Texas Medical Center

Can We Teach People to Be Innovative?


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By Ronda Wendler  |  Texas Medical Center News

Roberta Ness’ first encounter with innovative, nontraditional thinking occurred when she was a medical intern at Bellevue Hospital in New York City.

Ness was taking care of a 16-year-old prostitute who had an infected heart valve caused by shooting up heroin. While delivering intravenous antibiotics to her patient, Ness became acquainted with the girl over the course of several days, or so she thought. The teen seemed eager to put her life back on the right track, and Ness encouraged her to get off the street and go back to school.

Then about halfway through her treatment, the patient disappeared with her intravenous catheter still in place – “a great way to shoot up,” a more street-savvy resident later told Ness.

“I knew it would be only a matter of time before she landed back in the emergency room, having failed to complete her course of antibiotics,” Ness recalls. “The bacteria still inside her heart valve would have eaten away the tissue, leaving only a gaping hole. She’d need a new valve.”

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Roberta Ness, M.D., M.P.H., vice president for 
innovation at The University of Texas Health 
Science Center at Houston and dean of the 
university’s School of Public Health, is author 
of “Genius Unmasked,” a new book that dissects 
how geniuses think.

Ness, who today is vice president for innovation at The University of Texas Health Science Center at Houston and dean of the university’s School of Public Health, counted the young prostitute as her first failure, and agonized over why her intentions to help the girl weren’t enough.

Lewis Goldfrank, M.D., who at the time was chairman of Bellevue’s emergency medicine department, shared his novel perspective with Ness.

“He explained that while the infection caused the teen’s valve to deteriorate,” Ness recounts, “so did the events that caused her to become a drug addict in the first place.”

This was Goldfrank’s way of thinking, Ness says. Along with supervising the delivery of emergency care, he was passionate about finding ways to avert repeat visits to the emergency room. Medical emergencies were largely preventable, he believed, by identifying and eliminating the circumstances that led up to those emergencies.

“He taught his residents to think broadly, to back up and walk in their patients’ shoes,” Ness says. “Those were the nontraditional thought processes that he embedded in our minds.”

It was this mode of thinking that replaced Ness’ desire to become a medical doctor with a new desire to help prevent disease before it took a toll.

After seven years of training to be a physician, she reversed course and went back to public health school to become an epidemiologist – a scientist who, rather than treating disease one patient at a time, studies patterns of illness among thousands.

Goldfrank, along with other creative thinkers, is the inspiration for Ness’ new book, “Genius Unmasked,” which seeks to reveal the nature of genius by offering insights into the thought processes of 15 geniuses who lived in the 19th and 20th centuries. Their innovative thinking made the world better, Ness says.

Among those featured are Charles Darwin who rattled creationists with his theory of evolution, Maria Montessori who proposed that children learn most effectively on their own and from other children, and Paul Baran who studied the brain’s neural networks to design computer networks that played a key role in the development of the Internet.


GENIUS’ TOOLBOX

Through the years, genius has been attributed to genetics – “he or she is a born genius” – and sometimes even to divine intervention. But after studying how some of the world’s most illustrious geniuses think, Ness says otherwise.

“Geniuses are not omnipotent and they are not divine. They simply are particularly skilled at crafting what I call creative surprise – which happens when one generates original or novel ideas that lead to health and prosperity,” she says. “Using creative thinking to develop something that is surprising and has the potential to improve our lives results in innovation.”

“Geniuses are not omnipotent 
and they are not divine. They are 
simply skilled master craftsmen 
of creative surprise.”


—Roberta Ness, M.D., M.P.H.

Many describe innovation as “creativity with a use,” but Ness prefers an alternate definition – “surprise in the service of health and prosperity.”

Even the greatest innovative minds, she says, have a cognitive toolbox that can be opened and understood.

“We can dissect that toolbox, identify the tools inside that support innovative thinking, and use them to bring out our own genius,” she says.

Some of the most important tools inside the genius’ toolbox are: knowing the right questions and the right people to ask; observing patiently and carefully; changing your point of view and starting over, or reversing course if necessary; approaching a question from every possible angle; broadening your perspective and seeking input from others whose views are different than your own; and among the most effective – a concept known as frame breaking.


FRAME BREAKING

Humans habitually think in what are called “frames,” which Ness describes as a set of expectations that we use to interpret new information.

Expecting summer to be warm and winter to be cold is a frame. Expecting a bride to wear a white or off-white dress is a frame. Expecting the world to be flat was a frame Christopher Columbus shattered when he proved it to be round. Many balked at Columbus’ interpretation, and it took years for his theory to be accepted.

“Frames are extraordinarily powerful, and we don’t tend to jump outside of them,” Ness says. “Frame breaking conveys a notion of disorder and unpredictability that is foreign to our fundamental need to create order and control where there is none. When someone breaks your frame, they shatter your expectations.”

Yet frame breaking is a must in achieving innovation and creativity, Ness says, “which is why innovation is so difficult.”

“You have to break a habitual, comfortable and accepted expectation,” she says, “in order to propose something really novel and surprising.”


SEMMELWEIS’ SIMPLE SOLUTION

In medicine, nowhere is frame breaking better illustrated than with Ignaz Semmelweis, a young Austrian obstetrician who began working at the Vienna General Hospital in 1846, two decades before Louis Pasteur and Robert Koch hypothesized germ theory. When Semmelweis began practicing, germs had not yet been discovered and were not even thought about in the medical community.

At the hospital, puerperal fever, now known to be caused by a bacteria named Staphylococcus aureus, was killing a large number of obstetric patients. But since germs did not exist in the knowledge of the day, no one knew why so many new mothers were dying.

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Ignaz Semmelweis
introduced hand-
washing to the
medical profession.

Newly admitted obstetric patients begged to be admitted to the ward staffed by nurse midwives, rather than the ward staffed by medical residents. Rumor had it that the nurse midwife ward was safer and had fewer deaths than the physician ward. But hospital staff refused to believe this and dismissed the women’s concerns as “unclear thinking brought about by labor.”

Semmelweis was the only physician who would listen, and after many months of collecting data, he found that the patients were correct. His data revealed an enormous, almost tenfold difference in mortality between the two units. Why was that, he wanted to know?

Semmelweis zealously worked to find the cause, talking with everyone, peering into everything, and turning over every possibility.

A breakthrough came when a young medical resident who was conducting an autopsy on a woman who had died of puerperal fever accidentally poked himself with a scalpel during the procedure, developed puerperal fever himself, and died.

Semmelweis had an “Aha” moment, and made the connection that something transmissible from physician to patient was sticking to physicians’ hands. He went on a hand-washing rampage, insisting that all medical staff in delivery rooms scrub before each delivery. In every delivery room, he installed concentrated solutions of chlorine water and supervised each resident’s hand-washing to assure compliance.

The mortality rate among new mothers plummeted by 90 percent. Unfortunately, Semmelweis’ colleagues complained that the chlorine in the hand-washing solution was chaffing and reddening their skin, and they began to challenge the need for hand-washing. Semmelweis became all the more insistent, he and the other physicians quarreled regularly, and at the end of his first hospital term, he was not reappointed.

He moved to the country and worked at a small hospital where he implemented hand-washing and again, puerperal fever was virtually eliminated. But once more he was viewed as a zealot and ejected from the hospital. With his spirit and mind broken, he died prematurely in an insane asylum, never realizing the magnitude of the contribution he made.

“Semmelweis was a genius way before his time,” says Ness. “But his way of thinking was revolutionary, and like many geniuses, his ideas were buried for 50 to 100 years.

The British medical journal The Lancet published a special issue on hand-washing 100 years after it was introduced by Semmelweis, because hand-washing still was not practiced in many countries.

“Even today, innovative thinkers like Semmelweis encounter a lot of resistance, no doubt about it,” Ness says. “I can cite example after example of people who came up with earth-shattering ideas that aided health and prosperity, yet their ideas were rejected for decades.”


RE-THINKING OBESITY

Ness herself has broken a few frames, the most recent being her theory for taking on obesity in America.

“We blame the victim in this country,” Ness says, “but the culprit is our environment. The way we eat and what we eat must change,” she says.

For example, take a road trip in Europe and exit the highway to stop for a snack. At the European equivalent to a Stop ’n Go or 7-Eleven convenience store, a chef stands before a stove cooking fresh pasta with organic vegetables, a splash of olive oil and herbs picked from a nearby garden.

Now take a road trip in the United States. Stop for a snack at a roadside store.

“Everything, and I mean everything, is processed food in a box or a bag,” says Ness. “Choose chips, candy, jerky, packaged cookies, but nowhere will you find a piece of fruit or a vegetable,” she says. “Instead, snack offerings consist of packaged food products pumped full of chemicals, preservatives, color additives, saturated fats, and heaven knows what else.”

It’s processed foods like these that have contributed most of the additional calories to the American diet in the last generation, and which are largely to blame for America’s obesity, says Ness.

“A handful of very large food companies are creating and marketing these processed food products that contain almost no nutritional value and an incredible amount of excess calories,” she says.

“What if,” Ness proposes, “we were to go after these big food companies in the same way we went after tobacco companies?” That’s exactly what should happen, she says.

Like tobacco products, processed food products should be heavily taxed, advertising – especially to children – should be restricted, and counter-advertising which features ads against processed food products should be launched, she says.

“These are the same measures we used to regulate tobacco,” Ness says, “and they have been very, very successful.”

In the 1950s and 60s, almost 70 percent of American men smoked, compared to 20 percent today.

“America’s anti-smoking campaign is one of the great success stories of modern public health,” Ness says, “and it should be used as a model to fight obesity.”

Ness concedes that some say her argument is ridiculous, because while people have to eat, they don’t have to smoke. She counters that most people don’t grow their own food, and therefore must choose from what’s available in the store – much of which is processed.

Ness recently authored a blog about this topic, and readers “just went nuts,” she said. Some heartily agreed, while others became incensed.

Ness says the irate readers commented, “What about personal responsibility? What about freedom of choice?” “People got really enraged, and when that happened I thought, ‘I just broke a frame.’”


AFFORDABLE CARE ACT

Today, the United States is in the beginning stages of what Ness says is one of the biggest frame breaks in health care access and delivery since the 1960s when Medicare and Medicaid were introduced.

The Affordable Care Act, with its goal of improving access to care and controlling costs, is an example of major experimentation and frame breaking, Ness says.

“It’s a shake up,” she contends. “For decades, health care across the country has been remarkably uniform and unchanging, but not anymore. The Affordable Care Act is among the most significant innovations in health care in a very long time. We’re witnessing transformation and history in the making.”


THE BANDWAGON

However, when it comes to inventing and discovering new scientific technologies and medical cures, Ness says the United States is lagging and has been for some time.

“This will probably fly in the face of what a lot of people believe,” she says. “But if you look at the greatest threats to health and humanity, including emerging infections, Alzheimer’s disease, cancer, obesity, global warming – things that are significantly impacting life expectancy, morbidity, quality of life, and prosperity – science is making slow and unsteady progress.”

Life expectancy for the major adult cancers is a prime example, Ness says.

“For adult cancers of the lung, colon, breast, and prostate,” she says, “life expectancy is only marginally better than it was years ago.”

But for children diagnosed with cancer, it’s a different story – one Ness calls a “modern miracle.”

“We’ve had tremendous, unbelievable success in discovering cures for childhood cancers,” she says.

Alzheimer’s disease is another case in point. In science, Ness says, everybody jumps on the bandwagon. “In Alzheimer’s, the bandwagon is amyloid.”

Amyloid is a sticky, starchy protein that clumps together to form plaques that coat the outside of nerve cells in the brains of Alzheimer’s patients. Because the waxy substance inhibits cell-to-cell communication and brain function, it is widely believed to be associated with Alzheimer’s.

“But we don’t fundamentally know whether amyloid is the cause of Alzheimer’s,” Ness says. “Amyloid might simply be something that happens as a result of an upstream cause, and knocking out amyloid might do absolutely nothing to help patients. Or it might be the magic bullet that cures Alzheimer’s. My point is, we have no idea.”

But everybody jumps on the amyloid bandwagon, Ness says, and research aimed at developing drugs that knock out amyloid is what gets funded.

“We need to be looking at a variety of different explanations instead of putting all our eggs in one basket,” she says. For example, some researchers believe Alzheimer’s may be an infectious disease.

“Maybe Alzheimer’s disease has some other environmental trigger or risk factor or etiology,” Ness says. “We won’t know until we investigate.”

But government funding doesn’t support or promote “coming up with crazy ideas, pursuing them, and discarding them if they’re crazy,” she says.

The business world learned a long time ago what the science world has yet to learn, Ness says.

“In business, you take risks, and you keep 20 or 30 different irons in the fire. You don’t put an enormous amount of dollars behind any of them, because they’re just experiments. You conduct those experiments, and if they don’t work, you can easily walk away from them.”

But in science, once researchers get on a track, like the amyloid track, they stay on that track until it ends, without reversing course.

“That’s the wrong approach,” Ness says. “We should break that frame.”