Sometimes, even a book’s title and book-jacket copy can be riveting. That was the case for me when I recently came across the 2011 book, Adapt: Why Success Always Starts with Failure, by Tim Harford, a British author, columnist, and essayist. As the book’s jacket puts it, “In this groundbreaking book, Tim Harford, the Undercover Economist, shows us a new and inspiring approach to solving the most pressing problems in our lives. When faced with complex situations, we have all become accustomed to looking to our leaders to set out a plan of action and blaze a path to success. Harford argues that today’s challenges simply cannot be tackled with ready-made solutions and expert opinion; the world has become far too unpredictable, and profoundly complex. Instead, we must learn to adapt.”
The book jacket continues, “Deftly weaving together psychology, evolutionary biology, anthropology, physicians, and economics, along with compelling stories of hard-won lessons learned in the field, Harford makes a passionate case for the importance of adaptive trial and error in tackling terrorism, climate change, poverty, and financial crises—as well as in fostering innovation and creativity in our business and personal lives.”
What’s more, in the book, Harford shares literally dozens of fascinating examples of failures that have led to successes. Among the stories he tells is a rather complicated one about the British Air Ministry, and its search in 1931 for a new fighter aircraft model. Trying to develop an aircraft type that to date had not existed, he notes that, “Rather than rely on known technology, the bureaucrats [at the British Air Ministry] wanted aviation engineers to abandon their orthodoxies and produce something completely new.” At first, they experienced a series of failures. But eventually, “[A]n enterprising civil servant by the name of Air Commodore Henry Cave-Brown-Cave decided to bypass the regular commissioning process and order the new plane as ‘a most interesting experiment.’ The plane was the Supermarine Spitfire,” which the Royal Air Force used to defy “overwhelming odds to fight off the Luftwaffe’s onslaught in the Battle of Britain."
A key point that Harford makes about the outcome of the Spitfire’s development is this: it’s not smart thinking to think about the outcome in terms of “return on investment,” a standard way to evaluate effort and outcome in the business world. As he writes, “What was the return on Henry Cave-Brown-Cave’s investment of £10,000? Four hundred and thirty thousand people saved from the gas chambers, and denying Adolf Hitler the atomic bomb. The most calculating economist would hesitate to put a price on that. Return on investment is simply not a useful way of thinking about new ideas and new technologies,” he writes. “It is impossible to estimate a percentage return on blue-sky research, and it is delusional even to try.”
Reading this felt resonant to me in a particular way. As I was interviewing the leaders of pioneering medical groups for this issue’s cover story, it seemed very clear to me that those leaders who are moving forward most quickly to transform their organizations in order to take on financial risk and to transition into the new healthcare, are not looking narrowly at the “ROI” on their efforts; they know that it will take years for their investments of time, effort, and IT investment, to pay off. And that’s fine with them. So leaders like Jeffrey LeBenger, M.D. of Summit Medical Group, Scott Hines, M.D. of Crystal Run Healthcare, Jim Whitfill, M.D. of Innovation Care Partners, Mark DeRubeis of Premier Medical Group, and others, are plunging ahead, and creating the healthcare of the future, right now. Air Commodore Cave-Brown-Cave would be delighted.