A 2007 book edited by iconoclast John Brockman asks the question: "What is your dangerous idea?" The book invites more than one hundred of "today's leading thinkers" to describe their "dangerous idea"; (this, plus an introduction by Steven Pinker and an afterward by Richard Dawkins). Pinker defines a dangerous idea as one that challenges "the collective decency of an age". An oft-cited example is Copernicus' dangerous idea: humans are not the center of the universe. Contributor Mihaly Csikszentmihalyi perhaps puts it best when he writes: "generally ideas are thought to be dangerous when they threaten an entrenched authority."

Depending on one's religious, moral or scientific beliefs, the ideas in the book may seem obvious to some; to others, jarring. For example, the idea that we are entirely alone in the universe (Keith Devlin); that our planet is not in peril (Oliver Morton); that parents have zero influence on their children (Judith Rich Harris); or that school is harmful for children (Roger C. Schank).

In my view, Brockman - a man whom I greatly admire for inspiring the so-called 'third culture' of scientists who challenge orthodoxy and communicate their thoughts to the public in plain English - has for the most part selected fairly dangerous ideas, even if some may seem favorable at first glance. It is the consequence of the idea that matters most. Example: Paul W. Ewald's dangerous idea is that we are at the brink of a new golden age of medicine where we will, within a relatively short period of time, and with much fewer resources than is generally assumed, prevent most debilitating illnesses in developed and developing countries. The dangerous consequence is that this golden age will threaten the livelihood of many: the prestige and influence of physicians and pharmaceutical companies will disappear, as will medical science and the entire industry of biomedical research and its allied non-governmental agencies.

The most dangerous idea

Consider Daniel Gilbert's dangerous idea, of relevance to any industry, including healthcare. Gilbert's is the "most dangerous idea," which he calls the "only dangerous idea: the idea that ideas can be dangerous." "We live in a world," Gilbert writes, "in which people are beheaded, imprisoned, demoted, and censured simply because they have opened their mouths, flapped their lips, and vibrated some air." Of greatest import is his envoi: "When all the words in our public conversation are fair, good, and true, it's time to make a run for the fence."

Although denying promotions for provocateurs is scarily common in North American industry, beheadings (as far as I'm aware) are rare. What about organizational orthodoxy? Are we allowed to utter only what is fair, good, and true? In your organization, does the leadership team consider only ideas that are fair, good and true, supported by "consensus-opinion"? Are practices and protocols rigidly followed because it has always been thus? Is structure so formal that one does one's job and nothing more - anything else is "sorry, that's out of my job description"?

When I talk about dangerous ideas in healthcare, I am not talking about tinkering with funding models or introducing a new performance indicator. A dangerous idea is one that turns status quo thinking on its head. Consider, for example, a gear-shift in cultural norms such that the privacy of health records is irrelevant to the vast majority of citizens; or that the political inevitability of mass immigration (say, quintupling the annual number of immigrants) eliminates the human resource challenge in healthcare and solves the spiraling costs of caregiver burden in this country. (For the record, I disagree with the first dangerous idea; I believe in the second).

This is not to say imaginative ideas don't exist in healthcare; rather, it is to say I am concerned that they do not cycle their way up to executive teams and CEOs. I have heard senior healthcare executives and officials tell me (confidentially) extraordinary things about whole buckets of activity commonplace in healthcare administration which they consider counter-productive to organizational and system excellence. I am worried that too few people in healthcare voice dangerous ideas - for fear, perhaps, of retribution or demotion or of being deemed a quack.

And so, my dangerous idea has less to do with the dearth of dangerous ideas in our midst, but rather the difficulty they have of being taken seriously and implemented. One of the problems in healthcare - and in all industries - is that we assume, incorrectly, that the best ideas will flow from the top. Brockman's book suffers this same logic flaw. All the contributors have fancy-sounding job titles, best-sellers under their belt, or affiliations with academic institutions. John Brockman and the wonderful Edge Foundation, which supported this book, chose as contributors only people who had passed a biased market test - "leading thinkers". Statistically, and based on historical precedent, it is absurd to suggest that the miniscule proportion of people with university affiliations or best-selling authorships or magazine editorships offer the most dangerous ideas. In our age of social networks and the billions of conversations that flourish online, this is doubly absurd. (Ironically, the Internet and inventions such as Twitter™ enabled the Edge Foundation's very ideas to market themselves to prominence among the public).

So, more concretely, my dangerous idea is this: In the near future we will have low-cost, widely available tools to intelligently identify dangerous ideas from all sectors of society, from among the young and the old, from among the poor and the rich, and from all areas of the world. Technology will be able to elegantly segment these ideas into ones with the highest return-on-investment; we will know which ideas have the fewest negative knock-on effects; and which will enjoy fruition.

The consequence of my dangerous idea is the end of leadership as we know it. If leaders are those who today are charged with selecting the best ideas, tomorrow their charge will be entirely different, one that Simon Baron-Cohen, in his contribution, calls leading a "system based on empathy," not on hierarchy or rules enforcement. We would then have leaders (notably politicians) "who respond sensitively to a different point of view, and who can be flexible about where the dialogue might lead. Instead of seeking to control and dominate, our politicians would be seeking to support, enable, and care." This is our future; it is very dangerous.

Comments

Anna Di Pietro wrote:

Posted 2011/07/07 at 11:37 AM EDT