought struggle to escape colonialism and worries about China’s descent into colonialism itself.

As a mystery, this book had something lacking.  Firstly there were simply too many coincidences.  You’ve probably noticed them:  Roslin’s convenient time off work, her friend’s fortuitous trip to China, the killer clipping the lamp ribbon and dropping it at the scene.  There was also a rather unsatisfying ending, although I must say that mysteries with clear-cut endings seem to be going out of style.  However, the characterization, especially of Birgitta Roslin, was great.   And touring vicariously around China and Mozambique, and getting a taste of history and history-in-the-making was thoroughly enjoyable.  I’ve been meaning to read Mankell’s series about the detective Wallenberg (now on TV with Kennth Branaugh in the starring role) and this has certainly increased my motivation.

The Mark News

Thought readers of this blog might be interested in a short article published in The Mark News about TED's evolution and spirit, and the TEDxIBYork conference in Toronto.  The Mark is an interesting site, aimed at providing an outlet for a wide variety of Canadian voices.  Check it out.

Dr. Greg Wells Joins the TEDxIBYork Roster

During the Winter Olympics this year, I was riveted to the TV when Dr. Greg Wells was explaining the physiology of the athletes as they performed astonishing feats on ice and snow.  Science, graphics and clear explanations by someone who looked like he was having the time of this life all combined to make this one of my favourite parts of Olympic coverage. 

Did you enjoy him too?  If so, now's your chance to hear Greg Wells in person, at TEDxIBYork.  Wells has studied extreme human physiology in both elite athletes and children with chronic diseases.  He's going to talk to us about what makes Olympians different.  How do they live their lives differently in order to achieve their goals and how can we apply those lessons in our own lives?   Won't that be an interesting analysis?

A Corpse in the Koryo: An Inspector O Mystery

I'm continuing my habit of reading mystery/thriller books set in unusual locales .  The latest is about a police inspector in North Korea.  Really, North Korea. 


 The book opens with Inspector O being assigned to dawn surveillance on a deserted country road.  The assignment: take photos of any cars that pass.  When he returns to base, he hasn't any photos to show for his uncomfortable dawn vigil, because the camera's battery was dead.  In North Korea, the police can't always put their hands on batteries. 

So begins the slow unraveling of a mystery based on intense rivalry between the military and intelligence services, while simultaneously giving us insights into the privations of North Korean society.  Inspector O is that traditional mystery character, the assiduous detective who really wants to find the truth, despite the web of intrigue that the bureaucracy weaves around him.  O walks a tightrope between opposing forces, but he's not just fighting for his career.  He's struggling to save his own life.

The author, James Church, is a pseudonym for a a Western intelligence officer with lots of experience in Asia.  The picture he paints of North Korea is more evocative than all the news articles you read about this repressive, deprived country.  One vignette that really brought it all home to me was O's experience with sandpaper.  O's grandfather was a cabinet-maker, and O is assembling pieces of wood to build a bookcase.  He has a cache of sandpaper he has brought back from various trips to the West because there is no sandpaper in North Korea.  However, his apartment is searched and the sandpaper is confiscated, and he has only one used-up piece left, which he keeps in his office desk drawer.

This is Church's first book and I personally can't wait for a follow-up.