Fostering Innovation Russell S. Gonnering, M.D., M.M.M., F.A.C.S.
phthalmology in general and oculofacial surgery in particular are no strangers to innovative advances in care. Based on his observations of retained aircraft windscreen fragments, in November 1949 Sir Nicholas Harold Lloyd Ridley implanted the first intraocular lens.1 Sitting in a dental chair in 1964 having his teeth cleaned, Charles Kelman had a “bolt from the blue” on how ultrasound could revolutionize cataract surgery.2 Although originally developed as a nonsurgical treatment of strabismus, botulinum toxin was expanded to treat other neuromuscular problems in 1985.3 It was further expanded to treat problems of facial asymmetry and facial rhytids.4,5 In 1991, 2 existing technologies, the laser and the endoscope, were used in a novel combination for minimally invasive lacrimal surgery.6 These jumps forward were not built on a slow evolutionary research path. They were either the result of “exaptation,”7 the utilization of a feature other than that for which something was originally developed, or the combination of 2 or more existing elements in new or novel ways.8 But how are these processes themselves fostered? In “Group Genius,” Keith Sawyer contends that all creative power is ultimately the result of the collaborative mind.9 Even the examples cited above, seemingly the result of individual sparks of insight, have their basis in prior collaborative thought. Is that collaborative thought merely due to chance encounters? In many instances, it does appear to be serendipity with collaborators unintentionally thrown together in the creative cauldron. Lazar Greenfield had been working with Garman Kimmel, a petroleum engineer, on an unrelated project when he mentioned the need to prevent pulmonary emboli. The result was the Kimray-Greenfield inferior vena cava filter.10 Steven Johnson thinks we can improve on serendipity. In “Where Good Ideas Come From,” he describes the experiments of Kevin Dunbar at McGill.11 Dunbar mapped the physical location where breakthrough ideas originated. They tended to occur not at the laboratory bench, but during group discussions among investigators, often those working on completely different projects. Those fortunate enough to have participated in the famous “Brown Bag Lunches” David Cogan instituted at the Howe Laboratories recall similar episodes.12 Likewise, those at the Santa Fe Institute explain the intense value “Afternoon Tea” has to their research.13 All these activities involve stimulating conversation and interaction outside of one’s normal sphere of activity. It is at such collaborative venues, ordered yet unstructured, that the “edge of chaos” can be found and the creativity of a complex adaptive system can be unlocked. Yet these events are increasingly filtered from our professional lives. Attendance at Grand Rounds continues to decrease. Consider this comment from a hospital administrator on the cancellation of an annual Department of Ophthalmology, Medical College of Wisconsin, Elm Grove, Wisconsin, U.S.A. Accepted for publication April 16, 2014. The author has no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Russell S. Gonnering, M.D., M.M.M., F.A.C.S., Department of Ophthalmology, Medical College of Wisconsin, 1780 San Fernando Drive, Elm Grove, WI 53122. E-mail: [email protected]
Ophthal Plast Reconstr Surg, Vol. 30, No. 6, 2014
staff meeting: “What we are finding everywhere (except perhaps our smallest hospitals) is much less interest in general medical staff social events, and more interest in department or specialty based events.” We are clearly moving in the wrong direction. In his online course on Model Thinking, Scott Page investigates the role of innovation in the Solow Growth Model of Economics.14 Without innovation, models of economics reach an asymptotic maximum if labor and capital are kept constant. While we may think that we can no longer afford the luxury of collaborative conversation outside our immediate sphere of professional interests, the exact opposite is the case. We must innovate if we are to survive. It is imperative that leaders in our field take the initiative to restore and even expand such collaborative venues. We should follow the example of the “Pumps and Pipes” conference in Houston between cardiovascular physicians and petroleum engineers.15 Moreover, we as individuals must stretch the breadth of our vision as well as the depth of our endeavors. We have to explore the edges, not just of what we do but how we do it, with whom we do it, and how we communicate and teach it.
REFERENCES 1. Apple DJ, Sims J. Harold Ridley and the invention of the intraocular lens. Surv Ophthalmol 1996;40:279–92. 2. Goldstein JL. How a jolt and a bolt in a dentist’s chair revolutionized cataract surgery. Nat Med 2004;10:1032–3. Available at: http:// www.nature.com/nm/journal/v10/n10/full/nm1004-1032.html#B8. Accessed April 8, 2014. 3. Scott AB, Kennedy RA, Stubbs HA. Botulinum A toxin injection as a treatment for blepharospasm. Arch Ophthalmol 1985;103:347–50. 4. Clark RP, Berris CE. Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis. Plast Reconstr Surg 1989;84:353–5. 5. Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol 1992;18:17–21. 6. Gonnering RS, Lyon DB, Fisher JC. Endoscopic laser-assisted lacrimal surgery. Am J Ophthalmol 1991;111:152–7. 7. Gould SJ, Vrba ES. Exaptation—a missing term in the science of form. Paleobiology 1982;8:4–15. 8. Arthur WB. The Nature of Technology: What It Is and How It Evolves. New York, NY: Free Press, 2009:129–30. 9. Sawyer K. Group Genius: The Creative Power of Collaboration. New York, NY: Basic Books, 2007:77–149. 10. Greenfield LJ. Historical reminiscence: origin of the Greenfield filter. Am Surg 2010;76:1319–20. 11. Johnson S. Where Good Ideas Come from: The Natural History of Innovation. New York, NY: Riverhead Books, 2010: 59–62. 12. Garcia GE. MEEI & lasers. Scope. American Academy of Ophthalmology 2011;15:12. Available at: http://www.aao.org/ careers/seniors/upload/For-Web-Scope_Oct2011.pdf. Accessed April 8, 2014. 13. Mitchell M. Personal communication in “Introduction to Complexity”, MOOC presented by the Santa Fe Institute. Available at: http://www. complexityexplorer.org/online-courses. Accessed April 8, 2014. 14. Page S. Model thinking: 8.4 Solow growth model. Available at: http:// www.youtube.com/watch?v=1VvLiF1oVss. Accessed April 8, 2014. 15. University of Houston Division of Research. Using the other guy’s toolkit. Available at: http://www.research.uh.edu/Home/ News/2008/Using-the-Other-Guy-s-Toolkit--Similarities-of-Pum. Accessed April 9, 2014.