In his bestselling book, The Innovator’s Dilemma, Harvard Business School professor Clayton Christensen introduced the concept of “disruptive innovation.” Although that may have been the first time those two words were linked, the concept of disruptive innovation is familiar to all IRs. A key facet of disruptive innovation is developing new, simple applications early in the lifecycle of a product or service, such as off-label use or modification of devices. The mindset that informs disruptive innovation pervades the culture and practice of interventional radiology. But in today’s risk-averse, litigious climate, can it be sustained?
In a later volume, The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators, Christensen joined with two collaborators to outline the five discovery skills that distinguish innovative entrepreneurs: Associating, Questioning, Observing, Networking and Experimenting. It’s difficult to say whether the practice of IR develops these skills in interventional radiologists or the field simply attracts people who already have them, but one thing is clear: entrepreneurs may not be innovative, and innovators may not be entrepreneurial; but many interventional radiologists are at least one—and often both.
Associating
By its very nature, IR facilitates the skill of associating—with other practitioners and with patients. “The field attracts people who seek direct contact with patients and feel responsibility for their well-being,” says Keiran J. Murphy, MD, FSIR, vice chair and chief of medical imaging at the University of Toronto. “I think it’s genetic. We are all very similar in that way.”
As chair of the SIR 2011 Annual Scientific Meeting (“IR Innovation”), Dr. Murphy facilitated association among innovators and entrepreneurs by doing a survey of SIR members who hold patents. Holder of 62 patents himself, Dr. Murphy found that at least 457 interventional radiologists hold 2,492 patents, and he hopes to build a community of patent holders for SIR Foundation. “Interventional radiology attracts inventive people,” he says.
Association with patients also attracts people to the field. “What got me into the field was the ability of interventional radiology to make a dramatic change in a patient’s status in a short period of time,” says Julio C. Palmaz, MD, FSIR, chief scientist at Palmaz Scientific. “I found it intoxicating, engaging, fascinating.” Palmaz is the inventor of the Palmaz Stent and holds a total of 20 patents. He is a member of the National Inventors Hall of Fame.
Questioning
“Because ours is a relatively new field, I think the workforce is younger and less accepting of the status quo,” says Nicholas F. Franano, MD, founder and CEO of Novita Therapeutics, LLC. “This inspires them to think of things that don’t exist.”
“Interventional radiologists are engineers by nature. They are deft with their hands and like to solve problems. They have mechanical minds that understand gadgets and how they work,” says Dr. Palmaz.
“People who are creative are attracted to IR. People who are uncomfortable with an unclear path, or feel uncertain with a lack of structure or consistency, wouldn’t find it attractive,” Dr. Franano says.
Observing
One could argue that imaging and the interpretation of images is a form of observation, the fourth competency key to innovation. “Our biggest advantage is our very broad knowledge of imaging,” says Palmaz. “That made us uniquely enabled for intervention in many modalities.”
“Entrepreneurs must have strength, a thick skin and resilience, even through a string of failures. It’s just plain hard.”
— Julio C. Palmaz, MD, FSIR
Networking
Networking helps to reinforce and spread an innovative culture. “We are all innovators,” says Scott Trerotola, MD, FSIR, chief of interventional radiology at the University of Pennsylvania Medical Center and holder of eight patents. “Every day I do something I’ve never done before. I pass that on to trainees by telling stories on a daily basis, asking questions and attending SIR meetings.”
Some environments or practice areas facilitate the networking that can drive innovation. For example, Dr. Franano cites matching fund programs and public–private partnerships in Canada and some U.S. states that provide important resources. The value of associating and networking has been scientifically validated by Dr. Murphy. In his paper, “A Study of Inventiveness Among Society of Interventional Radiology Members and the Impact of Their Social Networks,” published last year in the Journal of Vascular Interventional Radiology, he concluded that 1) “Creativity and inventiveness stem from institutions that are hubs of innovation” (Associating) and 2) inventors “are facilitated by… strong industry contacts” (Networking).
“Rather than major institutions directly supporting inventors or promoting innovation, their more important quality may be to act as gathering points for cutting-edge thinkers,” he wrote.
Despite those findings, Dr. Murphy also finds enormous potential in being alone with one’s thoughts. “When you’re in a quiet place, the ideas start coming. Throughout history, inventions have come from periods of prolonged isolation.”
Experimenting
The dictionary defines experiment as “a test, trial or tentative procedure.” The off-label use of a device or drug certainly meets that dictionary definition. As regards innovation, Christensen et. al. say that “experimenters construct interactive experiences and try to provoke unorthodox responses to see what insights emerge” and engage in “active experimentation,” which includes physical tinkering.
“Every inventor has a need to look for solutions when they encounter a problem. They keep thinking after they fail. It was that motivation to improve that led me to the development of the stent,” says Dr. Palmaz.
“Before the 1980s, you were not supposed to leave things in the patient,” he continues. “But as we saw the field developing in the intervention era, we laid claim to a host of materials we could use in patients, and provided solutions at the time they were needed.”
In The Little Black Book of Innovation, author Scott D. Anthony calls this “associational thinking”—thinking about problems by association. Associational thinkers ask themselves, “Is there a similar problem that has already been solved in another category?” The evolution Palmaz describes is an example of associational thinking.
Dr. Franano agrees. “Interventional radiology was born from repurposing tools from other fields for use in novel ways. It has always been acceptable to express ourselves through experimentation,” he says. And it probably contributes to professional satisfaction and pride: “We have the freedom to innovate. IR feels fun to creative people, where other surgical specialties might feel stifling,” he says.
This kind of experimentation requires risk-taking, Trerotola emphasizes, but it’s not “cowboyism.”
“Being honest with patients is key. It’s a shared risk; everyone is on the same page,” he says.
From innovator to entrepreneur
Interventional radiologists and entrepreneurs share many key traits, Dr. Franano says. “IRs understand the concept of urgency. You can only sedate patients for two or two and a half hours; there’s not a minute to spare. Good entrepreneurs feel the same way: The clock is ticking; time is passing you by.” He likens the experience to rowing a boat across a big lake while the boat is on fire.
Drs. Murphy and Franano emphasize that innovation, or inventiveness, and entrepreneurship are not the same thing.
An inventor becomes an entrepreneur when he begins to make money from his innovation, but the drive for the vast majority of interventional radiologists is not money, Dr. Murphy says.
Entrepreneurs are willing to take personal risk and are determined to see their innovation through a long, hard process, emphasizes Dr. Franano. “The idea is very important, but 99 percent of the work is the value creation that comes afterward,” he says. “Then one day you wake up and 50,000 people a year are benefiting from your idea.” It took 13 years for Dr. Franano to move his first idea to phase 3 testing.
“You need a long-term vision and the commitment to grind it out. The idea is just the very first, modest step,” he says.
A tolerance for failure is as important as patience, notes Palmaz: “Entrepreneurs must have strength, a thick skin and resilience, even through a string of failures. It’s just plain hard.”
Observing the tenets of good business and strong planning can set a would-be innovator up for success, says Dr. Franano. “Establish a good long-term plan before you take someone else’s money or convince them to quit their job to work with you. You must be ready.”
Can innovation and entrepreneurship be taught? How can they continue to be promulgated in the field of interventional radiology? Dr. Palmaz, Ashbel Smith Professor at the University of Texas Health Science Center at San Antonio, believes that innovation courses should be part of the medical school curriculum. In the meantime, however, he has some advice for young people entering the profession:
- Adapt your goals to your capabilities: time, resources, intelligence.
- Be willing to be number 1. Pursue excellence, but remember it can be a small area; don’t bite off more than you can chew.
- Be an intellectual rebel. Question everything, asking, Can it be changed for the better?
- Don’t pursue an idea just for financial gain.
