Does True Innovation Require Domain Expertise?

This entry is part 2 of 3 in the series The Others: How Outsiders Can Help Health Care IT

It is a common belief that true innovation requires domain expertise. Malcolm Gladwell, the author of Outliers: The Story of Success, says it takes 10,000 hours of practice to become expert in any given domain. He indicates that the process of becoming an expert produces truly exceptional people and ideas. 1 Certainly, expertise is a necessary component of innovation, but perhaps not in and of itself a sufficient one. Naveen Jain, board member of the X Prize Foundation and founder of Moon Express, World Innovation Institute and Infospace, offers a viewpoint contrary to Gladwell. He states “people…with creative solutions to solve the world’s biggest problems…will NOT be experts in their fields. The real disruptors will be those individuals who are not steeped in one industry of choice, with those coveted 10,000 hours of experience, but instead, individuals who approach challenges with a clean lens, bringing together diverse experiences, knowledge and opportunities.” 2

Jain explains that while experts do play an important role, they can get lost in the details of their expertise and are too often myopic. The challenges ahead require technology never imagined before, particularly in health care. This is where Jain argues that outsiders are key. They provide a new perspective; offer new and innovative ideas, free from the details and enlightened by the big picture. He underscores this point, noting the neo-cortex of an expert’s brain recognizes patterns relevant to their knowledge area, drawing conclusions from them. Outsiders, lacking this knowledge, rely more on their brain’s abstract ability, the capacity to see qualities of a problem uninhibited by the details. 2

Decreasing HIT missteps and increasing successful innovation requires more than just balancing the tug-of-war between health care and non-health care viewpoints. Mixing experts and outsiders from diverse backgrounds together in teams requires a special kind of collaboration. For this collaboration to thrive, it must capture the deep and varied brilliance of individual participants while simultaneously leveraging group tensions and differences.

The challenges of this collaboration demand special leadership. A 2013 worldwide Ernst and Young study of 821 company executives revealed that diverse teams have a greater success rate when leadership provides clear direction, creates an open and inclusive team culture, empowers team member autonomy, and develops and coaches team members. The research also cites the importance of building team diversity. Nine out of ten companies surveyed agreed problems confronting them are so complex that team diversity is essential to effective solutions. Survey participants noted that diverse team composition requires “…looking further afield by recruiting members from different organizational functions.” 4

What are some key health care benefits we can reap from diverse expert and outsider HIT team membership? To begin with, widening the diversity of HIT team membership helps to overcome Not Invented Here (NIH) syndrome. Outsider team members successfully contributing fresh solutions erode the NIH prejudice favoring “our own” ideas and ignoring solutions to problems because they come from a third party or external origins. Many non-health care organizations have either ready solutions or are far ahead of the health care industry in trying to solve similar problems. A simple example, borrowed from the airline industry’s pilot’s preflight briefing is the surgical pause, a safety procedure where a surgical team ensures they have the right patient, right site and right procedure. 5

A more complex example involves criminal justice. Criminal justice includes multiple organizations with vastly different computer systems sharing data successfully. These interfaces occur in an environment with, for example, extremely significant data security requirements; decentralized stakeholder groups like voters, collective bargaining units, appointed employers, constitutionally separated judges; highly complex regulations.

Another key benefit of diverse teams is reducing the sense of exclusiveness and narrowness. Outsiders on teams reduce the focus on making ourselves comfortable instead of solving the problem. While not a cure-all, diverse teams composed of both health care and non-health care participants help to minimize distorted personal narratives inferring that sameness is safe because we avoid exposing our fear of differences. “Otherness” is the birthplace of ideas crucial to informing and shaping successful HIT solutions. On a broader scale, sameness “lowers people down” while health care is in the business of “lifting them up.” In short, we simply cannot afford HIT team sameness.

Within health care there is some evidence the tide is changing – at least in the highest levels of our organizations. In recent years the percentage of new “outsider” CEO hires is increasing. The FPL Advisory Group 2014 Healthcare Leaders Survey states that future leaders coming from the “outside” will likely be from the finance, hospitality, investment and pharmaceutical industries. As FPL Advisory Group co-CEO William Ferguson observed, “It’s been very recent in our 25+ years of experience in executive search that a shift to a skill set outside of the industry norm has become acceptable, but with growth and recapitalization of key strategic priorities, as well as the rise of guest-focused care, it’s not surprising that finance and hospitality were the two ‘outside’ industries our respondents thought could be most successful.” 6

Similarly, a 2013 Black Book poll of over 1,400 health care board members and human resource officers predicted that two-thirds of CEO hires in 2014 would have little to no health care experience. A Black Book managing partner noted, “An outside hire will not have developed hospital management skills from within or understand an organization’s unwritten rules at first, but that’s not a bad thing either as more hospitals face fresh ideas to avoid bankruptcy, expedite smoother consolidations, conquer payment reform, and productivity issues.” 7

Does this trend also apply across all levels of the health care organization, including IT? We know there is a distinct HIT staff shortage to support the shift towards digital medical records. 8 The 2013 article “Talent shortage may threaten IT momentum” published in Healthcare IT News 9 suggests some of the reasons we still lack the skills required, affecting the success of critical HIT projects. The Whitridge Associates blog states, “There is a requirement almost industry-wide in healthcare IT that in order to get a job…you must have healthcare IT experience. If there are not enough skilled professionals presently in IT today then this practice will prevent us from ever getting to the level necessary to satisfy the demands…It is time to recognize that if we truly are committed to changing the efficiency within healthcare we have to be willing to train some ‘outsiders’ to help us get it built.” 10

The “blind men and the elephant” parable illustrates one of the most fundamental Jainism doctrines – “manysidedness,” i.e., pluralism or the multiplicity of viewpoints. It is the concept that we perceive truth and reality from different viewpoints, and none is the complete truth. 11 If we fail to effectively bring experts and outsiders (from both within and outside health care) together in HIT teams, we may not grasp the “truth” we sorely need to successfully implement HIT and minimize our ongoing health care crisis.

  1.  Gladwell, Malcolm (June 2011). Outliers: The Story of Success. Boston: Back Bay Books. ISBN-13: 978-0316017930
  2. Jain, Naveen (July 12, 2012). Rethinking the Concept of “Outliers”: Why Non-Experts are Better at Disruptive Innovation. Forbes (web site). Retrieved from
  3. Jain, Naveen (July 12, 2012). Rethinking the Concept of “Outliers”: Why Non-Experts are Better at Disruptive Innovation. Forbes (web site). Retrieved from
  4.  EY Press release (London, November 26, 2013). Organizations that develop cross-disciplinary, diverse teams perform better – but lack of “inclusive leaders” hinders success. Retrieved from–diverse-teams-perform-better-but-lack-of-inclusive-leaders-hinder-success
  5. CMS Safe Surgery Checklist is More Than a 2013 ASC Reporting Requirement (May 24, 2013). Surgical Outcomes Information Exchange (web site). Retrieved from
  6.  Outsiders May Rule in New Era of Healthcare Leadership (Chicago, January 14, 2014). PR Newswire (web site). Retrieved from
  7. Brown, Doug (December 17, 2013). Big change coming to hospitals at top. Healthcare IT News. Retrieved from
  8. William Hersh, MD and Adam Wright, PhD (April 17, 2008). “What Workforce is Needed to Implement the Health Information Technology Agenda? Analysis from the HIMSS Analytics Database™.” American Medical Informatics Association. AMIA Annu Symp Proc. 2008; 2008; 303-307. Published online 2008. PMCID: PMC2656033. Retrieved from
  9. Millard, Mike, editor (August 5, 2013). Talent shortages threaten IT momentum. Healthcare IT News. Retrieved from
  10.  Information Technology will change the face of healthcare (or will a skills shortage get in the way?). (web site). Retrieved on March 3, 2015:
  11.  Dundas, Paul (2004). “Beyond Anekāntavāda: A Jain approach to religious tolerance.” In (ed.) Tara Sethia. Ahimsā, Anekānta, and Jaininsm. Delhi: Motilal Banarsidass Publ. pp. 123–136. ISBN 81-208-2036-3
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Posted on November 11th, 2015 in Innovating Health Care IT
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